Surgical Procedures, Operative Commons^™

Analgesic Efficacy Of Perineural Dexmedetomidine With Bupivacaine In Adductor Canal Block For Post Total Knee Arthroplasty: A Randomized Controlled Trial, Vachira Udompornmongkol

Chulalongkorn University Theses and Dissertations (Chula ETD)

Objectives: The primary objective was to study the anaนาlgesic efficacy of perineural dexmedetomidine with bupivacaine in adductor canal block (ACB) in patients undergoing total knee arthroplasty (TKA) and the secondary objectives were to investigate the ambulation ability and the side effects. Materials and Methods: Sixty patients aged 18-85 years, ASA status I-III underwent primary, unilateral TKA under spinal anesthesia. They were randomized into 2 groups; Group C received 20 ml 0.25% bupivacaine and Group D received 20 ml 0.25% bupivacaine plus 0.5 mcg/kg dexmedetomidine for ACB. The primary outcome was 1st rescue analgesic duration. 24-hour morphine consumption, postoperative pain score, …

Vaginal Atrophy Treatment Using Microablative Fractional Carbon Dioxide Laser: A Randomized Patient And Evaluator-Blinded Sham-Controlled Trial, Purim Ruanphoo

Chulalongkorn University Theses and Dissertations (Chula ETD)

Introduction: In recent years, microablative fractional carbon dioxide (CO2) laser becomes popular in treatment of vaginal symptoms including vaginal atrophy. This study aimed to evaluate efficacy of vaginal CO2 laser in treatment of vaginal atrophy, compared to the sham procedure. Methods: Between June 2016 and May 2017, postmenopausal women with moderate to severe intensity of any symptoms of vaginal atrophy were invited to the study. A total of 88 women were randomized for treatment with vaginal CO2 laser or sham procedure every 4 weeks for 3 sessions. The participants were blinded to the intervention they received. The operator was also …

The Positive Effects Of Exercise On Active Transplant Recipients And Its Impact On Medication Adherence, Travane Morrison

Theses

Organ failure is a life-threatening condition (Daugirdas et al, 2014). Non-adherence to medication is one of the main causes of the failure of a transplanted organ (Oberlin et al, 2016). In an effort to combat non-adherence to medication, research had employed intervention studies to tackle the main cause of non-adherence (Chisholm-Burns, 2013). The aims of this project are three fold. Firstly it aims to find if complications associated with organ transplant affect the individual’s medication adherence. Secondly, it explores the connections between exercise and medication adherence. Thirdly the research explores if exercise assists with possible complications associated with an organ …

The Efficacy Of Acute Normovolemic Hemodilution Compared To Cell Salvage As A Blood Transfusion Alternative, Julia Yu

Capstone Showcase

Blood transfusions are currently the treatment of choice for significant blood loss. However, there are a variety of reasons for which they cannot be utilized. Current alternatives are acute normovolemic hemodilution (ANH) and cell 1 This study analyzes whether ANH or cell salvage is more effective in minimizing blood loss in perioperative or trauma patients. Multiple different studies involving either ANH or cell salvage were compared to each other. However, due to the lack of research conducted in either method, results obtained were largely inconclusive.

Torsion Of An Accessory Spleen In A Child With Biliary Atresia Splenic Malformation Syndrome., David A. Simon, Nathan R. Fleishman Md, Pamala Choi, Jason D. Fraser, Ryan T. Fischer

Manuscripts, Articles, Book Chapters and Other Papers

Torsion of an accessory spleen is an exceedingly rare cause of abdominal pain in pediatric patients. The diagnosis is frequently challenging as presentation is variable and diagnostic imaging can be aspecific. The current case describes an unusual presentation of a torted accessory spleen in a 5-year-old girl with biliary atresia splenic malformation syndrome who initially presented with non-specific abdominal symptoms and fever. The diagnosis was made following fine-needle aspiration of a suspected intraabdominal abscess. The case highlights the diagnostic challenge of accessory splenic torsion and stresses the importance of its inclusion on the differential diagnosis of pediatric patients, especially those …

Open Surgery With Intraoperative Enteroscopy In Jejunoileal Massive Bleeding In Pediatric Patient: An Evidence-Based Case Report, Rini Y. Husni, Kshetra Rinaldhy

The New Ropanasuri Journal of Surgery

Introduction. A case report of surgical exploratory laparotomy with intraoperative enteroscopy (IOE) as a treatment in massive jejunoileal bleeding in children.

Method. We conducted a literature search on databases such as Cochrane, PubMed, ScienceDirect, and Google Scholar. Abstract and title screening was done based on exclusion criteria, inclusion criteria, and double filtering. The selected article then reviewed using critical appraisal tools based on its validity, importance, and applicability. Selected articles were benchmark to the discussion.

