Surgery Commons^™

Septic Arthritis Of The Hip In Children: Aga Khan University Hospital Experience In Pakistan, Muhammad Umer, Pervaiz Hashmi, Tashfeen Ahmad, M Ahmed, Masood Umer

Section of Orthopaedic Surgery

Objective: To present clinical, radiological and bacteriological features and short term outcome of septic arthritis of the hip in children.
Methods: There were 23 male and 16 female children, including 6 neonates and 10 infants with a mean age of 3.9 years. Diagnosis of septic hip was made on clinical grounds, supplemented by X-rays, leukocyte count and the erythrocyte sedimentation rate (ESR). Thirty nine patients with 40 hips were followed for a mean time period of 76 weeks. All patients had a positive joint aspirate (pus) and underwent surgical decompression along with intravenous antibiotic therapy.
Results: Symptoms of pain, fever …

Laparoscopic Appendicectomy At The Aga Khan Hospital, Nairobi, S. C. Patel, G. F. Jumba, S. Akmal

General Surgery, East Africa

Objective: To evaluate our experience of laparoscopic appendicectomy at the Aga Khan Hospital, Nairobi over a six year period from the inception of the technique and to assess its advantages and disadvantages.

Design: Case series study.

Setting: The Aga Khan Hospital, Nairobi.

Patients: One hundred and six cases operated on from May 1996 to June 2002. Main outcome measures: Clinical presentation, age and sex demographics, average hospital stay, operating time, intra-operative and post-operative complications and outcome.

Results: There was a female preponderance with a female to male ratio of 2:3:I. Mean age was 30.6 years. There was a slightly more …

Seek And Ye Shall Find, Vivian Mcalister

Data and Test Instruments

The United States has relaxed its ban on the importation of Canadian meat cuts from cattle less than 30 months of age. Mexico, too, is reopening its borders to Canadian beef.The principal argument Canada has used to reassure its trading partners is that only one older cow, and none of the 2,700 animals with which that cow came into contact, tested positive for mad-cow disease. Meanwhile, the Canadian Food Inspection Agency has detailed measures it is taking to prevent mad-cow disease, or bovine spongiform encephalopathy, "from entering Canada." Surveillance and testing of animals has been increased.But it's folly to try …

Peritumoral Cystic Meningioma, Arshad A. Siddiqui, Junaid Asharaf, Ahmed Ali Shah

Section of Neurosurgery

A case of 39 years old male is described who presented with headache, right-sided focal fits and decreased power in the right hand. CT scan brain showed a left fronto-parietal cystic lesion with centrolateral intramural nodule with homogenous enhancement. At surgery, the extra-axial lesion with cyst containing xanthochromic fluid had a well-defined capsule that could easily be separated from the peri-lesional cortical surface. The dural-based nodule with its cyst wall was resected in toto. The histopathology of mural nodule was reported as meningioma while the cyst wall histology revealed meningothelial cells.

Experience In 118 Consecutive Patients Undergoing Ct-Guided Stereotactic Surgery Utilizing The Cosman-Robert-Wells (Crw) Frame, G. R. Sharma, H. Siddiqui, Rashid Jooma

Section of Neurosurgery

Aims: To evaluate the efficacy of CT-guided neurosurgical procedures done on patients operated by this modality.
Methods: Between January 1997 and March 2000, 118 patients undergoing CT-guided stereotactic procedures were recruited to the study. The CRW III stereotactic system (Radionics, USA) and the TSX-00ZA CT Scanner (Toshiba, Japan) were used for all the procedures in the series. These procedures were directed to symptomatic brain lesions or for the treatment of Parkinsonian tremor.
Results: Of 118 patients, 109 had intra-cranial lesions and 9 had Parkinson's Disease. The stereotactic procedures performed on these patients were: biopsies in 62, guided mini-craniotomies in 22, …

Radiosurgery For The Control Of Glomus Jugulare Tumours, Muhammad Ehsan Bari, A A. Kemeny, D M C Forster, M W. Radatz

