Surgery Commons^™

Degenerative Changes Of The Canine Cervical Spine After Discectomy Procedures, An In Vivo Study., Peter Grunert, Yu Moriguchi, Brian P Grossbard, Rodolfo J Ricart Arbona, Lawrence J Bonassar, Roger Härtl

Articles, Abstracts, and Reports

BACKGROUND: Discectomies are a common surgical treatment for disc herniations in the canine spine. However, the effect of these procedures on intervertebral disc tissue is not fully understood. The objective of this study was to assess degenerative changes of cervical spinal segments undergoing discectomy procedures, in vivo.

RESULTS: Discectomies led to a 60% drop in disc height and 24% drop in foraminal height. Segments did not fuse but showed osteophyte formation as well as endplate sclerosis. MR imaging revealed terminal degenerative changes with collapse of the disc space and loss of T2 signal intensity. The endplates showed degenerative type II …

Outcomes Of Post-Neurosurgical Ventriculostomy-Associated Infections, Muhammad Ehsan Bari, Ghani Haider, Komail Malik, Muhammad Waqas, Syed Faisal Mahmood, Mubbashira Siddiqui

Section of Neurosurgery

Background: Ventriculostomy-associated infection (VAI) is a major concern to physicians. Limited studies have looked at the outcomes of external ventricular drain (EVD) infection and predictors of unfavorable outcomes. In this study, we assessed the outcomes of EVD infection and predictors of unfavorable outcomes.
Methods: This was a retrospective medical chart review, conducted at the Aga Khan University Hospital. All the patients irrespective of age and gender, fulfilling the diagnostic criteria of VAI were included. Patients with preexisting bacterial meningitis or ventriculitis were excluded from the study. Outcome assessment was based on Glasgow outcome scale (GOS) at 1 and 3 months …

Completion Dissection Or Observation For Sentinel-Node Metastasis In Melanoma., Mark B. Faries, John F. Thompson, Alistair J. Cochran, Robert H. Andtbacka, Nicola Mozzillo, Jonathan S. Zager, Tiina Jahkola, Tawnya L. Bowles, Alessandro Testori, Peter D. Beitsch, Harald J. Hoekstra, Marc Moncrieff, Christian Ingvar, Michel W.J.M. Wouters, Michael S. Sabel, Edward A. Levine, Doreen Agnese, Michael Henderson, Reinhard Dummer, Carlo R. Rossi, Rogerio I. Neves, Steven D. Trocha, Frances Wright, David R. Byrd, Maurice Matter, Eddy Hsueh, Alastair Mackenzie-Ross, Douglas B. Johnson, Patrick Terheyden, Adam C. Berger, Tara L. Huston, Jeffrey D. Wayne, B. Mark Smithers, Heather B. Neuman, Schlomo Schneebaum, Jeffrey E. Gershenwald, Charlotte E. Ariyan, Darius C. Desai, Lisa Jacobs, Kelly M. Mcmasters, Anja Gesierich, Peter Hersey, Steven D. Bines, John M. Kane, Richard J. Barth, Gregory Mckinnon, Jeffrey M. Farma, Erwin Schultz, Sergi Vidal-Sicart, Richard A. Hoefer, James M Lewis, Randall Scheri, Mark C. Kelley, Omgo E. Nieweg, R. Dirk Noyes, Dave S.B. Hoon, He-Jing Wang, David A. Elashoff, Robert M. Elashoff

Department of Surgery Faculty Papers

BACKGROUND: Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear.

METHODS: In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis.

