Surgery Commons^™

Perceptions As A Barrier To Emergency Medical Services Utilization Among Syrian Refugees In Jordan, Elizabeth Shan Wang

Independent Study Project (ISP) Collection

The purpose of this study is to evaluate perceptions of emergency medical services (EMS) among Syrian refugees living in urban host communities in Jordan. The research questions are as follows: To what extent do public perceptions of emergency medical services affect the utilization of ambulances? How does awareness about available emergency medical services shape refugees’ attitudes towards it? Because this topic is qualitative and exploratory in the case of Jordan, there was no clear hypothesis. The assumption, however, is that positive perceptions and awareness about EMS can encourage refugees to call an ambulance for transportation to the hospital during a …

Total Hip Arthroplasty: Copd And Its Effect On Postoperative Complications, Camille Boustani, Shane A. Sobrio, Alex Gu, Chapman Wei, Andrew Holmes

GW Research Days 2016 - 2020

Introduction

The demand for Total Hip Arthroplasty (THA) has rapidly risen and continues to due to high success rates of this procedure and the growing aging population. Particularly in Chronic Obstructive Pulmonary Disease (COPD), studies have indicated an increased risk of various postoperative complications across several surgery types. Despite the prevalence of COPD, very little has been investigated regarding postsurgical complications in patients with COPD following a THA. The aim of the current study is to utilize the NSQIP database and determine differences in short-term postoperative complications after undergoing THA, comparing patients with and without COPD.

Methods

In total, 74,814 …

Cost-Effectiveness Of Alternative Anticoagulation Strategies For Postoperative Management Of Total Knee Arthroplasty Patients, Savannah R. Smith, Jeffrey Katz, Elena Losina

GW Research Days 2016 - 2020

Background: Anticoagulation is essential for deep vein thrombosis (DVT) and pulmonary embolism (PE) prevention following total knee arthroplasty (TKA). Some research has suggested that longer duration anticoagulation can substantially reduce the risks of DVT and PE; however, in the absence of definitive recommendations, physicians are left weighing the risks of DVT and PE against those of anticoagulation, including gastrointestinal (GI) and central nervous system (CNS) hemorrhage and increased likelihood of prosthetic joint infection (PJI). We conducted a cost-effectiveness analysis to evaluate the benefits and risks of 14- and 35-day therapy with the most commonly prescribed anticoagulants post-TKA.

Background: Anticoagulation is …

Lumbar Decompression Surgery: Does Chronic Steroid Use Increase The Risk Of Postoperative Infectious Complications? – A Study Of The National Surgical Quality Improvement Program (Nsqip) Database, Shane Sobrio, Mikel Thista, Raj Rao, Alex Gu, Chapman Wei, Warren Yu

GW Research Days 2016 - 2020

Intro: It has long been established that corticosteroids have a negative impact on the human immune system’s ability to function at an optimal level. Many past studies have shown that patient’s will have higher rates of infection if they are taking chronic steroids. What has yet to be established is just how much of an increased risk patients on chronic steroids have for infection after undergoing lumbar decompression surgeries, of which there are thousands per year. We hypothesize that patients on chronic steroids will have higher rates of surgical site infections and higher rates of other infections (UTI, pneumonia, etc.) …

Parental Compliance For Two Stage Fowler-Stephens Laparoscopic Orchiopexy: Is Everyone Following Up For The Second Stage And, If Not, Who Is At Risk?, Campbell Grant, H. Gil Rushton, Tanya D. Davis

GW Research Days 2016 - 2020

Purpose: Patients undergoing a two-stage Fowler-Stephens laparoscopic orchiopexy for intra-abdominal testes are typically recommended to undergo the second stage 4-6 months after the first stage. . As part of a quality care initiative, our studied examined if patients were in fact following up within this window and, if not, why patients were lost to follow up.

