Surgery Commons^™

The Utility Of Impedance Cardiography In Hemodynamic Monitoring Of Patients With Sepsis, James Butz, Yizhi Shan, Andres Samayoa, Orlando C. Kirton, Thai Vu

Abington Jefferson Health Papers

BACKGROUND: Commonly used biochemical indicators and hemodynamic and physiologic parameters of sepsis vary with regard to their sensitivity and specificity to the diagnosis. The aim of this preliminary study was to evaluate non-invasive impedance cardiography as a monitoring tool of the hemodynamic status of patients with sepsis throughout their initial volume resuscitation to explore the possibility of identifying additional measurements to be used in the future treatment of sepsis.

METHODS: Nine patients who presented to the emergency room and received a surgical consultation during a 3-month period in 2016, meeting the clinical criteria of sepsis defined by systemic inflammatory response …

Drug-Induced Autoimmune Hepatitis From Hydralazine Leading To Acute Liver Failure And Liver Transplantation, Jasleen Grewal, Angela Doan, Annie S. Hong, Arpit Amin, Jason V. Scapa, Ramy Hanna, Francisco Durazo, Beshoy Yanny

School of Medicine Faculty Research

We describe a woman with no previous liver disease who developed drug-induced autoimmune hepatitis from hydralazine prescribed to her for hypertension. Despite the discontinuation of the medication, she developed acute liver failure and subsequently underwent successful liver transplantation. She survived and had a good clinical outcome.

Does Perioperative Use Of Renin-Angiotensin System Inhibitors Improve Patient Outcomes In Cardiac Surgery?, Qian Ding, Mark Berguson, Zugui Zhang, Hong Liu, Huang Nie, Jordan E. Goldhammer, Rohinton J. Morris, Jianzhong Sun

Department of Anesthesiology Posters

• 2011 ACCF/AHA Guidelines for CABG: Uncertain about the safety of the preoperative administration of ACE inhibitors or ARBs in patients on chronic therapy and the safety of initiating ACE inhibitors or ARBs before hospital discharge
• 2014 ESC Guidelines: ACE inhibitors might be stopped 1 to 2 days before CABG to avoid the potential deleterious consequences of perioperative hypotension
• Guidelines state that ACE inhibitors or ARBs should be initiated postoperatively in CABG patients who were not receiving them preoperatively if they have an LVEF ≤40%, hypertension, diabetes, or CKD (Level of Evidence: A)
• There is still a lack of large clinical …

Sclerosing Peritonitis Presenting As Complete Mechanical Bowel Obstruction: A Case Report, Sabah Saqib, K. M. Inam Pal

Section of General Surgery

Introduction: Sclerosing peritonitis or abdominal cocoon syndrome is characterized by small bowel loops completely encapsulated by a fibrocollagenous membrane in the center of the abdomen. Although cocooning of the abdomen is mostly seen in patients on peritoneal dialysis, it can occur de novo; it very rarely manifests as complete mechanical bowel obstruction.
Case Presentation: A 46-year-old Asian man presented with complete mechanical bowel obstruction. He had previous attacks of partial bowel obstruction during the past 6 to 8 months, which was misdiagnosed as abdominal tuberculosis because tuberculosis is very prevalent in the region in which he lives. He took anti-tuberculosis …

Recovery Priorities In Degenerative Cervical Myelopathy: A Cross-Sectional Survey Of An International, Online Community Of Patients., Benjamin Davies, Oliver Mowforth, Iwan Sadler, Bizhan Aarabi, Brian Kwon, Shekar Kurpad, James S Harrop, Jefferson R Wilson, Robert Grossman, Michael G Fehlings, Mark Kotter

Department of Neurosurgery Faculty Papers

OBJECTIVES: To establish the recovery priorities of individuals suffering with degenerative cervical myelopathy (DCM).

DESIGN: A cross-sectional, observational study.

SETTING: Patients from across the world with a diagnosis of DCM accessed the survey over an 18-month period on Myelopathy.org, an international myelopathy charity.

PARTICIPANTS: 481 individuals suffering from DCM completed the online survey fully.