Section of Neurosurgery

Objective: To ascertain the efficacy of stereotactic radiosurgery (gamma knife) for the control of glomus jugulare tumours.
Method: Between March 1994 and December 1997 we treated eight patients of glomus jugulare tumour with radiosurgery. These patients have been followed for more than four years (range 52 to 97 months). The age of the patients ranged between 32-64 years (mean 53 years). The male: female ratio was 3:5. Three patients had previously undergone surgery and one had unsuccessful embolization. The dose applied to tumour margin ranged between 16-25 Gy (median 25 Gy). Patients were followed up with yearly MRI scans and …

Tacrolimus As A Liver Flush Solution To Ameliorate The Effects Of Ischemia/Reperfusion Injury Following Liver Transplantation., Shawn D. St Peter, David J. Post, Manuel I. Rodriguez-Davalos, David D. Douglas, Adyr A. Moss, David C. Mulligan

Manuscripts, Articles, Book Chapters and Other Papers

The goal of this report is to evaluate in a prospective randomized fashion the effect of flushing hepatic allografts with tacrolimus before transplantation. A prospective, double-blinded, randomized trial was performed. Twenty patients receiving orthotopic liver transplants from October 2000 to October 2001 were randomized into two groups. Group 1 (active) was administered tacrolimus, 20 ng/mL, plus Plasma-lyte A (Baxter Healthcare Corp, Deerfield, IL) liver flush solution; and group 2 (placebo) was administered only Plasma-lyte A. Ischemia/reperfusion injury was assessed in both groups after transplantation by means of serum laboratory values to assess hepatocellular damage, synthetic function, and ion transport capacity. …

Effects Of Tacrolimus On Ischemia-Reperfusion Injury., Shawn D. St Peter, Adyr A. Moss, David C. Mulligan

Manuscripts, Articles, Book Chapters and Other Papers

In addition to efficacious immunosuppression for the benefit of organ transplantation, tacrolimus has diverse actions that result in amelioration of ischemia-reperfusion injury. Knowledge is accumulating rapidly on the mechanisms through which tacrolimus exerts these cytoprotective effects, including alterations in microcirculation, free radical metabolism, calcium-activated pathways, inflammatory cascades, mitochondrial stability, apoptosis, stress-response proteins, and tissue recovery. Within the nucleus, actions mediating the effects of tacrolimus appear to be dominantly influenced by interactions with the transcription factor, nuclear factor-kappaB. Because tacrolimus is a cornerstone agent in immunosuppression regimens throughout the world and knowledge of its cellular mechanisms is evolving, it is important …

The Prevalence Of Silent Kidney Stones: An Ultrasonographic Screening Study, Buchholz Niels-Peter, Farhat Abbas, R Khan, Jamsheer J. Talati, M Afzal, I Rizvi

Section of Urology

Objective: Silent and not yet discovered stones of the upper urinary tract are potentially dangerous, since in due course they may cause infection, obstruction and renal damage. The aim of this study was to determine the prevalence of such silent kidney stones in a representative Pakistani population of Karachi.
Subjects and Methods: We studied 201 consecutive subjects at our hospital who underwent additional kidney screening whilst undergoing abdominal ultrasound. All these subjects did not have a history or symptoms of urolithiasis.
Results: We found silent kidney stones in 3% of subjects. All stone bearers were males. Most stones were in …

Optimization Of Low Pre-Operative Hemoglobin Reduces Transfusion Requirement In Patients Undergoing Transurethral Resection Of Prostate, Hammad Ather, Nuzhat Faruqui, F. Abid

Section of Urology

Objective: To identify factors that influence peri-operative hemorrhage in view of reducing the need for transfusions in patients undergoing trans uretheral resection of prostate (TURP).
Methods: All patients undergoing TURP between January 1997 and December 1999 were identified using lCD 9CM coding and indexing system. Overall 430 patients were identified, however, 384 charts were included and reviewed for demographics, pre and intra-operative data and post-operative morbidity. Patients were divided into two groups on the basis of presence of significant hemorrhage.
Results: Overall 384 patients were analyzed. Nineteen patients had hemorrhage - group I whereas 365had no significant hemorrhage …

