Surgery Commons^™

Retroperitoneal Hematoma, Christopher Mondie, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Retroperitoneal hematoma is defined as bleeding into the retroperitoneal space. This clinical entity is often occult and under-recognized by clinicians and is a cause of significant morbidity and mortality. Often patients do not manifest clinically apparent signs and symptoms until a substantial amount of blood loss has occurred. It is not uncommon for patients to present in frank hemorrhagic shock due to an underlying retroperitoneal hematoma. The retroperitoneal space lies directly posterior to the peritoneal cavity. An organizational schema dividing the retroperitoneal space into three different “zones” is widely prevalent in the surgical literature. The central-medial zone (Zone I) falls …

Health Care Professionals’ Compliance To Tracheal Suctioning Policy At A Tertiary Care Hospital, Rozina Khimani, Fauziya Ali, Salma Amin Rattani, Mohammad Sohail Awan

Department of Surgery Docs

Objective: To assess the compliance of tracheal suctioning practices against the standard guidelines of a tertiary care hospital, with regard to the participants’ professional characteristics.
Methods: Using cross sectional study design, forty health care professionals (HCPs) were assessed twice, using a quantitative structured observational design, for tracheal suctioning practices, in one of the surgical care units of the tertiary care hospital. Tracheal suctioning policy which was used as a tool, its inter-rater reliability was tested and each step showed the Kappa value of 0.65 to 1.000. Data was analyzed using epidata info version 3.5.1 and SPSS version 19.
Results: From …

Recanalization Of The Chronically Occluded Internal Carotid Artery: Review Of The Literature., Mario Zanaty, Jorge A. Roa, Pascal Jabbour, Edgar A. Samaniego, David M. Hasan

Department of Neurosurgery Faculty Papers

Introduction: We reviewed the literature on interventions for patients with medically refractory chronically occluded internal carotid artery (COICA) to assess the risks and/or benefits after recanalization via an endovascular technique (ET) or hybrid surgery (HS, i.e., ET plus carotid endarterectomy).

Methods: A systematic search of the electronic databases was performed. Patients with COICA were classified into 4 different categories according to Hasan et al classification.

Results: Eighteen studies satisfied the inclusion criteria. Only 6 studies involved an HS procedure. We identified 389 patients with COICA who underwent ET or HS; 91% were males. The overall perioperative complication rate was 10.1% …

Early Surgery For Traumatic Spinal Cord Injury: Where Are We Now?, Jefferson R. Wilson, Christopher D. Witiw, Jetan Badhiwala, Brian K. Kwon, Michael G. Fehlings, James Harrop

Department of Neurosurgery Faculty Papers

Study Design: Narrative review.

Objective: There is a strong biological rationale to perform early decompression after traumatic spinal cord injury (SCI). With an enlarging clinical evidence base, most spine surgeons internationally now favor early decompression for the majority of SCI patients; however, a number of pertinent questions remain surrounding this therapy.

Methods: A narrative review evaluating the status of early surgery for SCI. In particular, we addressed the following questions: (1) Which patients stand to benefit most from early surgery? 2) What is the most appropriate time threshold defining early surgery?

Results: Although heterogeneity exists, the evidence generally seems to …

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 …

Implementation Of A Spine-Centered Care Pathway At A Regional Academic Spine Center., George M Ghobrial, Jefferson Wilson, Daniel Franco, Kristen Vogl, Alexander R Vaccaro, James S Harrop

Department of Neurosurgery Faculty Papers

Study Design: Retrospective case series.

Objective: To describe the early implementation of an inpatient spinal surgery unit and measure the impact on cost and length of stay (LOS).

Methods: A retrospective case review was performed for frequent spine-related diagnosis-related groups (DRGs) cared for by a dedicated multidisciplinary team: combined anterior/posterior (AP) spinal fusion with major complicating or comorbid condition (MCC), combined (AP) spinal fusion with CC, combined (AP) spinal fusion without complicating or comorbid (CC)/MCC, cervical spinal fusion with MCC, cervical spinal fusion with CC, and cervical spinal fusion without CC/MCC. Four time periods were compared: historical control, initial pathway …

Evaluating The Effects Of A Total Joint Education Class On Patient Outcomes, Kevin Marshall

Walden Dissertations and Doctoral Studies

As the population ages and as people live longer, there is a growing demand for total hip and total knee procedures. Possible outcomes for these procedures is a postoperative joint infection (PJI) that can cause long postoperative lengths of stay (LOS) in the hospital. The PJIs can also negatively impact the quality of life for the patient. Using the roadmap of the continuous quality improvement theory, the purpose of this quantitative study was to examine the relationship between the independent variables (joint education class participation, body mass index [BMI], A1c, and smoking) and dependent variables (PJI and LOS). To evaluate …