MAIN OUTCOME MEASURES: Functional recovery domains were established through qualitative interviews and a consensus process. Individuals were asked about their disease characteristics, including limb pain (Visual Analogue Scale) and functional disability (patient-derived version of the modified Japanese Orthopaedic Association score). Individuals ranked recovery domains (arm and …

Chronic Vulvar Paget’S Disease: A Therapeutic Challenge With A Review Of The Literature, Bouhani Malek, Zemni Ines, Fertani Yasmine, Bouzaiene Hatem, Rahal Khaled

Journal of Mind and Medical Sciences

Vulvar Paget’s disease is an uncommon adenocarcinoma of the female genital tract, occuring more often in postmenopausal Caucasian women and accounting for 1-2% of all vulvar malignancies. A 39-year-old female patient was examined for the erythematous and pruritic vulvar lesion, with biopsy and histological examination revealing vulvar Paget’s disease. We did not diagnose any associated neoplasm. The patient underwent four surgical resections for relapsed disease, varying from local excision to extended excision, including radical vulvectomy, with esthetic coverage. The margins were involved. Due to the extended target volumes, radiotherapy was rejected and the patient underwent a local topical therapy with …

Breast Implant Illness: A Step Forward In Understanding This Complex Entity And The Impact Of Social Media, Răzvan Danciu, Cristina N. Marina, Valeriu Ardeleanu, Romeo Marin, Răzvan V. Scăunașu, Laura Răducu

Journal of Mind and Medical Sciences

Introduction. The number of implant-related complaints is constantly rising, a phenomenon probably accentuated by the extensive use of social media by patients. Material and method. A group of signs and symptoms considered to be caused by mammary implants is known as “Breast Implant Illness”. This paper analyzes the increased number of posts by patients on social media in which they describe their symptoms, their disappointment with the decision of using breast implants, and the beneficial effects of explantation. The case of a patient with breast implants who visited our clinic is reported here. The patient complained of two palpable masses, …

Can Intraoperative Manometry Influence The Outcome Of The Surgical Treatment Of Achalasia?, Lucian Alecu, Iulian Slavu, Adrian Tulin, Daniela Mihaila, Robert Ivascu, Liliana Mirea

Journal of Mind and Medical Sciences

Introduction. Achalasia is defined as incomplete or even absent relaxation of the lower esophageal sphincter secondary to the chronic degeneration of unspecified etiology of the myenteric nerve plexus. Material and method. The retrospective study extended over 1 year. The collected variables were: age, sex, type of surgical intervention, intraoperative manometry results, and postoperative complications. Results. We identified 8 patients. The mean operative time was 100 minutes. The use of manometry determined an increase in time of 30 to 40 minutes. Manometry was successfully achieved in all cases, although in one case the sensor could not pass through the lower esophagus, …

Conservative Surgical Treatment In Cervical Dysplastic Lesions Associated With Cystorectocele, Bogdan Marian Puca, Anca D. Braila, Cosmin V. Obleaga, Mihai Braila, Hany Saad, Cristian Lungulescu, Mihai Deca

Journal of Mind and Medical Sciences

The treatment of cervical intraepithelial neoplasia aims at removing the squamocolumnar junction area, including abnormal tissues, up to the healthy tissue. Old postpartum perineal tears associated with cystorectocele, hypertrophic cervical elongation, and first and second degree uterine prolapse are pelvic static disorders. Particular aspects of pelvic-genital static disorder are related to the vulnerability of the pelvic-perineal floor during birth. On the occasion of birth, especially when there are different forms of dystocia during labor, the degradation of soft pelvic, genital, and vaginal-perineal tissues can occur. The objective of this study was to re-evaluate the conservative treatment of cervical dysplasia, depending …

Laparoscopic Resection Of Gastric Gists. Where Do We Stand Now? A Single-Centered Experience, Iulian Slavu, Lucian Alecu, Adrian Tulin, Dana L. Stanculeanu, Cornelia Nitipir

Journal of Mind and Medical Sciences

Introduction. Gastrointestinal stromal tumors (GISTs) represent a rare type of gastrointestinal neoplasms. Resection with negative margins has been established as a mainstay treatment, but laparoscopic resections are still open to debate. Material and method. This retrospective study was conducted at a single institution, with data collected over 2 years (01.01.2017-01.01.2019). The variables examined were age, tumor location with regard to the gastric wall, the results of the intraoperative endoscopy, intraoperative and postoperative complications, the surgical technique, and histopathological reports. Results. We identified 12 relevant cases, of which 8 were females and 4 males. The average tumor diameter was 2.3 cm. …

