Surgery Commons^™

Spermine Synthase And Myc Cooperate To Maintain Colorectal Cancer Cell Survival By Repressing Bim Expression, Yubin Guo, Qing Ye, Pan Deng, Yanan Cao, Daheng He, Zhaohe Zhou, Chi Wang, Yekaterina Y. Zaytseva, Charles E. Schwartz, Eun Young Lee, B. Mark Evers, Andrew J. Morris, Side Liu, Qing-Bai She

Markey Cancer Center Faculty Publications

Dysregulation of polyamine metabolism has been linked to the development of colorectal cancer (CRC), but the underlying mechanism is incompletely characterized. Here, we report that spermine synthase (SMS), a polyamine biosynthetic enzyme, is overexpressed in CRC. Targeted disruption of SMS in CRC cells results in spermidine accumulation, which inhibits FOXO3a acetylation and allows subsequent translocation to the nucleus to transcriptionally induce expression of the proapoptotic protein Bim. However, this induction is blunted by MYC-driven expression of miR-19a and miR-19b that repress Bim production. Pharmacological or genetic inhibition of MYC activity in SMS-depleted CRC cells dramatically induces Bim expression and apoptosis …

Effects Of Coronavirus (Covid-19) Pandemic On Orthopedic Residency Program In The Seventh Largest City Of The World: Recommendations From A Resource-Constrained Setting, Marij Zahid, Syed Arif Ali, Naveed Baloch, Shahryar Noordin

Section of Orthopaedic Surgery

The coronavirus (COVID-19) pandemic has hit the entire world hard. Since its inception from Wuhan China the whole world is affected now. Health care facilities and workers are overwhelmed and the situation is changing on daily basis. With the changes in the dynamics of the hospitals, residency and fellowships training programs have also suffered undoubtedly. Due to decreased elective cases and outpatient clinics surgical training gets compromised, however on the other side this physical distancing and isolation have proven to be effective measures in controlling the disease. In this article we share our experience of effect of COVID-19 pandemic on …

Acute Opioid Withdrawal Mimicking Postoperative Joint Infection Following Anterior Cruciate Ligament (Acl) Reconstruction: A Case Report., Qingwu Kong, Martin Griffis, Brandon J Shallop, Amrit S Khalsa, Kyle Brougham, Paul A Marchetto

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND A short course of opioid narcotics is often prescribed for postoperative anterior cruciate ligament (ACL) reconstruction pain management. Unfortunately, there is a well-documented incidence of opioid withdrawal syndrome (OWS) following short-term use of these medications. OWS can present with symptoms such as influenza-like illness. It is important to differentiate OWS from infectious illnesses, especially after surgery. CASE REPORT We present a case of OWS in a patient who underwent ACL reconstruction 7 days prior. The patient's OWS symptoms were similar to symptoms of a postoperative infection. The knee was aspirated, and the analysis of the aspirate was not concerning …

En Bloc Resection Of A Giant Retroperitoneal Liposarcoma: A Surgical Challenge, Talal Almas, Muneeb Ullah, Maryam Ehtesham, Absam Akbar, Muhammad Kashif Khan

Medical College Documents

Liposarcomas are exceedingly rare entities that evoke malignant transformation of connective tissue and fat cells.These tumours occur throughout the soft tissues of the body, afflicting a myriad of regions. In the adult population, liposarcomas represent the most prevalent subtype of sarcomas, and often arise de novo. Retroperitoneal liposarcomas (RLS) are a ubiquitous subset of sarcomas that, due to their deep location in the hollow abdomen, can grow to astronomical proportions before manifesting any noticeable symptoms; a prompt diagnosis of RLS is therefore often rendered dilatory. We hereby delineate the case of a 43-year-old woman who presented with vague left hemiabdominal …

