Surgery Commons^™

Moyamoya Disease Presenting With Intracranial Haemorrhage, Ali Akbar, Aftab Qureshi, Rashid Jooma

Section of Neurosurgery

No abstract provided.

Preoperative Work Up: Are The Requirements Different In A Developing Country?, K M. Pal, I A. Khan, B Safdar

Department of Surgery Docs

In developing countries there is a tendency to advocate routine testing in asymptomatic healthy patients to identify undocumented significant medical conditions. A retrospective review of pre- operative laboratory investigations undertaken in patients attending the General Surgical department was performed. Three hundred and twenty patients case notes were reviewed, patients were selected on the basis of common general surgical procedures. Two hundred and sixteen patients (67.5%) did not have any associated medical illness on history and physical examination. Analysis of laboratory results showed that 42/216 (19.4%) had low hemoglobin. An abnormal chest X-ray was the next common abnormality 11/103 (10.6%). Mild …

Dobutamine Stress Echocardiography For Assessing Coronary Artery Disease After Transplantation In Children., R L. Larsen, P M. Applegate, D A. Dyar, P A. Ribeiro, S D. Fritzsche, N F. Mulla, Girish S. Shirali, M A. Kuhn, R E. Chinnock, P M. Shah

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: The purpose of this study was to determine the feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography (DSE) for evaluating posttransplant coronary artery disease (TxCAD) in children, and to determine the frequency of selected cardiac events after normal or abnormal DSE.

BACKGROUND: Posttransplant coronary artery disease is the most common cause of graft loss (late death or retransplantation) after cardiac transplantation (CTx) in children. Coronary angiography, routinely performed to screen for TxCAD, is an invasive procedure with limited sensitivity. The efficacy of DSE for detecting atherosclerotic coronary artery disease is established, but is unknown in children after CTx. …

Posttransplant Recoarctation Of The Aorta: A Twelve Year Experience., Girish S. Shirali, C E. Cephus, M A. Kuhn, K K. Ogata, L K. Vander Dussen, R E. Chinnock, N F. Mulla, J K. Johnston, L L. Bailey, S R. Gundry, A J. Razzouk, R L. Larsen

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: This study was undertaken to investigate the incidence of posttransplant recoarctation of the aorta, delineate the mode of presentation, identify risk factors that predict recoarctation and examine the results of intervention for posttransplant recoarctation.

BACKGROUND: Patients with aortic arch hypoplasia require extended arch reconstruction at transplant, with an inherent possibility of subsequent recoarctation of the aorta.

METHODS: This was a retrospective review of all children (ageyears) who underwent cardiac transplantation over a 10-year period. Collected data included pretransplant diagnosis, details of the transplant procedure and posttransplant data including development of recoarctation of the aorta, interventions for recoarctation and the …

Appendicitis: A Continuing Challenge, K M. Pal, A Khan

Department of Surgery Docs

Acute appendicitis is a common surgical emergency in urban setting, of a developing country. The computerised hospital patient database at Aga Khan University Hospital, Karachi, was utilised to obtain records of all adults with a histologically proven diagnosis of acute appendicitis. A review of patients treated over a 18 month period was undertaken. One hundred and three appendicectomies were performed for acute appendicitis during this period. The diagnosis was clinical in all cases. Investigations like leucocyte count and lower abdominal ultrasound scan were used to improve diagnostic accuracy without a clear advantage. A number of routine investigations like, haemoglobin estimation …

Hydatidosis: Experience With Hepatic And Pulmonary Hydatid Disease, T Pishori, R Azami, S M. Ali

Department of Surgery Docs

From 1989-1992, 35 cases comprising of 20 hepatic and 15 pulmonary hydatid cysts were seen. Four patients with pulmonary hydatid disease had previous or concomitant hepatic hydatidosis compared to no concomitant pulmonary hydatid disease in the hepatic group. Hepatic hydatid disease had a greater tendency to be right sides, infected and calcified. Anaphylactic reactions occurred in 3 of 20 patients with hepatic hydatid disease against none in 15 patients with pulmonary disease. Management consisted of evacuation, drainage and obliteration of the residual cavity by capittonage in the lung and omentoplasty in the liver. Two patients, one hepatic and one with …

