Surgery Commons^™

Outcome Of Decompressive Craniectomy In Traumatic Closed Head Injury, Altaf Ali Laghari, Muhammad Ehsan Bari, Muhammad Waqas, Syed Ijlal Ahmed, Karim Rizwan Nathani, Wardah Moazzam

Section of Neurosurgery

Objective: The aim of the current study was to observe functional outcomes of patients undergoing decompressive craniectomy (DC) for raised intracranial pressure (ICP) after blunt head injury and to assess possible predictive factors.
Methodology: This study was a prospective cohort study which was conducted at Aga Khan University Hospital, Karachi over a period of 2 years (January 2015-December 2016). Adult patients, aged between 15 and 65 years of both genders undergoing DC during the study period were selected. Outcomes of DC were assessed at an interval of 3 months following injury using the Glasgow outcome score. The data were analyzed …

Tumour Treating Fields (Ttfs) For Recurrent And Newly Diagnosed Glioblastoma Multiforme, Farhan Ahmed, Muhammad Shahzad Shamim

Section of Neurosurgery

In the last decade, significant advances have been made in Glioblastoma Multiforme treatment with the novel use of alternating electrical fields, also termed as tumour treating fields (TTFs). This modality has shown promising results in recurrent and newly diagnosed GBM patients, and according to some, may soon be considered an addition to the previously known 'trifecta' of GBM standard of care, i.e., surgery, chemo and radiation therapy.Here we review the existing data on TTF for both recurrent and newly diagnosed GBM. This review does not discuss the limitations of TTF, especially from compliance and cost point of view.

Frequency Of Ocular Emergencies In A Tertiary Care Setting In Karachi, Pakistan: It Is Time To Reduce Unnecessary Visits, Rashid Baig, Khabir Ahmad, Sidra Zafar, Nadeem Ullah Khan, Areeb Ashfaq

Section of Ophthalmology

Objective: To examine the frequency of ocular emergencies received in a tertiary care setting..
Methods: This retrospective clinical audit was undertaken at the Emergency Department of the Aga Khan University Hospital, Karachi, and comprised data of all individuals who presented between January and October 2016. The department's triage database was used to retrieve the data on patient's age, gender, presenting complaints, time and date of presentation. Data was analyzed using SPSS 19.
Results: Of the 74729 individuals who presented, 928 (1.2%) presented with ocular complaints. The age range with the highest total number of visits was 0-9 years followed by …

Intra-Tracheal Extension Of Hilar Mass Mimicking Severe Asthma: Anesthesiologist Perspective, Khalid M Siddiqui, Muhammad Faisal Khan, Muhammad A. Asghar, Syed S. Uddin

Department of Anaesthesia

No abstract provided.

Preliminary Radiological Result After Establishment Of Hospital-Based Trauma Registry In Level-1 Trauma Hospital In Developing Country Setting, Prospective Cohort Study, Obada Hussein Hasan, Adeel Samad, Zohaib Nawaz, Tashfeen Ahmad, Zehra Abdul Muhammad, Shahryar Noordin

Section of Orthopaedic Surgery

Introduction: Injuries are the second most common cause of disability, the fifth most common cause of healthy years of life lost per 1000 people and unfortunately 90% of mortality takes place in low-to middle-income countries. Trauma registries guide policymakers and health care providers in decision making in terms of resource allocation as well as enhancing trauma care outcomes. Furthermore data from these registries inform policy makers to decrease the rate of death and disability occurring as a result of injuries. We present our experience in setting up an orthopedic trauma registry and the first short term follow-up of radiological outcomes. …

Tranexamic Acid For Significant Traumatic Brain Injury (The Crash-3 Trial): Statistical Analysis Plan For An International, Randomised, Double-Blind, Placebo-Controlled Trial, Ian Roberts, Antonio Belli, Amy Brenner, Rizwana Chaudhri, Bukola Fawole, Tim Harris, Rashid Jooma, Abda Mahmood, Temitayo Shokunbi, Haleema Shakur, Crash-3 Trial Collaborators

Section of Neurosurgery

Background: Worldwide, traumatic brain injury (TBI) kills or hospitalises over 10 million people each year. Early intracranial bleeding is common after TBI, increasing the risk of death and disability. Tranexamic acid reduces blood loss in surgery and death due to bleeding in trauma patients with extra-cranial injury. Early administration of tranexamic acid in TBI patients might limit intracranial bleeding, reducing death and disability. The CRASH-3 trial aims to provide evidence on the effect of tranexamic acid on death and disability in TBI patients. We will randomly allocate about 13,000 TBI patients (approximately 10,000 within 3 hours of injury) to an …

Noncontact Speckle Contrast Diffuse Correlation Tomography Of Blood Flow Distributions In Tissues With Arbitrary Geometries, Siavash Mazdeyasna, Chong Huang, Mingjun Zhao, Nneamaka B. Agochukwu, Ahmed A. Bahrani, Lesley Wong, Guoqiang Yu

Biomedical Engineering Faculty Publications

A noncontact electron multiplying charge-coupled-device (EMCCD)-based speckle contrast diffuse correlation tomography (scDCT) technology has been recently developed in our laboratory, allowing for noninvasive three-dimensional measurement of tissue blood flow distributions. One major remaining constraint in the scDCT is the assumption of a semi-infinite tissue volume with a flat surface, which affects the image reconstruction accuracy for tissues with irregular geometries. An advanced photometric stereo technique (PST) was integrated into the scDCT system to obtain the surface geometry in real time for image reconstruction. Computer simulations demonstrated that a priori knowledge of tissue surface geometry is crucial for precisely reconstructing the …

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

Department of Surgery

No abstract provided.

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

Section of Neurosurgery

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

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

Department of Neurosurgery Faculty Papers

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

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

Department of Radiology Faculty Papers

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

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

Surgery Articles

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

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

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

Department of Anaesthesia

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

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

Clinical Research in Practice: The Journal of Team Hippocrates

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

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

Department of Surgery Faculty Papers

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

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

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

MaineHealth Maine Medical Center

Problem/Impact Statement:

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

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

Section of Ophthalmology

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

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

Section of Neurosurgery

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

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

Master's Projects and Capstones

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

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

Surgery Faculty Publications

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

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

Journal of Health Disparities Research and Practice

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

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

Section of Neurosurgery

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

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

Section of Ophthalmology

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

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

Section of Neurosurgery

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

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

Section of Neurosurgery

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

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

Section of Neurosurgery

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

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

Department of Surgery Updates

A four page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, and more.

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

Articles, Abstracts, and Reports

Study Design: Systematic review.

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

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

Results: Six lower quality retrospective studies (evidence …

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

Department of Surgery Faculty Papers

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

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

Section of Orthopaedic Surgery

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