Surgery Commons^™

3d - Printed Patient Specific Instrumentation In Corrective Osteotomy Of The Femur And Pelvis: A Review Of The Literature, Njalalle Baraza, Chris Chapman, Sima Zakani, Kishore Mulpuri

General Surgery, East Africa

Background: The paediatric patient population has considerable variation in anatomy. The use of Computed Tomography (CT)-based digital models to design three-dimensionally printed patient specific instrumentation (PSI) has recently been applied for correction of deformity in orthopedic surgery. This review sought to determine the existing application of this technology currently in use within paediatric orthopaedics, and assess the potential benefits that this may provide to patients and surgeons.

Methods: A review was performed of MEDLINE, EMBASE, and CENTRAL for published literature, as well as Web of Science and clinicaltrials.gov for grey literature. The search strategy revolved around the research …

Global Safety In Anaesthesia And Surgery: Implications For Anaesthesia In Pakistan, Fauzia Khan

Department of Anaesthesia

The Lancet Commission report in 2015 highlighted the role of safe surgery and anaesthesia. They also gave a framework of recommendations, indicators and targets to achieve universal access to safe surgery. This article explores the applicability of these indicators in Pakistan namely; access to timely surgery, specialist surgical workforce diversity, surgical volumes, perioperative mortality rate, protection against impoverishing expenditure and protection against catastrophic expenditure.

Anaesthetic Management Of Patients Undergoing Deep Brain Simulation: A Retrospective Review Of 8 Cases From A Tertiary Care Center Of Pakistan, Usama Ahmed, Faraz Shafiq, Dileep Kumar, Khalid Ahsan, Waleed Bin Ghaffar, Muhammad Ehsan Bari

Department of Anaesthesia

Objectives: To review anaesthesia related outcome, perioperative complications and overall length of stay (LOS) in hospital for patients who had deep brain stimulation (DBS).
Methods: The study was retrospective review of patients medical records diagnosed with Parkinson disease (PD) and underwent DBS at The Aga Khan University Hospital, Karachi from 2017-2019. Data was reviewed from file notes and patient chart and recorded on predesigned Performa. Frequency and percentages were used to present the data.
Results: All patients were anaesthetized using Sleep-Awake-Sleep technique (SAS). Dexmedetomidine was mainly used for conscious sedation. Bispectral index monitor (BIS) was used to monitor the depth …

Childhood Medulloblastoma, Naureen Mushtaq, Shahzadi Resham, Muhammad Shahzad Shamim, Bilal Mazhar Qureshi, Quratulain Riaz, Eric Bouffet

Section of Haematology/Oncology

Medulloblastoma is the most common malignant brain tumour in children and is a major cause of mortality and morbidity, particularly in low- and middle-income countries. It has been risk-stratified on the basis of clinical (age, metastasis and extent of resection) and histological subtypes (classic, desmoplastic and anaplastic). However, recently medulloblastoma has been sub-grouped by using a variety of different genomic approaches, such as gene expression profiling, micro-ribonucleic acid profiling and methylation array into 4 groups, namely Wingless, Sonic hedgehog, Group 3 and Group 4. This new sub-grouping has important therapeutic and prognostic implications. After acute leukaemia, brain tumour is the …

Pyloric Stenosis Leading To Sinus Venous Thrombosis; A Case Report, Amber Wright, Andrew J. Weaver, Daniel Beals

Marshall Journal of Medicine

Pyloric stenosis is typically diagnosed early and repaired after resuscitation and electrolyte correction in a timely manner. Delay in diagnosis or presentation of patient can lead to significant morbidity and even mortality. Here we present a case of pyloric stenosis leading to dehydration severe enough to lead to venous sinus thrombosis. This case highlights the importance of early detection of pyloric stenosis with timely correction of fluid status and electrolytes. Venous sinus thrombosis is a serious complication associated with our patient’s pyloric stenosis that has not yet been reported in literature.