RESULTS: Immediate completion …

Quantification And Expert Evaluation Of Evidence For Chemopredictive Biomarkers To Personalize Cancer Treatment., Shruti Rao, Robert A. Beckman, Shahla Riazi, Cinthya S. Yabar, Simina M. Boca, John L. Marshall, Michael J. Pishvaian, Jonathan R. Brody, Subha Madhavan

Department of Surgery Faculty Papers

Predictive biomarkers have the potential to facilitate cancer precision medicine by guiding the optimal choice of therapies for patients. However, clinicians are faced with an enormous volume of often-contradictory evidence regarding the therapeutic context of chemopredictive biomarkers.We extensively surveyed public literature to systematically review the predictive effect of 7 biomarkers claimed to predict response to various chemotherapy drugs: ERCC1-platinums, RRM1-gemcitabine, TYMS-5-fluorouracil/Capecitabine, TUBB3-taxanes, MGMT-temozolomide, TOP1-irinotecan/topotecan, and TOP2A-anthracyclines. We focused on studies that investigated changes in gene or protein expression as predictors of drug sensitivity or resistance. We considered an evidence framework that ranked studies from high level I evidence for randomized …

Pineal Gland Agenesis: Review And Case Illustration., Marcus A Cox, Michele Davis, Vlad Voin, Mohammadali Shoja, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

Agenesis of the pineal gland has rarely been reported in the medical literature. Herein, we report a cadaveric specimen found to have agenesis of the pineal gland. The remaining gross examination of the brain was normal. A review of the literature was performed on this unusual finding.

Patients’ Level Of Knowledge And Perception Of The Involvement Of Post-Graduate Trainees In Their Surgical Care At Aga Khan University Hospital, Nairobi., Jane Mugure Githae

Master of Medicine in General Surgery

Introduction: Surgical training is fashioned on a system of graduated responsibilities and independence for acquisition of skills and competence. While many benefit from acquisition of these skills, few would want to be the ‘practicing ground’ for the trainee surgeon. Moreover, disclosure is inappropriate and surgical care does not specifically spell out the role of the surgical trainee in these procedures. A pilot survey conducted on 20 first-time patients presenting to General Surgery and Orthopaedic Clinics at Aga Khan University Hospital, Nairobi, revealed varied understandings as to who is a post-graduate surgical trainee. Objective: To explore the patients’ level of knowledge …

Department Of Surgery Update, June 2017, Wright State University Department Of Surgery

Department of Surgery Updates

A three page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, and more.

Outcome Of Judet's Quadricepsplasty For Knee Contractures And The Effect Of Local Infiltration Of Epinephrine On Reducing Blood Loss, Akber Jalil Zuberi, Haroon Rashid, Rizwan Haroon Rashid, Moiz Ali, Pervaiz Hashmi

Section of Orthopaedic Surgery

Objective: To evaluate the effectiveness of Judet's quadricepsplasty for treatment of knee contractures and to identify the effect of local infiltration of epinephrine on blood loss associated with this procedure.
Methods: A retrospective cohort study was conducted in which all cases of knee contractures managed with Judet's quadricepsplasty from 1st January 2009 to 31st December 2013 were included and were divided into two groups. The epinephrine group included patients who were infiltrated with diluted epinephrine (1:400,000) along with xylocaine, around the operative field 15 min prior to the incision time, while the control group did not receive any infiltration. Judet's …

Extent Of Resection And Timing Of Surgery In Adult Low Grade Glioma, Farhan A. Mirza, Muhammad Shahzad Shamim

Section of Neurosurgery

Low grade glioma is a group of WHO grade II tumours including diffuse astrocytoma, oligodendroglioma, and oligoastrocytoma. Strong evidence exists in literature now to support early surgery and higher extent of safe resection in improving outcomes. In this review, we are highlighting some of the important studies done in the last few years specifically addressing timing of surgery and extent of resection.

Crispr Knockout Of The Hur Gene Causes A Xenograft Lethal Phenotype., Shruti Lal, Edwin C, Cheung, Mahsa Zarei, Ranjan Preet, Saswati N. Chand, Nicole C. Mambelli-Lisboa, Carmella Romeo, Matthew C. Stout, Eric Londin, Austin Goetz, Cinthya Y. Lowder, Avinoam Nevler, Charles Yeo, Paul M. Campbell, Jordan M. Winter, Dan A. Dixon, Jonathan Brody

