Surgery Commons^™

Comparison Of Survival Indicators Between Myocardial Infarction Patients And Septic Patients Who Received Veno-Arterial Extracorporeal Membrane Oxygenation, Niharika Boinpally, Kennedy Gallagher, Allison Eisenhauer Pa-C, Michael Healy, Kristina Postko Pa-C, James K. Wu Md

Department of Surgery

No abstract provided.

Role Of Palliative Csf Diversion In Patients With Intracranial Metastatic Disease And Symptomatic Hydrocephalus, Farhan A. Mirza, Muhammad Shahzad Shamim

Section of Neurosurgery

Hydrocephalus, unless treated, is one of the terminal manifestations of intracranial metastatic disease. Single lesions causing obstructive hydrocephalus are amenable to surgical resection, but in the setting of multiple lesions and communicating hydrocephalus from leptomeningeal disease, the approach to treatment is much less defined. The use of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting (VPS) has been described, but data is limited. In this review, we summarize the sparse data available in literature describing the use of CSF diversion for patients with metastatic disease presenting with hydrocephalus and neurological decline.

Twenty-Four Month Results From A Randomized Trial Of Cyanoacrylate Closure Versus Radiofrequency Ablation For The Treatment Of Incompetent Great Saphenous Veins., Kathleen Gibson, Nick Morrison, Raghu Kolluri, Michael Vasquez, Robert Weiss, Daniel Cher, Monte Madsen, Andrew Jones

Surgery Articles

OBJECTIVE: We previously reported 3-month and 12-month occlusion rates after treatment of clinically symptomatic saphenous vein reflux with either cyanoacrylate closure (CAC) using the VenaSeal Closure System (Medtronic, Dublin, Ireland) or radiofrequency ablation (RFA) in a randomized, multicenter, clinical trial, VenaSeal Sapheon Closure System vs Radiofrequency Ablation for Incompetent Great Saphenous Veins (VeClose). Herein we report the 24-month follow-up results of the VeClose trial.

METHODS: There were 222 patients with symptomatic great saphenous vein (GSV) incompetence who were randomly assigned to receive either CAC (n = 108) or RFA (n = 114). Patients were not allowed to receive adjunctive treatment …

Plasma Soluble Human Elastin Fragments As An Intra-Aneurysmal Localized Biomarker For Ruptured Intracranial Aneurysm, Daichi Nakagawa, Mario Zanaty, Joseph Hudson, Nahom Teferi, Daizo Ishii, Lauren Allan, Pascal Jabbour, Santiago Ortega-Gutierrez, Edgar A. Samaniego, David M. Hasan

Department of Neurosurgery Faculty Papers

Background—Fragmentation of the tunica media is a hallmark of intracranial aneurysm formation, often leading to aneurysmal progression and subsequent rupture. The objective of this study is to determine the plasma level of elastin fragments in the lumen of ruptured versus unruptured human intracranial aneurysms. Methods and Results—One hundred consecutive patients with/without ruptured saccular intracranial aneurysms undergoing endovascular coiling or stent-assisted coiling were recruited. Blood samples were collected from the lumen of intracranial aneurysm using a microcatheter. The tip of the microcatheter was placed inside the aneurysm’s sac in close proximity to the inner wall of the dome. Plasma levels of …

A Narrative Review On Contrast-Enhanced Ultrasound In Aortic Endograft Endoleak Surveillance., Sriharsha Gummadi, John R. Eisenbrey, Andrej Lyshchik

Department of Radiology Faculty Papers

Endovascular repair of abdominal aortic aneurysms have been performed successfully since 1991. However, 20% to 50% of these patients may develop an endoleak or continued aneurysmal sac expansion or perfusion despite stent graft coverage. Current recommendations suggest lifelong surveillance with computed tomographic angiography (CTA) at least 1 month after intervention and yearly after that. In select patients with a stable aneurysm sac on computed tomography performed 1 year after treatment, future screening could be performed with ultrasonography. However, color Doppler ultrasound can fail to detect as many as 31% of endoleaks. Contrast-enhanced ultrasound (CEUS) provides an alternative approach to excluded …

