Surgery Commons^™

Goblet Cell Carcinoma Of The Appendix: A Case Report On Goblet Cell Carcinoid, Sheliza Kabani, Aubtin Saedi, Austin Lehr, Lina O'Brien

HCA Healthcare Journal of Medicine

Goblet cell carcinoid of the appendix is a rare neoplasm with histological features of both neuroendocrine and adenocarcinomas. The combination of its aggressive behavior, infrequent occurrence, and variable clinical presentation convolutes the management of this tumor. We report the case of a 75-year-old female presenting with acute appendicitis. A laparoscopic appendectomy was performed. The pathology report showed goblet cell carcinoid at the base of the appendix with involvement of the proximal surgical margins. At her postoperative visit, the patient’s pathology report and options for management were reviewed, and the patient agreed to proceed with a right hemicolectomy 8-10 weeks after …

Current Role Of Laser Interstitial Thermal Therapy In The Treatment Of Intracranial Tumors, Farhan A. Mirza, Rida Mitha, Muhammad Shahzad Shamim

Section of Neurosurgery

Laser interstitial thermal therapy (LITT) is gaining popularity in the treatment of both primary and secondary intracranial tumors. The goal of LITT is to deliver thermal energy in a predictable, controlled, and minimally invasive fashion. It can be particularly valuable in patients with recurrent tumors who, due to previous radiation or surgery, may have a potentially higher risk of wound breakdown or infection with repeat craniotomy. Deep-seated lesions that are often inaccessible through open approaches (thalamus, hypothalamus, mesial basal temporal lobe, brainstem) may also be suitable targets. The experience and data published thus far on this modality is limited but …

Outcomes Of Chronic Distal Biceps Reconstruction With Tendon Grafting: A Matched Comparison With Primary Repair., Benjamin A. Hendy, Eric M. Padegimas, Thomas Harper, Mark D Lazarus, Joseph A Abboud, Surena Namdari, John Horneff Iii, Md

Rothman Institute Papers

Background: The purpose of this analysis was to analyze outcomes of distal biceps reconstruction with soft tissue allograft in the setting of chronic, irreparable distal biceps ruptures. The outcomes of these cases were then compared with a matched cohort of distal biceps ruptures that were able to be repaired primarily.

Methods: Retrospective review of an institutional elbow surgery database was conducted. All cases of distal biceps repairs were identified by Common Procedural Terminology, ICD-9, and ICD-10 codes from January 2009 to March 2018. A direct review of operative reports was then conducted to identify which cases required allograft reconstruction. After …

Opioid Free Anesthesia, Sarah Medina

Doctor of Nursing Practice Projects

Patients undergoing surgery are often given opioids intraoperatively. Administration of opioids is associated with untoward side effects that include nausea, respiratory depression, constipation, ileus, hyperalgesia, prolonged length of stay, and the potential for dependence (Garimella & Cellini, 2013). Emerging research on the topic of opioid-free anesthesia (OFA) is available and indicates several benefits of OFA, including reduction in postoperative pain, reduction in postoperative nausea and vomiting, reduction in postoperative shivering, and improved oxygen saturation levels (Mulier et al., 2018). This quality improvement project aimed to advance anesthesia providers' understanding of OFA by creating an OFA guideline and providing a learning …

The Survival Rate Of Colorectal Cancer In Dr. Cipto Mangunkusumo Hospital, Wifanto S. Jeo, Feyona H. Subrata

The New Ropanasuri Journal of Surgery

Introduction. Colorectal cancer (CC) is a malignancy with the third highest incidence and the second cause of death. 1.4 million new cases of colorectal cancer occurred in 2012, increasing to 1.8 million new cases in 2019, with almost 900,000 deaths caused by CC in the world. In Indonesia, there were 30,017 new cases of CC in 2019, with fatalities reaching nearly 16,000 cases. There are differences in the survival rates of the CC between developed countries and Indonesia. This study aims to determine the survival rate of CC patients in Indonesia.

