Surgery Commons^™

Neoplastic Growth Of Cerebral Cavernous Malformation Presenting With Impending Cerebral Herniation: A Case Report And Review Of The Literature On De Novo Growth Of Cavernomas, Arshad A. Siddiqui, Rashid Jooma

Section of Neurosurgery

Background: Cerebral cavernomas are rare vascular anomalies and their expansile growth has been considered to be mainly due to recurrent hemorrhages. They are not generally reported to show aggressive behavior.
Case description: A 27-year-old male presented with headache, visual disturbances, and a 17-year history of seizures. He was known to have a temporal lobe lesion on CT scan, consistent with a diagnosis of cavernous malformation but with no relevant family history. Serial clinical and radiological follow-up revealed a progressive increase in the size of the lesion with formation of a growing cyst of 7 cm in diameter, which produced mass …

An Audit Of Blood Cross-Match Ordering Practices At The Aga Khan University Hospital: First Step Towards A Maximum Surgical Blood Ordering Schedule, T Chawla, G N. Kakepoto, M A. Khan

Department of Surgery Docs

Objective: In the absence of an explicit maximum blood order policy, ordering for blood transfusion is frequently based on subjective anticipation of blood loss instead of evidence based estimates of average requirement in a particular procedure. This study was done to assess current practice and the feasibility of a prospective randomized work to develop practice guidelines.METHOD: We audited transfusion data for elective surgical procedures in our hospital during the last 2 years. Cross-matched to transfused ratio (C/T ratio) and Transfusion Index (Ti) for each of the elective surgical procedures was performed during the study period. C/T ratio is used as …

Association Of Viral Genome With Graft Loss In Children After Cardiac Transplantation., Girish S. Shirali, J Ni, R E. Chinnock, J K. Johnston, G L. Rosenthal, N E. Bowles, J A. Towbin

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The survival of recipients of cardiac allografts is limited by rejection, lymphoproliferative disease, and coronary vasculopathy. The purpose of this study in children who had received heart transplants was to evaluate the cardiac allografts for myocardial viral infections and to determine whether the presence of viral genome in the myocardium correlates with rejection, coronary vasculopathy, or graft loss.

METHODS: We enrolled heart-transplant recipients 1 day to 18 years old who were undergoing evaluation for possible rejection and coronary vasculopathy. Endomyocardial-biopsy specimens were evaluated for evidence of rejection with the use of standard criteria and were analyzed for the presence …

Diagnostic Issues In Abdominal Tuberculosis, M R. Khan, I R. Khan, K M. Pal

Department of Surgery Docs

Objective: To analyze the modes of presentation and diagnostic issues in the management of abdominal tuberculosis at a tertiary care hospital in a developing country, where most of the established diagnostic modalities are available.SETTING: The Aga Khan University Hospital, Karachi.Methods: This study is a retrospective review of medical records of all inpatients, diagnosed to have abdominal tuberculosis, from January 1991 to December 1997. The data was collected and particularly analyzed for spectrum of presentation and role of various diagnostic modalities. Of special interest was the sub-group of patients, who after all investigations did not have a firm diagnosis. Following a …

Vestibular Schwannomas: Clinical Presentation, Management And Outcome, M S. Awan, H U. Qureshi, A A. Sheikh, M M. Ali

Section of Neurosurgery

Objective: To review the demographic trends clinical spectrum, diagnosis, management and outcome of patients with vestibular Schwannoma and to identify areas where improvements are needed.
Methods: All patients with vestibular schwannoma admitted to the Aga Khan University Hospital over the past 11 years were reviewed retrospectively.
Results: The age range of majority of 22 patients analyzed, was 41-50 years (23%). Hearing loss was the most common presenting symptom (96%). Other clinical features included cranial nerve palsies (59%) and headache (55%). Fifty percent had signs of raised intracranial pressure. Neuroimaging revealed "Stage IV b" (tumor distorting the brainstem and compressing the …

Is Extended Volume Of External Beam Irradiation Beneficial In Post-Esophagectomy High Risk Patients Receiving Combined Chemoradiation Therapy?, E. Yu, A. R. Dar, R. Ash, G. Videtic, P. Truong, L. Stitt, A. Tomiak, M. Vincent, R. Malthaner, I. Craig, E. Brecevic, W. Kocha, R. Inculet, M. Lefcoe

Oncology Presentations

OBJECTIVE: To assess the value of extended volume irradiation with anastomotic coverage in high risk resected esophageal cancer patients.