Seasonal Influence On Postoperative Hip Fracture Complications: Retrospective Cohort Of More Than 1000 Patients From A Tertiary-Care University Hospital, Obada Hasan, Mashal Amin, Fatima Mahmood, Amna Rabbani, Umar Rabbani, Shahryar Noordin

Department of Paediatrics and Child Health

Background: Hip fractures account for one of the most debilitating conditions affecting the general population amongst the developed and developing nations. Investigators aimed to study the influence of the ongoing season i.e. whether patients operated upon in summer or winter, on post-operative complications occurring within 30 days of surgical procedure for hip fractures at a tertiary care hospital and level 1 trauma center.
Materials and methods: Investigators conducted a non-funded, non-commercialized retrospective cohort of 1045 patients with hip fractures managed surgically. Primary exposure was surgical procedures undertaken during the summer months (April-September). Our primary outcome was determining post-operative complication rates …

Effectiveness Of Home-Based Rehabilitation Program In Minimizing Disability And Secondary Falls After A Hip Fracture: Protocol For A Randomized Controlled Trial, Anum Sadruddin Pidani, Saniya Sabzwari, Khabir Ahmad, Ata Khan, Shahryar Noordin

Department of Surgery Docs

Introduction: Hip fractures are a major health problem globally and are associated with increased morbidity, mortality, and substantial economic costs. Successful operative treatment of hip fracture patients is necessary for the optimization of post-op mobility and functional recovery of the patient. Rehabilitation after surgical stabilization of a hip fracture is crucial in order to restore pre-fracture function and to avoid long-term institutionalization. In particular ongoing exercise which targets balance can prevent up to 40% of falls. Therefore, we have designed a post-discharge home-based physical rehabilitation intervention program to minimize disability and falls in this high-risk elderly population.
Methods and analysis: …

Do New Trainees Pose A Threat To Postoperative Complications After Hip Fracture Surgeries? Retrospective Cohort Of 1045 Patients Over A Decade At A University Hospital, Obada Hasan, Mashal Amin, Umar Rabbani, Amna Rabbani, Fatima Mahmood, Shahryar Noordin

Department of Paediatrics and Child Health

Introduction: Induction of new residents and surgical trainees in most institutes occurs once a year. Fresh residents with no experience, may pose a threat to the surgical procedure outcome and there can be a potential increase in patients' morbidity and mortality as a result of this turnover. Literature is inconclusive about this effect. Our aim was to study the "new residents' induction effect" on postoperative complications after hip fracture surgeries.
Methodology: This is non funded non commercialized study from a university hospital. Investigators studied a retrospective cohort of 1045 adult hip fracture patients who were operated at our tertiary care …

Circulating Tumor Cell And Regulator T-Lymphocyte In Core Biopsy For Breast Cancer, Sonar Soni Panigoro, Diani Kartini, Dewi Wulandari, Arif Supono

The New Ropanasuri Journal of Surgery

Introduction: Breast cancer is the most common malignancy found in Indonesia. Core biopsy is one of the modalities used in breast cancer diagnosis with sensitivity of 91-99% and specificity of 96-100%. The procedure causes damage to tumor tissue thus causing tumor cells to enter circulation (CTC) and therefore acute inflammation and infiltration of inflammatory cells. In the final phase of infiltration, the number of Tregs cells will increase, as well as secretion of TGFβ and IL-10, creation of immunosuppresion microenvironment, COX2 stimulation by TGFβ then conversion of CD4+ T cells into FoxP3+ (Tregs), therefore the number of Tregs cells will …

Purse-String Suture For Skin Closure Following Large Thyroidectomy, Ahmad Kurnia, Bintang Abadi Siregar, Muchlis Ramli

The New Ropanasuri Journal of Surgery

Introduction. The total number of patients with thyroid nodules, especially large thyroid nodules (> 6 cm diameter), is increasing. However, the conventional suturing technique for closure of thyroidectomies is still only recommended as the standard for the tumor with a diameter up to 6 cm. Hence, this study aims to prove another surgical technique, purse-string stitching technique, for better esthetic outcomes on large thyroidectomy.