Method. A retrospective cohort study design with …

The Efficiency Of Well-Written Manuals Aided-Hand Knotting Skills Acquisition For Undergraduates, Theddeus O.H Prasetyono, Putri Rezkini

The New Ropanasuri Journal of Surgery

Introduction. Standard procedural skills training methods include tutorial, workshop, and feedback. Written manuals might add value to those standard methods; nevertheless, depends on how well they are composed. This research is aimed to evaluate the efficiency of well-written manuals of hand knotting skills in order to improve students’ procedural skills learning and competency.

Methods. This research was conducted through preliminary study to identify the assessor reliability and main study to evaluate the students’ scores for reef and surgeon’s knots using an objective structured assessment of technical skills (OSATS). Subjects’ preparedness and perception of the quality of the manuals …

The Application Of Bromelain Enzyme On Pig Skin To Be Used As Surgery Training Model, Theddeus O.H Prasetyono, Christopher R. Andrian, Elisabet L.A Kinanthi, Siti R.K Putri

The New Ropanasuri Journal of Surgery

Introduction. Postmortem changes in pigskin made it difficult to be manipulated as a model for advanced technique in surgery training. The use of bromelain enzyme on these pigskins could be an alternative way to obtain the ideal surgery training model.

Method. Thirty-five pigskin-blocks (10×15cm) was divided evenly into seven groups consisted of six groups of different bromelain enzyme treatment (4g/20min, 4g/40min, 8g/20min, 8g/40min, 12g/20min, 12g/40min) and one group of control. Then five chief-plastic-surgery-residents blindly assessed and scored each pigskin and compared its likeliness to the back of human skin. The scores were then analyzed with an interrater reliability …

The Use Of Laparoscopy In Treatment Of Perforated Peptic Ulcer: A Literature Review, Alif R. Soeratman, Agi S. Putranto

The New Ropanasuri Journal of Surgery

No abstract provided.

Management Of Uncomplicated Stanford Type B Aortic Dissection : A Literature Review:, Zamzania A. Shalih, Akhmadu Muradi

The New Ropanasuri Journal of Surgery

No abstract provided.

Transanastomotic Feeding Tube In Surgical Management Of Congenital Duodenal Obstruction: Case Series, Hardian Gunardi, Asri D. Rachmawati, Nanok E. Susilo, Riana P. Tamba

The New Ropanasuri Journal of Surgery

Introduction. Prolonged fasting is a major concern in the postoperative management of congenital duodenal obstruction. Massive dilatation of the proximal segment would lead to diameter discrepancy and lack of propulsion, thus delaying enteral feeding. A transanastomotic feeding tube is an option to deliver early enteral feeding after surgical correction. The study evaluates the effectiveness and safety of a transanastomotic feeding tubes in the surgical management of congenital duodenal obstruction.

Method. The transanastomotic feeding tube's effectiveness in cases of congenital duodenal obstruction of the newborn underwent surgical correction was evaluated. Those managed from January 2016 to December 2018 at …

Final Outcome Of Hybrid Laparoscopic For Colorectal Cancer: A Literature Review, Dyan Novitalia, Yarman Mazni

The New Ropanasuri Journal of Surgery

No abstract provided.

Academic Atmosphere In Training Program Of Surgery, Yefta Moenadjat

The New Ropanasuri Journal of Surgery

No abstract provided.

Analysis Of Preoperative And Intraoperative Risk Factors Of Surgical Site Infection In Gastrointestinal Surgeries, Annisa Syafitri, Yarman Mazni, Setyawati Budiningsih

The New Ropanasuri Journal of Surgery

Introduction. Surgical site infection (SSI) after gastrointestinal surgery can affect the mortality and morbidity of the patients. Risk factors are needed to prevent and decrease the number of SSI. This study investigated the incidence of SSI, the preoperative and intraoperative risk factors of gastrointestinal surgeries..

