Surgery Commons^™

Routine Evaluation With Gastric Ultrasound To Reduce Gastric Aspiration (Regurga), Joel Jackson

Doctor of Nursing Practice Scholarly Projects

When a patient undergoes anesthesia, there are inherent risks that the providers should protect the patient from. Despite adherence to fasting guidelines established by the American Society of Anesthesiologists (ASA), patients undergoing anesthesia continue to experience intrapulmonary aspiration of gastric contents. There are several factors that delay gastric emptying, including coexisting disease, trauma, pain, and opioid use. Gastric ultrasound assessment of the gastric antrum is a relatively new technology in anesthesia and can be used to assess the gastric antrum and provide information to anesthesia providers regarding the risk of aspiration in the perioperative period. The primary aim of this …

A Case Report And Review On The Anesthetic Considerations Of Anterior Mediastinal Masses, Carter A. Schulz, Joshua D. Mohs, Andrew M. Reuter

Aesculapius Journal (Health Sciences & Medicine)

Case summary: A 15-year-old female presented with chest pain, dyspnea, and weight loss. A chest X-ray and subsequent CT scan revealed a large anterior mediastinal mass with cervical lymphadenopathy and pericardial effusion. Two biopsies under general anesthesia were performed, with the latter confirming classic Hodgkin lymphoma, nodular sclerosis subtype.

Discussion: This case underscores the significant clinical challenges posed by anterior mediastinal masses due to their proximity to vital cardiovascular and respiratory structures. Physiologic changes during general anesthesia can exacerbate these challenges. Preoperative assessment, including imaging and symptom evaluation, is crucial to guide operative planning. It is key to individualize the …

Ogilvie's Syndrome: Acute Colonic Pseudoobstruction. A Review For Residents., Tyler Bayliss, Caleb Clark, Errington C. Thompson

Marshall Journal of Medicine

Ogilvie's syndrome (acute colonic pseudoobstruction) was first described in 1948. Acute colonic pseudoobstruction can occur in a variety of clinical settings, including postsurgical, obstetrics, pelvic surgery, critical care and sepsis. Clinicians need to recognize the syndrome early. Colonic distention without evidence of obstruction can be seen on plain films of the abdomen or CT scan. Successful therapies, including bowel rest, neostigmine and colonoscopic decompression, have been used. Avoiding respiratory compromise from abdominal distention and colonic perforation of the primary goals of treatment. Surgical intervention should be reserved for patients who are refractory to medical treatment or develops signs and symptoms …

Ultrasound – An Underutilized Diagnostic Tool For Ventricular Assist Device Driveline Infections, Kristina Krzelj, Tomislav Tokic, Tomislav Kopjar, Maja Cikes, Davor Milicic, Hrvoje Gasparovic

The VAD Journal

Patients with ventricular assist device (VAD) driveline infections (DLI) have reduced quality of life and increased risk of severe complications, such as sepsis, hemorrhagic or ischemic stroke, and wound infections. The management of VAD patients imposes a significant financial burden due to prolonged in-hospital stays, frequent re-admissions, expensive diagnostics, and the need for antibiotic therapy and/or surgical intervention. There is considerable room for improvement in DLI management, particularly in the early detection and treatment stages. Ultrasound, an easily applicable device available in almost every hospital, offers an unrecognized potential for the early detection of DLI. By increasing awareness about the …

La Incidencia Y El Tratamiento De Las Hernias En Ecuador En Comparación Con Los Estados Unidos Y Otros Países Del Mundo, Caleb Smith

NEXUS: The Liberty Journal of Interdisciplinary Studies

No abstract provided.

