Surgery Commons^™

Epidermal Growth Factor Mediated Healing In Stem Cell-Derived Vocal Fold Mucosa, Liliana Palencia, Amritava Das, Sean P. Palecek, Susan L. Thibeault, Ciara Leydon

Communication Disorders Faculty Publications

Background: The goal of vocal fold wound healing is the reconstitution of functional tissue, including a structurally and functionally intact epithelium. Mechanisms underlying reepithelialization in vocal folds are not known, although it is suspected that healing involves the interplay between several growth factors. We used a three-dimensional human embryonic stem cell-derived model of vocal fold mucosa to examine the effects of one growth factor, exogenous epidermal growth factor (EGF), on wound healing. Materials and methods: A scratch wound was created in the in vitro model. Rate of wound healing, epidermal growth factor receptor (EGFR) activation, and cell proliferation after injury …

Development And Implementation Of A Clinical Pathway Approach To Simulation-Based Training For Foregut Surgery., Kiyoyuki W. Miyasaka, Joseph Buchholz, Denise Lamarra, Giorgos C. Karakousis, Rajesh Aggarwal

Student Papers, Posters & Projects

INTRODUCTION: Contemporary demands on resident education call for integration of simulation. We designed and implemented a simulation-based curriculum for Post Graduate Year 1 surgery residents to teach technical and nontechnical skills within a clinical pathway approach for a foregut surgery patient, from outpatient visit through surgery and postoperative follow-up.

METHODS: The 3-day curriculum for groups of 6 residents comprises a combination of standardized patient encounters, didactic sessions, and hands-on training. The curriculum is underpinned by a summative simulation "pathway" repeated on days 1 and 3. The "pathway" is a series of simulated preoperative, intraoperative, and postoperative encounters in following up …

Epilepsy In Pakistan: National Guidelines For Clinicians, Fowzia Siddiqui, Tipu Sultan, Shahid Mustafa, Sarwar Jamil Siddiqui, Shaukat Ali, Abdul Malik, Zafar Sajjad, Saleem Barech, Rashid Jooma

Section of Neurology

Introduction: Epilepsy is one of the most common chronic neurological disorders requiring prolonged treatments and drugs. According to The World Health Organization (WHO), epilepsy is one of those serious brain disorders that affect not only the individual but has a deep impact on the family and society in general. Approximately 50 million people are affected with epilepsy around the world36, though proper epidemiological studies do not exist for Pakistan it is estimated that the prevalence of epilepsy is 9.99/1000. Highest prevalence is seen in people younger than 30 years of age, i.e. about 2 million people and 1/10th of the …

Ten-Sational!, Children's Mercy Hospital

Our Story Continues

Children’s Mercy lands top ranking in all 10 specialties from U.S. News and World Report

Combination Of Id2 Knockdown Whole Tumor Cells And Checkpoint Blockade: A Potent Vaccine Strategy In A Mouse Neuroblastoma Model., Lina Chakrabarti, Clifford Morgan, Anthony D. Sandler

Surgery Faculty Publications

Tumor vaccines have held much promise, but to date have demonstrated little clinical success. This lack of success is conceivably due to poor tumor antigen presentation combined with immuno-suppressive mechanisms exploited by the tumor itself. Knock down of Inhibitor of differentiation protein 2 (Id2-kd) in mouse neuroblastoma whole tumor cells rendered these cells immunogenic. Id2-kd neuroblastoma (Neuro2a) cells (Id2-kd N2a) failed to grow in most immune competent mice and these mice subsequently developed immunity against further wild-type Neuro2a tumor cell challenge. Id2-kd N2a cells grew aggressively in immune-compromised hosts, thereby establishing the immunogenicity of these cells. Therapeutic vaccination with Id2-kd …

Department Of Surgery Update, June 2015, Wright State University Department Of Surgery

Department of Surgery Updates

A three 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, scholarly activity and more.