Method. A retrospective audit analysis of age, nutritional status, preoperative length of stay, length of surgery, type of surgery, degree of contamination in adult gastrointestinal surgery patients at dr. Cipto Mangunkusumo General Hospital from 2012 to 2016. Outcomes consisted of incidence, and potential univariate risk factors were determined to investigate the independently associated …

External Validation Of 10 Points Intraoperative Gallbladder Scoring System (G10) In Laparoscopic Cholecystectomy At Rsupn Dr. Cipto Mangunkusumo, Yarman Mazni, Wifanto Saditya Jeo, Rony -

The New Ropanasuri Journal of Surgery

Introduction. Laparoscopic cholecystectomy has become a standard treatment for symptomatic cholecystolithiasis in dr. Cipto Mangunkusumo Hospital (RSCM). This study aims as a preliminary study to externally validate the 10-point intraoperative gallbladder scoring system (G10), an assessment system of laparoscopic cholecystectomy's difficulty.

Method. A cross-sectional study was carried out. Enrolling subjects who underwent laparoscopic cholecystectomy from January 2019 to December 2019. Data of the subjects were collected from medical records. We assessed each of the subjects' G10 scores and operation techniques based on the intraoperative images and surgical reports. The surgical technique divided into two groups, those are the …

Pulling Heart Strings: Quality Improvement Algorithm For Temporary Epicardial Pacing Wire Removal Post Cardiac Surgery, Jessica Norman

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The placement of temporary epicardial pacing wires (TEPW) is considered standard practice post cardiac surgery and is dependent on the patient’s cardiac function intra-operatively and their electrophysiologic profile after weaning from cardiopulmonary bypass (Reade, 2007; Elmistekawy et al, 2016). Complications associated with TEPW removal include myocardial damage, infection, perforation, tamponade, disruption of anastomoses, ventricular arrythmias, and death (Bojar, 2009; Carroll et al, 1998;Timothy & Rodeman, 2004). Currently there is no standard practice on the removal of TEPW and there is wide variation in removal practices involving patients who are routinely on medications such as dual antiplatelet therapies and systemic anticoagulation. …

Local Injections Of Β-Ngf Accelerates Endochondral Fracture Repair By Promoting Cartilage To Bone Conversion., Kevin O. Rivera, Fabrizio Russo, Ryan M. Boileau, Ryan E. Tomlinson, Theodore Miclau, Ralph S. Marcucio, Tejal A. Desai, Chelsea S. Bahney

Department of Orthopaedic Surgery Faculty Papers

There are currently no pharmacological approaches in fracture healing designed to therapeutically stimulate endochondral ossification. In this study, we test nerve growth factor (NGF) as an understudied therapeutic for fracture repair. We first characterized endogenous expression of Ngf and its receptor tropomyosin receptor kinase A (TrkA) during tibial fracture repair, finding that they peak during the cartilaginous phase. We then tested two injection regimens and found that local β-NGF injections during the endochondral/cartilaginous phase promoted osteogenic marker expression. Gene expression data from β-NGF stimulated cartilage callus explants show a promotion in markers associated with endochondral ossification such as Ihh, Alpl, …

Does Early Surgery Prevent Postoperative Icu Admission After Surgery For The Fracture Of The Hip. Nested Case Control Study Of 911 Patients, Obada Hasan, Laraib Mazhar, Umar Rabbani, Amna Rabbani, Fatima Mahmood, Shahryar Noordin

Department of Medicine

Introduction: Since most hip fractures are treated surgically, it is imperative to find an optimum fracture-to-surgery time to decrease the potential complications and enhance postoperative outcomes. In comparison to the vast plethora of literature available on surgical delay and its implications on mortality, very little, if any, research is available on the impact of delayed surgery on postoperative ICU admission. The primary objective of our study is to examine the factors influencing post-surgical ICU admission in order to work on preventive strategies to reduce the potential associated morbidity.
Material and methods: Investigators did a nested case control study in a …

A Case Of Carcinoid Heart Disease And Echocardiographic Findings, Brandon Alex, Jeffrey Songster, Helenmari L. Merritt, Rebecca A. Aron

Graduate Medical Education Research Journal

Abstract: Carcinoid heart disease occurs in approximately 50% of patients with carcinoid syndrome. Right heart involvement resulting in tricuspid regurgitation, tricuspid stenosis, pulmonic regurgitation and pulmonic stenosis is most common. We report a case of tricuspid heart disease resulting in tricuspid regurgitation, tricuspid stenosis, pulmonic regurgitation and pulmonic stenosis.