Methods. This study was a non-randomized control trial. The subjects included the patients of Cipto Mangunkusumo Hospital in 2013 to 2014 with a thyroid tumor > 6 cm in diameter without any history of anterior cervical …

A Solitary Bone Plasmacytoma In The Mandible: A Case Report, Erwin D. Yulian, Andre S. Suryadi

The New Ropanasuri Journal of Surgery

Abstract

Introduction: Solitary bone plasmacytoma (SBP) is a localized neoplasms in the bone consisting of abnormal plasma cells. We herein report an unusual case of SBP that presents in mandible bone.

Case Illustration: A 57-year-old woman, with chief complaint for the lump at right jaw, which gradually increasing in size since 13 years ago. Diagnosis was based on clinical, radiological, and histopathological findings. The patient was referred for radiotherapy before surgery using 50 Gy dose of radiation for 25 times with the result of partial response, followed by hemimandibulectomy and reconstruction with free fibular flap. Complete resection in a form …

Capsular Contracture, Prolonged Use Of Breast Implants With Pleural Effusion: A Case Report, Yefta Moenadjat

The New Ropanasuri Journal of Surgery

A case with prolonged implanted breast prosthesis experienced a prolonged capsular contracture complicated with pleural effusion. A complete capsular removal proceeded instead of removal of the prosthesis solely. The present case aimed to share experiences that may add to the scientific horizon regarding the rare complications of breast prosthesis and rarely reported.

Cardiac Tamponade And Laceration Of Right Ventricle In Blunt Thoracic Injury: A Case Report, Prabowo W. Simbolon, Muhammad A. Putra

The New Ropanasuri Journal of Surgery

Introduction. Cardiac tamponade caused by blunt thoracic injuries is a rare case with a high mortality rate. Generally, patients with blunt cardiac injury were not survived before they reach the hospital. We present the case of a 50-year-old man was admitted to our emergency department after a motorcycle hit the cart he was pushing on the street, and then the handle hit the chest. He presented with hemodynamically unstable and a bruised on precordial area, then he went into cardiac arrest. Standard CPR was done for 2 minutes, continued with intubation and ROSC. FAST showed fluid in the pericardial …

Minireview: Covid–19: Criticism Of The Pathogenesis Based On The Tropism, Yefta Moenadjat

The New Ropanasuri Journal of Surgery

No abstract provided.

Endovascular Management Of Post Traumatic Lower Extremity Pseudoaneurysm: An Evidence Based Case Report, Patrianef Darwis, Feyona H. Subrata

The New Ropanasuri Journal of Surgery

Introduction. Increasing incidence of trauma all over the world will increase the risk of vascular trauma, so will the prevalence of pseudoaneurysm. Post traumatic pseudoaneurysm occurs within days or months and commonly diagnosed as hematoma in its early presentation. An effective, less invasive, and low-cost treatment with high rate of survival is needed by patients with post traumatic pseudoaneurysm. Endovascular surgery is one of the less invasive techniques. This case report was made to find out the effectivity of endovascular surgery in the treatment of post traumatic pseudoaneurysm.

Method. Literature searching was performed in Cochrane Library, EBSCOhost, ClinicalKey, …

Hernia Through Winslow Foramen In Cipto Mangunkusumo General Hospital, Jakarta: A Case Report, Eko Ristiyanto, Taufik A. Wibowo, Ridho A. Syaiful, Benny Philippi, Toar J.M. Lalisang

The New Ropanasuri Journal of Surgery

Introduction. Hernias through Winslow foramen are extremely rare, occurred for 0.1% of all abdominal hernias and found during laparotomy due to strangulated bowel obstruction. This study aims to describe hernia of Winslow foramen and its management.

Method. Data were retrospectively collected based on medical records. Clinical manifestations, laboratory data, supporting radiographic examinations, treatment, postoperative care, and outcomes were collected.