A Six-Month Retrospective Study Of Resources Burden By Trauma Victims In The Surgical Intensive Care Unit Of A University Hospital In Pakistan, Muhammad Rizwan, Madiha Hashmi, Hasnain Zafar

Department of Anaesthesia

Introduction: Trauma is the fourth leading cause of death globally and constitutes a huge burden on limited critical care resources. Aim This study aimed to identify the trauma patient burden in terms of resources used in the surgical intensive care unit (SICU) of Aga Khan University Hospital in Pakistan which also included characteristics and outcomes of trauma and non-trauma patients.
Methods: We retrospectively reviewed all patient data for adult patients (>16 years old) admitted to the SICU from July through December 2014.
Results: Of 141 SICU cases included in our study period, 32 (22.7%) trauma patients were identified. On …

Heparin Bridging Therapy Is Not Necessary For Patients With Atrial Fibrillation Undergoing Temporary Interruption Of Warfarin Therapy For Elective Invasive Procedures Or Surgery, Shannon Paquette

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. New Engl J Med. Aug 2015;373(9):823-833. doi: 10.1056/NEJMoa1501035

Consecutive Case Series Of Melanoma Sentinel Node Biopsy For Lymphoseek Compared To Sulfur Colloids, Caitlin Silvestri, Adrienne Christopher, Md, Charles Intenzo, Md, John C. Kairys, Md, Sung Kim, Md, Alliric Willis, Md, Adam C. Berger, Md

Department of Surgery Faculty Papers

Introduction: Sentinel lymph node biopsy (SLNB) is an important adjunct in the staging of patients with melanoma. Preoperative lymphoscintigraphy (LS) with radiolabeled isotopes is essential to localize sentinel nodes for removal. Our study compared the effectiveness of Lymphoseek to standard sulfur colloids (SC) in patients with melanoma undergoing SLNB.

Methods: We queried our IRB-approved melanoma database to identify 370 consecutive patients who underwent SLNB from 2012-2016 with at least one year of follow up. There were 185 patients in each group. Data points included characteristics of the primary melanoma lymphoscintigraphy, and SLNB. Student’s t-test and Chi-Square were used to analyze …

First Case Start Times For Vascular Surgery, Timothy Kafer, Brian Nolan, Jill Knutson, Amy Fournier, Lori Luebbert, J Gregoire, M Daigle, M E. Souliere, J Colpitts, E Anderson, P Briggs, L Ramsey, R Pratt-Pooler, M Maclean, E Estes, S Cheney, D Buck, B Rioux, L Marles

MaineHealth Maine Medical Center

Problem/Impact Statement:

85% of first cases at Maine Medical Center for Vascular Surgery start late. According to one study done by Aurora Health Care; of 5,500 first case surgeries, 88% of them started late. The impact of this is far reaching. It is not in alignment with MMC value of Patient Centered Care because the patient becomes dissatisfied waiting to be brought in to surgery , they are fasting for longer than anticipated, and being away from their family while they wait causing anxiety. The financial impact is $1995 for each 1⁄2 hr. of O.R. time. Furthermore, this may result …

Sub-Retinal Abscess As Presenting Feature Of Endogenous Candida Endophthalmitis, Sidra Zafar, Rehman Siddiqui

Section of Ophthalmology

Background: Sub-retinal abscess as the presenting feature in the setting of endogenous fungal endophthalmitis is extremely infrequent. Immunodeficiency states are major predisposing risk factors. To the best of our knowledge, this is the first case report of Candida sub-retinal abscess as initial presentation in an immunocompetent patient.
Case Presentation: A 32-year old, generally fit and well, female presented to us with gradually deteriorating vision in her right eye. Visual acuity was counting fingers in the right eye and, 20/30 in the left eye. Right eye fundus examination showed a full thickness, yellowish-white foveal lesion, and significant vitreous haze. Left …