Outcomes After In Utero Myelomeningocele Repair Based On Delivery Location, Eric P Bergh, Kuojen Tsao, Mary T Austin, Stephen A Fletcher, Suzanne M Lopez, Kenneth J Moise, Anthony Johnson, Ramesha Papanna

Faculty, Staff and Student Publications

Maternal and pediatric delivery outcomes may vary in patients who underwent open fetal myelomeningocele repair and elected to deliver at the fetal center where their fetal intervention was performed versus at the referring physician’s hospital. A prospective cohort study of 88 patients were evaluated following in utero open fetal myelomeningocele repair at a single fetal center between the years 2011–2019. Exclusion criteria included patients that delivered within two weeks of the procedure (n = 6), or if a patient was lost to follow-up (n = 1). Of 82 patients meeting inclusion criteria, 36 (44%) patients were delivered at …

Association Between Perioperative Hypothermia And Surgical Site Infection After Elective Abdominal Surgery: A Prospective Cohort Study, Tayyab Siddiqiui, K. M. Inam Pal, Fatima Shaukat, Hadika Mubashir, Alisha Akbar Ali, Muhammad Jehangir A. Malik, Noman Shahzad

Section of General Surgery

Introduction: Surgical site infections (SSIs) account for 14-16% of nosocomial infections and are one of the major causes of increased morbidity, hospital stay, cost of care, and even mortality. Hypothermia as a risk factor for SSI is debated but there is lack of conclusive evidence. The present study explores the association of hypothermia with SSI.
Methodology: This is a prospective cohort study conducted on adult patients who underwent elective laparotomy. Patients were divided into two cohorts, the Hypothermia Cohort and the Normothermia Cohort, based upon episodes of hypothermia of <36⁰C in the perioperative period. SSI was diagnosed based upon …

Association Of Depression And Resilience With Fertility Quality Of Life Among Patients Presenting To The Infertility Centre For Treatment In Karachi, Pakistan, Shireen Shehzad Bhamani, Nida Zahid, Wajeeha Zahid, Salima Farooq, Saima Sachwani, Marilyn Chapman, Nargis Asad

School of Nursing & Midwifery

Background: In Pakistan there is a dire need to explore the quality of life in infertile males and females and its undesirable psychological outcomes. This, study aimed to compare the quality of life (QoL) of males and females visiting an infertility centre for treatment and to assess its association with resilience, depression, and other socio-demographic factors.
Methods: An Analytical Cross-Sectional study was conducted amongst infertile males and females at the Australian Concept Infertility Medical Centre (ACIMC), Karachi, Pakistan. The non-probability (purposive) sampling strategy was used to recruit the participants. The sample size was 668. Data was analysed using STATA version …

Occult Nodal Metastasis In Oral Cavity Cancers, Asif Ali Arain, Muhammad Shaheryar Ahmed Rajput, Shakil Akhtar Ansari, Zafar Mahmood, Ahmad Nawaz Ahmad, Muhammad Razzaq Dogar, Anwar Suhail

Section of Otolaryngology, Head & Neck Surgery

Introduction: In squamous cell carcinoma (SCC) of the oral cavity, there is always a risk of occult metastasis to neck nodes in the clinically and radiologically negative neck (N0). Therefore, elective neck dissection (END) has ever been under discussion since the beginning of their routine use for the management of neck for oral carcinomas. The purpose of the current study is to identify the percentage of occult nodal metastasis to neck levels I-V in the cases of oral carcinoma who were treated for the N0 with END.
Methods: Patients who were treated between June 2005 and May 2010 with END …

Validation Of An Endometrial Tumor Diameter Model For Risk Assessment In The Absence Of Lymph Node Mapping, Mckayla J. Riggs, Callie M. Cox Bauer, Caela R. Miller, James K. Aden, Scott A. Kamelle

Journal of Patient-Centered Research and Reviews

Purpose: This study aimed to assess the optimal tumor diameter for predicting lymphatic metastasis and to determine intraoperatively the need for lymph node dissection in patients with endometrioid endometrial cancer.

Methods: Military beneficiaries diagnosed with stage I–III endometrioid endometrial cancer during 2003–2016 who had at least 7 pelvic and/or paraaortic lymph nodes removed during the time of hysterectomy were studied. Tumor diameter was compared against the presence of positive nodes, using the prior models of 20 mm (ie, Mayo model) and 50 mm (ie, Milwaukee model), to determine the false-negative rate of each threshold. A separate analysis was completed to …

Action Items For Breast Cancer Awareness Month, Deanna J. Attai

Journal of Patient-Centered Research and Reviews

This special issue introduction provides a brief history of Breast Cancer Awareness Month and focuses on patient populations often omitted from annual marketing campaigns. The importance of research is emphasized as a means to improve the outcomes of people with metastatic breast cancer and male breast cancer as well as to address health care inequities related to breast cancer diagnosis and treatment.