Results. The application of open surgery with IOE as the final treatment that can be recommended in the critical or life-threatening condition …

Chlorhexidine Gluconate Vs Povidone-Iodine In The Prevention Of Clean-Contaminated Surgical Site Infections, Erin Layne, Abigail Stone

Physician Assistant Capstones, 2016 to 2019

Abstract

Background:

A patient’s skin is the major source of pathogens that can cause post-operative complications such as surgical site infections (SSIs). Optimization of pre-operative skin antisepsis is obtained with chlorhexidine gluconate (CG) and povidone-iodine (PI). These two solutions are the most widely used antiseptics for pre-operative purposes.

Objective:

Among surgical patients greater than 18 years of age undergoing clean-contaminated surgery, which antiseptic, iodophors or chlorhexidine gluconate, is more effective at reducing postoperative surgical site infections?

Methods:

A search was done in PubMed utilizing the terms chlorhexidine, infection control, iodophors, and surgical site infection. The limits applied included randomized …

Ulnar Collateral Ligament Reconstruction With Traditional Docking Compared To Novel Surgical Techniques, Kayley D. Guy, Brendon P. Mcdermott, Kaitlin Gallagher, Tyrone Washington

Health, Human Performance and Recreation Undergraduate Honors Theses

Background: Ulnar Collateral Ligament Reconstruction (UCLR) is a surgical procedure on one of the main ligaments that provides normal stability for the elbow joint against excessive valgus stress. Damage to this ligament is common in athletes performing overhead throwing activities, primarily baseball players, due to excessive valgus stress during the throwing motion. The most common form of treatment for this type of injury is reconstructive surgery of the ligament, especially if athletes wish to return to sport participation. This type of surgery is extremely invasive and requires extensive post-operative rehabilitation in order to facilitate return to play. To date, many …

Does An Acute Achilles Tendon Rupture Become A Patient's Achilles Heel In The Long-Term?, Michaela Cm Khan

Electronic Thesis and Dissertation Repository

It is unknown if deficits in the involved limb following acute Achilles tendon rupture (AATR) persist in the long-term, or differ between patients treated operatively or non-operatively. This study investigated 43 patients 15±1 years post-AATR from a previous randomized controlled trial (RCT) that compared operative and non-operative treatment. Structural characteristics in the Achilles tendon and surrounding musculature were assessed using magnetic resonance imaging. We also performed physical examinations and evaluated performance-based and patient-reported outcomes. Overall, there were substantial differences between the involved and uninvolved limbs in most outcomes. Some outcomes improved over time from the initial RCT to the final …

Is It Fair To Compare? A Patient And Family Experience Of Two Healthcare Systems And Neurosurgical Teams Within A Two-Week Period, Laura Miller Cpxp

Patient Experience Journal

As the mother of a 28-year-old son with cerebral palsy and hydrocephalus, and as a healthcare consultant focused on patient experience and professional development, I have a unique perspective and skill set. Recently he experienced symptoms that included an excruciating headache, neck pain and lethargy. Fearing his ventriculoperitoneal shunt had malfunctioned, he went to the emergency room and was later admitted on the neuro inpatient floor for a three-day hospitalization. His original shunt had been placed in 1991, and he never had an issue with until August 2018. While in the hospital, he was informed that he was no longer …

Safe And Effective Use Of A Hands-Free Intracorporeal Retractor For Suture-Based Liver Retraction During Minimally Invasive Bariatric Procedures: Results Of A Large Case Series, Roger De La Torre, Matthew Sappington, Tom Smith, Jeremy Bryner, David Mantilla, J Stephen Scott

General Surgery

Background

Laparoscopic bariatric surgery requires retraction of the left lobe of the liver to provide adequate operative view and working space. Conventional approaches utilize a mechanical retractor that requires a dedicated incision, may cause liver damage, and often requires an assistant. This study evaluated the safety and efficacy of hands-free intracorporeal retractors in a large series of subjects undergoing laparoscopic bariatric surgery. This method eliminates the need for a subxiphoid incision, enables full surgeon autonomy, and allows for adjustments throughout the procedure.

Methods

Retrospective chart review identified all subjects at a single hospital undergoing bariatric surgery between September 2017-March 2019 …

A Novel Polyelectrolyte Multilayer Nanofilm-Based Synthetic Bioresorbable Antimicrobial Matrix Accelerated Healing Of Chronic Wounds In A Prospective Clinical Evaluation, Sarah Waterman Manning Md, David A. Humphrey, Michael J. Schurr, Eric C. Crawford, Gaurav Pranami, William Shillinglaw, Lorinda K. Baker, Michael J. Schurr

General Surgery

No abstract provided.

Endoscopic Management Of A Surgical Clip Found Within The Common Bile Duct Following Remotely Performed Laparoscopic Cholecystectomy, Sheila Rastegari Do, Curtis Brewer Do, Long T. Hoang

Gastroenterology

Minimally invasive surgery with surgical clip placement has become the gold standard for management of cholecystitis and biliary colic due to its favorable safety profile and low rate of complications. Though generally safe, surgical clips may cause complications days to years after the cholecystectomy by migrating into the common bile duct and serving as a nidus for stone formation. To date, very few cases of this have been reported. While uncommon, this possibility should be considered in the differential diagnosis for choledocholithiasis with or without cholangitis post laparoscopic cholecystectomy.