Patent Urachus, Kayla B. Briggs, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

atent urachus refers to one condition in a rare spectrum of disorders referred to as urachal anomalies. These conditions result from the failure of the involution of normal embryologic tissues that serve to empty the fetal bladder. The location and amount of persistent tissue dictate the presenting symptoms. Some of these urachal anomalies are obvious at birth, while others are more subtle and not diagnosed until adulthood or only incidentally discovered after imaging is obtained for other reasons. Historically, surgical resection of urachal anomalies was routinely undertaken, given the potential for malignancy in retained ectopic tissue. Early surgical resection has …

Oophorectomy, Ashli A. Lawson, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Oophorectomy is the surgical removal of the ovary and can be unilateral or bilateral. Hysterectomy is the most common major gynecologic surgery, but salpingo-oophorectomy remains a frequent concomitant surgery. Surgery for ovarian pathology alone is still often encountered in females of all ages. While surgical removal of one ovary does not grossly affect the hormonal milieu of a patient, bilateral oophorectomy will render a patient infertile and menopausal with ensuing physiologic changes and risks. Forward-thinking discussions should be held with the patient before undertaking an oophorectomy.

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 …

Accuracy Of Blx And Blt Guided Implants In The Edentulous Maxilla: An In Vivo Study, Benjamin Andrew Kordusky

Graduate Theses, Dissertations, and Problem Reports (ETD)

Objectives: To determine the accuracy of dental implants placed using a dual scan CBCT protocol with a SLA 3D printed mucosa supported surgical guide using a flapless surgical approach with regard to sleeve position, type of implant, and regional location in the maxillary arch.

Methods: Nine patients received 4 dental implants utilizing a fully guided, flapless approach with a mucosa supported SLA surgical guide with 3 fixation pins. Implants were immediately loaded using an attachment placed in an existing Maxillary complete denture. Accuracy of implant positions were evaluated by the Treatment Evaluation module of coDiagnostiX (DentalWings, Montreal, Canada). Statistical analysis …

Protocatechuic Acid As A Topical Antimicrobial For Surgical Skin Antisepsis: Preclinical Investigations, Omid Jalali, Molly Best, Alison Wong, Brett Schaeffer, Brendon Bauer, Lanny Johnson

Faculty, Staff and Students Publications

BACKGROUND: There is a need for novel skin antiseptic agents to combat the health-care burdens associated with surgical site infection (SSI) and bacterial resistance. The purpose of this proof-of-principle pilot study was to investigate the potential of the phenolic compound protocatechuic acid (PCA) as a topical antimicrobial for surgical skin antisepsis.

METHODS: The Kirby-Bauer method of disc diffusion was used to investigate the in vitro antimicrobial activity and comparative effectiveness of PCA and 7 related compounds against SSI pathogens. To explore the in vivo efficacy of topical PCA for providing deep, penetrating skin antisepsis, living

RESULTS: Compared with other polyphenols, …

Perivascular Waste Metabolites Clearance In Central Nervous System (Cns), Yiming Cheng

Dissertations

Efficient clearance of interstitial waste metabolites is essential for normal brain homeostasis. Such effective clearance is hampered by the lack of a lymphatic system in the brain, and the cerebrospinal fluid (CSF) is unable to clear large size waste metabolites in the brain. Here, a novel idea that brain arterial endothelium and smooth muscle cells reactivity regulates the clearance of these water-insoluble large size waste metabolites through the perivascular dynamic exchange, and that low dose ethanol promotes this perivascular clearance is proposed.

In Aim 1, the biodistribution of a large size waste metabolite (Amyloid-β protein mimic) in rat perivascular space …

Effectiveness Of Balloon Angioplasty And Stent Angioplasty: Wound Healing In Critically Limb Ischemic, Wisnu Pamungkas, Patrianef Darwis

The New Ropanasuri Journal of Surgery

Introduction. Critical limb ischemia (CLI) is a vascular disease that has a significant amputation and mortality risk with diabetes mellitus; the most significant risk factor in CLI is prevalent among Indonesian. Endovascular intervention (EVI) is preferred in treating CLI because it is non-invasive and effective. Balloon angioplasty and stent angioplasty are the most common method of EVI in Indonesia. This study aims to compare the effectiveness of balloon angioplasty and stent angioplasty on wound healing in CLI.