Comparison Of Decompression Alone Versus Decompression With Fusion For Stenotic Lumbar Spine: A Systematic Review And Meta-Analysis, Syed Ijlal Ahmed, Gohar Javed, Syeda Beenish Bareeqa, Ali Shah, Maha Zubair, Rabbia Faisal Avedia, Noor Rahman, Syeda Sana Samar, Kashif Aziz

Section of Neurosurgery

The first line of treatment for lumbar spinal stenosis (with or without lumbar degenerative spondylolisthesis) involves conservative options such as anti-inflammatory drugs and analgesics. Approximately, 10%-15% of patients require surgery. Surgical treatment aims to decompress the spinal canal and dural sac from degenerative bony and ligamentous overgrowth. Different studies have given conflicting results. The aim of our study is to clear the confusion by comparing two surgical techniques. This meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A literature search was conducted of the Ovid Embase, Scopus, Pubmed, Ovid Medline, Google …

Educational Prevention Program Of Surgical Site Infections (Ssi), Carena Leung

Master's Projects and Capstones

Surgical site infections (SSI) cause negative health care effects to patients and hospitals. SSI is one of the most common types of healthcare-associated infections (HAI) accounting for 31% among hospitalized patients (Centers for Disease Control and Prevention [CDC], 2012). It is associated with prolonged length of stays (LOS), higher morbidity and mortality, and increased healthcare costs. The purpose of this quality improvement project is to decrease SSI rates by enhancing patient education and engagement in preoperative care and hygiene before surgery. In a metropolitan pediatric hospital, a microsystem analysis of the preoperative unit was conducted before generating the SSI Prevention …

Improving Follow-Up Skeletal Survey Compliance In Suspected Nonaccidental Trauma Patients: What's The Fuss About?, Tong Gan, John M. Draus Jr.

Surgery Faculty Publications

Introduction: Nonaccidental trauma (NAT) victims account for a significant percentage of our pediatric trauma population. The skeletal survey (SS) and follow-up skeletal survey (FUSS) are essential in the evaluation of selected NAT patients. We identified that our clinically indicated FUSS completion rate was suboptimal. We hypothesized that implementing an intervention of postdischarge follow-up in our pediatric surgery clinic would improve FUSS completion rates. Methods: A follow-up clinic for NAT patients was established in July 2013. A retrospective review was performed of all suspected NAT cases younger than 2 years old seen at Kentucky Children’s Hospital between November 2012 and February …

Impact Of Race And Insurance On Door-To-Appendectomy Time Among Pediatric Patients, Carla M. Lopez, Emily R. Christison-Lagay, Daniel Solomon

Journal of Health Disparities Research and Practice

Racial and ethnic disparities in the rate of appendiceal rupture have been widely reported among the pediatric population. The main reasons for this remain largely unknown given that previous explanations pointing to signs of poor health care access have recently been shown to account for only a small percentage of the difference in perforation rates between white and minority children. Because the risk of perforation increases with time, racial disparities in time delay from emergency department presentation to OR appendectomy may help account for the higher appendiceal perforation rates observed among minority children. This is the first study dedicated to …

Quality Of Life Among Patients Undergoing Decompressive Craniectomy For Traumatic Brain Injury Using Glasgow Outcome Scale Extended And Quality Of Life After Brain Injury Scale, Muhammad Waqas, Noor Malik, Muhammad Shahzad Shamim, Karim Rizwan Nathani, Sumia Andleeb Abbasi

Section of Neurosurgery

Objective: To assess quality of life of patients who underwent decompressive craniectomy (DC) for traumatic brain injury and satisfaction of caregivers with outcomes.
Methods: This cross-sectional study was conducted at a tertiary care urban center in Pakistan. All patients with severe traumatic brain injury who underwent DC and survived >6 months were included. Outcomes were assessed using 2 scales: Glasgow Outcome Scale Extended and Quality of Life After Traumatic Brain Injury (QOLIBRI). The proforma was translated and validated into the national language. Patient caregivers were interviewed to ask if they would opt for DC in a similar situation in future. …