Does Breast Cancer Subtype Impact Margin Status In Patients Undergoing Partial Mastectomy?, Andrew Fenton, Elisabeth Dupont, Theodore Tsangaris, Carlos Garcia-Cantu, Marissa Howard-Mcnatt, Akiko Chiba, Adam Berger, Edward Levine, Jennifer Gass, Kristalyn Gallagher, Sharon Lum, Ricardo Martinez, Alliric Willis, Sonali Pandya, Eric A. Brown, Amanda Mendiola, Naveenraj Solomon, Maheswari Senthil, David Ollila, David Edmonson, Melissa Lazar, Jukes Namm, Fangyong Li, Meghan Butler, Noreen Mcgowan, Maria Herrera, Yoana Avitan, Brian Yoder, Laura L. Walters, Tara Mcpartland, Victor Haddad, Hongwei Ma, Ming Xie, Anees Chagpar

Conference Presentation Abstracts

BACKGROUND: Molecular subtype in invasive breast cancer guides systemic therapy. It is unknown whether molecular subtype should also be considered to tailor surgical therapy. The present investigation was designed to evaluate whether breast cancer subtype impacted surgical margins in patients with invasive breast cancer stage I through III undergoing breast-conserving therapy.

METHODS: Data from 2 randomized trials evaluating cavity shave margins (CSM) on margin status in patients undergoing partial mastectomy (PM) were used for this analysis. Patients were included if invasive carcinoma was present in the PM specimen and data for all 3 receptors (ER, PR, and HER2) were known. …

International Evidence-Based Consensus Diagnostic And Treatment Guidelines For Unicentric Castleman Disease., Frits Van Rhee, Eric Oksenhendler, Gordan Srkalovic, Peter Voorhees, Megan Lim, Angela Dispenzieri, Makoto Ide, Sophia Parente, Stephen Schey, Matthew Streetly, Raymond Wong, David Wu, Ivan Maillard, Joshua Brandstadter, Nikhil Munshi, Wilbur Bowne, Kojo S Elenitoba-Johnson, Alexander Fössa, Mary Jo Lechowicz, Shanmuganathan Chandrakasan, Sheila K Pierson, Amy Greenway, Sunita Nasta, Kazuyuki Yoshizaki, Razelle Kurzrock, Thomas S Uldrick, Corey Casper, Amy Chadburn, David C Fajgenbaum

Department of Surgery Faculty Papers

Castleman disease (CD) includes a group of rare and heterogeneous disorders with characteristic lymph node histopathological abnormalities. CD can occur in a single lymph node station, which is referred to as unicentric CD (UCD). CD can also involve multicentric lymphadenopathy and inflammatory symptoms (multicentric CD [MCD]). MCD includes human herpesvirus-8 (HHV-8)-associated MCD, POEMS-associated MCD, and HHV-8-/idiopathic MCD (iMCD). The first-ever diagnostic and treatment guidelines were recently developed for iMCD by an international expert consortium convened by the Castleman Disease Collaborative Network (CDCN). The focus of this report is to establish similar guidelines for the management of UCD. To this purpose, …

A Comparison Of 4-Year Total Medical Care Costs, Adverse Outcomes, And Opioid/Prescription Analgesic Use For 3 Knee Osteoarthritis Pain Treatments: Intra-Articular Hyaluronic Acid, Intra-Articular Corticosteroids, And Knee Arthroplasty., John Mackowiak, John T Jones, Vinod Dasa