Post-Chemotherapy Residual Mass In Stage Iic Seminomatous Testicular Tumor, N A. Ahmad, S R. Biyabani, Farhat Abbas

Section of Urology

Introduction

The management of patients with residual masses following chemotherapy for advanced seminoma remains a difficult problem with no clear guidelines. While most patients with advanced seminoma achieve a complete or partial response with cisplatin based chemotherapy¹, a significant number will reveal a residual mass on follow up CT scan or MR imaging^2,3. Management options for post chemotherapy residual mass in a case of seminoma include close observation, radiation therapy and excisional surgery. While 80 to 85% of residual masses represent either fibrosis or necrotic tissue needing no further therapy, 10 to 15% may contain viable …

Faecal Empyema, R Layeeque, S Hussain, M Arshad, Farhat Moazam

Section of Urology

No abstract provided.

Optimisation Of Bile Production During Normothermic Preservation Of Porcine Livers., Charles J. Imber, Shawn D. St Peter, Inigo Lopez De Cenarruzabeitia, Hugh Lemonde, Mike Rees, Andrew Butler, Peter T. Clayton, Peter J. Friend

Manuscripts, Articles, Book Chapters and Other Papers

Machine perfusion of livers may provide a mechanism for extended preservation of marginal donor organs before transplantation, as well as a method for viability assessment. It has proved possible in a series of experimental porcine liver perfusions to maintain liver viability for up to 72 h. However, a reduction in bile production with associated histological evidence of cholestasis was seen after 10 h of perfusion, damaging the biliary canaliculi during the preservation period and leaving these organs in an unacceptable condition for transplantation. It was proposed that reduction in bile production was the result of a relentless depletion of available …

Current Practice Regarding The Use Of Fatty Livers: A Trans-Atlantic Survey., Charles J. Imber, Shawn D. St Peter, Inigo Lopez, Lynden Guiver, Peter J. Friend

Manuscripts, Articles, Book Chapters and Other Papers

A strong association exists between the presence of steatosis in a donor liver for transplantation and the development of primary nonfunction in the recipient. Despite this, appraisal of the donor remains one of the least scientific aspects of the transplantation process, and many centers base their practice on subjective opinion, rather than objective data. We conducted this survey to illuminate controversial issues and highlight the variation of opinion and practice policies both between and within the United Kingdom and the United States. A simple, anonymous, one-page, 10-question survey with tick-box answers was sent to every practicing liver transplant surgeon in …

Update - May 2002, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- The Compleat Physician
-- Informed Consent Documentation for Total Artificial Hearth Technology
-- Ralph J. and Carolyn Thompson Endowment established in 2001

Hepatic Steatosis And Its Relationship To Transplantation., Charles J. Imber, Shawn D. St Peter, Ashok Handa, Peter J. Friend

Manuscripts, Articles, Book Chapters and Other Papers

Fatty infiltration of the liver is common in the brain-dead donor population and has a strong correlation with primary nonfunction after cold preservation, a condition that is catastrophic to liver transplant recipients. This literature review examines factors associated with the development, diagnosis, quantification, and clinical management of this difficult condition.

Extended Preservation Of Non-Heart-Beating Donor Livers With Normothermic Machine Perfusion., Shawn D. St Peter, C J. Imber, I Lopez, D Hughes, P J. Friend

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Non-heart-beating donor (NHBD) livers represent an important organ pool, but are seldom utilized clinically and require rapid retrieval and implantation. Experimental work with oxygenated perfusion during preservation has shown promising results by recovering function in these livers. This study compared sanguinous perfusion with cold storage for extended preservation of the NHBD liver in a porcine model.