Echocardiographic Parameters Associated With Less Reverse Left Ventricular Remodeling After Transcatheter Aortic Valve Implant In Subjects With Prosthesis Patient Mismatch, Andrew C. Peters, Fei Fei Gong, Ashvita Ramesh, Adin Andrei, Madeline Jankowski, Eric Cantey, Vincent Chen, James D. Thomas, James D. Flaherty, S. Christopher Malaisrie, Kameswari Maganti

Division of Cardiology Faculty Papers

BACKGROUND: Transaortic valve implant (TAVI) is the treatment of choice for severe aortic stenosis (AS). Some patients develop prosthesis patient mismatch (PPM) after TAVI. It is challenging to determine which patients are at risk for clinical deterioration.

METHODS: We retrospectively measured echocardiographic parameters of left ventricular (LV) morphology and function, prosthetic aortic valve effective orifice area (iEOA) and hemodynamics in 313 patients before and 1 year after TAVI. Our objective was to compare the change in echocardiographic parameters associated with left ventricular reverse modeling in subjects with and without PPM. Our secondary objective was to evaluate echo parameters associated with …

A New Perspective On Intervertebral Disc Calcification-From Bench To Bedside, Emanuel Novais, Rajkishen Narayanan, Jose Canseco, Koen Van De Wetering, Christopher Kepler, Alan Hilibrand, Alex Vaccaro, Makarand Risbud

Department of Orthopaedic Surgery Faculty Papers

Disc degeneration primarily contributes to chronic low back and neck pain. Consequently, there is an urgent need to understand the spectrum of disc degeneration phenotypes such as fibrosis, ectopic calcification, herniation, or mixed phenotypes. Amongst these phenotypes, disc calcification is the least studied. Ectopic calcification, by definition, is the pathological mineralization of soft tissues, widely studied in the context of conditions that afflict vasculature, skin, and cartilage. Clinically, disc calcification is associated with poor surgical outcomes and back pain refractory to conservative treatment. It is frequently seen as a consequence of disc aging and progressive degeneration but exhibits unique molecular …

Oncoplastic Nipple Sparing Mastectomy And Immediate Reconstruction In Non-Ideal Candidates, Aaron I. Dadzie, Paul Berry

Research Symposium

Background: Mastectomies have long been used as a surgical treatment for malignant and benign disorders of the breast, both as a therapy and prophylaxis in high-risk patients. A nipple-sparing mastectomy (NSM) allows for removal of most of the glandular and ductal tissues while preserving the surface architecture of the nipple-areola complex (NAC). In satisfactory surgical candidates, this procedure allows for superior aesthetic outcomes compared to other mastectomy techniques and minimizes the need for additional procedures to reconstruct the nipple. Here, we summarize the established treatment standards and suggest an expansion of the established surgical techniques and selection criteria of NSM …

Whole Blood In Trauma, Jason P. Prevelige

Pacific Journal of Health

Abstract: Hemorrhage is a leading cause of death in trauma patients. Whole blood administration in trauma has gained a renewed interest in recent years, however the concept is not new at all, with its origins spanning over 100 years. Field experience in United States’ military conflicts has provided important data on the efficacy of whole blood in reducing mortality and amount of blood product administration. Civilian trials however have not necessarily shown similar results. The safety of whole blood however does not seem to be in question given the available data, and is an acceptable option for blood replacement in …

Phenytoin-Induced Cerebellar Atrophy: A Case For Reversibility Of Neurological Decline., Edwin Mogere, Davis Cheruiyot, Nassiuma Manakhe

General Surgery, East Africa

This case serves as a reminder of the infrequent, yet consequential occurrence of cerebellar degeneration linked to phenytoin usage. Whilst emphasizes the importance of monitoring patients on long-term phenytoin therapy, and it further suggests considering employing bedside imaging tools such as Ultrasound fusion imaging for follow-up of patients at risk of this type of disorder. We present a case study involving a 23-year-old woman who experienced significant neurological impairment resulting in severe cerebellar atrophy while undergoing phenytoin treatment. On cessation of phenytoin, the patient exhibited improvement with enhanced cerebellar function.