METHOD: A retrospective study was undertaken at LRCC from 1989-1999 for high risk resected esophageal cancer patients. Adjuvant treatments consisted of 4 cycles of chemotherapy (epirubicin/fluorouracil/cisplatin or cisplatin/fluorouracil), and local regional irradiation with or without coverage of the anastomotic site. Radiation dose ranged from 45-60Gy at 1.8-2.0 Gy/fraction given with initial anterior-posterior/posterior-anterior arrangement with either extended (with anastomotic coverage) or small (without anastomotic coverage) field followed by oblique fields for boost.

RESULT: One hundred eighty-eight charts were reviewed. Seventy-two patients were …

Foreign Body Granuloma After Craniotomy For Tumor: A Diagnostic Dilemma, Ashfaq A. Razzaq, M. K. N. Chishti

Section of Neurosurgery

No abstract provided.

Human Subject Research, Ethics And The Developing World, F Moazam

Department of Surgery Docs

No abstract provided.

Endocrine Cell Dysplasia (Nesidioblastosis): A Relatively Unrecognized Entity In Pakistan?, Nasim Sabir, Irshad Nabi Soomro, Zafar Nazir, Abdul Jabbar, Sheema Hasan

Section of Paediatric Surgery

Nesidioblastosis is quantitative as well as qualitative abnormality of pancreatic endocrine cells. There is scattering of small endocrine cell clusters arranged haphazardly rather than the peripheral location within the lobule^1,2. Islet contours are irregular, tailing off into parenchyma³. These islets are present in intimate association with ducts forming ductuloinsular complexes¹ We recently encountered a new born baby with signs and symptoms of endocrine cell dysplasia.

Non-Small Cell Lung Cancer: Disease Spectrum And Management In A Tertiary Care Hospital, M R. Khan, S B. Hasan, S A. Sami

Department of Surgery Docs

Objectives: To review the spectrum of presentation and the surgical management of Non Small Cell Lung Cancer (NSCLC) and the role of various diagnostic modalities in predicting the post-operative stage and the correlation of the post-operative stage with the chances of recurrence.SETTINGS: The Aga Khan University Hospital, Karachi--a tertiary care referral center in Paksitan.Methods: This is a retrospective study of medical records of all the patients who were managed at the Aga Khan University Hospital (AKUH) between 1988 and 1998. The patients with a diagnosis of lung cancer were identified using the ICD-9-CM coding system and the data was analyzed …

Surgical Management Of Penile Cancer: Report Of Two Cases, M Amjad Noor, Muhammad Hammad Ather, M Nasir Sulaiman, Farhat Abbas

Section of Urology

No abstract provided.

Genitourinary Tuberculosis: A Profile Of 55 In-Patients, N P. Buchholz, S Salahuddin, R Haque

Section of Urology

Objective: To outline the pattern and trends in major cases of genito-urinary tuberculosis (GUTB) which require hospital treatment.
Method: We retrospectively reviewed 55 patients with proven GUTB who were treated as in-patients in a major referral hospital in Pakistan.
Results: The male/female ratio was 3:1. Prevailing symptoms were lower urinary tract symptoms, flank pain, gross hematuria and fever. A urine culture was positive for tuberculosis (TB) in 57%, bladder biopsies in 54%. For renal TB, intravenous urogram (IVU) and ultrasound were suggestive in about 50% of cases. Ultrasound was very helpful in the diagnosis of testicular TB. Patients underwent surgery …

Tibial Plateau Fractures: A New Classification Scheme, Raja Muhammad Shahzad Khan, Shuja Hassan Khan, Agha Jamil Ahmad, Muhammad Umar

Section of Orthopaedic Surgery

Fractures of the tibial plateaus are common injuries. Various classification schemes have been used to describe these injuries. Although each system has its own purpose, the simpler systems do not allow comparison with more complex divisions. The problem is compounded by the variable use of adjectives that describe these fractures. A comprehensive classification of tibial plateau fractures should group fractures that are similar in topography, morphology, and pathogenesis, requiring similar treatment, and having a similar prognosis. Fracture dislocations and standard tibial plateau fractures should be incorporated into a single classification to avoid the use of two complementary classifications. Any such …

Cerebellopontine Angle Medulloblastoma, Naim-Ur-Rahman, A Jamjoom, M Al-Rayess, Z A. Jamjoom

Section of Neurosurgery

No abstract provided.

Pilomatrixoma And Pilomatrix Carcinoma Deceptively Similar But Distinct Entities, T S. Khan, A Khan

Department of Surgery Docs

No abstract provided.