School of Medicine Faculty Publications

To compare the medical costs associated with treatments for knee osteoarthritis (OA): intra-articular corticosteroids (ICS) and intra-articular hyaluronic acid (IHA) primarily, and ICS/IHA vs knee arthroplasty (TKA) secondarily. This was a retrospective analysis of an insurance claims database. Eligible members had diagnosed OA and no claims for ICS, IHA, or TKA during the 6–18-month look-back period. Cohorts of interest over the 4-year observation period were: patients who received ICS only, those who received IHA only, and those who received TKA only. Outcomes assessed included: (1) total allowed medical costs, (2) claims for pre-specified, treatment-related adverse outcomes and costs, and (3) …

Congenital Nasal Pyriform Aperture Stenosis Repair: A Case Series And Discussion Of Postoperative Care, Harper L. Wilson, Nicholas Van Maele, Kenneth C. Iverson

Otolaryngology--Head & Neck Surgery Faculty Publications

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare condition related to holoprosencephaly in which bony overgrowth of the medial nasal process of the maxilla narrows the pyriform aperture. CNPAS presents in neonates with signs of upper airway obstruction ranging from mild to severe respiratory distress and failure to thrive. Surgical intervention is indicated after failed conservative measures and generally includes temporary stent placement. We report a series of 3 cases of CNPAS treated surgically, examine postoperative care recommendations in the literature, and present a comprehensive postoperative care regimen with a novel method to maintain stent patency.

Increasing Nurse Knowledge Using A Formal Lung Transplant Education Program, Amy M. Stoddard, Donna Lynch-Smith, Kate Carlson Wrammert, Bobby Bellflower

Doctor of Nursing Practice Projects

This quality improvement project was completed to show that a formal lung transplant education course for nurses caring for lung transplant patients increased their knowledge. An eight-hour education course was developed by experts in the field of lung transplantation. A pretest was administered before the education course. A posttest was administered to determine if knowledge was improved. A three-month follow-up test was administered to determine knowledge retention. Based on the data analysis, nurse knowledge improved after formal education. Item analysis determined what areas of educational content need to be the focus of quarterly education. The education course was adopted as …

Residency Recruitment: Changes And Challenges, Karen A. Chojnacki, Md, Facs

Department of Surgery Presentations and Grand Rounds

No abstract provided.

Risk Of Mechanical Thrombectomy Recanalization Failure: Intraoperative Nuances And The Role Of Intracranial Atherosclerotic Disease, Joshua H. Weinberg, Ahmad Sweid, Ashlee Asada, Rawad Abbas, Keenan Piper, Daniel Joffe, Michael Reid Gooch, Stavropoula Tjoumakaris, Pascal Jabbour, Robert H. Rosenwasswer, Hekmat Zarzour

Department of Neurosurgery Faculty Papers

Objective: To present intraoperative observations that when recognized may facilitate the identification of patients at high risk of MT recanalization failure. We illustrate 4 cases of successful recanalization via rescue treatment with balloon angioplasty and/or stenting when such observations were noted. We also discuss the role of intracranial atherosclerotic disease in recanalization failure.

Patients and methods: We conducted a retrospective review of a prospectively maintained database for 450 stroke patients and identified 122 patients who underwent MT that failed to achieve recanalization. Operative notes were reviewed, and intraoperative nuances were discussed amongst neurointerventionalists.

Results: Intraoperative observations that may suggest a …

Three Decades Of Research On Recombinant Collagens: Reinventing The Wheel Or Developing New Biomedical Products?, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Collagens provide the building blocks for diverse tissues and organs. Furthermore, these proteins act as signaling molecules that control cell behavior during organ development, growth, and repair. Their long half-life, mechanical strength, ability to assemble into fibrils and networks, biocompatibility, and abundance from readily available discarded animal tissues make collagens an attractive material in biomedicine, drug and food industries, and cosmetic products. About three decades ago, pioneering experiments led to recombinant human collagens' expression, thereby initiating studies on the potential use of these proteins as substitutes for the animal-derived collagens. Since then, scientists have utilized various systems to produce native-like …