Ectopic Follicular Variant Of Papillary Thyroid Carcinoma In Anterior Mediastinum With A Normal Thyroid Gland: A Case Report, Farida Karim, Hina Inam, Usama Khalid Choudry, Saulat Hasnain Fatimi

Section of Ophthalmology

Introduction: Ectopic thyroid is rare, especially in the anterior mediastinum. Furthermore, true malignant transformation in ectopic location with normal orthotopic gland is exceptionally unusual. The authors have tried to put forward a challenging case of a malignant mediastinal mass managed successfully via a multidisciplinary approach.
Presentation of Case: We report the case of a 55 year old female with ectopic follicular variant of papillary thyroid cancer in the anterior mediastinum with no disease in the thyroid gland. Subsequently, complete excision of the mediastinal mass and total thyroidectomy was done followed by radio-iodine ablation with radiotherapy. Patient showed good uneventful recovery …

Biological Characteristics And Outcomes Of Gliosarcoma, Fauzan Alam Hashmi, Adnan Salim, Muhammad Shahzad Shamim, Muhammad Ehsan Bari

Section of Neurosurgery

Gliosarcoma is a highly aggressive primary brain tumour. It is a relatively rare tumour and comprises of two histological components, glial and sarcomatous. Gliosarcomas carry a poorer prognosis than that of Glioblastoma Multiforme (GBM). The current review highlights important histological and radiological features of gliosarcoma in the light of recent literature, and also touches upon the treatment options and outcomes of various types of gliosarcoma.

Development Of Criteria Highly Suggestive Of Spinal Tuberculosis, Gohar Javed, Altaf Ali Laghari, Syed Ijlal Ahmed, Sarosh Madhani, Ahmed Ali Shah, Faizuddin Najmuddin, Reehana Khawaja

Section of Neurosurgery

Background: In a developing country there is a need for development of criteria that can be used for the diagnosis of spinal tuberculosis, which is common in that region.
Methods: Demographic, clinical, and radiologic features of spinal tuberculosis and spinal epidural tumors have been compared statistically, and inferences have been drawn in terms of P values, sensitivity, specificity, positive predictive values, and negative predictive values.
Results: A statistically significant relationship was found between spinal tuberculosis and spinal pain, fever, gradually progressive lower limb weakness, contrast-enhancing epidural ± paravertebral lesions, continuous levels affected, spinal deformity, and raised erythrocyte sedimentation rate.
Conclusions: …

Value Of Routine Preoperative Tests For Coagulation Before Elective Cranial Surgery. Results Of An Institutional Audit And A Nationwide Survey Of Neurosurgical Centers In Pakistan, Naveed Zaman, Muhammad Bilal Tariq, Saad Akhtar, Sidra Sattar, Wajeeha Tariq, Muhammad Shahzad Shamim, Samie Asghar

Section of Neurosurgery

Background: Routine preoperative blood testing has become a dogma. The general practice is to order preoperative workup as a knee-jerk response rather than individualize it for each patient. The fact that the bleeding brain tends to swell, which coupled with limited options for proximal control, packing, and overall hemostasis, leads to an overemphasis on the preoperative coagulation profile.
Material and methods: This is a retrospective review of the medical records of patients admitted at Aga Khan University Hospital from January 2010 to December 2015 for an elective craniotomy. The hospital registry was used to identify files for review. Data were …

Department Of Surgery Update, August 2018, Wright State University Department Of Surgery

Department of Surgery Updates

A four 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.

Is There An Optimal Wound Closure Technique For Major Posterior Spine Surgery? A Systematic Review., Emre Yilmaz, Ronen Blecher, Marc Moisi, Chandra Ankush, Thomas M O'Lynnger, Amir Abdul-Jabbar, Joseph R Dettori, Rod J Oskouian

Articles, Abstracts, and Reports

Study Design: Systematic review.

