Surgery Commons^™

Impact Of Best Practice Guideline Statement On Anesthesia Practice In Rural Mississippi Hospitals With Obese Patients Undergoing Total Knee Arthroplasty, Steven Hodnett

Doctoral Projects

The aim of this best practice guideline (BPG) was to be a resource for anesthesia providers practicing with obese patients undergoing total knee arthroplasty (TKA) and to measure the knowledge of these providers. After dissemination of an executive summary to anesthesia providers in two hospitals in rural Mississippi, an anonymous online survey was provided via Qualtrics software for voluntary participation. The survey consisted of 10 questions. The data collection period was five weeks. Respondents are noted at N=2, and the data was reviewed and categorized into one of three domains (i.e., knowledge, practice, and safety). In the domain of knowledge, …

Ethical Standards For Cardiothoracic Surgeons' Participation In Social Media., Thomas K. Varghese, John W. Entwistle, John E. Mayer, Susan D. Moffatt-Bruce, Robert M. Sade

Department of Surgery Faculty Papers

No abstract provided.

Possible Skull Base Erosion After Prolonged Frontal Sinus Stenting, Nathaniel H. Reeve Md, Harry H. Ching Md, Yuna Kim Md, Walter W. Schroeder Md

School of Medicine Faculty Research

Frontal sinus stenting is widely used with the goal of maintaining nasofrontal duct patency after sinus surgery. The general recommendation is to leave stents in place for 6 months; however, prolonged stenting up to 6 years has been reported with no complication. We present the first reported case of frontal sinus posterior table and skull base erosion following prolonged frontal sinus stenting. A 57-year-old female presented with chronic sinusitis and nasal obstruction. Imaging revealed pansinusitis with retained stents in each frontal sinus that were placed 8 years prior. On the right, there was an area of skull base erosion at …

Current Management Of Glioma In Pakistan, Umme E Hani Abdullah, Altaf Ali Laghari, Muhammad Usman Khalid, Huzaifa Bin Rashid, Fatima Ali, Adnan Jabbar, Asim Hafiz, Muhammad Shahzad Shamim, Ather Enam

Section of Neurosurgery

To date, information on the management of specific neurosurgical tumors, such as glioma, in Pakistan remains scattered and scarce. Our review synthesizes the predicaments of glioma management routinely presented to the neurosurgery, medical oncology, radiation oncology, and radiology departments in Pakistan. Expert opinions were integrated from each of the relevant fields in the form of personal citations. The data presented in our review were collected from various PubMed and non-PubMed indexed articles, coupled with various health reports from the Government of Pakistan along with the World Health Organization. Through these data, it was postulated that the utilization of innovative and …

Metformin Blunts Muscle Hypertrophy In Response To Progressive Resistance Exercise Training In Older Adults: A Randomized, Double‐Blind, Placebo‐Controlled, Multicenter Trial: The Masters Trial, R. Grace Walton, Cory M. Dungan, Douglas E. Long, S. Craig Tuggle, Kate Kosmac, Bailey D. Peck, Heather M. Bush, Alejandro G. Villasante Tezanos, Gerald Mcgwin, Samuel T. Windham, Fernando Ovalle, Marcas M. Bamman, Philip A. Kern, Charlotte A. Peterson

Center for Muscle Biology Faculty Publications

Progressive resistance exercise training (PRT) is the most effective known intervention for combating aging skeletal muscle atrophy. However, the hypertrophic response to PRT is variable, and this may be due to muscle inflammation susceptibility. Metformin reduces inflammation, so we hypothesized that metformin would augment the muscle response to PRT in healthy women and men aged 65 and older. In a randomized, double-blind trial, participants received 1,700 mg/day metformin (N = 46) or placebo (N = 48) throughout the study, and all subjects performed 14 weeks of supervised PRT. Although responses to PRT varied, placebo gained more lean body …

Effects Of Accelerated Versus Standard Care Surgery On The Risk Of Acute Kidney Injury In Patients With A Hip Fracture: A Substudy Protocol Of The Hip Fracture Accelerated Surgical Treatment And Care Track (Hip Attack) International Randomised Controlled Trial, Flavia K. Borges, P J. Devereaux, Meaghan Cuerden, Mohit Bhandari, Ernesto Guerra-Farfán, Ameen Patel, Alben Sigamani, Masood Umer, John Neary, Maria Tiboni