Evaluating The Sensitivity Of The Nanostrong Ncounter® Analysis System To Determine Gene Expression Changes Associated With Chemotherapy Treatment, Katerina Dukleska, Md, Christopher W. Schultz, Bs, Mahsa Zarei, Phd, David Mckeown, Md, Charles J. Yeo, Md, Jonathan Brody, Phd, Jordan M. Winter, Md

Department of Surgery Posters

Introduction

• Pancreatic ductal adenocarcinoma (PDA) remains a deadly disease with a 5-year survival of 8% for all stages combined (Siegel RL et al.). Currently, it’s the third leading cause of cancer-related deaths in the United States and by 2020 it is projected to become the second leading cause (Rahib L, et al).
• The poor prognosis in PDA is in part due to the limited therapies that are currently available.
• This highlights the importance of high-throughput technologies for gene expression analyses and drug screens.
• A recently developed NanoString Technologies nCounter® analysis system, an example of high-throughput technology, utilizes a color-coded barcode …

Differential Expression Of Chemokines In A Mouse Model Of Wound Healing, Susan H. Jackman, Matthew B. Yoak, Shivaleela Keerthy, Bonnie L. Beaver

Biochemistry and Microbiology

Macrophages have a multifaceted role in wound healing. While their initial activity may be in the degradation and elimination of damaged tissue, macrophages also produce and secrete a variety of mediators that can participate in the repair process as well. To perform these functions, macrophages must be recruited to a wound site. Our purpose was to examine the temporal and spatial expression of macrophage chemoattracting cytokines (chemokines) at a surgical wound site. A surgical wound was prepared on the dorsal aspect of B6AFI/J mice. Biopsies were obtained from the wound and a comparable nonwounded area between 6 and 72 hr …

Laparoscopic Cholecystectomy At The Aga Khan Hospital, Nairobi, S. C. Patel, J. R. Bhatt

General Surgery, East Africa

Objective: To evaluate our experience of laparoscopic cholecystectomies at the Aga Khan Hospital, Nairobi over a three-year period from the inception of the technique, and to assess its value and advantages to the patients.

Design: A prospective case series study.

Setting: The Aga Khan Hospital, Nairobi.

Patients: One hundred and thirty five cases operated from February 1996 to April 1999. All patients were subjected to the American method of laparoscopic cholecystectomy, which is described in detail in this paper.

Main outcome measures: Clinical presentation, age and sex demographics, average hospital stay, intraoperative and postoperative complications and outcome.

Results: There was …

Diagnosis And Management Of The Neonatal Cloaca, A Samad, S Hussain, M Arshad, F Moazam

Department of Surgery Docs

No abstract provided.

Sirolimus-Tacrolimus Combination Immunosuppression., Vivian Mcalister, Zu-Hua Gao, Kevork Peltekian, Javier Domingues, Kamran Mahalati, Allan Macdonald

Data and Test Instruments

A series of 32 recipients of liver, kidney, or pancreas transplants who were treated with sirolimus and low-dose tacrolimus experienced a low rate of rejection and excellent graft function without drug-related toxic effects.

Canadian Medical Officers In The Royal Navy (Book Review), Vivian Mcalister

Data and Test Instruments

CANADIAN MEDICAL OFFICERS IN THE ROYAL NAVY -- WORLD WAR II. Harry Stafford Morton. 112 pp. Illust. Canadian Naval Memorial Trust, HMCS Sackville, PO Box 99000, Stn Forces, Halifax NS B3K 5X5. 2000. Can$18.00 At the beginning of the Second World War, the Royal Canadian Navy offered 90 medical officers on loan to the Royal Navy. The author was among that group, which included leaders in Canadian surgery such as Surgeon Lieutenant McLachlin of London, Ont. The history of these medical officers has not been written because it fell between histories of the Royal Canadian Navy and the Royal Navy. …

Ultrasonographic Renal Size In Individuals Without Known Renal Disease, Niels-Peter Buchholz, Farhat Abbas, Syed Raziuddin Biyabani, Qaiser Javed, Jamsheer Jehangir Talati, Masood Afzal, Imtiaz Rizvi

Section of Urology

Objective: In order to establish some preliminary data of our population, we determined the ultrasonographic kidney dimensions in individuals withoud known renal disease. We assessed whether age, sex, side, body mass index (BMI) and presence or absence of diabetes mellitus and hypertension affect the renal size.
Methods: Ultrasonographic kidney measurements were performed on 194 adult patients without known kidney lesions. Measurements included length, width, cortical thickness and estimation of renal size which was obtained by multiplying the first three variables. The effect of age, gender, side, height, weight, BNll, hypertension and diabetes mellitus was statistically analyzed.
Results: The mean kidney …

The Use Of Intra Aortic Baloon Pump In Patients Undergoing Coronary Artery Bypass Grafting At The Aga Khan University Hospital, Karachi, Aamir M. Jafarey, Muneer Amanullah, Sajid A. Khan, Sulaiman B. Hasan