Objectives: In patients undergoing posterior spinal fusion: (1) What are the types and risks of wound complications in major (≥3 levels) surgery, and does the risk vary by number of levels fused? (2) What types of fascial closure result in the fewest wound complications? (3) What subcutaneous closure technique is more effective in preventing wound complications for obese patients (body mass index >30 kg/m

Methods: Electronic databases and reference lists of key articles were searched from January 1, 2000 to December 4, 2017 to identify studies meeting inclusion criteria.

Results: Six lower quality retrospective studies (evidence …

Prevalence Of And Factors Associated With Negative Microscopic Diagnosis Of Cutaneous Leishmaniasis In Rural Peru., Ryan Lamm, Clark Alves, Grace Perrotta, Meagan Murphy, Catherine Messina, Juan F. Sanchez, Erika Perez, Luis Angel Rosales, Andres G. Lescano, Edward Smith, Hugo Valdivia, Jack Fuhrer, Sarah-Blythe Ballard

Department of Surgery Faculty Papers

Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results …

Enhanced Co-Registration Methods To Improve Intracranial Electrode Contact Localization., Walter A. Hinds, Amrit Misra, Michael R. Sperling, Ashwini Sharan, Joseph I. Tracy, Karen A. Moxon

Department of Neurology Faculty Papers

Background: Electrode contact locations are important when planning tailored brain surgeries to identify pathological tissue targeted for resection and conversely avoid eloquent tissue. Current methods employ trained experts to use neuroimaging scans that are manually co-registered and localize contacts within ~2 mm. Yet, the state of the art is limited by either the expertise needed for each type of intracranial electrode or the inter-modality co-registration which increases error, reducing accuracy. Patients often have a variety of strips, grids and depths implanted; therefore, it is cumbersome and time-consuming to apply separate localization methods for each type of electrode, requiring expertise across …

Bone Graft Donor Site Infection With A Rare Organism, Aeromonas Hydrophila: A Typical Location, Presentation And Organism With 2 Years Follow-Up: Case Report, Obada Hasan, Wajiha Khan, Muneeba Jessar, Aly Zaheer Pathan, Riaz Hussain Lakdawala

Section of Orthopaedic Surgery

Introduction: Aeromonas are Gram-negative bacilli often causing necrotizing fasciitis or sepsis in immunocompromised patients. Aeromonas Hydrophila is most often found in immunocompromised patients or those with burns or aquatic trauma. When patients present with a discharge and infection on bone graft donor site and progressive sepsis, an Aeromonas hydrophila infection should be considered in the differential diagnosis.
Presentation of Case: We report here a rare case of Aeromonas hydrophila with surgical site sep- sis/infection in an immunocompromised 69 years old female, with several comorbids. Here we are reporting infection on donor surgical graft site, sparing major surgical site with the …

The Tentorium Cerebelli: A Comprehensive Review Including Its Anatomy, Embryology, And Surgical Techniques., Rabjot Rai, Joe Iwanaga, Gaffar Shokouhi, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The tentorium cerebelli functions as a partition, dispelling the burden of weight from supratentorial structures upon inferior brain matter. Clinicians and neurosurgeons, when assessing pathological findings, should have knowledge regarding the tentorium cerebelli anatomy. This work of literature is a comprehensive review of the tentorium cerebelli, including its anatomy, embryology, and clinical and surgical implications. The evolutionary pattern demonstrates sequential stages to higher mammalian lineage. An understanding of the complexity of the neurovascular structures and the anatomy of the tentorium cerebelli is crucial for surgical procedures by neurosurgeons.

Epigenetics In Ovarian Cancer: Premise, Properties, And Perspectives., Qilian Yang, Yuqing Yang, Nianxin Zhou, Kexin Tang, Wayne Bond Lau, Bonnie Lau, Wei Wang, Lian Xu, Zhengnan Yang, Shuang Huang, Xin Wang, Tao Yi, Xia Zhao, Yuquan Wei, Hongjing Wang, Linjie Zhao, Shengtao Zhou