Section of Orthopaedic Surgery

Introduction: Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI.
Methods and analysis: Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after …

Resilience And Quality Of Life (Qol) Of Head And Neck Cancer And Brain Tumour Survivors In Pakistan: An Analytical Cross-Sectional Study Protocol, Nida Zahid, Wardah Khalid, Khabir Ahmad, Shireen Shehzad, Iqbal Azam Syed, Nargis Asad, Adnan Jabbar, Mumtaz J Khan, Ather Enam

Department of Surgery Docs

Background: Cancer is a devastating disease and has detrimental effects on the quality of life (QoL) of cancer survivors and interferes with their treatment compliance. The aim of the study is to assess resilience and QoL among cancer survivors and to evaluate the important factors affecting their resilience and QoL, with respect to the Pakistani cultural context.
Method and Analysis: A cross-sectional study will be conducted at a tertiary care hospital in Karachi, Pakistan. A minimum sample size of 250 head and neck cancers and 250 brain tumour survivors with 10% inflation for non-response rate will be required. The SD …

Comparison Of Lumbar Laminectomy Alone, Lumbar Laminectomy And Fusion, Stand-Alone Anterior Lumbar Interbody Fusion, And Stand-Alone Lateral Lumbar Interbody Fusion For Treatment Of Lumbar Spinal Stenosis: A Review Of The Literature., Manan Shah, Bradley Kolb, Emre Yilmaz, Dia R Halalmeh, Marc D Moisi

Articles, Abstracts, and Reports

Lumbar spinal stenosis is defined as narrowing of the lumbar spinal canal, which causes compression of the spinal cord and nerves. Spinal stenosis can cause leg pain and potentially back pain that can affect the quality of life. Ultimately, surgical decompression is required to alleviate the symptoms. In this review, we first utilize several important studies to compare lumbar laminectomy alone versus lumbar laminectomy and fusion. We also compare the effectiveness of more novel surgical approaches, stand-alone anterior lumbar interbody fusion (ALIF), and stand-alone lateral lumbar interbody fusion (LLIF). These techniques have their own advantages and disadvantages in which many …

Endovascular Management And The Risk Of Late Failure In The Treatment Of Ureteroarterial Fistulas, George Titomihelakis, Anthony Feghali, Tuong Nguyen, Dawn Salvatore, Paul Dimuzio, Babak Abai

Department of Medicine Faculty Papers

Ureteroarterial fistula (UAF) is a rare and life-threatening source of hematuria. A high index of suspicion is warranted for early diagnosis and timely intervention. Because of high perioperative risk and comorbidities in UAF patients, the endovascular approach has become preferred for repair. Infection can complicate this mode of therapy, and treatment with antibiotics is important. Herein we present five cases of secondary UAFs treated with stent graft alone or stent graft and embolization.

Use Of Gastric Bypass Surgery For The Treatment Of Type 2 Diabetes Mellitus, Kaitlin A. Sanders, Jenna L. Schaffner, Leslie M. Hart, Whitney N. Detillion, Anne Gentry

Pharmacy and Wellness Review

Over the past decade, the incidence of type 2 diabetes mellitus (T2DM) has increased significantly. Evidence has shown that a clear association exists between obesity and diabetes development. This association has inspired researchers to explore bariatric surgery as an option for diabetes management and possible disease reversal. Improvement of T2DM using Roux-En-Y gastric bypass (RYGB) is thought to result from from a combination of weight loss, decreased caloric intake, hormonal changes and rearrangement of the gastrointestinal anatomy. Positive outcomes resulting from the procedure include decreased mortality rates, normalization of HbA1c levels, decreased dependence on diabetic medications, and increased insulin sensitivity. …

Laparoscopic Cholecystectomy In The Acute Care Surgery Model: Risk Factors For Complications, Emily Fletcher, Erica Seabold, Ronald J. Markert, Alyssa J. Gans, Akpofure Peter Ekeh

Department of Surgery Faculty Publications

Background: The Acute Care Surgery (ACS) model developed during the last decade fuses critical care, trauma, and emergency general surgery. ACS teams commonly perform laparoscopic cholecystectomy (LC) for acute biliary disease. This study reviewed LCs performed by an ACS service focusing on risk factors for complications in the emergent setting. Methods: All patients who underwent LC on an ACS service during a 26-month period were identified. Demographic, perioperative, and complication data were collected and analyzed with Fisher's exact test, χ ² test, and Mann-Whitney U Test. Results: During the study period, 547 patients (70.2% female, mean age 46.1±18.1, …