METHODS: Porcine livers were subjected to 60 min of in vivo total warm ischaemia before flushing, after which they were preserved by one of two methods: group 1 (n = 4), University of Wisconsin (UW) solution by standard cold storage for 24 h; …

Lake Mead Hospital Conversion To Complete Delivery System, Roger W. Noorda

UNLV Theses, Dissertations, Professional Papers, and Capstones

The objective of this case study is to determine the cost difference between using a conventional type of inventory system in the operating room versus using a pack system in the operating room. In this study three different ways of delivering disposables for a laminectomy procedure were considered: 1) multiple distributors of disposables, 2) single distributor of disposables, and 3) the pack system (CDS by Medline). The first comparison was of multiple distributors vs. a single distributor with a cost difference of $90.08 per procedure and $18,916.80 annually, multiple distributor costing less. The second comparison was between Medline as a …

Predictors Of Mortality In Brain Abscess, H U. Qureshi, A A. Habib, A A. Siddiqui, T Mozaffar, A R. Sarwari

Section of Neurosurgery

Objective: Brain abscess carries significant morbidity and mortality. Our objective was to elucidate the clinical presentation of brain abscess and to assess predictors of mortality in these patients.
Methods: All patients with a brain abscess presenting to the Aga Khan University Hospital, a tertiary care referral center in Karachi, Pakistan, were studied retrospectively. Statistical analysis involved univariate analysis and a logistic regression model.
Results: Among the 66 patients analyzed, a distant metastatic focus of infection was the most commonly identified predisposing factor (29%). Otogenic infection was the commonest contiguous source and sinusitis was noticeably absent. Multiple abscesses were frequent (35%). …

Circulating Testosterone And Prostate-Specific Antigen In Nipple Aspirate Fluid And Tissue Are Associated With Breast Cancer., Edward R Sauter, David S Tichansky, Inna Chervoneva, Eleftherios P Diamandis

Department of Surgery Faculty Papers

Preliminary evidence has associated testosterone and prostate-specific antigen (PSA) with breast cancer. Our objective was to determine whether a) testosterone levels in nipple aspirate fluid (NAF), serum, or breast tissue are associated with breast cancer; b) testosterone levels in serum are associated with levels in NAF; c) PSA in NAF, serum, or breast tissue is associated with breast cancer; and d) serum PSA is associated with NAF PSA levels. We obtained 342 NAF specimens from 171 women by means of a modified breast pump. Additionally, we collected 201 blood samples from 99 women and 51 tissue samples from 41 subjects …

Early Surgical Results With Intent To Treat By Radical Retropubic Prostatectomy For Clinically Localized Prostate Cancer, Farhat Abbas, Kamran Siddiqui, Syed R. Biyabani, Jamsheer J. Talati, S. H. Hasan

Section of Urology

Aims: To evaluate the early cancer control rates, morbidity and mortality in men undergoing radical retropubic prostatectomy (RRP) for clinicallylocalized adenocarcinoma prostate.
Methods: Patient's characteristics, operative data, progressive-free survival rates, morbidity and mortality were analyzed for 23 men with clinical T1-2 prostate cancer who underwent surgery with an intent to treat by RRP between December 1997 to July 2001.
Results: Patient's mean age was 63 +/- 6.2 years (range 51 to 76 years) with American Society of Anesthesiology (ASA) status I in 4%, II in 65% and III in 31%. Two third of the patients had lower urinary tract obstructive …

Beta-Galactosidase As A Marker Of Ischemic Injury And A Mechanism For Viability Assessment In Porcine Liver Transplantation., Shawn D. St Peter, Charles J. Imber, Inigo Lopez De Cenarruzabeitia, James Mcguire, Tim James, Richard Taylor, Peter J. Friend

Manuscripts, Articles, Book Chapters and Other Papers

Glycohydrolases are a group of enzymes contained predominantly within lysosomes, which are released during Kupffer cell activation or death. One of these, beta-galactosidase, has been proposed as a marker of ischemia-reperfusion injury in the liver because Kupffer cell activation represents a primary event in the injurious reperfusion cascade. In this study, we compared B-galactosidase with more traditional indicators of liver injury and function in a porcine model of liver preservation. Porcine livers were allocated into two groups: group C (n = 5), preserved in University of Wisconsin solution by standard cold storage for 24 hours, and group W (n = …