Department of Emergency Medicine Faculty Papers

Malignant ovarian tumors bear the highest mortality rate among all gynecological cancers. Both late tumor diagnosis and tolerance to available chemical therapy increase patient mortality. Therefore, it is both urgent and important to identify biomarkers facilitating early identification and novel agents preventing recurrence. Accumulating evidence demonstrates that epigenetic aberrations (particularly histone modifications) are crucial in tumor initiation and development. Histone acetylation and methylation are respectively regulated by acetyltransferases-deacetylases and methyltransferases-demethylases, both of which are implicated in ovarian cancer pathogenesis. In this review, we summarize the most recent discoveries pertaining to ovarian cancer development arising from the imbalance of histone acetylation …

An Atypical Case Of Silent Aortic Dissection In A Peritoneal Dialysis Patient: A Case Report And Review Of Literature, Waqas Javed Siddique, Ali Arif, Mohammad Harisullah Khan, Maryam Khan, Muhammad Owais Hanif, Muhammad Junaid Mehboob, Muhammad Aslam, Ayesha Aslam, Hasan Arif, Sandeep Aggarwal

Medical College Documents

Objective: Unusual clinical course
Background: Aortic dissection presents with acute chest or back pain and is associated with high mortality. We present a case of aortic dissection with an atypical presentation in a peritoneal dialysis patient, and the challenges met with peritoneal dialysis.
Case Report: A 53-year-old African American male presented with progressively worsening exertional dyspnea and orthopnea for 3 days without any history of chest pain. His chest x-ray showed mild pulmonary edema. He was admitted with a diagnosis of heart failure. Bedside echocardiogram revealed severe aortic regurgitation and concern for possible aortic dissection. Computed tomography …

Radial Artery Injury With Attempted Intravenous Catheterization On The Dorsal Hand: A Case Report., Yusuf Alimi, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

Intravenous (IV) access on the dorsum of the hand is of high clinical significance. As it is possible for an arterial injury during IV access on the dorsum of the hand to occur, clinicians and healthcare providers should be cognizant of regional anatomy and anatomical variations during IV placement so as to prevent injuries to the radial artery. We report a case of an injury to the radial artery with an attempted hand IV placement in a cadaver and suggest possible ways to prevent this complication.

Select Biomarkers On The Day Of Anterior Cruciate Ligament Reconstruction Predict Poor Patient-Reported Outcomes At 2-Year Follow-Up: A Pilot Study, Christian Lattermann, Caitlin E. -W. Conley, Darren L. Johnson, Emily K. Reinke, Laura J. Huston, Janet L. Huebner, Ching-Heng Chou, Virginia B. Kraus, Kurt P. Spindler, Cale A. Jacobs

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background. The majority of patients develop posttraumatic osteoarthritis within 15 years of anterior cruciate ligament (ACL) injury. Inflammatory and chondrodegenerative biomarkers have been associated with both pain and the progression of osteoarthritis; however, it remains unclear if preoperative biomarkers differ for patients with inferior postoperative outcomes. Hypothesis/Purpose. The purpose of this pilot study was to compare biomarkers collected on the day of ACL reconstruction between patients with "good" or "poor" 2-year postoperative outcomes. We hypothesized that inflammatory cytokines and chondrodegenerative biomarker concentrations would be significantly greater in patients with poorer outcomes. Study Design. Prospective cohort design. Methods. 22 …

Transplant Critical Care: Is There A Need For Sub-Specialized Units? — A Perspective, Sujit Vijay Sakpal, Suresh Kumar Agarwal, Hector Saucedo-Crespo, Christopher Auvenshine, Robert N. Santella, Steven Donahue, Jeffery Steers

Department of Surgery

The critical care involved in solid-organ transplantation (SOT) is complex. Pre-, intra- and post-transplant care can significantly impact both – patients’ ability to undergo SOT and their peri-operative morbidity and mortality. Much of the care necessary for medical optimization of end-stage organ failure (ESOF) patients to qualify and then successfully undergo SOT, and the management of peri-operative and/or long-term complications thereafter occurs in an intensive care unit (ICU) setting. The current literature specific to critical care in abdominal SOT patients was reviewed. This paper provides a contemporary perspective on the potential multifactorial advantages of sub-specialized transplant critical care units in …