Surgery Commons^™

Acute Mesenteric, Portal And Inferior Vena Cava, Venous Thrombosis, Anticoagulation, Abdul Rehman Alvi, Shahida Bibi, Zia Ur Rehman, Sameullah Khan Niazi

Section of Cardiothoracic Surgery

The prevalence and clinical spectrum of acute mesenteric venous thrombosis (AMVT) in Pakistan is largely unknown. The authors report two patients with acute mesenteric, portal and inferior vena cava venous thrombosis confirmed on CT imaging. The diagnoses were established within 24 hours of presentation and both patients were successfully treated with therapeutic heparin during hospital admission and continued on oral warfarin because of hypercoagulable state. The protocol that we currently use is evidence based and is leading to optimal outcome.

Endoscopic Repair Of High-Flow Cranial Base Defects Using A Bilayer Button., Adam J. Luginbuhl, Peter G. Campbell, James Evans, Marc Rosen

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES/HYPOTHESIS: Repair of the skull base still begins with a direct repair of the dural defect. We present a new button closure for primary repair of the dura for high flow defects.

STUDY DESIGN: Retrospective review.

METHODS: We reviewed our 20 cases of primary button grafts and compared the results to the previous 20 high-flow open-cistern cerebrospinal fluid (CSF) cases. Subjects were excluded if they had no violation of the arachnoid space or potential for low-flow CSF leak. The button is constructed so that the inlay portion is at least 25% larger than the dural defect, and the onlay portion …

Pregnancy Outcomes In Female Liver Recipients Transplanted Under The Age Of 21, Carlo B. Ramirez, Warren R. Maley, Cataldo Doria, Lisa A. Coscia, Michael J. Moritz, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions: Liver recipients transplanted under the age of 21 are able to maintain pregnancy with 75% resulting in a livebirth. Pregnancy, potential risks for mother and newborn, and long-term maternal survival should be discussed with the recipient and the parents of the recipient. Transplant centers are encouraged to report pregnancy outcomes in these recipients to the NTPR.

Acute Mesenteric, Portal And Inferior Vena Cava (Ivc) Venous Thrombosis: Optimal Outcome Achieved With Anticoagulation, Abdul Rehman Alvi, Shahida Bibi, Zia Ur Rehman, Sameullah Khan Niazi

Department of Surgery Docs

The prevalence and clinical spectrum of acute mesenteric venous thrombosis (AMVT) in Pakistan is largely unknown. The authors report two patients with acute mesenteric, portal and inferior vena cava venous thrombosis confirmed on CT imaging. The diagnoses were established within 24 hours of presentation and both patients were successfully treated with therapeutic heparin during hospital admission and continued on oral warfarin because of hypercoagulable state. The protocol that we currently use is evidence based and is leading to optimal outcome.

Solid-Organ Transplant Recipients And Breastfeeding While On Immunosuppression, Schweta Arakali, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

The relatively small amount of drug transferred in breast milk and the lack of reported adverse effects along with the known benefits of breastfeeding may outweigh the risk of drug exposures in the transplant population.

The threshold for determining the level of exposure of an immunosuppressive agent that is acceptable is not known at present.

Continued study and follow-up of all breast-fed transplant recipient offspring is warranted.

Centers are encouraged to report all pregnancies in transplant recipients to the NTRR.

Pregnancy Outcomes In Female Lung Transplant Recipients, Julie Shaner, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Female lung recipients appear to face higher risks related to pregnancy when compared to other solid organ transplant recipients.

Although successful pregnancies have been reported in female lung recipients, analyses of larger numbers of cases may help to identify pre-pregnancy factors predictive of adverse outcomes.

Centers are encouraged to report all pregnancies in transplant recipients to the NTPR.

Pregnancy Outcomes With Exposure To The Mycophenolic Acid Products (Mpa), To Dung K. Nguyen, Faith Carlin, Lisa A. Coscia, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Reports to NTPR to date continue to reveal an increased incidence of birth defects in transplant recipients maintained on MPA products during gestation compared to those not maintained on these agents.

Structural birth defects consisting of microtia (ear deformity) and facial defects suggest a pattern of malformations.

Evaluation of the higher incidence of non-viable outcomes requires further study in this cohort.

Centers are encouraged to report all pregnancy exposures in transplant recipients to the NTPR.

Pregnancy Outcomes In Pancreas-Kidney Vs. Kidney-Alone Diabetic Female Transplant Recipients, Lyuba Gitman, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

The high incidences of hypertension, preeclampsia, and infection during pregnancy underscore the high-risk nature of pregnancy in both pancreas-kidney and kidney alone recipients.