The Impact Of Covid-19 Pandemic On Global Neurosurgery Collaborations., Alvan Emeka Ukachukwu, Nancy Abu Bonsrah, Andreas Seas, Zoey Petitt, Romaric Waguia Kouam, Samantha Ramos, Alyssa Edwards, Di Deng, Michael Haglund, Mahmood Qureshi

General Surgery, East Africa

No abstract provided.

The Management And Outcomes Of Hepatocellular Carcinoma In Sub-Saharan Africa: A Systematic Review., Sanju Sobnach, Urda Kotze, Wendy Spearman, Mark Sonderup, Pueya Nashidengo, Chikwendu Ede, Elie Keli, Onesai Chihaka, Luiz Zerbini, Yifan Li, Karan Gandhi

General Surgery, East Africa

Background: Hepatocellular carcinoma (HCC) is a leading cause of mortality in sub-Saharan Africa (SSA). This systematic review aimed to appraise all population-based studies describing the management and outcomes of HCC in SSA.

Methods: A systematic review based on a search in PubMed, PubMed Central, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AfricaWide and Cochrane up to June 2023 was performed. PRISMA guidelines for systematic reviews were followed. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration no: CRD42022363955).

Results: Thirty-nine publications from 15 of 48 SSA countries were …

Preoperative Predictors Of Arthroscopic Partial Meniscectomy Outcomes: The Apm Index Score, Natalie Lowenstein, Yuchiao Chang, Hanna Mass, Angela M. Mercurio, Chierika Ukogu, Jeffrey N. Katz, Elizabeth G. Matzkin

Alpha Omega Alpha Research Symposium Posters

Problem Statement:

- Arthroscopic partial meniscectomy (APM) has been shown to be the most common meniscal surgical treatment in the United States

- Pre-op risk factors known to contribute to poor outcomes after APM:

• Symptom duration and radiographic OA at baseline

• Baseline knee functional score, location of meniscal tear, BMI, activity level, age, sex, and chondral damage on MRI

Project AIM:

To create an index score using easily available preoperative risk factors such as Kellgren-Lawrence (KL) grade, age, duration of symptoms, BMI, activity level, and preoperative outcome scores to predict the …

Volar V-Y Advancement Flaps In Reconstructing Fingertip Injuries, Sawsan Abiad

BAU Journal - Science and Technology

Fingertip injuries with exposed bones and joints require immediate or early closure for the preservation of function and avoidance of complications. The ideal procedure should maintain the length of the finger and cover the defect with non-tender, well-padded skin with normal sensation. The aim of this study was to evaluate the role of the different types of volar V-Y advancement flaps in reconstructing and resurfacing injuries of the fingertips at different levels and angles. Thirty patients (N=30) sustaining fingertip injuries of variable etiology and lost components, type III & IV according to Allen’s classification were divided into two groups (n=15) …

Factors Influencing Ulcer Healing In Chronic Limb Threatening Ischemia Patients After Endovascular Angioplasty At Cipto Mangunkusumo General Hospital, Raden Suhartono, Ghany H. Wijaya, Akhmadu Muradi

The New Ropanasuri Journal of Surgery

Introduction. Chronic limb–threatening ischemia (CLTI) can cause rest pain in the lower extremities and the formation of ulcers or gangrene. Revascularization, which can be done using open surgery or endovascular procedures, is the first line of treatment in CLTI management. CLTI patients at CMGH usually came with advanced conditions and high re–amputation rates even after revascularization. This study aimed to determine factors associated with the outcome of endovascular angioplasty, especially ulcer healing.

Method. A cross–sectional study was conducted at CMGH, enrolling CLTI patients with Rutherford grades 5 and 6 who underwent angioplasty. Age, gender, history of smoking, hypertension, atrial fibrillation, …

Neutrophil-Lymphocyte-Ratio As Predictor Of Morbidity And Mortality In Adults With Gastrointestinal Obstruction, Agi S. Putranto, Bimo D. Pramesta

The New Ropanasuri Journal of Surgery

Introduction. Gastrointestinal (GI) obstruction is a condition that often requires surgery and can lead to severe complications. The neutrophil-to-lymphocyte ratio (NLR) has been used as an inflammation indicator in various medical conditions, but research on the relationship between NLR and GI obstruction is still limited. Therefore, this study aims to evaluate the role of NLR as a cost-effective and simple preoperative predictor of postoperative mortality and morbidity, mainly surgical site infection, in adult patients with GI obstruction.