Angled Snare Assembly, Bradley B. Hill

Surgery Faculty Patents

A snare assembly includes an outer, flexible sheath having a distal opening and a loop received for relative sliding movement with respect to the sheath. The loop has a proximal end and a distal end. The loop is formed from a resilient wire and includes a substantially 180° reverse bend at a midpoint forming the distal end and the ends of the wire are fastened together at the proximal end. A control handle is carried on the sheath for extending and retracting the loop out of and into the sheath through the distal opening. A flexible connector connects the control …

Primary Spinal T-Cell Rich B-Cell Lymphoma: A Case Report, Suhail Muzaffar Suhail Muzaffar, Irshad Nabi Soomro, Naila Kayani, Shahid Siddiqui, Yousuf A. Husein, Rashid Jooma

Department of Pathology and Laboratory Medicine

No abstract provided.

Acquired Arterio-Venous Fistula With Mycetoma: Two Entities Coinciding: A Case Report, Saldar Nasim Khan, Nabil Wasif, Masood Umar, Mohamrnad Umar

Section of Orthopaedic Surgery

No abstract provided.

Open Fractures Caused By High Velocity Missiles: The Outcome Of Treatment Of 39 Fractures Followed For 1-3 Years, M A. Khan, R Hussain, S H. Khan, M Umar

Department of Surgery Docs

Between 1993 and 1995, thirty-three patients having 39 fractures caused by missiles fired from a high velocity rifle were reviewed retrospectively between 1 and 3 years after injury and the outcome of treatment assessed. Majority (33 out of 39) were Grade III. Union was achieved in 35 out of 39 fractures, there was deep infection and delayed union in one case each. Non-union occurred in three fractures. The fractures were stabilized using different techniques, but highest complication rate was seen with the use of the static external fixator. This was related to the severe nature of the injury as well …

The Optimal Fontan Connection: A Growing Extracardiac Lateral Tunnel With Pedicled Pericardium., S R. Gundry, A J. Razzouk, M J. Del Rio, Girish S. Shirali, L L. Bailey

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: The concept of a lateral tunnel for the Fontan operation is now widely accepted. Most lateral tunnels are constructed intraatrially with the use of aortic crossclamping. Construction of extracardiac lateral tunnels with the use of homografts or other nonviable tubes eliminates aortic crossclamping but lacks growth potential in length or width. The native pericardium, which is "sealed" posteriorly along the pulmonary artery, atrium, and inferior vena cava, could be turned down onto the right atrium to form a viable extracardiac lateral tunnel.

METHODS: We designed and successfully constructed extracardiac lateral tunnels using viable autologous pericardium, pedicled on its lateral …

Method For Employing The Delta Opioid Dadle To Extend Tissue Survival Time During Ischemia, Sufan Chien

Surgery Faculty Patents

This invention concerns a method for extending the survival time of mammalian lung tissue subjected to ischemia, by which said tissue is perfused with a preservation solution comprising a therapeutic dose of the delta opioid DADLE ([D-Ala²,D-Leu⁵]-Enkephalin) under hypothermic conditions.

Endothelial Nitric Oxide Synthase And Growth Factor Regulation Of Flow-Mediated Vascular Remodeling, David Anthony Tulis

Theses and Dissertations in Biomedical Sciences

This study was designed to characterize structural remodeling of male Wistar rat mesenteric arteries exposed to elevated blood flow in vivo for 1, 3, or 7 days. A series of arterial ligations induced blood flow increases in ileal and second-order branch arteries compared to same animal control vessels. Neither mean carotid nor local mesenteric arterial pressures changed significantly pre- to post-ligation. The primary flow-mediated force in both vessels was shear stress with possible involvement of acute stretch-induced wall stress in the ileal artery. Significant luminal expansion and medial wall hypertrophy occurred in the ileal and second-order arteries in a time-dependent …

Fine Needle Aspiration Cytology In Parotid Lumps, A Zafar, M Shafi, S H. Hassan, S Malik

Section of Otolaryngology, Head & Neck Surgery

Over a period of two years, Fine Needle Aspiration Cytology (FNAC) was performed on 33 patients presenting with a parotid lump. Five patients were excluded as they were treated medically after FNAC report. The FNAC results of 28 cases were compared with histopathological diagnoses of surgically resected specimens. There were 8 true positive, 17 true negative, 1 false positive and 2 false negative cases. Sensitivity was 80%, specificity 94.4% and diagnostic accuracy 89.3%. FNAC is a simple quick, accurate and virtually complications free investigative modality. It is also helpful adjunct to assess preoperatively the suitability and extent of the surgical …