Materials and Methods: We retrospectively reviewed a cohort of 105 patients who underwent the first stage of a 2-stage Fowler-Stephens orchidopexy at our institution between 1/2005 to 1/2015. Bivariate and multivariate analyses were performed to compare clinical, surgical, and socioeconomic factors. Patients identified as …

Risk For Post-Spinal Surgery Complications Associated With Pre-Operative Blood Transfusions, Ryan Lee, William Probasco, Alex Gu, Raj Rao

GW Research Days 2016 - 2020

Introduction: The frequency of spinal surgeries has increased dramatically in the United States over the past decade and, as with all surgeries, spinal procedures carry inherent risks for complications after the operation. Recently, it has been recognized that procedures in which intra-operative/post-operative blood transfusions are administered carry a higher risk of postoperative morbidity and increased length of hospital stay (Seisean et al.). Despite this, there is little literature, currently, analyzing post-operative complications associated with blood transfusions taking place 72 hours prior to spinal operations. The aim of this study was to investigate the prevalence of pre-operative blood transfusions in …

Morbid Obesity Is Associated With Postoperative Complications In Laparoscopic Hysterectomy, Margaret Berrigan, Maria Victoria Vargas, Alex Gu, Chapman Wei, Hannah Robinson, Paul Tyan, Gaby Moawad

GW Research Days 2016 - 2020

Background: The prevalence of obesity in American women is 38.3%. Hysterectomy is the second most common surgery in reproductive age women; most of these procedures are performed laparoscopically. From 2011 to 2015, 3.2% of women age 15-44 years underwent hysterectomy; 89.6% of these procedures were performed for management of medical conditions including uterine fibroids, menstrual disorders, uterine prolapse, and endometriosis. The high rates of obesity and hysterectomy in women demand better understanding of the relationship between obesity and postoperative complications following laparoscopic hysterectomy. Methods: We conducted a retrospective cohort study using the American College of Surgeons National Quality Improvement Database …

30-Day Readmission Rate And Its Causes In General Surgical Patients, Rizwan Sultan, Umme Hani Abdullah, Tabish Chawla

Section of General Surgery

Objective: To find out the 30-day readmission rate for different surgical procedures and determine the causes for readmissions.
Study Design: An audit report.
Place and duration of study: Department of Surgery, The Aga Khan University Hospital, Karachi, in the calendar year 2014.
Methodology: Records were retrospectively reviewed for 30-day readmission rate and their cause in general surgical patients who underwent a general surgical procedure at The Aga Khan University Hospital, Karachi, in the year 2014.
Results: Out of 217 (6.4%) readmissions in 3,387 patients, more than 50% unplanned readmissions were avoidable. The highest readmission rate was after placement of feeding …

Resolution Of Gestational Gigantomastia With Termination Of Pregnancy, Syed Sarmad Bukhari, Haris Manan, Mah Muneer Khan, Syed Shahmeer Raza

Section of Neurosurgery

Less than 100 cases of gestational gigantomastia have been described in literature. The aetiology and risk factors are not well-established. Various treatments have been used with some consensus. We present the case of a 47-year-old female who presented to us with bilateral gigantomastia in her 16th week of gestation. She had massively enlarged breasts which were very painful. Relevant laboratory investigations were normal. An incisional biopsy done prior to, and two trucut samples at presentation to us, showed normal breast tissue proliferation. In the absence of adequate pain control, it was decided to electively terminate the pregnancy and give a …

Prognostic Implications Of Histological Clear Cells In High-Grade Intracranial Ependymal Tumors: A Retrospective Analysis From A Tertiary Care Hospital In Pakistan, Fauzan Alam Hashmi, Hamid Hussain Rai, Muhammad Faheem Khan, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Clear cell variant in ependymal tumors is rare. We aimed to compare the features and outcome of the World Health Organization (WHO) Grade 3 ependymal tumors with clear cells to the WHO Grade 3 classic anaplastic ependymoma (AE).
Materials and methods: A retrospective cohort study conducted at the Department of Neurosurgery, Aga Khan University, Pakistan, from 2003 to 2013. The medical records and radiology of patients with proven histopathology were reviewed. The analysis was done on SPSS 20.
Results: Nine cases of clear cell variant and 23 cases of classic AE were found, both of which combined equated to …