Method. This cross-sectional study was conducted at Cipto Mangunkusumo General Hospital in Jakarta. The study sample consists of 150 adult patients with GI …

Correlation Of Thyroid Stimulating Hormone (Tsh), T3, And T4 Hormones With Histopathological Characteristics Of Thyroid Cancer At Cipto Mangunkusumo General Hospital, Ahmad Kurnia, Kristaninta Bangun, Fatahillah Muazdhani

The New Ropanasuri Journal of Surgery

Introduction. In a study spanning 2008 to 2012 at Cipto Mangunkusumo General Hospital (CMGH) Jakarta, 668 cases of thyroid cancer were identified among 18,216 cancer cases. Globally, the papillary subtype is prevalent, and prior research indicates a link between thyroid hormone changes and thyroid carcinoma risk. To improve surgical care, this study aims to find the association between thyroid hormone levels and histological subtypes in thyroid carcinoma patients.

Method. This cross-sectional study focused on thyroid cancer patients managed from 2013 to 2017. Despite subjects' characteristics, thyroid hormone levels and histopathological findings were the variables of interest. The findings were analyzed …

Open Sympathectomy Effectiveness On Buerger's Disease’S Pain: An Evidence–Based Case Report, Rangga S. Prawiro, Alexander J. Utama

The New Ropanasuri Journal of Surgery

Introduction. Thromboangiitis obliterans, often referred to as Buerger's disease, is a vascular disease that causes chronic inflammatory conditions, edema, and vascular obstruction due to blood clots. In Cipto Mangunkusumo General Hospital (CMGH), sympathectomy is a rarely done procedure. This evidence–based case report aimed to prove the effectiveness of sympathectomy for Buerger's Disease to reduce pain.

Method. We reported a case of 44–year–old male with progressive pain and a history of darkened fingers of left limbs six months before admission. The patient underwent a lumbar sympathectomy, and there was no recurrence of symptoms after one year of follow–up. A systematic literature …

Outcome Of Endovascular Procedure In Chronic Limb Ischemia Femoropopliteal Lesion: A Literature Review, Alexander J. Utama, Robby E. Thio

The New Ropanasuri Journal of Surgery

Introduction. Angioplasty and stenting are the two main endovascular treatments for femoropopliteal lesions associated with chronic limb ischemia. To summarize the research in this area, this article examines the state of these treatments today, diving into clinical subtleties and new trends. The objectives was to thoroughly analyze the body of research, combining knowledge about the results of endovascular angioplasty and stenting.

Methods: Literature was searched in some databases (Cochrane, PubMed, and EBSCO) from June to July 2021.

Results: Five articles that met the inclusion and exclusion criteria were identified. There were two randomized control trials and three cohort …

D-Dimer And Ultrasonography As The Early-Diagnostic Tools For Lower-Limb Trauma Patients With Deep Vein Thrombosis: A Literature Review, Faranita Muchtar, Akhmadu Muradi

The New Ropanasuri Journal of Surgery

Introduction. The mortality of venous thromboembolism increased among trauma patients. Both the D-dimer test and ultrasonography are selected to diagnose venous thromboembolism due to non-traumatic causes but are rarely utilized in emergency trauma settings.

Objectives. This literature review comprehensively explains the accuracy of the D-dimer test and ultrasonography for deep vein thrombosis (DVT) diagnosis. This study finding might broaden the diagnostic recommendation for traumatic patients with deep vein thrombosis.

Method. This study used articles from four distinct journal databases. Only eight of the 480 articles found during searching proceeded with the screening process. Thus, five articles were included …