Perioperative Use Of Renin-Angiotensin System Inhibitors And Outcomes In Patients Undergoing Cardiac Surgery., Qian Ding, Zugui Zhang, Hong Liu, Huang Nie, Mark Berguson, Jordan E. Goldhammer, Nilas Young, Douglas Boyd, Rohinton Morris, Jianzhong Sun

Department of Anesthesiology Faculty Papers

It remains disputable about perioperative use of renin-angiotensin system inhibitors (RASi) and their outcome effects. This multicenter retrospective cohort study examines association between use of perioperative RASi and outcomes in patients undergoing coronary artery bypass graft and/or valve surgery. After the exclusion, the patients are divided into 2 groups with or without preoperative RASi (PreRASi, n = 8581), or 2 groups with or without postoperative RASi (PostRASi, n = 8130). With using of propensity scores matching to reduce treatment selection bias, the study shows that PreRASi is associated with a significant reduction in postoperative 30-day mortality compared with without one …

Reducing The Risk For Surgical Site Infections: Will Evidence-Based Practices Really Lead Us To The Promised Land?, Charles E. Edmiston Jr., Phd, Sm (Ascp), Cic (Cbic)

Fleming Infection Prevention and Infectious Disease Symposium

No abstract provided.

Incidence Of Intraocular Lens Exchange After Cataract Surgery, Maram E. A. Abdalla Elsayed, Khabir Ahmad, Abdulelah A. Al-Abdullah, Rizwan Malik, Rajiv Khandekar, Hernan Martinez-Osorio, Marco Mura, Patrik Schatz

Department of Surgery Docs

Intraocular lens (IOL) exchange after cataract surgery is unusual but may be associated with suboptimal visual outcome. The incidence of IOL exchange has not been consistently estimated. Such information is invaluable when counseling patients prior to cataract surgery. We examined the incidence of, and indications and risk factors for, IOL exchange after cataract surgery. We also assessed visual outcome of eyes that had an IOL exchange. A cohort design was used to estimate the incidence of IOL exchange and a case-control design to identify factors associated with it. All phacoemulsification surgeries with IOL (n = 17415 eyes) during 2010-2017 and …

Irisin Functions To Inhibit Malignant Growth Of Human Pancreatic Cancer Cells Via Downregulation Of The Pi3k/Akt Signaling Pathway., Deguo Zhang, Ping Zhang, Luan Li, Nan Tang, Fei Huang, Xianguo Kong, Xueying Tan, Guangjun Shi

Department of Medicine Faculty Papers

Introduction: Irisin is a newly identified cytokine that has gained increasing attention because of its potential therapeutic applications in metabolic diseases and human cancers. Recently, accumulating evidence indicates that irisin plays an important role in the development and metastasis of various tumors. The aim of this study was to evaluate the effects and underlying mechanisms of irisin on malignant growth of pancreatic cancer cells.

Materials and methods: The anti-proliferative effect of irisin was examined using the CCK-8 assay. Irisin-induced apoptosis was determined by the annexin V-FITC/PI staining assay. The effects of irisin on cell migration and invasion were assessed using …

Geriatric Hepatology: The Hepatic Diseases Of The Elderly And Liver Transplant, Shima Ghavimi, Hamed Azimi, Neel Patel, Oleg Shulik

Internal Medicine

Introduction: With the aging US population, chronic liver diseases are becoming more commonly diagnosed in the geriatric population. Advanced age leads to changes in liver blood flow, volume, morphology and normal physiology. This predisposes elderly patients to develop certain chronic liver diseases. Also, the clinical course and management differ in an older patient when compared to a younger patient. Some causes of chronic liver disease in the geriatric population include Hepatitis A, B, C, Non-Alcoholic Fatty liver disease, prolonged alcohol use and inflammation. Many chronic liver diseases are characterized by a slow, indolent course of progression with non-specific symptoms and …

Management And Outcomes Of Gastrointestinal Congenital Anomalies In Low, Middle And High Income Countries: Protocol For A Multicentre, International, Prospective Cohort Study, Naomi Jane Wright, Andrew Leather, Nick Sevdalis, Niyi Ade-Ajayi, Adesoji O. Ademuyiwa, Emmanuel A. Ameh, Justine Davies, Kokila Lakhoo, Samuel Parker, Muhammad Arshad