Non-Incarcerated Inguinal Hernia With Sigmoidal Diverticulitis, Umair J. Khan, Ali Hassan, Kingsley Dah, M Lambing, P Mathew

Internal Medicine

Introduction: Abdominal wall hernia is defined as a protrusion of a part or whole organ through the wall of a cavity. Inguinal hernias account for 75% of abdominal wall hernias, with a lifetime risk of 27% in men and 3% in women. Indirect inguinal hernia account for 80% of total inguinal hernias. A wide variety of pathological processes can present as inguinal hernias however, large reducible inguinal hernias are quite rare. Recent studies have associated abdominal wall hernia with colonic diverticulosis, a term referred to as herniosis. This association suggests that an underlying connective tissue disorder could be a common …

Sarcoidosis Presenting With Massive Splenomegaly And Severe Epistaxis, Austen Stoelting Md, Shawn B. Esperti Do, Andrew Mangano Do, Nino Balanchivadze Md

Internal Medicine

No abstract provided.

Intraabdominal Fire During Emergency Laparotomy, Heather Christopherson Md, Alan Kroll Md

Anesthesiology

72 yo obese male presented to ED for 2 day history abdominal pain: sharp, radiating bilateral upper quadrants, n/v/constipation. Patient took entire bottle magnesium citrate, pain became unbearable. On arrival SaO2 88% RA, other vitals stable, Lactic Acid 1.85 mg/dl, CT abdomen massive free air. Taken to OR, intubated, general anesthesia, peritoneal cavity entered with cautery device. Upon entering peritoneum abdomen, flames erupted from the cavity. Flames spontaneously extinguished. No thermal injury sustained by patient. Surgeon’s eyebrows where singed, no other injuries sustained by OR staff. Patient remained hemodynamically stable, surgery proceeded without incident.

Pediatric Surgery Opioid Prescription Follow-Up, Gadison Quick, Nathaniel Aviles, Gabriel Melgarejo, Hunjung Choi, Elizabeth Edmundson

Posters

This quality improvement project is assisting general and orthopedic surgeons in gaining greater clarity when prescribing opioids for specific surgical procedures. Additional surgical services are being added to the project fall of 2019. Opioid prescribing patterns are, and will continue to be, key to all prescribing providers within our organization.

An Unusual Case Of Small Bowel Obstruction Secondary To Calcium Carbonate Use, Selsabeel Elyaman, Uma Gudur Md, Hady Khalifa, Alan Hamza, Andrew Seevaratnam Md

Gastroenterology

A Gastric Bezoar is defined as an accumulation of indigestible foreign material found in an individual’s GI tract. The incidence of gastric bezoar is 0.3% as reported by endoscopy studies. These formations usually consist of insoluble vegetable matter (phytobezoars), hair (trichobezoars), or medications (pharmacobezoar). In general, they can be asymptomatic for many years or cause nonspecific symptoms including abdominal pain, early satiety, and weight loss. However, in recent years, these have become increasingly problematic for the general population attributing to a variety of GI disturbances. We are reporting a case which revolves around a female patient with no history of …

Effect Of 3-Dimensional Virtual Reality Models For Surgical Planning Of Robotic-Assisted Partial Nephrectomy On Surgical Outcomes: A Randomized Clinical Trial., Joseph D Shirk, David D Thiel, Eric M Wallen, Jennifer M Linehan, Wesley M White, Ketan K Badani, James R Porter

Articles, Abstracts, and Reports

Importance: Planning complex operations such as robotic-assisted partial nephrectomy requires surgeons to review 2-dimensional computed tomography or magnetic resonance images to understand 3-dimensional (3-D), patient-specific anatomy.

Objective: To determine surgical outcomes for robotic-assisted partial nephrectomy when surgeons reviewed 3-D virtual reality (VR) models during operative planning.

Design, Setting, and Participants: A single-blind randomized clinical trial was performed. Ninety-two patients undergoing robotic-assisted partial nephrectomy performed by 1 of 11 surgeons at 6 large teaching hospitals were prospectively enrolled and randomized. Enrollment and data collection occurred from October 2017 through December 2018, and data analysis was performed from December 2018 through March …

System Integration Of C-Arm Robotic Prototype Using Motion Capture Guidance For Accurate Repositioning, Alireza Yazdanshenas

Mechanical Engineering Theses

One of the important surgical tools in spinal surgery is the C-Arm X-ray System. The C-Arm is a large “C” shaped and manually maneuvered arm that provides surgeons and X-ray technicians the ability to take quick quality X-rays during surgery. Because of its five degrees of freedom, the C-Arm can be manually maneuvered around the patient to provide many angles and perspectives, ensuring surgical success.

This system works fine for most surgical procedures but falls short when the C-Arm must be moved out of the way for complicated surgical procedures.

The aim of this thesis is to develop an accurate …