Computed Tomography-Guided Biopsy For Potts Disease: An Institutional Experience From An Endemic Developing Country, Muhammad Waqas, Mohsin Qadeer, Faizuddin Faiz, Mohammad Ali Alvi, Muhammad Ehsan Bari

Section of Neurosurgery

Study design: A retrospective chart review.
Purpose: In endemic resource poor countries like Pakistan, most patients are diagnosed and treated for Potts disease on clinical and radiological grounds without a routine biopsy. The purpose of this study was to evaluate the use and effect of computed tomography (CT)-guided biopsy in the management of Potts disease since the technique is becoming increasingly available.
Overview of literature: CT-guided biopsy of spinal lesions is routinely performed. Literature on the utility of the technique in endemic resource poor countries is little.
Methods: This study was conducted at the Neurosurgery section of Aga Khan University …

Alton Ochsner, Md (1896-1981): Surgical Pioneer And Legacy Linking Smoking And Disease., Christina L. Costantino, Md, Jordan M. Winter, Md, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

Edward William Alton Ochsner kept a plain, metal card file in which he recorded close to 50 years worth of medical experiences, research, and insights. The most populated topics were filed as "Cancer, Lung" and "Cancer, Bronchogenic." These reflected his areas of greatest interest, for which he would go on to produce groundbreaking work. Of his many lifetime accomplishments, he is perhaps best known for being the first to report a link between cigarette smoking and lung cancer. This was just one of the many ways in which Ochsner worked to effect social change. The establishment of the Ochsner Health …

An Ex Vivo Approach To Complex Renal Artery Aneurysm Repair, Noah T. Scherrer, Roberto Gedaly, Ramakrishna Venkatesh, Michael A. Winkler, Eleftherios S. Xenos

Surgery Faculty Publications

Ex vivo repair technique for a complex renal artery aneurysm may have several advantages. Smaller incision size and use of minimally invasive techniques may decrease incisional morbidity and improve recovery time, especially in patients with a high body mass index. Improved visualization afforded by back-table methods may also be valuable when repair of aneurysms involving multiple branches is necessary. We report of a successful case of laparoscopic nephrectomy, followed by back-table aneurysmorrhaphy and autotransplant, in a patient with a renal artery aneurysm.

Entral Corneal Thickness Changes After Phacoemulsification, Tanveer Anjum Chaudhry, Muhammad Hamza, Wajiha Koomal, Khabir Ahmad

Department of Surgery Docs

Purpose: To determine when the mean central corneal thickness (CCT) returns to normal values after uneventful phacoemulsification. Material and Methods: This was a prospective case series. The study was carried out at the Section of Ophthalmology, Department of Surgery, Aga Khan University Hospital, Karachi. Eyes scheduled to undergo phacoemulsification during December 2011 – March 2012 were eligible to be included. Eyes with corneal degenerations, dystrophies or high pre-op astigmatism were excluded. A structured proforma was used to collect data on sociodemographics, comorbids, visual acuity, and CCT before surgery and 1 day, 1 week and 1 month after surgery. Changes in …

Diagnosis Of Second Mesiobuccal Canal In Maxillary First Molars Among Patients Visiting A Tertiary Care Hospital., Muhammad Hasan Hameed, Farhan Raza Khan

Department of Surgery Docs

No abstract provided.

Understanding Nucleus Pulposus Cell Phenotype: A Prerequisite For Stem Cell Based Therapies To Treat Intervertebral Disc Degeneration., Hyowon Choi, Zariel I. Johnson, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Intervertebral disc (IVD) degeneration and associated low back pain (LBP) remains a major burden to our society without significant improvements in treatment strategies or patient's quality of life. While the recent cell-transplantation studies for treatment of degenerative disc disease have shown promising results, to better gauge the success and functional outcomes of these therapies, it is crucial to understand if transplanted cells give rise to healthy nucleus pulposus (NP) tissue. NP cell phenotype is unique and is defined by expression of a characteristic set of markers that reflect specialized physiology and function. This review summarizes phenotypic markers that mirror the …

Development Of A Guide By Postgraduate Residents On Receiving Feedback From Faculty In The Operating Theatre At Aga Khan University Hospital, David Karuri Maina

Master of Medicine in General Surgery

Background: Direct observation of residents in clinical encounters by faculty and assessment for learning has now become a key component of postgraduate training programs. DOPS, a workplace-based assessment form, was designed to provide formative assessment and feedback about a trainee’s procedural skills. Interactions between residents and faculty are central to this learning process and are influenced by multiple factors both at faculty and resident levels as well as contextual factors. The feedback may be used by the receiver to contemplate behaviour change. The receptivity of the resident to the feedback is a key determinant as to whether the process to …

2015 Annual Nsqip Conference Erin (Enhanced Recovery In Nsqip) Session, Michael D. Pasquale Md, Facs, Fccm, Pat Toselli Do, Richard Kolesky Md, Robert J. Sinnott Do, Cathleen Webber Rn, Mshs, Sharon Pustilnik Rn, Bs, Justina A. Momah Rn, Crnp

Department of Surgery

No abstract provided.