Section of Paediatric Surgery

Introduction: Congenital anomalies are the fifth leading cause of death in children globally, contributing an estimated half a million deaths per year. Very limited literature exists from low and middle income countries (LMICs) where most of these deaths occur. The Global PaedSurg Research Collaboration aims to undertake the first multicentre, international, prospective cohort study of a selection of common congenital anomalies comparing management and outcomes between low, middle and high income countries (HICs) globally.
Methods and Analysis: The Global PaedSurg Research Collaboration consists of surgeons, paediatricians, anaesthetists and allied healthcare professionals involved in the surgical care of children globally. Collaborators …

Surgical Stress And Cancer Progression: The Twisted Tango., Zhiwei Chen, Peidong Zhang, Ya Xu, Jiahui Yan, Zixuan Liu, Wayne Bond Lau, Bonnie Lau, Ying Li, Xia Zhao, Yuquan Wei, Shengtao Zhou

Department of Emergency Medicine Faculty Papers

Surgical resection is an important avenue for cancer treatment, which, in most cases, can effectively alleviate the patient symptoms. However, accumulating evidence has documented that surgical resection potentially enhances metastatic seeding of tumor cells. In this review, we revisit the literature on surgical stress, and outline the mechanisms by which surgical stress, including ischemia/reperfusion injury, activation of sympathetic nervous system, inflammation, systemically hypercoagulable state, immune suppression and effects of anesthetic agents, promotes tumor metastasis. We also propose preventive strategies or resolution of tumor metastasis caused by surgical stress.

The Art Of Surgery: The Strange World Of The Placebo Response., Joseph R Dettori, Daniel C Norvell, Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

Outcomes Of Bilateral Shoulder Arthroplasties: A Comparison Of Bilateral Total Shoulder Arthroplasties And Bilateral Reverse Shoulder Arthroplasties., Ryan Matthew Cox, Tyler James Brolin, Eric Michael Padegimas, Mark D. Lazarus, Charles Lonnie Getz, Matthew Lee Ramsey, Gerald Ross Williams, Joseph Albert Abboud

Rothman Institute Papers

Background: The purpose of this study was to compare outcomes of patients who underwent bilateral total shoulder arthroplasties (TSAs) for osteoarthritis (OA) versus bilateral reverse shoulder arthroplasties (RSAs) for cuff tear arthropathy (CTA).

Methods: Inclusion criteria were patients who underwent bilateral TSAs for OA or bilateral RSAs for CTA with at least 2 years of follow-up. Twenty-six TSA patients (52 shoulders) were matched 2 to 1 with 13 RSA patients (26 shoulders) by sex, age at first surgery, and time between surgeries. Outcomes measured were shoulder range of motion (ROM), complications, and patient-reported scores.

Results: Preoperatively, TSA patients had significantly …

Peripheral Vascular Injuries - Not To Miss Or Mess Them!, Zia Ur Rehman

Department of Surgery Docs

No abstract provided.

Association Between Maxillary Transverse Discrepancy And Occurrence Of Potentially Impacted Maxillary Canines In Mixed Dentition Patients, Farhana Ghaffar, Rashna Hoshang Sukhia, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

Objective: The aim of this study was to determine the association between transverse maxillary discrepancy and occurrence of potentially impacted maxillary canines in mixed dentition patients.
Material and methods: This cross-sectional analytical study was conducted on 85 Pakistani subjects (32 males and 53 females) aged between 8 to 13 years, having good quality orthopantomographs and dental casts. Maxillary transverse discrepancy was assessed by subtracting the mandibular intermolar width from the maxillary intermolar width on dental cast. Maxillary lateral incisors and canines were traced from orthopantomographs, and canines were placed into sector classification. Chi-square test was used to determine the difference …

Meta-Analysis A Myriad Of Data - Is It Helpful?, James Harrop

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Hidradenitis Suppurativa: A Comparison Of Institutional Experience With The Tracking, Sean J. Wallace Md, Andrew Steele Md, Nathan Miller Md, Yee-Cheng Low Md, Robert X. Murphy Jr, Md, Ms

Department of Surgery

No abstract provided.