Department of Surgery Faculty Papers

Pancreatic ductal adenocarcinoma (PDA) is the third leading cause of cancer-related deaths in the United States, whereas colorectal cancer is the third most common cancer. The RNA-binding protein HuR (ELAVL1) supports a pro-oncogenic network in gastrointestinal (GI) cancer cells through enhanced HuR expression. Using a publically available database, HuR expression levels were determined to be increased in primary PDA and colorectal cancer tumor cohorts as compared with normal pancreas and colon tissues, respectively. CRISPR/Cas9 technology was successfully used to delete the HuR gene in both PDA (MIA PaCa-2 and Hs 766T) and colorectal cancer (HCT116) cell lines. HuR deficiency has …

Role Of Early Contrast Enhanced Ct Scan In Severity Prediction Of Acute Pancreatitis, Noman Shahzad, Muhammad Rizwan Khan, K. M. Inam Pal, Dawar Khan, Muhammad Shahrukh Effendi

Department of Surgery Docs

Abstract

Severe pancreatitis occurs in approximately 15-25% of patients with acute pancreatitis. The objective of our study was to compare the CTSeverity Index (CTSI) with a clinical score (BISAP score) to predict severity of acute pancreatitis. Forty-eight consecutive patients with acutepancreatitis who underwent contrast enhanced CT scan within 72 hours of presentation were included. Results of our study showed that both CTSI and BISAP score were reliable predictors of mortality (p value = 0.019 and <0.001 respectively) and need for mechanical ventilation (p value = .002 and .006 respectively). Positive predictive value of CTSI to predict recovery without intervention was 91.4% as compared to 78% for that of BISAP score. Receiver Operating Characteristics (ROC) Curves showed CT scan was superior to BISAP Score in predicting need of percutaneous or surgical intervention. Early CT scan may be utilized for prediction of clinical course of patients with acute pancreatitis.

Correlation Of Tp53 Overexpression And Clinical Parameters With Five-Year Survival In Oral Squamous Cell Carcinoma Patients, Syed A. Ali, Hamza A Khan, Omar Irfan, Adeel Samad, Yamna Mirza, Mohammad Sohail Awan

Section of Otolaryngology, Head & Neck Surgery

Abstract

Introduction TP53 mutation and overexpression have been correlated with poor survival in many cancers including oral squamous cell carcinoma (OSCC). We aim to understand the role of TP53 overexpression in OSCC in our population and correlate it with five-year survival to test its viability as a prognostic marker for OSCC patients. Materials and methods Patients with biopsy proven OSCC at Aga Khan University Hospital from January 2000 to January 2008 were recruited. Immunohistochemistry was used to establish TP53 status and the results were published. Following up on these patients, five-year data were collected and correlated with TP53 status and …

Validation Of The Iief - 5 Questionnaire In A Clinic Population At Aga Khan University Hospital, Nairobi, Denis Otim

Master of Medicine in General Surgery

Background: Men with lower urinary tract symptoms (LUTS) are at risk of erectile dysfunction (ED) and other co - morbidities. The clinical assessment of ED is unreliable and the International Index of Erectile Function – 5 (IIEF – 5) a widely used tool is not validated in our setting. We aimed to validate the IIEF – 5 as a screening tool for ED in men with LUTS visiting the outpatient services. Methodology: In the study, 99 men above 40 years with LUTS attending the urology clinics were consecutively enrolled, administered with the IIEF – 5 and assigned an ED status. …

Role Of Differentially Expressed Microrna-139-5p In The Regulation Of Phenotypic Internal Anal Sphincter Smooth Muscle Tone., Jagmohan Singh, Ipsita Mohanty, Sankar Addya, Benjamin Philllips, Hwan Mee Yong, Steven S. An, Raymond B. Penn, Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

The present study focused on the role of microRNA-139-5p (miRNA-139-5p) in the regulation of basal tone in internal anal sphincter (IAS). Applying genome-wide miRNA microarrays on the phenotypically distinct smooth muscle cells (SMCs) within the rat anorectrum, we identified miRNA-139-5p as differentially expressed RNA repressor with highest expression in the purely phasic smooth muscle of anococcygeus (ASM) vs. the truly tonic smooth muscle of IAS. This pattern of miRNA-139-5p expression, previously shown to target ROCK2, was validated by target prediction using ingenuity pathway (IPA) and by qPCR analyses. Immunoblotting, immunocytochemistry (ICC), and functional assays using IAS tissues and cells subjected …