Value-Based Medicine: The Financial Impact Of A Pressure Ulcer Prevention Program On A Trauma Population, Jayme D. Lieberman Md, Patrick S. Duffy Md, Kai L. Bortz Rn, Rovinder S. Sandhu Md, Michael D. Pasquale Md, Facs, Fccm, Michael M. Badellino Md

Department of Surgery

No abstract provided.

Preop Evaluation/Post Operative Care (Nutrition, Pain Management), Malia Eischen Md, Meghan L. Good Md, Lung-Ching Lee Md

Department of Surgery

No abstract provided.

Comparison Of Wound Complications In Open Vs Closed Lateral Internal Sphincterotomy For Anal Fissure (Presentation), Gregg M. Baranski Md, Arthur Yushuva Md, John S. Park Md

Department of Surgery

No abstract provided.

Acute Care Surgical Service Experience With Ruptured Visceral Artery Aneurysms, Jayme D. Lieberman Md, Meghan L. Good Md, Rovinder S. Sandhu Md, Michael M. Badellino Md

Department of Surgery

No abstract provided.

Indications For Warfarin In Trauma Patients, Victor V. Ha Md, Rovinder S. Sandhu Md

Department of Surgery

No abstract provided.

Robotic Sublobar Resection For The Surgical Management Of Isolated Pulmonary Nodules, Victor S. Reis Md, Kyle M. Langston Pa-C, Alec Talsania, Alexander Werner, Michael F. Szwerc Md, Timothy S. Misselbeck, Mark E. Perry Md

Department of Surgery

No abstract provided.

Gap In Patient Expectations Of Deep Brain Stimulation For The Treatment Of Parkinson's Disease, Colleen D. Knoop Dnp-C

Graduate Theses, Dissertations, and Capstones

Abstract

Purpose: This project studied a specific group of patients with Parkinson’s disease to: determine if they were asked to verbalize expectations of DBS pre-operatively; determine if patient expectations were met post-operatively; gain information that could aid in improved pre-operative patient education for deep brain stimulation (DBS), address unrealistic expectations before surgery, and meet patient expectations post-operatively.

Methodology: This study was a retrospective, single academic center, two-part design that included a questionnaire and chart review of 29 patients. Those included were patients with Parkinson’s disease who had DBS programming at the academic center, between the years 2007 and 2014.

Results: …

Transplantation Of Kidneys From Donors With Acute Renal Failure Five-Year Results From Double Center Experience, Ahmad Safra, Md, Ashesh P. Shah, Md, Cataldo Doria, Md, Phd, Warren R Maley, Md, Adam M. Frank, Md, Chad Gorn, Laurel Lerner, Rn, Marie Manley, Carlo B Ramirez, Md

Department of Surgery Faculty Papers

Background:

Transplantation of kidneys from deceased donors with acute renal failure (ARF) has been described and represents an underutilized source of renal grafts. We reviewed retrospectively our double center experience with transplantation of ARF donor kidneys.

Methods:

Between January 2009 and June 2014, we performed a total of 397 kidney transplants at the two hospitals. Of which, 65 came from donors with ARF. The outcome was compared with 62 expanded criteria donor kidneys and 270 standard criteria donor kidneys. ARF was defined as donor terminal creatinine higher than 2. All kidneys from ARF donors had acceptable biopsies and were pumped. …

Declaring A Patient Brain Dead On Extracorporeal Membrane Oxygenation (Ecmo): Are There Guidelines Or Misconceptions, Kristin J. Kreitler, Nicholas C. Cavarocchi, Hitoshi Hirose, Sharon West, Richard Hasz, Michelle Ghobrial, Rodney D. Bell

Department of Surgery Faculty Papers

Objectives:

• To review the clinical practice variations and trends with declaring patients brain dead on ECMO
• To highlight the need for the development of consensus guidelines to assist clinicians in the accurate diagnosis of brain death in this specific patient population

Department Of Surgery Update, May 2015, Wright State University Department Of Surgery

Department of Surgery Updates

A five page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, pictures of the new interns for 2015-2016, scholarly activity and more.