Pituitary Adenoma With Calcifications: A Case Report, Yakoot Khan, Noor Malik, Saba Iqbal Awan, Syed Hassan Khalid, Altaf Ali Laghari

Section of Neurosurgery

Pituitary adenomas and Rathke’s cleft cyst with calcification are rarely seen and craniopharyngioma still remains the common sellar suprasellar space occupying lesion with calcification. Presence of calcification is reported in pituitary adenoma in only 0.2% to 8% cases. The pituitary adenoma with calcification is a rare radiological finding and it must be distinguished from other lesions of the pituitary gland as the management and prognosis differs significantly. We report a case of a 29-year-old gentleman presented electively with the complaints of deterioration of vision for four months. CT-scan without contrast examination revealed pituitary adenoma with calcification. The patient underwent transsphenoidal …

Optimal Timing And Route Of Nutritional Support After Esophagectomy: A Review Of The Literature., Richard Zheng, Courtney L. Devin, Michael J. Pucci, Adam C. Berger, Ernest L. Rosato, Francesco Palazzo

Department of Surgery Faculty Papers

Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy. Variation in practices during the perioperative period exists including the type of nutrition started, the delivery route, and its timing. Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery, which can affect their ability to regain or maintain weight. Methods of feeding after an esophagectomy include total parenteral nutrition, nasoduodenal/nasojejunal tube feeding, jejunostomy tube feeding, and oral feeding. Recent evidence suggests that early oral feeding is associated with shorter LOS, faster return of …

The Characteristics Of Appendicoliths Associated With Acute Appendicitis, Mohammad Shoaib Khan, Mustafa Belal Hafeez Chaudhry, Noman Shahzad, Muhammad S. Khan, Maryam Wajid, Wasim Memon, Abdul Rehman Alvi

Section of General Surgery

Introduction: Differences between appendicoliths associated with appendicitis and those found incidentally have not been studied. The objective of this study was to determine the characteristics of appendicoliths that are associated with acute appendicitis.
Methods: A cross-sectional study of patients with appendicoliths identified on computed tomographic (CT) scan from January 2008 till December 2014 was conducted. Patients were divided into two group: appendicitis and appendicoliths (AA) and incidentally discovered appendicoliths (IA).
Results: Overall, 321 patients were included in the study. Of these, 103 (32%) patients were in the AA group while 218 (68%) patients were in the IA group. Both groups …

Obgyn Surgical Prep Standardized Process Presentation, Cortney Hartman Mba-Hm, Cst, Crcst, Cis

Posters & Presentations

OBGYN Surgical Prep Presentation.

To lower the occurrences of SSIs and standardize the process of surgical preparation across Parkview Health System, the following changes were adopted on August 15, 2019.

This is version 2.0

• Infection Prevention Bundle
• Vaginal Prep Instructions
• Abdominal Prep Instructions
• Chlorohexidine-alcohol (Chloraprep)

Leaving Against Medical Advice From In-Patients Departments Rate, Reasons And Predicting Risk Factors For Re-Visiting Hospital Retrospective Cohort From A Tertiary Care Hospital, Obada Hasan, Muhammad Adil Samad, Hamza Khan, Maryam Sarfraz, Shahryar Noordin, Tashfeen Ahmad, Gul Nowshad

Section of Orthopaedic Surgery

Background: Approximately 1% to 2% of hospitalized patients get discharged or leave from the hospital against medical advice and up to 26% in some centers. They have higher readmission rate and risk of complications than patients who receive complete care. In this study we aimed to determine the rate of leave against medical advice (LAMA) and reasons for the same across different in-patient departments of a tertiary care hospital.
Methods: Retrospective cohort study on patients admitted in all departments at our institute over a 1-year period. All patients who were admitted to an in-patient ward at the hospital and who …

Predictors Of An Increased Length Of Stay Following Total Knee Arthroplasty: Survey Report, Azeem Tariq Malik, Syed Hamza Mufarrih, Arif Ali, Shahryar Noordin

Section of Orthopaedic Surgery

Objective: To find various preoperative, intraoperative and postoperative factors that predict an increased length of stay in patients following total knee arthroplasty.
Methods: The retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised record of patients regardless of gender, co-morbids and age who had undergone a unilateral or bilateral total knee arthroplasty between January 2007 and December 2015. An increased length of stay was defined as ≥75th centile (≥11 days).
Results: Of the 577 patients, 448(77.6%) were women. Overall, 311(53.9%) patients were aged 56-70 years. Of the total, 100(17.3%) patients stayed for at least 11 …