Undetected Small Accessory Mental Foramina Using Cone-Beam Computed Tomography., Joe Iwanaga, Koichi Watanabe, Tsuyoshi Saga, Shogo Kikuta, Yoko Tabira, Sadaharu Kitashima, Christian Fisahn, Fernando Alonso, R Shane Tubbs, Jingo Kusukawa, Koh-Ichi Yamaki

Articles, Abstracts, and Reports

INTRODUCTION: The accessory foramina could not be identified on some imaging modalities such as surface-rendered images. The purpose of this study was to investigate the ability of surface-rendered images in detecting these foramina.

MATERIALS AND METHODS: We analyzed 20 accessory mental foramina (AMF) in nine mandibles removed from cadavers with cone-beam computed tomography (CBCT) and assessed in surface-rendered images. All AMF were divided into three groups depending on their visibility.

RESULTS: Group 1 included AMF that were clearly visible as foramina, Group 2 were not clearly visible but could be recognized with concave parts, and Group 3 were not visible …

Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini

Doctoral Projects

Colorectal cancer is a leading cause of cancer death in the United States (Mandel, Tanner, Lichtenstein, Metz, Katzka, Ginsberg, & Kochman, 2008; Siegel, DeSantis, & Jemal, 2014). Because this lethal disease claims lives of many people every year, more patients are undergoing screening colonoscopies, which have greatly aided in decreasing the number of colorectal cancer deaths (Siegel et al., 2014). The most common form of sedation for colonoscopies is moderate sedation with a benzodiazepine and an opioid (Cohen, Hightower, Wood, Miller, & Aisenberg, 2004; Lera dos Santos, et. al., 2013). However, sedation by anesthesia providers using propofol is becoming more …

Prognostic Significance Of Idh 1 Mutation In Patients With Glioblastoma Multiforme, Inamullah Khan, Muhammad Waqas, Muhammad Shahzad Shamim

Section of Neurosurgery

Focus of brain tumour research is shifting towards tumour genesis and genetics, and possible development of individualized treatment plans. Genetic analysis shows recurrent mutation in isocitrate dehydrogenase (IDH1) gene in most Glioblastoma multiforme (GBM) cells. In this review we evaluated the prognostic significance of IDH 1 mutation on the basis of published evidence. Multiple retrospective clinical analyses correlate the presence of IDH1 mutation in GBM with good prognostic outcomes compared to wild-type IDH1. A systematic review reported similar results. Based on the review of current literature IDH1 mutation is an independent factor for longer overall survival (OS) and progression free …

Concurrent Surgery And Informed Consent, Andrew M. Weller

College Honors Program

This thesis seeks to construct an ethical course of action for concurrent surgery, a practice brought into the public eye by The Boston Globe, which argued against allowing one attending surgeon to oversee two cases on separate patients in different operating rooms. First, the common morality and its four main principles relevant to biomedical ethics will be described which will be subsequently used to show that concurrent surgery is allowed according to non-violation of the principle of non-maleficence through current empirical evidence, and supported by the principle of beneficence and justice. Next, the principle of respect for autonomy will be …

Quality Of Life In Individuals Surgically Treated For Congenital Hydrocephalus During Infancy: A Single-Institution Experience, Saad Akhtar Khan, Muhammad Faheem Khan, Saqib Kamran Bakhshi, Omar Irfan, Hamza Abdur Rahim Khan, Asad Abbas, Safia Awan, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Congenital hydrocephalus (CH) is a frequently encountered birth anomaly that can hinder long-term neurologic maturity and social well-being of affected children. This study was undertaken to assess quality of life (QOL) 10-15 years after surgical treatment for primary CH during infancy at a tertiary care hospital in a developing country.
Methods: This retrospective cohort study included individuals who presented to Aga Khan University Hospital, Karachi, Pakistan, between 1995 and 2005 at QOL.
Results: Of 118 patients, 90 patients participated in the study. Mean age at first admission was 6.2 months. Mean length of follow-up was 5.4 years. Of these, …

