Surgery Commons^™

The Efficacy Of Thoratec Implantable Ventricular Assist Devices Compared To Syncardia Total Artificial Hearts As Bridge-To-Transplantation Therapy In Adults With Biventricular Heart Failure, Alexandria Davenport

Capstone Showcase

Abstract

Introduction: Systolic heart failure is a chronic condition in which there is a decrease in the heart’s ability to pump blood to the body. While there are several treatments for the symptoms of heart failure, the only curative treatment for most causes of chronic heart failure is a heart transplant. Due to the limited number of heart donors, 72.2% of patients in need of a heart transplant in 2017 spent up to 2 years waiting for a transplant. Mechanical circulatory support has been used to increase patient survival to transplantation. In the past, these machines were external devices that …

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.

Gynecologic Large Cell Neuroendocrine Carcinoma: A Review, Grant Burkeen, Aman Chauhan, Rohitashva Agrawal, Riva Raiker, Jill M. Kolesar, Lowell B. Anthony, B. Mark Evers, Susanne Arnold

Internal Medicine Faculty Publications

Large cell neuroendocrine carcinomas (LCNEC) are rare, aggressive high-grade neuroendocrine neoplasms within the neuroendocrine cell lineage spectrum. This manuscript provides a detailed review of published literature on LCNEC of gynecological origin. We performed a PubMed search for material available on gynecologic LCNEC. We analyzed 104 unique cases of gynecologic LCNECs, of which 45 were cervical primary, 45 were ovarian, 13 were uterine, and 1 was vaginal. A total of 45 cases of cervical LCNEC were identified with a median age of 36 years. Median overall survival was 16 months. We identified 45 ovarian LCNEC cases in the published literature with …

Cyto-Histological Correlation Of Thyroid Cytology And Associated Adverse Surgical Outcomes At Aga Khan University Hospital, Nairobi., Moses Barasa

Master of Medicine in General Surgery

Background: Solitary thyroid nodules are commonly encountered endocrine disorders in surgical practice. Fine Needle Aspiration Cytology (FNAC) is a minimally invasive, accurate and cost-effective diagnostic tool that provides basis for surgical decisions-making in thyroid lesions management. Thus, it’s imperative that such a test should have high diagnostic accuracy in order to avoid under or over-treatment arising from false negative or positive results respectively. Studies from the African region, compared to the developed world have reported higher thyroid cyto-histologic discrepancy. Objective: To determine the diagnostic accuracy and adverse surgical outcome of discrepant thyroid cytology. Methods: Retrospective cross-sectional analytical study conducted at …

Local Anaesthetic Wound Infusion Versus Thoracic Epidural Analgesia For Post-Operative Pain Control Following Elective Laparotomy: A Randomised Controlled Trial, Daniel Gathege Mwangi

Master of Medicine in General Surgery

Background: Post-operative pain control is an important pillar in enhanced recovery after surgery. There is a paucity of data that compares efficacy of pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients Objective: To evaluate pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients. Design: A randomised, single-blind, controlled clinical trial. Setting: Aga Khan University Hospital, Nairobi, Kenya. Population: Patients undergoing elective laparotomy. Methods: Thirty eight patients scheduled for elective laparotomy were randomized into two equal groups to receive either continuous local anaesthetic wound infusion or …

Ageism In Consent? In A Decision-Making Capable Geriatric Orthopaedic Trauma Patient Population, Does Increased Age Impact Who Physicians Consent For Surgical Fixation?, Madeline M. Mcgovern, Michael F. Mctague, Mph, Marilyn Heng, Md, Mph, Frcsc

Phase 1

Introduction: Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Our study examines the consenting process in an orthogeriatric trauma patient population to determine if there is a relationship between increased age at presentation and utilization of health care proxies (HCPs) for surgical procedure consent.

Methods: We retrospectively reviewed medical records of patients aged 65 and older admitted for an operative fracture between 2013 and 2016. Patients were considered decision-making capable if there was absence of history of cognitive impairment prior to surgical consent and if the patients screened negative in …

Renewing Hearts: Catholic Perspectives In Valve Replacement Surgery For Those Who Use Intravenous Drugs, Kimberly Feeney, Robert Perkel, Md

Phase 1

Introduction: The incidence of infectious endocarditis has been increasing, particularly among those with a history of intravenous drug use (IVDU). Although current bioethics literature supports valve surgery as treatment for this patient population, clinical guidelines and literature continues to provide unclear recommendations for physicians. Catholic bioethics may provide a different perspective to re-contextualize the recommendations of secular ethics.