Case summary. We report the first case of Winslow foramen hernia at Cipto Mangunkusumo General Hospital, Jakarta. A man 54 years in 2019. Ileus was the main clinical symptoms and presented epigastric pain, nausea and vomiting. Plain abdominal x-ray …

Intraoperative Pancreatic Assessment In Pancreaticoduodenectomy The Correlation With Pancreatic Fistula Formation, Yarman Mazni, Ardani F. Syafiuddin, Agi S. Putranto

The New Ropanasuri Journal of Surgery

Background Pancreatic cancer affects 25,000 to 30,000 people in the United States each year and is the fourth or fifth leading cause of cancer-related death in this country. It is generally resected by pancreaticoduodenectomy, with or without preservation of the pylorus and proximal duodenum. Anastomotic leaks, intra-abdominal abscesses, and delayed gastric emptying account for most of the perioperative complications after pancreaticoduodenectomy. Anastomotic leaks of pancreas are resulted pancreatic fistula about 45%. A lot of study that have been done to find risk factors of postoperative pancreatic fistula (POPF) with contradictive results.

Method This study was done for 70 patients …

Risk Factors That Influence Hospital Length Of Stay In Diabetic Foot Ulcer With Negative Pressure Wound Therapy At Rs. Dr. Cipto Mangunkusumo, Prabowo W. Simbolon, Hilman Ibrahim

The New Ropanasuri Journal of Surgery

Introduction. It is estimated that around 15% of diabetic patients will experience diabetic foot ulcer (DFU) in their lifetime. Negative Pressure Wound Therapy (NPWT) is proven to be more effective than conventional treatments. NPWT creates a moist wound environment, increases local blood flow and stimulates tissue granulation thereby accelerating wound healing. This study was conducted to determine the risk factors that affect the length of stay of DFU with NPWT. Knowing this risk factors may be helpful for optimizing management strategy.

Method. This research was a retrospective study with a cross-sectional analytic design in 105 subjects treated in January 2016 …

Postoperative Wound Irrigation Using Distilled Water In Preventing Surgical Site Infection In A Tertiary Hospital: A Retrospective Cohort And Cost-Effective Study, Wifanto S. Jeo, Dennis W. Pratama, Yoni Vanto, Aria Kekalih, Yefta Moenadjat

The New Ropanasuri Journal of Surgery

Background. The incidence of surgical site infections (SSIs) is reducing following the global campaign that requires all the stakeholder involvement. However, of all hospital-acquired infection prevention programs, wound irrigation is hard to be implemented in our hospital. There is a belief that the wound irrigation procedure leading to the spreading of infection. In contrast, the use of antiseptic and topical antibiotic, as well as systemic antibiotic, is uncontrolled high. Thus, we run a cost-effective study of wound irrigation to change the practice.

Method. We carried out a prospective cohort study comparing wound irrigation and the standard protocol in wound …

Evaluation Of The Implementation Of Eras Protocol In Colorectal Surgery At Dr. Cipto Mangunkusumo General Hospital, Jakarta, Wifanto S. Jeo, Yarman Mazni, Andre S. Suryadi

The New Ropanasuri Journal of Surgery

Background: The enhanced recovery after surgery (ERAS) protocol, an evidence-based perioperative strategy, has been proven in reduces the postoperative length of stay and perioperative complications rates in colorectal surgery. The implementation of ERAS defined by 15 components. However, the evaluation of ERAS component that have been applied to the outcomes in unclear.

Methods: A retrospective study was performed on 63 patients who undergone elective colorectal surgery based on ERAS protocol from January 2015 to December 2017 at Cipto Mangunkusumo Hospital. Patient characteristics, demographic, clinical findings, and length of stay (LOS) colleted from medical records. The relationship between the number of …

Telemedicine For The Spine Surgeon In The Age Of Covid-19: Multicenter Experiences Of Feasibility And Implementation Strategies., Daniel Franco, Thiago Montenegro, Glenn A Gonzalez, Kevin Hines, Aria Mahtabfar, Melvin D Helgeson, Rakesh Patel, James Harrop

Department of Neurosurgery Faculty Papers

STUDY DESIGN: Multicenter study.