Antibiotics In Acute Calculous Cholecystitis : Do Tokyo Guidelines Influence The Surgeons’ Practices?, Hassaan Bari, Muhammad Rizwan Khan, Amir Hafeez Shariff, Amir Hafeez Shariff

Department of Surgery Docs

Abstract

OBJECTIVE:

To observe changes in surgeons' practice of antibiotic usage in patients with acute cholecystitis before and after the implementation of Tokyo Guidelines.

METHODS:

This retrospective, descriptive study was conducted at the Aga Khan University Hospital, Karachi, and comprised the medical records of all patients with the diagnosis of acute calculus cholecystitis who presented in 2009 and those who presented in 2014 after the implementation of Tokyo Guidelines. The major variables included patients' demographics, antibiotics used and surgical outcomes. SPSS 19 was used for data analysis.

RESULTS:

Of the 356 patients, 96(27%) were treated in 2009 and 260(73%) in …

Management Of Hypertension In Patients Undergoing Surgery, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

The Use Of Intraosseous Needles For Injection Of Contrast Media For Computed Tomographic Angiography Of The Thoracic Aorta, Michael A. Winkler, Cynthia Talley, Connor Woodward, Alexander Kingsbury, Frank Appiah, Hossam Elbelasi, Kevin P. Landwehr, Xingzhe Li, Dominik Fleischmann

Radiology Faculty Publications

Background

The objective of this study is to evaluate the safety and quality of computed tomographic angiography of the thoracic aorta (CTA-TA) exams performed using intraosseous needle intravenous access (ION-IVA) for contrast media injection (CMI).

Methods

All CTA-TA exams at the study institution performed between 1/1/2013 and 8/14/2015 were reviewed retrospectively to identify those exams which had been performed using ION-IVA (ION-exams). ION-exams were then analyzed to determine aortic attenuation and contrast-to-noise ratio (CNR). Linear regression was used to determine how injection rate and other variables affected image quality for ION-exams. Patient electronic medical records were reviewed to identify any …

Comparison Of Enteral Versus Intravenous Potassium Supplementation In Hypokalaemia In Paediatric Patients In Intensive Care Post Cardiac Surgery: Open-Label Randomised Equivalence Trial (Eips), Naveed Ur Rehman Siddiqui, Quratulain Merchant, Babar Hasan, Arjumand Rizvi, Muneer M Amanullah, Amina Rehmat, Anwarul Haque

Department of Surgery Docs

Objectives: The primary objective was to compare the efficacy of enteral potassium replacement (EPR) and intravenous potassium replacement (IVPR) as first-line therapy. Secondary objectives included comparison of adverse effects and number of doses required to resolve the episode of hypokalaemia.|
Trial design: The EIPS trial is designed as a randomised, equivalence trial between two treatment arms.
Study setting: The study was conducted at the paediatric cardiac intensive care unit (PCICU) at Aga Khan University Hospital, Karachi.
Participants: 41 patients (aged 1 month to 15years) who were admitted to PCICU post cardiac surgery were recruited (23 IVPR arm and 18 …

Angiosarcoma Of The Lower Extremity Presenting As Bilateral Pneumothoraces, Mark H. Cooper

Marshall Journal of Medicine

Abstract

Spontaneous pneumothorax usually presents as unilateral disease. Bilateral spontaneous pneumothoraces are less common and are more likely to be secondary than primary. We describe a case of bilateral spontaneous pneumothoraces that were resistant to conventional treatment, and found ultimately to be secondary to angiosarcoma of the lower extremity. A previously well 49 year old white female was referred to our institution in London with bilateral pneumothoraces. A left video assisted thoracoscopic procedure was undertaken, and the wedge resection of the lung specimen contained an area of metastatic tumor. Talc was placed into the left pleural cavity; talc was also …