Methods: A PubMed search was used to gain background information regarding the incidence of infectious endocarditis and current treatment guidelines, as well as historical and current ethical considerations. Search terms included: “infectious endocarditis,” “IE,” “intravenous drug use,” “IVDU,” “ethics.” Related citations were …

A Policy Analysis Of The 2017 Fasting Guidelines Among Gi Surgical Patients, Toney Banks

Doctor of Nursing Practice Projects

The objective of the fasting guidelines is to improve the quality and efficacy of anesthesia care. It is based on two main researched principles: The ingested material must be clear without particulates, and it must not be within two hours of the procedure. The purpose of this project is to equip the medical community with the latest guidelines on NPO (fasting), ensuring that patients are seen on time without delays or cancellations of surgery and with improved patient comfort. A retrospective chart review of 500 randomly chosen charts from patients seen at an Endoscopy Center. Pearson’s Chi-square value and the …

Minimizing Blood Loss In Spine Surgery., Christopher Mikhail, Zach Pennington, Paul M Arnold, Darrel S Brodke, Jens R Chapman, Norman Chutkan, Michael D Daubs, John G Devine, Michael G Fehlings, Daniel E Gelb, George M Ghobrial, James S Harrop, Christian Hoelscher, Fan Jiang, John J Knightly, Brian K Kwon, Thomas E Mroz, Ahmad Nassr, K Daniel Riew, Lali H Sekhon, Justin S Smith, Vincent C Traynelis, Jeffrey C Wang, Michael H Weber, Jefferson R Wilson, Christopher D Witiw, Daniel M Sciubba, Samuel K Cho

Department of Neurosurgery Faculty Papers

Study Design: Broad narrative review.

Objective: To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery.

Methods: A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery.

Results: There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous …

Quality Improvement And Spine Surgery., James Harrop

Department of Neurosurgery Faculty Papers

AO Spine North American (AOSNA) is honored to have the ability to present this focused issue on improving quality health care for spine patients. This issue is dedicated to improvements in quality for patient benefits.

Empathy In Clinical Practice: A Qualitative Study Of Early Medical Practitioners And Educators, Sonia Ijaz Haider, Qamar Riaz, Roger Christopher Gill

Department for Educational Development

Objective: To explore the reasons for decline in empathy among physicians and to identify strategiesfor fostering empathetic clinical practice.
Methods: The qualitative study was conducted at the Aga Khan University Hospital, Karachi, from February to June 2017, and comprised focus group discussions involving separate sessions with medical students, residents and clinical teachers. Content analysis was used to analyse the verbatim transcripts for identification of codes which led to derivation of themes from the data. Consolidated criteria for reporting qualitative research was used to assess the quality of the study.
Results: Of the 109 subjects, 57(52.3%) were medical students, 30(27.5%) residents …

Heightened Levels Of Antimicrobial Response Factors In Patients With Rheumatoid Arthritis, Prathapan Ayyappan, Robert Z. Harms, Jennifer A. Seifert, Elizabeth A. Bemis, Marie L. Feser, Kevin D. Deane, M Kristen Demoruelle, Ted R. Mikuls, V Michael Holers, Nora Sarvetnick

Journal Articles: Surgery

Rheumatoid arthritis (RA) is a chronic progressive autoimmune disease leading to considerable disability over time. The disease can be characterized by the presence of multiple autoantibodies in the serum and synovial fluid. Microbial dysbiosis is proposed to play a role in the pathogenesis of RA. Increased systemic bacterial exposure leads to elevated levels of antimicrobial response factors (ARFs) in the circulation. In the present study, we tested whether RA patients have increased levels of ARFs by analyzing the levels of multiple ARFs in serum from RA patients and healthy age and sex-matched controls. The levels of soluble CD14 (sCD14), lysozyme, …

Complexation-Induced Resolution Enhancement Of 3d-Printed Hydrogel Constructs, Jiaxing Gong, Carl C. L. Schuurmans, Anne Metje Van Genderen, Xia Cao, Wanlu Li, Feng Cheng, Jacqueline Jialu He, Arturo López, Valentin Huerta, Jennifer Manríquez, Ruiquan Li, Hongbin Li, Clément Delavaux, Shikha Sebastian, Pamela E. Capendale, Huiming Wang, Jingwei Xie, Mengfei Yu, Rosalinde Masereeuw, Tina Vermonden, Yu Shrike Zhang

Journal Articles: Surgery

Three-dimensional (3D) hydrogel printing enables production of volumetric architectures containing desired structures using programmed automation processes. Our study reports a unique method of resolution enhancement purely relying on post-printing treatment of hydrogel constructs. By immersing a 3D-printed patterned hydrogel consisting of a hydrophilic polyionic polymer network in a solution of polyions of the opposite net charge, shrinking can rapidly occur resulting in various degrees of reduced dimensions comparing to the original pattern. This phenomenon, caused by complex coacervation and water expulsion, enables us to reduce linear dimensions of printed constructs while maintaining cytocompatible conditions in a cell type-dependent manner. We …

Prior Tonsillectomy Is Associated With An Increased Risk Of Esophageal Adenocarcinoma., Katherine S Garman, Teminioluwa A Ajayi, Harold J Boutte, Shih-Ting Chiu, Richard J Von Furstenberg, Benjamin R Lloyd, Cecelia Zhang, Mark W Onaitis, Shein-Chung Chow, Shannon J Mccall