Although overall offspring outcomes are similar in both PK and K groups, pregnancy in PK recipients may be associated with higher incidences of maternal infections and overall graft loss.

Centers are encouraged to report all pregnancies in transplant recipients to the NTPR.

Immunosuppressive Therapy For Autoimmune Disease And Pregnancy Outcomes, Karolina Paziana, Faith Carlin, Lisa A. Corcia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Cyclosporine exposure during pregnancy in the transplant population does appear to be associated with premature delivery and low infant birthweight.

Data from the NPR show that cyclosporine exposure during pregnancy in women with psoriasis does not appear to be associated with low gestational age or low infant birthweight.

Maternal comorbidities or other factors, such as multiple drug regimens, likely play a role in the higher rates of premature delivery and low birthweight infants in the kidney transplant population.

Further investigation is warranted to evaluate the impact of comorbidities and other factors on pregnancy outcomes of women taking Neoral®.

The Type 1 Insulin-Like Growth Factor Receptor In Hepatocellular Carcinoma Cell Lines, Zhengyu Wei, Phd, Tiziana Deangelis, M.S., Reginald Hurtt, B.S., Renato Baserga, M.D., Cataldo Doria, M.D., Ph.D

Department of Surgery Faculty Papers

Summary:

1. Human HCC cells have higher expression levels of IGF-1R, IRS1, and c-Met.

2. IRS1 interacts with c-Met. The role of IGF-1R in human HCC should be revisited.

3. Lentivirus-mediated shRNA delivery system targeting IGF-1R showed significant suppressive effects on HCC cell growth, promising a potential therapeutic treatment for human HCC.

Download The Full Pdf Of Jefferson Surgical Solutions Spring 2010, Volume 5, Number 1

Jefferson Surgical Solutions

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News In Brief

Jefferson Surgical Solutions

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Jefferson Awards Gala Celebrates A Dedicated Faculty Member

Jefferson Surgical Solutions

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On The Job-Katie Ashburn, Crnp, And Shawn Pierce, Cnrp

Jefferson Surgical Solutions

No abstract provided.

Brody Recognized For Promising Pancreatic Cancer Research

Jefferson Surgical Solutions

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Please Welcome-Joyce Hartmann, Physician Liaison For Liver Transplant Program

Jefferson Surgical Solutions

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The New Breast Care Center: Truly “Managed Care” For Women

Jefferson Surgical Solutions

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Overview-Charles J. Yeo, Md Samuel D. Gross Professor And Chair, Department Of Surgery

Jefferson Surgical Solutions

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The Surgeon Speaks-Carlo Ramirez, Md, Facs

Jefferson Surgical Solutions

No abstract provided.

Kidney Transplant Program Offers Many Options And Encourages Living Donors

Jefferson Surgical Solutions

No abstract provided.

Preoperative Drainage In Pancreatic Cancer., Eugene P Kennedy, Ernest L Rosato, Charles J Yeo

Department of Surgery Faculty Papers

Van der Gaag et al. conclude that preoperative biliary drainage in patients undergoing surgery for cancer of the head of the pancreas increases complications. Previous studies have shown that stenting is associated with a doubling in the risk of wound infection and an overall slightly increased risk of any complication.

Stuck Together: Searching For A Model Of Peritoneal Adhesions Using The August Rat, James W. Bathe

Honors Theses

Fibrous adhesions, a by-product of the healing process, often appear post-surgically as a result of peritonitis related to the surgery. These adhesions can be either primarily "scar tissue" or excess "healthy tissue," and are the leading cause of intestinal obstruction in modern medicine. Shockingly, adhesions occur in up to 96% of patients undergoing intra-abdominal surgery. Adhesions can lead to multiple complications other than obstructions such as inadvertent enterotomy at the time of adhesiolysis, chronic pain, and female infertility. Additional complications arise from the adhesions preventing the free movement of organs and causing strangulations. The causes of the peritonitis, and therefore …

Is Early Correction Of Congenital Ventricular Septal Defect A Better Option In A Developing Country, Awais Ashfaq, Hassaan Ashraf Zia, Muhammad Muneer Amanullah

Section of Cardiothoracic Surgery

OBJECTIVE: To assess and evaluate the effectiveness of early ventricular septal defect (VSD) repair in a developing country by comparing the outcomes in two age groups.