OBJECTIVES: The COVID-19 pandemic has obligated physicians to recur to additional resources and make drastic changes regarding the standard physician-patient encounter. In the last century, there has been a substantial improvement in technology, which over the years has opened the door to a new form of medical practicing known as telemedicine.

METHODS: Healthcare workers from three hospitals involved in the care for COVID-19 patients in the united states were invited to share their experience using telemedicine to deliver clinical care to their patients.

RESULTS: Since the appearance of this worldwide outbreak, social distancing has been a …

Endoluminal Graft System And Method Of Implanting The Same, David J. Minion

Surgery Faculty Patents

An endoluminal graft system comprising an endoluminal graft including a framework and a flexible fabric surrounding the framework, a deflection means configured for placement through an opening to a branching vessel, and a delivery catheter configured to position the endoluminal graft within a primary vessel. A method of implanting the endoluminal graft includes positioning the endoluminal graft within a primary vessel with a leading edge of the endoluminal graft adjacent to an opening to a branching vessel. A deflecting means is positioned through the opening to the branching vessel adjacent to the leading edge of the endoluminal graft. The endoluminal …

Feminizing Genitoplasty In A Young Girl With Glanzmann's Thrombasthenia-Management Of Haemostasis, Kashaf Khalid Turk, Zafar Nazir

Section of Paediatric Surgery

We report peri- and post-operative management of haemostasis in a 11-year old girl with Glanzmann Thrombasthenia (GT) who had feminizing genitoplasty for genital ambiguity due to Congenital Adrenal Hyperplasia (CAH-21 Hydroxylase deficiency). A blend of Glanzmann Thrombasthenia (GT) and DSD 46XX due to CAH is not reported in literature. Surgery particularly genitourinary reconstruction in patients with GT is challenging due to risk of intra and post-operative bleeding. Haemostasis can successfully be achieved with platelet transfusions, antifibrinolytic (Tranexamic acid) and judicious use of recombinant factor VIIa (rFVIIa) even in a resource limited setting.

Permanent Pre-Operative Cerebrospinal Fluid Diversion In Paediatric Patients With Posterior Fossa Tumours, Ummey Hani, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Management options for obstructive hydrocephalus in children with posterior fossa tumours have been debated upon throughout the course of neurosurgical practice. Permanent pre-operative CSF diversion via ventricular shunts or endoscopic third ventriculostomy have been employed to prevent the possible persistence of hydrocephalus after tumour removal, but is considered unnecessary and even dangerous amongst a large group of neurosurgeons. In this paper, we have reviewed the literature for the merits and demerits of pre-operative permanent CSF diversion in paediatric patients presenting with posterior fossa tumours.

Medial Femoral Condyle Vascularized Bone Graft For Treatment Of Midshaft Clavicle Recalcitrant Nonunion With Use Of The Transverse Cervical Artery As An Anastomosis., Christopher M Belyea, Jefferson L Lansford, Joseph B Golden, Emily H Shin, Rey D L Gumboc

Articles, Abstracts, and Reports

Vascularized medial femoral condyle bone grafts have been reported to be a reliable treatment for recalcitrant bony nonunions of the extremities. Although clavicle fracture nonunions are rare after treatment with open reduction internal fixation, symptomatic nonunions can be a challenge. The medial femoral condyle vascularized bone graft has been described as a treatment option for clavicle nonunions with the thoracoacromial trunk as the recipient anastomosis site. This case illustrates how the transverse cervical artery and accompanying veins can be used as an anastomosis when the thoracoacromial trunk is inaccessible because of previous surgical- and infection-related scaring. At the final follow-up, …