Department of Surgery Docs

Objective: To review the experience in the use of Intra Aortic Balloon Pump (IABP) in patietits undergoing Coronary Artery Bypass Grafting (CABG) at a tertiary care hospital with a new Open Heart surgery program. Design: Retrospective study. Setting: The Aga Khan University Hospital, Karachi.
Patients: Medical records of all patients undergoing CABG between November 1994 and July 1997 were reviewed and those in whom IABP device was used, were included in this study.
Results: A total of 15 patients had IABP suppOrt during the study period. Four surgeries were done urgently while two were emergencies. There were three mortalities. Ejection …

Ethnic Variability In The Treatment Of Pain, Rafael A. Ortega, Benjamin A. Youdelman, Richard C. Havel

Department of Surgery Faculty Papers

Ethnicity has been shown to be an important determinant of behavior during illness, particularly when a painful condition is present. Studies have shown that pain may be undertreated among different ethnic groups of patients. Whereas individual variations in the reaction to pain occur, available data do not support racial and/or ethnic differences in the perception of pain, leaving no justification for this discrepancy in treatment. Regardless of ethnicity, inadequate treatment of pain has been known for some time and has been referred to in recent literature as "oligoanalgesia." Lack of understanding of different ethnic and cultural groups can lead to …

Spinal Cord Compression Caused By Metastatic Epithelial Myoepithelial Carcinoma Of The Parotid Gland, I N. Soomro, A S. Hussainy, K Chishti, M H. Pui, S A. Khan, R Ahmed, S H. Hasan

Department of Pathology and Laboratory Medicine

No abstract provided.

Global Cns Gene Transfer For A Childhood Neurogenetic Enzyme Deficiency: Canavan Disease., Paola Leone, Christopher G Janson, Scott J Mcphee, Matthew J During

Department of Neurosurgery Faculty Papers

The neurogenetic prototypic disease on which we chose to test our gene therapy strategy is Canavan disease (CD). CD is an autosomal recessive leukodystrophy associated with spongiform degeneration of the brain. At present the disease is uniformly fatal in affected probands. CD is characterized by mutations in the aspartoacylase (ASPA) gene, resulting in loss of enzyme activity. In this review, recent evidence is summarized on the etiology and possible treatments for CD. In particular, we discuss two gene delivery systems representing recent advances in both viral and liposome technology: a novel cationic liposome-polymer-DNA (LPD) complex, DCChol/DOPE-protamine, as well as recombinant …

Laser Skin Graft Harvesting Apparatus And Related Method, David S. Kirn

Surgery Faculty Patents

A laser dermatome is disclosed for harvesting and meshing grafts of skin. A roller driven by a motor lifts the leading edge of a portion of skin for cutting by a beam of light generated by a laser. Adhesive tape attached to the roller aids in lifting the portion of skin and is further utilized to secure the severed portion of skin to the roller. A stage mounted atop an axle supports the laser or a beam director. The movement of the stage is controlled by second and third motors which drive the stage along or rotate it about the …

Small Bowel Strangulation As Yet Another Complication Of The Rectus Abdominis Donor Site., Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

Insulinlike Growth Factor 1- And 2-Augmented Collagen Gel Repair Of Facial Osseous Defects, James S. Toung, Roy C. Ogle, Raymond F. Morgan, William H. Lindsey

School of Medical Diagnostics & Translational Sciences Publications

BACKGROUND: Defects of the facial bone structure are common problems for the facial plastic surgeon. Native type 1 collagen gels (T1CGs) have been shown to mediate repair of facial critical-size defects in rat models.

OBJECTIVE: To evaluate the efficacy of T1CG augmented with insulinlike growth factor (IGF) 1, IGF-2, and a combination of IGF-1 and IGF-2 on the repair of facial critical-size defects in a rodent model.

METHODS: Twenty-four retired male breeder Sprague-Dawley rats were divided into 4 groups of 6 animals. Facial critical-size defects were created by removing the nasalis bones with a bone-cutting drill. Defects were treated with …

Portocaval-Right Atrial Shunt, Bradley B. Hill

Surgery Faculty Patents

A shunt includes a tubular body having first and second legs at a proximal end and a third leg at a distal end. A fluid distensible balloon and cooperating insufflation conduit are carried on the tubular body. The first leg of the tubular body includes a longitudinal slit for receiving the second leg whereby the first and second legs may be positioned substantially coaxial so as to allow easier introduction of the shunt into the blood vessel of a patient. Similarly, the second leg having a longitudinally slit for receiving a portion of the cooperating insufflation conduit and also holding …