Articles, Abstracts, and Reports

BACKGROUND: Esophageal cancer is a deadly cancer with 5-year survival

METHODS: Cases included 452 esophagectomy cases, including 396 with EAC and 56 who underwent esophagectomy for Barrett's esophagus (BE) with high grade dysplasia (HGD). 1,102 thoracic surgery patients with surgical indications other than dysplastic BE or esophageal cancer represented the controls for our analysis. The association of tonsillectomy and HGD/EAC were primarily evaluated by using univariate tests and then verified by logistic regression analysis. Baseline demographics, medical history, and thoracic surgery controls were compared by using χ2 tests or 95% CIs. Significant risk factors were considered as covariates in the …

Prospective Molecular Profiling Of Circulating Tumor Cells From Patients With Melanoma Receiving Combinatorial Immunotherapy., Selena Y Lin, Shu-Ching Chang, Stella Lam, Romela Irene Ramos, Kevin Tran, Shuichi Ohe, Matthew P Salomon, Ali Asgar S Bhagat, Chwee Teck Lim, Trevan D Fischer, Leland J Foshag, Christine L Boley, Steven J O'Day, Dave Hoon

Articles, Abstracts, and Reports

BACKGROUND: Blood molecular profiling of circulating tumor cells (CTCs) can enable monitoring of patients with metastatic melanoma during checkpoint inhibitor immunotherapy (CII) and in combination with targeted therapies. We developed a microfluidics-based CTC platform to explore CTC profiling utility in CII-treated patients with melanoma using a melanoma messenger RNA (mRNA)/DNA biomarker panel.

METHODS: Blood samples (n = 213) were collected prospectively from 75 American Joint Committee on Cancer-staged III/IV melanoma patients during CII treatment and those enriched for CTCs. CTC profiling was performed using 5 known melanoma mRNA biomarkers and BRAF V600E DNA mutation. CTC biomarker status associations with clinical …

Persistent Reduction In The Age Adjusted Mortality Rate From Aortic Valve Surgery In The United State With Elimination Of Gender Gap In Recent Years., Mohammad Reza Movahed, Sara Etemad, Mehrnoosh Hashemzadeh, Mehrtash Hashemzadeh

Articles, Abstracts, and Reports

BACKGROUND: Advancement in the surgical techniques should translate into better outcome. The goal of this study was to evaluate mortality trends from aortic valve surgery in the United State using large inpatient database.

METHOD: The Nationwide Inpatient Sample (NIS) database was used to calculate the age-adjusted mortality rate from aortic valve surgery from 1988 to 2011 in the United State using ICD-9 coding for aortic valve surgery.

RESULTS: We found that age adjusted mortality rate from aortic valve surgery gradually decreased from 1988 until end of study in 2011 to the lowest level with elimination of gender gap that was …

Current Advancements In The Management Of Spinal Cord Injury: A Comprehensive Review Of Literature., Manan Shah, Catherine Peterson, Emre Yilmaz, Dia Radi Halalmeh, Marc Moisi

Articles, Abstracts, and Reports

Background: Spinal cord injury (SCI) carries debilitating lifelong consequences and, therefore, requires careful review of different treatment strategies.

Methods: An extensive review of the English literature (PubMed 1990 and 2019) was performed regarding recent advances in the treatment of SCI; this included 46 articles written over 28 years.

Results: Results of this search were divided into five major modalities; neuroprotective and neuroregenerative pharmaceuticals, neuromodulation, stem cell-based therapies, and various external prosthetic devices. Lately, therapeutic strategies were mainly focused on two major areas: neuroregeneration and neuroprotection.

Conclusion: Despite recent advancements, more clinical trials on a larger scale and further research are …

Targeting Homologous Recombination Addicted Tumors: Challenges And Opportunities, Talia Golan, Jonathan Brody, Md

Kimmel Cancer Center Faculty Papers

Recent advances in next generation sequencing (NGS) and molecular subtyping of tumors have opened the door to clinically available targeted therapies. Although the treatment of many solid tumors still rely on a steady regimen of non-targeted chemotherapeutic agents, it is becoming increasingly more apparent that certain tumors with defects in DNA damage repair (DDR) genes may be exquisitely sensitive to DNA damaging agents or therapies targeting key elements of this pathway such PARP1, ATR, or ATM. Still, for tumors with DDR defects the challenges are multi-fold including: (I) identifying these tumors in patients in time for a window of opportunity …

Investigation Of Molecular Mechanisms Of Liver Preservation Injury: A Complication Preceding Organ Transplantation, Ria C. Fyffe-Freil

Theses and Dissertations

Of the over 108,000 American awaiting a life-saving organ transplant today, over 12,000 (11%) of those need a new liver (OPTN, 2020). Last year, only 35% of patients on the waiting list for an organ were transplanted. Improving the quality of marginal organs by preventing or reversing preservation injury could vastly increase the number of transplants performed. Washout of circulating blood during liver procurement with cold University of Wisconsin solution flushes out any endogenous pro-survival signaling molecules. We investigated lysophospholipid (LPL) surface receptors (G-protein coupled receptors for lysophosphatidic acid (LPA) and sphingosine- 1-phosphate (S1P)) and their role in protecting hepatocytes …

Acute Mesenteric Thrombosis: A Hematologist Perspective, Bushra Moiz, Zaid Muslim, Zahraa Farrukh Siddiqui, Hasnain Zafar

Department of Pathology and Laboratory Medicine

No abstract provided.