A Prospective Study Of Patterns Of Regret In The Year After Hysterectomy, Roopina Sangha, Andrew Bossick, Wan-Ting K. Su, Chad Coleman, Neha Chavali, Ganesa Wegienka

Journal of Patient-Centered Research and Reviews

Purpose: This study sought to identify patterns of self-reported regret after hysterectomy.

Methods: Women undergoing hysterectomy for a benign indication were recruited in the 2 weeks prior to surgery. Women reported demographics and completed validated questionnaires (Decisional Regret Scale, Patient Health Questionnaire-9, Decisional Conflict Scale, and the Comprehensive Score for Financial Toxicity) up to 7 times over the first year postsurgery. Medical records were reviewed for clinical and operative details. Latent class growth mixture models were applied to the repeated regret scores to identify patterns after hysterectomy. Clinical and other participant characteristics were compared across the classes.

Results: Three latent …

Conference Proceedings: Aurora Scientific Day 2020

Journal of Patient-Centered Research and Reviews

Abstracts published in this supplement were among those presented at the 46th annual Aurora Scientific Day research symposium, held virtually on May 20, 2020. The symposium provides a forum for describing research studies conducted by faculty, fellows, residents, and allied health professionals affiliated with Wisconsin-based Aurora Health Care, a part of the Advocate Aurora Health health system, which publishes the Journal of Patient-Centered Research and Reviews.

Bioactivating A Bone Substitute Accelerates Graft Incorporation In A Murine Model Of Vertical Ridge Augmentation, Jinlong Chen, Xue Yuan, Zhijun Li, Daniel J Bahat, Jill A Helms

Department of Orthopaedic Surgery Faculty Papers

OBJECTIVE: Compared to autologous bone grafts, allogeneic bone grafts integrate slowly, which can adversely affect clinical outcomes. Here, our goal was to understand the molecular mechanisms underlying graft incorporation, and then test clinically feasible methods to accelerate this process.

METHODS: Wild-type and transgenic Wnt "reporter" mice were used in a vertical ridge augmentation procedure. The surgery consisted of tunneling procedure to elevate the maxillary edentulous ridge periosteum, followed by the insertion of bone graft. Micro-computed tomographic imaging, and molecular/cellular analyses were used to follow the bone graft over time. Sclerostin null mice, and mice carrying an activated form of β-catenin …

Osseous Changes Following Reverse Total Shoulder Arthroplasty Combined With Latissimus Dorsi Transfer: A Case Series, Jason S Klein, Peter S Johnston, Benjamin W Sears, Manan S Patel, Armodios M Hatzidakis, Mark D. Lazarus

Department of Orthopaedic Surgery Faculty Papers

Background: This is the first report on the incidence of proximal humerus osseous changes and associated clinical consequences in reverse total shoulder arthroplasty combined with a latissimus dorsi tendon transfer (RTSA+LDT).

Methods: A multicenter, retrospective review identified all patients who had undergone a primary RTSA+LDT and had at least 3-month radiographic follow-up between 2012 and 2017. Data collection included demographics, oral steroid use, repair technique for LDT fixation, radiographic humeral osseous changes, complications, and need for revision surgery.

Results: Twenty-four patients were included with an average age of 70.7 ± 7.9 years and follow-up of 16.3 (3-50) months. Ten patients …

Outcomes And Management Approaches Of Resuscitative Endovascular Balloon Occlusion Of The Aorta Based On The Income Of Countries, Ramiro Manzano-Nunez, David Mcgreevy, Claudia P. Orlas, Alberto F. Garciá, Tal M. Hörer, Joseph Dubose, Carlos A. Ordoñez, Aast-Aorta Investigators And The Abotrauma Registry Group

Department of Surgery Faculty Publications

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries' income based on the World Bank Country and Lending Groups. Methods: We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and …

Transcutaneous Energy Transmission: Can We Do It Now?, Yuriy Pya

The VAD Journal

The percutaneous driveline used in contemporary LVADs presents a continuous risk of infection for the duration of support. Minimizing infection in durable mechanical circulatory support systems requires total implantation of all components and energy transfer by means other than percutaneous drivelines. A novel coplanar energy transfer (CET) system, similar to the original transcutaneous energy transfer (TET) design, is unique by incorporating two large rings with coil-within-the-coil topology to ensure strong resonance power. The CET system consists of an internal integrated controller, a battery coupled with an internal thoracic coil ring, and the LVAD pump. External equipment includes a power transmission …