Optimization Of Fluorescent Imaging In The Operating Room Through Pulsed Acquisition And Gating To Ambient Background Cycling, Kristian J. Sexton, Yan Zhao, Scott C. Davis, Shudong Jiang, Brian Pogue

Dartmouth Scholarship

The design of fluorescence imaging instruments for surgical guidance is rapidly evolving, and a key issue is to efficiently capture signals with high ambient room lighting. Here, we introduce a novel time-gated approach to fluorescence imaging synchronizing acquisition to the 120 Hz light of the room, with pulsed LED excitation and gated ICCD detection. It is shown that under bright ambient room light this technique allows for the detection of physiologically relevant nanomolar fluorophore concentrations, and in particular reduces the light fluctuations present from the room lights, making low concentration measurements more reliable. This is particularly relevant for the light …

Generation Of Crispr Knockout Of Idh1 In Pancreatic Ductal Adenocarcinoma Cell Line: An Optimal Model To Study Pancreatic Cancer Metabolic Reprogramming, Katerina Dukleska, Md, Mahsa Zarei, Phd, Ali Vaziri-Gohar, Phd, Charles J. Yeo, Md, Jonathan Brody, Md, Jordan M. Winter, Md

Department of Surgery Posters

Introduction

• Pancreatic ductal adenocarcinoma (PDA) is the third leading cause of cancer-related death in the US.

• PDA is resistant to conventional chemotherapy; however, mechanisms that contribute to this chemoresistance are not well-described.

• The tumor microenvironment in PDA has a dense stromal reaction, which is thought to result in low oxygen and low nutrient conditions (Feig, C., et al. 2012).

• Isocitrate Dehydrogenase 1 (IDH1) has been identified as an enzyme that plays an important role in chemoresistance in PDA (Zarei, M., et al. In progress).

• We sought to establish an IDH1 knockout cell line to further …

Colorectal Cancer In Nonagenarians: Treatment Decisions And Outcomes., Daniel Sarmiento Garzon, Daniel Meikle Md, Martin Alvarez Md, Mark Wiseman Md, John S. Park Md

Department of Surgery

No abstract provided.

Association Of Magnet Status With Hospitalization Outcomes For Ischemic Stroke Patients., Kimon Bekelis, Symeon Missios, Todd A. Mackenzie

Department of Neurosurgery Faculty Papers

BACKGROUND: It is not clear whether Magnet recognition by the American Nurses Credentialing Center (nursing excellence program) is associated with improved patient outcomes. We investigated whether hospitalization in a Magnet hospital is associated with improved outcomes for patients with ischemic stroke.

METHODS AND RESULTS: We performed a cohort study of patients with ischemic stroke from 2009 to 2013, who were registered in the New York Statewide Planning and Research Cooperative System database. Propensity-score-adjusted multivariable regression models were used to adjust for known confounders, with mixed effects methods to control for clustering at the facility level. An instrumental variable analysis was …

Comparison Of Stroke Cohorts Cared For By Two Different Specialties In A Practice-Based Tele-Stroke Population, Elias Atallah, Kimon Bekelis, Hassan Saad, Ayan Kumar, Justin Turpin, Randa Barsoom, Sophia Dang, Jonathan Li, Stavropoula Tjoumakaris, David Hasan, Maureen Deprince, Giuliana Labella, Robert H. Rosenwasswer, Pascal Jabbour

Department of Neurosurgery Posters

Conclusion

• Telemedicine is allowing for more patients suffering from AIS to receive care by dedicated stroke physicians including neurovascular surgeons.
• Our study does not find any difference in outcome between neurologists, who have traditionally managed stroke care, and neurosurgeons.
• Although ischemic stroke is a matter of multidisciplinary management, these surgeons are appropriately knowledgeable to prescribing IVrt-PA and concurrently performing MT in a highly-specialized stroke unit.

Unmet Need For Surgery In South Asia, Sanjay Nagral, Maharra Hussain, Sarder A. Nayeem, Ranjan Dias, S. Ather Enam, Samiran Nundy

Section of Neurosurgery

No abstract provided.