Lars-Like Symptoms In The General Population May Suggest The Significance Of Postoperative Functional Problems And Emotional Implications Of Rectal Surgery, Tudor-Cristian Frunza, Sorinel Lunca, Iustina Baciu, Iulia Axinia, Cezar V. Mocanu, Andreea Crudu, Narcis Bujor, Lucia F. Livenschi, Claudiu A. Nicolaiev, Andreea Hulubencu, Anca Diaconu, Emilia Valasciu, Ioana Jalobceastai, Malina Tibirna, Mihail G. Dimofte

Journal of Mind and Medical Sciences

Background & Aim. Sphincter-saving rectal surgery is prone to cause changes in bowel function associated with Low Anterior Resection Syndrome (LARS). Our aim was to assess LARS-like symptoms within a population of 50-80-year old in order to understand the functional disturbances and emotional impact of LARS. Materials and methods: We used a questionnaire to evaluate LARS with the following categories of symptoms: flatulence control, anal incontinence, frequency, clustering and urgency of the stools, and the psycho-emotional impact created by the presence of these symptoms. We calculated the severity of LARS on 343 responders. Results. The average age of the responders …

Indocyanine Green Utility In Sentinel Node Detection For Cervical Cancer Patients, Nicolae Bacalbașa, Irina Balescu, Cristian Balalau, Mihaela Vilcu, Iulian Brezean

Journal of Mind and Medical Sciences

With wide implementation of screening tests for the Human Papilloma Virus, the number of diagnosed cases of premalignant or early stages of cervical cancer has increased considerably. As a consequence, surgeons’ attention has focused on determining how best to limit the surgical procedure so the benefits of the procedure will not be surpassed by postoperative morbidity. In this respect, extended lymph node dissection, routinely associated so far with cervical cancer patients, has in the last decades been replaced with sentinel node detection and biopsy. Initially performed through radiocolloid injection, this method has undergone permanent changes in order to maximize its …

Impact Of Best Practice Guideline Statement On Anesthesia Practice In Rural Mississippi Hospitals With Obese Patients Undergoing Total Knee Arthroplasty, Steven Hodnett

Doctoral Projects

The aim of this best practice guideline (BPG) was to be a resource for anesthesia providers practicing with obese patients undergoing total knee arthroplasty (TKA) and to measure the knowledge of these providers. After dissemination of an executive summary to anesthesia providers in two hospitals in rural Mississippi, an anonymous online survey was provided via Qualtrics software for voluntary participation. The survey consisted of 10 questions. The data collection period was five weeks. Respondents are noted at N=2, and the data was reviewed and categorized into one of three domains (i.e., knowledge, practice, and safety). In the domain of knowledge, …

Ethical Standards For Cardiothoracic Surgeons' Participation In Social Media., Thomas K. Varghese, John W. Entwistle, John E. Mayer, Susan D. Moffatt-Bruce, Robert M. Sade

Department of Surgery Faculty Papers

No abstract provided.

Possible Skull Base Erosion After Prolonged Frontal Sinus Stenting, Nathaniel H. Reeve Md, Harry H. Ching Md, Yuna Kim Md, Walter W. Schroeder Md

School of Medicine Faculty Research

Frontal sinus stenting is widely used with the goal of maintaining nasofrontal duct patency after sinus surgery. The general recommendation is to leave stents in place for 6 months; however, prolonged stenting up to 6 years has been reported with no complication. We present the first reported case of frontal sinus posterior table and skull base erosion following prolonged frontal sinus stenting. A 57-year-old female presented with chronic sinusitis and nasal obstruction. Imaging revealed pansinusitis with retained stents in each frontal sinus that were placed 8 years prior. On the right, there was an area of skull base erosion at …

Current Management Of Glioma In Pakistan, Umme E Hani Abdullah, Altaf Ali Laghari, Muhammad Usman Khalid, Huzaifa Bin Rashid, Fatima Ali, Adnan Jabbar, Asim Hafiz, Muhammad Shahzad Shamim, Ather Enam