Method. A cross sectional study enrolled 90 subjects of CLI who underwent endovascular intervention using balloon angioplasty dan stent angioplasty from …

Association Between The Adequacy Of Preoperative Antituberculosis Treatment With Abdominal Postoperative Morbidity And Mortality On Tuberculosis Patients, Riza El Anshori, Agi S. Putranto

The New Ropanasuri Journal of Surgery

Introduction. The adequacy of tuberculosis treatment before abdominal surgery is a dilemma faced by surgeons who aims for low risk of morbidity and mortality. In addition, there is no data on morbidity and mortality post abdominal operation on TB patients in RSCM and RS Persahabatan. Therefore, this research aims to show the correlation between the adequacy of preoperative TB treatment and postoperative morbidity (fistula enterocutaneous, obstruction, and surgical site infection) and mortality.

Method. This study is a descriptive-analytic cross-sectional study done in Cipto Mangunkusumo Hospital dan Persahabatan Hospital using total sampling method, a total of 59 subjects with …

The Role Of Melatonin In Improving Hypoxia In Malignant Tumor: A Mini-Review, Diani Kartini, Akmal Taher, Sonar S. Panigoro, Rianto Setiabudy, Sri W. Jusman, Sofia M. Haryana, Murdani Abdullah, Primariadewi Rustamadji

The New Ropanasuri Journal of Surgery

No abstract provided.

Association Between Obesity And Hormone Receptor Characteristics Of Primary Breast Cancer At Cipto Mangunkusumo General Hospital, Jakarta, In 2017, Hardian Gunardi, Diani Kartini

The New Ropanasuri Journal of Surgery

Introduction. Obesity is an independent risk factor and prognostic factor of primary breast cancer. Abundant adipose tissue would lead to increment of blood estrogen level; thus, promoting proliferation of cancer cell, especially those with positive estrogen receptor (ER) and progesterone receptor (PR). No study reported the association between obesity and hormone receptor characteristics of primary breast cancer in Indonesia.

Method. We collected cases of primary breast cancer which is diagnosed and undergone immunohistochemistry examination at Cipto Mangunkusumo General Hospital in 2017. The subjects divided into obese group and non-obese group. The ER and PR characteristics of both groups were compared …

Correlation Between Internal Jugular Vein Tunnel Cuffed Catheter Tip Position As Hemodialysis Access With Suspected Catheter Related Bacteremia And Related Risk Factors At Rscm 2018–2019, Susatyo J. Pratomo, Akhmadu Muradi

The New Ropanasuri Journal of Surgery

Introduction. Infection is the main complication of prolonged–term catheter uses as hemodialysis access. The KDOQI recommends the insertion of tunnel venous hemodialysis catheter in the right internal jugular vein (IJV) where the tip placed in the right atrium and the arterial opening enfacing the mediastinum. The previous study showed that the incidence of catheter–related bacteremia (CRB) is 35% at three months' use and 54% at six months' use. The TCC tip position as hemodialysis access in left IJV is correlated more to dysfunction and infection compared to the right IJV.

Method. A cross–sectional study was conducted with 62 subjects …

Initial Experience On Laparoscopic Pyeloplasty In Persahabatan General Hospital, Jakarta: A Case Series, Moammar Ar Siregar, Hendy Mirza

The New Ropanasuri Journal of Surgery

Introduction. Untreated ureteropelvic junction obstruction would lead to infection and many other complications. The gold standard to treat this condition is pyeloplasty. Nowadays, laparoscopic pyeloplasty has emerged as a potential modality better than open pyeloplasty.

Method. Data retrospectively obtained from the medical records of UPJO patients at Persahabatan Hospital, Jakarta. The patient’s age, gender, weight, and BMI noted. Duration of operation, intraoperative blood loss, and complications recorded as the intraoperative status. Length of hospital stay, pain score on the first post-operative day, time to do the daily activity, and return to work recorded as post-operative variables of this …

Recanalization After Radio-Frequency Ablation (Rfa) In Limb Varices At Dr. Cipto Mangunkusumo And Fatmawati General Hospitals From 2015- 2017, Rudi Hermansyah, Dedy Pratama, Witra Irfan

The New Ropanasuri Journal of Surgery

Introduction. Ligation in upper location and stripping of the varicose veins, enfacing high incidence of failure, recanalization. Endovascular surgery is a modality used to treat limb varicose. However, the recanalization following the procedure was never evaluated.

Method. We ran a cohort study on subjects with reflux of the great saphenous vein treated by RFA. Following the RFA procedure, the evaluation proceeded using ultrasound within the first three weeks.

Results. A total of 77 subjects were analysed for recanalization post-RFA. Recanalization was found in one subject (1.3%), partial recanalization in 6 subjects (7.79%), and no recanalization in 70 …