Angiotensin Inhibition And Gastrointestinal Bleeding Prevention In Patients With Left Ventricular Assist Devices, Phillip A. Weeks

The VAD Journal

Gastrointestinal bleeding remains a common complication in advanced heart failure patients following implantation of continuous-flow left ventricular assist devices. While the cause is likely multifactorial, development of arterial venous malformations in the gastrointestinal mucosa are a key factor. Inhibition of angiotensin II activity has been postulated to disrupt the signaling that promotes angiogenesis in these patients. We aim to review the theoretical basis for angiotensin receptor blockade, which has been proposed and explore the published evidence regarding this therapy and gastrointestinal bleeding in LVAD patients.

Management Of Early Rectal Cancer: Current Practice And Future, Bhavani Mothe, Hasnain Zafar, Shakil Ahmed

Section of General Surgery

Early rectal cancer management includes tumour stages TiS, T1 and some selected T2 lesions that undergo appropriate clinical pre-operatie evaluation. Local excision of these lesions with acceptable recurrence rate can be achieved through various transanal endoscopic techniques like transanal endoscopic microsurgery (TEM) and transanal minimal invasive surgery (TAMIS) that are superior to simple transanal excision (TAE). The current literature review was planned to present the oncological evaluation of local excision in the context of available evidence. An overview of perioperative adjuvant therapies employed along with local excision is presented, with an update on the latest trials.

Surgical Outcomes Of Intramedullary Spinal Cord Ependymomas, Ummey Hani, Muhammad Waqas Saeed Baqai, Muhammad Shahzad Shamim

Section of Neurosurgery

Intramedullary Spinal Cord Ependymomas (ISCE) are uncommon pathologies that need to be aggressively managed before clinical deterioration sets in. Novel application of different therapeutic strategies is being assessed for improving long-term outcomes in patients presenting with these rare neoplasms. In this review, we have discussed the existing literature on ISCEs, and the role of surgery in determining outcomes in terms of neurological status, progression-free survival (PFS) and overall survival (OS).

Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes., Eric O Klineberg, Peter G Passias, Gregory W Poorman, Cyrus M Jalai, Abiola Atanda, Nancy Worley, Samantha Horn, Daniel M Sciubba, D Kojo Hamilton, Douglas C Burton, Munish Chandra Gupta, Justin S Smith, Alexandra Soroceanu, Robert A Hart, Brian Neuman, Christopher P Ames, Frank J Schwab, Virginie Lafage

Articles, Abstracts, and Reports

STUDY DESIGN: Retrospective review of prospective database.

OBJECTIVE: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes.

METHODS: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 >weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], …

Nipple Sparing Mastectomy: A Review Of Outcomes At A 1 Single Institution, Steven Woodward, Md, Alliric Willis, Melissa Lazar, Adam C. Berger, Theodore Tsangaris

Department of Surgery Faculty Papers

Introduction

Nipple sparing mastectomy (NSM) offers patients who are not candidates for breast conserving treatment an aesthetically pleasing alternative to traditional mastectomy. Some studies have demonstrated its oncologic safety while others have demonstrated residual occult tumor cells at the nipple areolar complex (NAC). These data prompt further review of oncologic outcomes after NSM.

Methods

A single institution retrospective chart review of all NSMs performed by 4 breast surgeons at Thomas Jefferson University Hospital over a span of 2012-2019. In this cohort we review the reconstruction performed, axillary lymph node status, surgical margins, final pathology, loss of the NAC, recurrence rates, …

Ruptured Mycotic Reverse Saphenous Vein Graft Aneurysm: A Late Complication Of Mediastinitis, Yasir Bilal Khan, Shiraz Hashmi, Saulat Hasnain Fatimi

Section of Cardiothoracic Surgery

Reverse saphenous vein graft aneurysm (RSVGA) is a rare complication that occurs after coronary bypass grafting surgery. Mycotic aneurysm of reverse saphenous vein graft is even more rare. We describe the case of a 76-year-old man who underwent coronary artery bypass grafting 10 years back and had mediastinitis four to five months after surgery. He presented with chest pain in July 2017 and was diagnosed as NSTEMI. Angiography showed left main coronary artery disease (90%) with aneurysm of reverse saphenous vein graft to right posterior descending artery(RPDA). Emergent percutaneous coronary intervention (PCI) of the left main artery was performed as …