Mirizzi Syndrome Type Ii: Is Laparoscopic Cholecystectomy Justified?, D C Desai, R D Smink

Department of Surgery Faculty Papers

Mirizzi syndrome type II is an uncommon cause of obstructive jaundice caused by an inflammatory response to an impacted gallstone in Hartmann's pouch or the cystic duct with a resultant cholecystocholedochal fistula. Two cases of Mirizzi syndrome type II are presented. Clinically only one patient had jaundice and endoscopic retrograde cholangiopancreatogram (ERCP) established a preoperative diagnosis of Mirizzi syndrome. The other patient's diagnosis of Mirizzi syndrome was made intraoperatively. It is important to properly identify the anatomy at the time of surgery to avoid compromising the common bile duct. Operative treatment of Mirizzi syndrome type II includes laparoscopic or open …

Protection With High-Pressure Irrigation Of Contaminated Wounds., Robert X. Murphy Jr, Md, Ms

Department of Surgery

No abstract provided.

Ambulatory Arthroscopic Knee Surgery Results Of Partial Meniscectomy, Muhammad Umar

Section of Orthopaedic Surgery

In an open prospective study the results of arthroscopic partial meniscectomy were reviewed in 188 knees. Group I comprised of 139 (65%) knees with pure meniscus lesions without any ligament laxity, the remaining 49 (35%) knees in group II had anterior cruciate ligament (ACL) deficiency in addition to meniscus lesions. In group I, 93% had excellent to good and 7% had fair results by criteria of Tapper and Hoover. In group II, 75% had excellent to good and 25% had fair results. Arthroscopic knee surgery was a good method of identifying patients in group II who required anterior cruciate reconstruction. …

Axotomy And Regeneration Of The Rat Facial Nerve: A Histomorphometric Study Of The Facial Nucleus, Nerve And Orbicularis Oculi Muscle In An Experimental Model Of Facial Paralysis, Peter Konstantinos Thanos

Theses and Dissertations in Biomedical Sciences

One of the most unsettling sequela of facial paralysis (FP) is the loss of eye sphincter function and the blink response, leading to functional, psychological and aesthetic deficits. A medley of restorative microsurgery approaches have been employed in treating these deficits, however full recovery of function remains elusive. The present research utilized the rat model of facial paralysis, and consisted of three stages. Stage I examined the facial motor neuron (FMN) pool of the eye sphincter (orbicularis oculi muscle=OOM) and identified the facial nerve branch which provides the majority of innervation to the OOM. II. Examined the efficacy of the …

Re: Midpalmar Approach To The Carpal Tunnel: An Alternative To Endoscopic Release., Robert X. Murphy Jr, Md, Ms

Department of Surgery

No abstract provided.

Punitive Damages...Just So You Know., Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

Method Of Tendon Repair, Bradley B. Hill

Surgery Faculty Patents

A method for repairing a transected or torn flexor or extensor tendon of a finger that has retracted proximally within its protective sheath includes the steps of: (a) visually locating a distal end of the tendon within the sheath; (b) engaging the distal end of the tendon, (c) pulling the tendon distally through the sheath to a tendon mending position; and (d) repairing the tendon.

Needle Localization Of Non-Palpable Breast Lesions, S Khan, N Mitha, F Kazi, M Siddiqui

Department of Surgery Docs

Screening mammography identifies suspicious, non palpable mammary lesions. Mammographic needle localization (MNL) is currently being used to facilitate excision biopsy of these lesions. Thirty-two patients underwent biopsies of the breast after MNL for non-palpable lesions. Mammographic indications for biopsy consisted of microcalcifications (48%), mass or abnormal density (21%) or mass+abnormal density (24%). The carcinoma was identified in four cases (12%). Two of these were in situ, one was microinvasive and one was frankly invasive. Three were treated with a modified radical mastectomy. One of these non palpable lesion demonstrated nodal metastasis but none showed distant metastasis. All radiologically detected abnormalities …

Penile Fracture, M A. Khan, M N. Sulaiman

Department of Surgery Docs

No abstract provided.