Section of Neurosurgery

To date, information on the management of specific neurosurgical tumors, such as glioma, in Pakistan remains scattered and scarce. Our review synthesizes the predicaments of glioma management routinely presented to the neurosurgery, medical oncology, radiation oncology, and radiology departments in Pakistan. Expert opinions were integrated from each of the relevant fields in the form of personal citations. The data presented in our review were collected from various PubMed and non-PubMed indexed articles, coupled with various health reports from the Government of Pakistan along with the World Health Organization. Through these data, it was postulated that the utilization of innovative and …

Metformin Blunts Muscle Hypertrophy In Response To Progressive Resistance Exercise Training In Older Adults: A Randomized, Double‐Blind, Placebo‐Controlled, Multicenter Trial: The Masters Trial, R. Grace Walton, Cory M. Dungan, Douglas E. Long, S. Craig Tuggle, Kate Kosmac, Bailey D. Peck, Heather M. Bush, Alejandro G. Villasante Tezanos, Gerald Mcgwin, Samuel T. Windham, Fernando Ovalle, Marcas M. Bamman, Philip A. Kern, Charlotte A. Peterson

Center for Muscle Biology Faculty Publications

Progressive resistance exercise training (PRT) is the most effective known intervention for combating aging skeletal muscle atrophy. However, the hypertrophic response to PRT is variable, and this may be due to muscle inflammation susceptibility. Metformin reduces inflammation, so we hypothesized that metformin would augment the muscle response to PRT in healthy women and men aged 65 and older. In a randomized, double-blind trial, participants received 1,700 mg/day metformin (N = 46) or placebo (N = 48) throughout the study, and all subjects performed 14 weeks of supervised PRT. Although responses to PRT varied, placebo gained more lean body …

Effects Of Accelerated Versus Standard Care Surgery On The Risk Of Acute Kidney Injury In Patients With A Hip Fracture: A Substudy Protocol Of The Hip Fracture Accelerated Surgical Treatment And Care Track (Hip Attack) International Randomised Controlled Trial, Flavia K. Borges, P J. Devereaux, Meaghan Cuerden, Mohit Bhandari, Ernesto Guerra-Farfán, Ameen Patel, Alben Sigamani, Masood Umer, John Neary, Maria Tiboni

Section of Orthopaedic Surgery

Introduction: Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI.
Methods and analysis: Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after …

Resilience And Quality Of Life (Qol) Of Head And Neck Cancer And Brain Tumour Survivors In Pakistan: An Analytical Cross-Sectional Study Protocol, Nida Zahid, Wardah Khalid, Khabir Ahmad, Shireen Shehzad, Iqbal Azam Syed, Nargis Asad, Adnan Jabbar, Mumtaz J Khan, Ather Enam

Department of Surgery Docs

Background: Cancer is a devastating disease and has detrimental effects on the quality of life (QoL) of cancer survivors and interferes with their treatment compliance. The aim of the study is to assess resilience and QoL among cancer survivors and to evaluate the important factors affecting their resilience and QoL, with respect to the Pakistani cultural context.
Method and Analysis: A cross-sectional study will be conducted at a tertiary care hospital in Karachi, Pakistan. A minimum sample size of 250 head and neck cancers and 250 brain tumour survivors with 10% inflation for non-response rate will be required. The SD …

Comparison Of Lumbar Laminectomy Alone, Lumbar Laminectomy And Fusion, Stand-Alone Anterior Lumbar Interbody Fusion, And Stand-Alone Lateral Lumbar Interbody Fusion For Treatment Of Lumbar Spinal Stenosis: A Review Of The Literature., Manan Shah, Bradley Kolb, Emre Yilmaz, Dia R Halalmeh, Marc D Moisi

Articles, Abstracts, and Reports

Lumbar spinal stenosis is defined as narrowing of the lumbar spinal canal, which causes compression of the spinal cord and nerves. Spinal stenosis can cause leg pain and potentially back pain that can affect the quality of life. Ultimately, surgical decompression is required to alleviate the symptoms. In this review, we first utilize several important studies to compare lumbar laminectomy alone versus lumbar laminectomy and fusion. We also compare the effectiveness of more novel surgical approaches, stand-alone anterior lumbar interbody fusion (ALIF), and stand-alone lateral lumbar interbody fusion (LLIF). These techniques have their own advantages and disadvantages in which many …