Inferior Vena Cava Injuries - A Clinical Review, Zia Ur Rehman

Department of Surgery Docs

Inferior vena caval (IVC) injuries are uncommon and challenging to treat. Less than 5% of patients with penetrating abdominal trauma and less than 0.5% of patients with blunt abdominal trauma have this injury. Patient can present with intraperitoneal haemorrhage or with a contained retroperitoneal haematoma. Mostly it is associated with other abdominal structures injuries. Most commonly injured segment is infrarenal IVC. Operative strategy is different for each segment of injured vein. Infrahepatic injuries are exposed by medial visceral rotation. Retrohepatic and suprahepatic injuries need infrequent exposures. Mortality remains high and range between 31-51% for the patient brought alive to the …

Patient Delay In Breast Cancer Diagnosis In Two Hospitals In Karachi, Pakistan: Preventive And Life-Saving Measures Needed, Uzma Shamsi, Shaista Khan, Syed Iqbal Azam, Shaheryar Usman, Amir Maqbool, Tiffany Gill, Romaina Iqbal, David Callen

Department of Surgery Docs

Purpose: Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them.
Methods: Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review.
Results: The mean (standard deviation) age of patients with …

Asymptomatic Fluid Collections Following Distal Pancreatectomy – Is Intervention Warranted?, Elwin Tham, Md, Emily Papai, Ms, David Nauheim, Ms, Michael Morano, Ms, Nicole Wagner, Ms, Shawnna Cannaday, Crnp, Theresa P. Yeo, Phd, Geoffrey Krampitz, Md, Phd, Charles J. Yeo, Md, Harish Lavu, Md

Health Equity and Quality Improvement (HEQI) Summit

Objective

To determine the incidence, associated factors, natural history, and interventions for FCs.

General Surgery Mobile Procedure Cart: Providing Safe And Efficient Procedure Based Care To The Bedside, Ryan Lamm, Ellen Caparosa, James Fraser, Lindsay Lynch, Uzma Rahman, Lindsay Weil, Harish Lavu

Health Equity and Quality Improvement (HEQI) Summit

Objective

To create a mobile supply cart with all necessary supplies needed for the most common general surgery bedside procedures in order to decrease the amount of times residents need to “shop” for supplies from other locations and prevent delays in procedures to get supplies that are not available. In turn, this will increase patient safety and quality of procedure-based care delivered.

Thoracostomy Tube Placement: Resident Experience And Confidence At A Large Academic Medical Center, Lisa A. Bevilacqua, Md, Prashanth Palvannan, Md, Mph, Meryl Abrams, Md, D. Brock Hewitt, Md, Mph, Kory London, Md, Francesco Palazzo, Md, Tyler Grenda, Md

Health Equity and Quality Improvement (HEQI) Summit

The goal of this study was to investigate TT placement patterns and resident confidence at one academic medical center. In addition, our second objective was to gather quantitative data on the frequency and context of TT placement, rates of complications, and factors associated with complications among residents at TJUH.

Long-Term Patient-Reported Outcome Measures After Injury: National Trauma Research Action Plan (Ntrap) Scoping Review Protocol, Juan Pablo Herrera-Escobar, Manuel A. Castillo-Angeles, Samia Y. Osman, Claudia P. Orlas, Mahin B. Janjua, Muhammad Abdullah Arain, Emma Reidy, Molly P. Jarman, Michelle A. Price, Adil H. Haider

Medical College Documents

Background: A significant proportion of patients who survive traumatic injury continue to suffer impaired functional status and increased mortality long after discharge. However, despite the need to improve long-term outcomes, trauma registries in the USA do not collect data on outcomes or care processes after discharge. One of the main barriers is the lack of consensus regarding the optimal outcome metrics.
Objectives: To describe the methodology of a scoping review evaluating current evidence on the available measures for tracking functional and patient-reported outcomes after injury. The aim of the review was to identify and summarize measures that are being used …