Burden Of Ileal Perforations Among Surgical Patients Admitted In Tertiary Care Hospitals Of Three Asian Countries: Surveillance Of Enteric Fever In Asia Project (Seap), September 2016-September 2019, Saqib Hamid Qazi, Mohammad Tahir Yousafzai, Irum Fatima Dehraj, Rozina Thobani, Afshan Akhtar, Abdul Momin Kazi, Aneeta Hotwani, Najeeb Rahman, Junaid Mehmood, Farah Naz Qamar

Section of Paediatric Surgery

Background: Typhoid fever is caused by Salmonella enterica subspecies enterica serovar Typhi (S. Typhi) and can lead to systemic illness and complications. We aimed to characterize typhoid-related ileal perforation in the context of the population-based Surveillance of Enteric Fever in Asia Project (SEAP) in Bangladesh, Nepal and Pakistan.
Methods: Between September 2016 and September 2019, all cases of nontraumatic ileal perforation with a clinical diagnosis of typhoid were enrolled from 4 tertiary care hospitals in Karachi, 2 pediatric hospitals in Bangladesh, and 2 hospitals in Nepal. Sociodemographic data were collected from patients or their caregivers, and clinical and outcome data …

Salvage Of Failed Femoral Neck Fracture Fixation With Conversion Total Hip Arthroplasty Using The Direct Anterior Approach., Andrew G Yun, Marilena Qutami, Kory B Dylan Pasko

Articles, Abstracts, and Reports

Purpose: Failed femoral neck fracture (FNF) fixation with

Materials and Methods: Medical records for 42 patients with a prior history of FNF fixation who underwent conversion THA with hardware removal between 2009 and 2019 were retrospectively reviewed. Surgery was performed by a single surgeon at a single institution. All patients underwent hardware removal followed by direct anterior approach (DAA) THA using two separate incisions. Clinical outcomes, radiographic findings, and perioperative morbidity and mortality are reported.

Results: Clinically, there were no postoperative dislocations, periprosthetic fractures, or infections at follow-up. After a mean follow-up of 4 years, the mean hip disability and …

Conversion From Knee Arthrodesis Back To Arthroplasty: A Particular Challenge In Combination With Fungal Periprosthetic Joint Infection., Sven Frieler, Emre Yilmaz, Ryan Goodmanson, Yannik Hanusrichter, Thomas A Schildhauer, Hinnerk Baecker

Articles, Abstracts, and Reports

A 58-year-old female treated at an outside facility with knee arthrodesis due to persistent periprosthetic joint infection fulfilled all prerequisites for a conversion back to arthroplasty, as part of a 2-stage revision. Owing to the detection of Candida parapsilosis, the treatment concept was converted to a three-stage procedure. A scheduled spacer exchange with additional amphotericin B-loaded polymethylmethacrylate was conducted as an intermediate revision before reimplantation. Conversion in the setting of fungal periprosthetic joint infection presents a challenge, and successful treatment hinges on the use of proper antifungal and antimicrobial protocols, advanced surgical techniques, and a multidisciplinary team approach. At …

Covid-19 Pandemic: Economic Burden On Patients With Musculoskeletal Injuries In A Tertiary Care Hospital Of Lmic; Retrospective Cross Sectional Study, Pervaiz Hashmi, Shah Fahad, Hammad Naqi Khan, Marij Zahid, Anum Sadruddin Pidani, Shahryar Noordin

Section of Orthopaedic Surgery

Covid-19 has adversely impacted the health care organizations by over burdening with Covid patients and suspending the elective surgeries and clinics. Hospitalization during pandemic may increase health cost of patients for elective and emergency procedure due to extra cost of covid testing and isolation. A single center retrospective study was conducted to quantify losses due to postponement of elective surgeries and extra cost for procurement of PPEs. The secondary objective was to see the effect of Covid -19 on the total costs of inpatient care during Covid era.
Patient and method: We included all the patients admitted in orthopedic section …