METHODS: A total of 39 patients underwent VSD repair at a tertiary care hospital in Karachi over a period of 2.5 years. Patients were divided into Group 1 (years) and Group 2 (2-18 yrs). Perioperative and postoperative variables were reviewed retrospectively for each patient and compared with the development of complications and the effect on postoperative recovery times. The data was analyzed using Mann Whitney test for continuous variables and Fischer's exact test for …

Occipital Nerve Stimulator Systems: Review Of Complications And Surgical Techniques, Steven Falowski, Dajie Wang, Arvind Sabesan, Ashwini Sharan

Department of Neurosurgery Faculty Papers

Introduction: Stimulation of the occipital nerves is becoming more widely accepted in the treatment of occipital neuritis and migraine disorders.

Objective: Presently, equipment available for spinal cord stimulation is adapted for insertion into the subcutaneous space over the occipital nerves. Many technical factors need to be reassessed to optimize the therapy.

Methods: We performed a retrospective review of patients implanted from 2003 to 2007 at a single center. We aimed to analyze the rate of surgical complications related to implantation technique. A total of 28 patients were present for analysis. Patients were followed up to 60 months with a mean …

Anxiolytic Effect Of Midazolam Premedication Assessed By Clinical And Platelet Aggregation Profiles, Ehtesham I Khan, Rehana S Kamal, Hameed Ullah

Department of Anaesthesia

BACKGROUND: It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient's outcome. This study was designed to assess the anxiolytic effect of midazolam in pre-anaesthetic medication by using clinical and platelet aggregation profiles.METHODS: Sixty ASA I and II female patients aged between 35 and 60 years undergoing elective abdominal hysterectomy were randomly divided into two equal groups. Group I received placebo as pre-medication while group II received 0.15 mg/kg midazolam as pre-medication 1 hour preoperatively. They were monitored for visual analogue scale (VAS) for anxiety, observer's anxiety criteria, sedation score, blood pressure, …

Association Of Depression With Newly Diagnosed Type 2 Diabetes Among Adults Aged Between 25 To 60 Years In Karachi, Pakistan., Shazia Perveen, Muhammad S Otho, Muhammad N Siddiqi, Juanita Hatcher, Ghazala Rafique

Section of Cardiothoracic Surgery

Background:The combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.

Methods:

From July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from …

Surgical Response To Catastrophe - Learning From Canada’S Experience Abroad, Vivian Mcalister

Data and Test Instruments

No abstract provided.

Clinical Outcome Of Iridotomy With Argon-Yag Laser At A Tertiary Care Center In Karachi, Pakistan, Rashid Baig, Aziz Khan

Section of Ophthalmology

Objective: To assess the the efficacy and early and late complications of Argon-YAG combined laser iridotomy in the outpatient department of a tertiary care hospital.
Methods: This was a prospective observational study conducted at Aga Khan University Hospital Karachi, Pakistan. After detailed history taking and clinical examination, patients who had goniscopically evident closed angles and a positive provocative test were selected for laser iridotomy. They underwent iridotomy using Argon laser followed by YAG laser. The main outcome measures were patency of iridotomy at 6 months, angle grading at 6 months and early and late complications.
Results: Overall 40 eyes of …

Ultrasound Visualization Vs. Electrical Nerve Stimulation For Interscalene And Axillary Nerve Block In Upper Extremity Surgery: A Prospective Randomized Trial (Poster), Joseph W. Galassi Md, Jodie Buxbaum Md, J John Collins Md, Dorothy Hartman Md, Michael He Md, Farheen Hussain Ms, Leslie Baga Bsn, Sherrine Eid Mph, Mary Jane Cerrone Msn, Nanette M. Schwann Md

Department of Anesthesiology

No abstract provided.

On Pump Coronary Surgical Revascularization In A Patient With Chronic Immune Thrombocytopenic Purpura, Saulat Fatimi, Danesh K Kella, Marium Muzaffar, Hashim Muhammad Hanif

Section of Cardiothoracic Surgery

We performed on-pump coronary artery bypass graft surgery on a 54-year-old female, known case of chronic Idiopathic Thrombocytopenic Purpura (ITP), hypertension and dyslipidaemia who had presented to us with progressive exertional shortness of breath and chest pain. The decision of going on with CABG was made after two weeks of preoperative treatment with prednisolone. Her platelet counts pre-operatively and on the 4th post-operative day were 135 x 10(9)/L and 32 x 10(9)/L. She had an unremarkable post-operative recovery, without requiring whole blood or platelet transfusions. We recommend preoperative steroid treatment in patients with chronic ITP undergoing CABG.