Cardioplastic Approach To Omental Flap Coverage For Severe Aortic Root Infections In The Opioid Era, Alisha R. Bonaroti, R. Wesley Edmunds, Ryan C. Decoster, James Y. Liau, Michael E. Sekela, Henry C. Vasconez

Surgery Faculty Publications

Aortic root abscesses are severe sequelae of endocarditis that clinically manifest as life-threatening infection. As the opioid epidemic continues to yield a national crisis, the incidence and severity of this disease process have increased. Reconstruction of the aortic root is a challenging undertaking and carries the risk of recurrent infection. The omentum has an established reputation as a reliable flap in thoracic reconstruction, given its amorphous form and immunogenic properties, but it has not been utilized for aortic root infections. We present a novel indication for the omental flap using a cardioplastic approach in coverage of aortic root reconstruction. Four …

From Leads To Leadless: A Convoluted Journey, Vipin Dulam, Joshua M. Cooper, Chethan Gangireddy, Mohammed A. Kashem, Yoshiya Toyoda, Suresh Keshavamurthy

Surgery Faculty Publications

No abstract provided.

Role Of Fine Needle Aspiration Cytology In The Diagnosis Of Parotid Gland Tumors: Analysis Of 193 Cases, Rahim Dhanani, Haissan Iftikhar, Mohammad Sohail Awan, Nida Zahid, Sehrish Nizar Ali Momin

Section of Otolaryngology, Head & Neck Surgery

Introduction: Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings.
Objective: To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the …

Orthopedic Principles To Facilitate Enhanced Recovery After Cardiac Surgery, Marc W Gerdisch, Keith B Allen, Yoshifumi Naka, Mark R Bonnell, Kevin P Landolfo, John Grehan, Kendra J Grubb, David J Cohen, T. Sloane Guy, Nirav C Patel, Vinod H Thourani

Department of Surgery Faculty Papers

Enhanced recovery after surgery (ERAS) protocols recognize early postoperative mobilization as a driver of faster postoperative recovery, return to normal activities, and improved long-term patient outcomes. For patients undergoing open cardiac surgery, an opportunity for facilitating earlier mobilization and a return to normal activity lies in the use of improved techniques to stabilize the sternal osteotomy. By following the key orthopedic principles of approximation, compression, and rigid fixation, a more nuanced approach to sternal precaution protocols is possible, which may enable earlier patient mobilization, physical rehabilitation, and recovery.

Sirolimus For Kaposiform Hemangioendothelioma And Kasabach-Merritt Phenomenon In A Neonate, Trevor B Cabrera, Allison L Speer, Matthew R Greives, Donna A Goff, Neethu M Menon, Eric W Reynolds

Faculty, Staff and Student Publications

We present a case of a neonate born with kaposiform hemangioendothelioma (KHE), complicated by Kasabach-Merritt phenomenon (KMP) and other serious conditions, who was successfully treated with sirolimus. In addition to complications from thrombocytopenia and fluid overload, during the course of therapy, our patient experienced supratherapeutic drug levels at the commonly accepted starting dose of sirolimus. Patients with KHE and KMP should be closely monitored for potential complications of both the initial disease and unexpected side effects of treatments.

A Hyperpigmented Plaque In A Female Patient, Harel G. Schwartzberg, Alexandra Bourgeois, Amber Souers, Jeremy Atkinson, Pamela Martin

School of Medicine Faculty Publications

No abstract provided.

Complex Reconstruction After Extreme Fournier’S Gangrene; A Case Report, Serban Dumitrache, Leonida A. Goman, Raluca Dutu, Raluca Capatina, Carmen Giuglea, Dan M. Enescu

Journal of Mind and Medical Sciences

In this article we present a severe case of Fournier's gangrene (FG) that affected a 64-year-old male patient, with no other known comorbidities. FG is a type of necrotizing fasciitis of the perineal and genital regions, that affects mostly males in the 5th-7th decades, with mortality rates that reach 70%. The infection usually advances through the superficial fascial layers of the perineum and abdomen and affects the skin. In our case the infection also affected the spermatic fasciae and advanced in the abdominal and pelvic cavities, abdominal muscles, and surrounding soft tissues. Subsequent debridement left the patient with large soft …