A Case Of Pediatric Melanoma: Treatment Considerations In Advanced Disease., Frank P Albino, Benjamin C. Wood, Albert Oh, Gary F Rogers, Tina Sauerhammer

Surgery Faculty Publications

We document a 3-year-old healthy African American girl who developed malignant melanoma on her lower extremity. The clinical appearance offered little indication of the lesion’s severity (T4), and only the history of de novo presentation and disproportionate growth raised clinical suspicion. This case report highlights the subtle clinical findings of this condition and presents controversies related to surgical management of pediatric melanoma.

Frederic E. Mohs, M.D. (1910-2002): Physician And Innovator., Nicholas A. Ross, B.A., Nazanin Saedi, Md, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

Frederic “Fred” E. Mohs was an “honest and good man, a ferocious and courageous worker.”1 Husband, father of three, prolific writer, and speaker, Dr. Mohs was a pioneer in many fields. His desire to do good was fueled by his enthusiasm for scientific advancement (Frederic E. Mohs Jr., personal communication, 2014). He is most remembered for Mohs Micrographic Surgery, formerly chemosurgery, which allows visualization and examination of all tissue margins achieving skin cancer cure rates of 98 to 99 per cent.

Tetralogy Of Fallot With Absent Pulmonary Valve Syndrome; Appropriate Surgical Strategies, Fatima Shahid, Maria Tariq Siddiqui, Muneer M Amanullah

Department of Surgery Docs

Abstract

OBJECTIVE:

To evaluate patients presenting with Tetralogy of Fallot with absent pulmonary valve syndrome to a tertiary care hospital and their surgical management.

METHODS:

The retrospective study was conducted at Congenital Cardiac Services, Aga Khan University Hospital, Karachi, Pakistan, and comprised data of Tetralogy of Fallot patients between April 2007 and June 2012. Data was analysed together with follow-up echocardiography. Variables assessed included demographics, imaging, operative technique, complications, post-operative recovery and follow-up echocardiography. SPSS 17 was used for statistical analysis.

RESULTS:

Of the 204 patients, 6 (3%) had undergone surgical correction for Tetralogy of Fallot with absent pulmonary valve …

Osteoid Osteoma Of Acetabulum A Rare Presentation, Irfan Ashraf, Sidra Kanwal,, Pervaiz Hashmi

Department of Surgery Docs

Abstract

The case of a relatively frequent benign osteoblastic tumour, osteoid osteoma at an atypical site is presented. It was in a 20 year old man who attended the outpatient department of Aga Khan University Hospital, Karachi with pain in left groin since last 6 months which often occurred at night and was relieved by taking NSAIDs. X-ray failed to reveal the cause. CT scan showed central radiolucent nidus with surrounding sclerosis suggestive of osteoid osteoma in the left acetabulum. Acetabulum is a rare site for osteoid osteoma, the usual sites are diaphysis of long bones. Hence, the diagnosis is …

Epidemiology Of Karachi Road Traffic Crash Mortality In 2013, Rashid Jooma, Masood Ali Shaikh

Department of Surgery Docs

Abstract

Road Traffic Crash (RTC) is the eighth leading cause of death globally. In a recent World Health Organization report, there were 5,192 RTC deaths reported from Pakistan in 2010. The Road Traffic Injury Research and Prevention Center (RTIRPC) is a unique public-private public health enterprise in Karachi, and collects data from five major public and private hospitals' emergency departments in the city. Cumulatively, 1130 deaths were recorded in the year 2013. Males accounted for 981 (86.8%) deaths. The most vulnerable decades of life were twenties and thirties; accounting for 307 (27.2%) of all deaths. In terms of involvement of …

Glanzmann’S Thrombasthenia Diagnosed Following Knee Arthroscopy, John Zvijac, Gary Kiebzak

All Publications

A 41-year-old man with an unremarkable medical history presented with a painful knee after a sports injury. He was diagnosed with a medial meniscal tear. Symptoms did not abate after 6 months of physical therapy, and he underwent arthroscopic partial medial meniscectomy. A week after beginning physical therapy he experienced a knee effusion, decreased ROM, and inability to flex his quadriceps. His knee was aspirated. Blood tests were ordered and his complete blood count, liver functions tests, and INR/PTT were normal. The patient had recurrent effusions requiring three additional joint aspirations. Ten weeks after the initial surgery, the patient underwent …