In-Gel Purified Ditags Direct Synthesis Of Highly Efficient Sage Libraries, Saroj P. Mathupala, Andrew E. Sloan

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

SAGE (serial analysis of gene expression) is a recently developed technique for systematic analysis of eukaryotic transcriptomes. The most critical step in the SAGE method is large scale amplification of ditags which are then are concatemerized for the construction of representative SAGE libraries. Here, we report a protocol for purifying these ditags via an 'in situ' PAGE purification method. This generates ditags free of linker contaminations, making library construction simpler and more efficient.

Results

Ditags used to generate SAGE libraries were demarcated 'in situ' on preparative polyacrylamide gels using XC and BPB dyes, which precisely straddle the ditag …

Nipple Aspirate Cytology And Pathologic Parameters Predict Residual Cancer And Nodal Involvement After Excisional Breast Biopsy., E R Sauter, H Ehya, A Mammen, G Klein

Department of Surgery Faculty Papers

We previously demonstrated that abnormal nipple aspirate fluid (NAF) cytology predicted residual breast cancer (RC) and tumour size after excisional biopsy (EB), although normal NAF cytology did not exclude RC. Tumour size correlates with the risk of lymph node (LN) metastases. LN metastases provide prognostic information allowing medical and radiation oncologists to determine the need for adjuvant therapy. We hypothesized that pathologic factors known after EB, combined with NAF cytology, would predict with a high degree of accuracy the presence of RC and LN spread. NAF cytology and pathologic parameters: tumour distance from biopsy margins, multifocal and multicentric disease, sub-type …

Prevalence Of Smokers Among Air-Conditioned Coaches, Pakistan, R Mal, N Rizvi, S Rathi

Section of Otolaryngology, Head & Neck Surgery

Objective: To estimate the proportion of smokers among passengers of air-conditioned (A/C) coaches running between Karachi and Hyderabad. Pakistan.METHOD: A cross-sectional survey was done on passengers and staff members of 20 air-conditioned coaches.Results: Of 847 passengers interviewed, 17.3% were smokers and 11.7% passengers smoked during travel while rest of them remained passive smokers. Out of 147 smokers 91.2% were literate persons. Among staff members 59.3% were smokers. Approximately 56% of smokers among passengers were in the age range of 14-40 years. In 95% of A/C coaches there were no anti-smoking warning signs or written words present.CONCLUSION: In this study majority …

Bilateral Cervical Radiculopathy As A Presentation Of Spinal Tuberculosis: Report Of Two Cases, G R. Sharma, Rashid Jooma

Section of Neurosurgery

No abstract provided.

Continuous Quality Assessment; Development Of A Simple Computer Based Model For Audit, N K. Waheed, F S. Awan, A Ahad, A Rahman, K M. Pal

Department of Surgery Docs

Objective: Accurate assessment of quality of care is a fundamental first step in the process of quality improvement. The vast amount of data generated in a hospital mandates some form of computerization for management of information. We describe a locally developed simple computer based program to access relevant information from a hospital patient management network. The objective was to reduce the amount of manual work involved for busy clinicians attempting to audit quality of care.Methods: A single surgical procedure, Laparoscopic Cholecystectomy was chosen. Quality indicators were identified by literature review as conversion rate from laparoscopic to open cholecystectomy and length …

Giant Hypothalamic Hamartoma And Associated Seizure Types, M K. Chishti, Ashfaq A. Razzaq

Section of Neurosurgery

No abstract provided.

Thymic Hyperplasia: A Cause Of Respiratory Distress, F K. Tareen, S Hussain, F Moazam

Department of Surgery Docs

No abstract provided.

Problem Based Learning In The 3rd World Context, V Zaman

Department of Pathology and Laboratory Medicine

No abstract provided.