Prefabrication Of A Secondary Tram Flap., Geoffrey G. Hallock Md

Department of Surgery

A secondary TRAM flap was prefabricated in a rat model using the rectus muscle. The right rectus muscle was elevated as an inferiorly pedicled muscle flap in one experimental group (n = 6) and as a superiorly pedicled muscle flap in a second group (n = 5) and then sandwiched between a silicone sheet and the abdominal skin. Two weeks later, the abdominal skin and attached rectus muscle were elevated over the silicone sheet as a secondary TRAM flap. The surviving skin paddle areas of these prefabricated TRAM flaps were compared with superiorly (n = 7) and inferiorly (n = …

Complications, Untoward Events, And Reality., Geoffrey G. Hallock Md

Department of Surgery

The only surgeons who do not have deal with complications are those who do not operate.1

The Extranasal Glioma - A Cause Of Neonatal Respiratory Distress, Muneer Amanullah, F Attar Z

Department of Surgery Docs

Normal brain tissue in an abnonnal configuration, occurring at a site away from the cranial cavity, is temied an Extranasal Glioma. Since its first description in 1852 by Reid², only 140 patients with this entity have been reported. Heterotopic brain tissue when present in a confined area may cause obstmction, pressure and pain. Its occurrence in the nasopharyngeal region is relatively rare and only 19 cases have been reported so far², the majority presenting with respiratory distress in the early neonatal period. The objective of this report is to create an awareness amongst the physicians of …

Knowledge, Sources Used And Factors Considered In The Surgical Treatment Decisions Of Women With Breast Cancer, Debra J. Bisel

Masters Theses

The purpose of this replication study was to examine how women with breast cancer reached their decision for surgical treatment (Ward, Heidrich and Wolberg 1989). Twenty-one women who met the surgical criteria, i.e. option for Breast Conserving surgery or Modified Radical Mastectomy, completed four surveys 1 to 7 days post operatively. The women were divided into two groups, 13 who had Breast Conserving surgery and 8 who had Modified Radical Mastectomy. The surveys assessed demographic characteristics of the groups, the level of knowledge regarding breast cancer, factors considered important in reaching the decision for surgery and the sources of information …

Ventricular Remodeling Following Infant-Pediatric Cardiac Transplantation. Does Age At Transplantation Or Size Disparity Matter?, Girish S. Shirali, F Lombano, W L. Beeson, D A. Dyar, N F. Mulla, A Khan, J K. Johnston, R E. Chinnock, S R. Gundry, A J. Razzouk

Manuscripts, Articles, Book Chapters and Other Papers

Early left ventricular (LV) remodeling following pediatric cardiac transplantation has not been described. To identify patterns and determinants of change in left ventricular mass and volume posttransplant, we studied 125 consecutive children who underwent cardiac transplantation between January 1, 1989 and July 31, 1993. Two-dimensional imaging-directed M-mode echocardiograms were studied weekly until 26 weeks post-transplant. LV mass and volume (indexed to BSA1.5) were measured. LV mass index increased until 3 weeks post-transplant, and then decreased. The mean decrement in LV mass index after 8 weeks post-transplant (relative to baseline) was significantly larger in patients with donor-recipient weight ratio > 1.5 compared …

Constitutive Alzheimer's-Type Tau Epitopes In A Neuritogenic Rat Cns Cell Line, Mary P. Lambert, Shasta Sabo, Chi Zhang, S. Ather Enam, William L. Klein

Section of Neurosurgery

Paired helical filaments (PHFs) of Alzheimer's disease (AD) largely comprise hyperphosphorylated forms of the cytoskeletal protein tau. AD-type tau phosphoepitopes, detected by various monoclonal antibodies, are absent from normal adult neurons, but recent studies have shown that their expression may contribute to neuritogenesis and axon differentiation in the developing nervous system. Therefore, we have examined a brain nerve cell line that is spontaneously neuritogenic for possible expression of AD-type tau epitopes. The neuritogenic rat brain cell line B103 was found to constitutively produce two AD-related epitopes of tau, detected by cellular immunofluorescence studies with the PHF-1 and Alz-50 monoclonal antibodies. …

The Rat Tram Flap: A Human Analogue?, Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.