Depression In Adult Patients With Primary Brain Tumours: A Review Of Independent Risk Factors, Anum Sadruddin Pidani, Aaida Mumtaz Rao, Muhammad Shahzad Shamim

Section of Neurosurgery

Depression is considered an under-diagnosed problem, especially in patients with malignancies. Patients with brain tumours in particular, have a relatively higher risk of developing depression, which is multifactorial. Herein, the authors review the recent literature on the prevalence of depression in patients with brain tumours, and explore the various risk factors involved.

Clinical Outcomes Of Endovascular Thrombectomy In Tissue Plasminogen Activator Versus Non-Tissue Plasminogen Activator Patients At Primary Stroke Care Centers., Gregory Imbarrato, Joshua Bentley, Ajeet Gordhan

Articles, Abstracts, and Reports

Background: The effect of intravenous tissue plasminogen activator (IV tPA) administration before endovascular intervention as compared to without at thrombectomy-capable low-volume centers on procedural aspects and patient outcomes has not been investigated.

Methods: Retrospective chart review was performed in all consecutive large vessel cerebrovascular accident patients treated with endovascular therapy at two select rural primary stroke centers between 2011 and 2015. Patients' data regarding age, sex, and medical history, as well as thrombus location by catheter-based cerebral angiography, postprocedural reperfusion status, and clinical outcomes were reviewed. The primary outcome measure of the study was a comparison of modified Rankin scale …

Ring And Peg Simulation For Minimally Invasive Surgical Robot, Evan Brown

Department of Mechanical and Materials Engineering: Dissertations, Theses, and Student Research

Surgical procedures utilizing minimally invasive laparoscopic techniques have shown less complications, better cosmetic results, and less time in the hospital than conventional surgery. These advantages are partially offset by inherent difficulties of the procedures which include an inverted control scheme, instrument clashing, and loss of triangulation. Surgical robots have been designed to overcome the limitations, the Da Vinci being the most widely used. A dexterous in vivo, two-armed robot, designed to enter an insufflated abdomen with a limited insertion profile and expand to perform a variety of operations, has been created as a less expensive, versatile alternative to the Da …

Menopausal-Related Symptoms In Women One Year After Breast Cancer Surgery., Melissa Mazor, Kathryn Lee, Anand Dhruva, Janine K Cataldo, Steven M Paul, Michelle Melisko, Betty J Smoot, Jon D Levine, Charles Elboim, Yvette P Conley, Christine Miaskowksi

Articles, Abstracts, and Reports

CONTEXT: Approximately 60% to 100% of women with breast cancer experience at least one menopausal-related symptom. Little is known about associations between menopausal status and symptoms in women 12 months after breast cancer surgery.

OBJECTIVES: The purpose of this study was to evaluate for differences in occurrence, severity, and distress of symptoms between pre- and postmenopausal women 12 months after breast cancer surgery.

METHODS: Women with breast cancer (n = 327) completed the Menopausal Symptoms Scale, which evaluated the occurrence, severity, and distress of 46 common menopausal-related symptoms. Regression analyses were used to evaluate between-group differences in the seven symptoms …

A Sub-Type Of Familial Pancreatic Cancer: Evidence And Implications Of Loss-Of-Function Polymorphisms In Indoleamine-2,3-Dioxygenase-2., Avinoam Nevler, Alexander J. Muller, Joseph A. Cozzitorto, Austin Goetz, Jordan M. Winter, Theresa P. Yeo, Harish Lavu, Charles Yeo, George C. Prendergast, Jonathan Brody

Department of Surgery Faculty Papers

BACKGROUND: Variation in an individual's genetic status can impact the development of pancreatic ductal adenocarcinoma; however, the majority of familial pancreatic cancers (FPC) cannot yet be attributed to a specific inherited mutation. We present data suggesting a correlation between loss-of-function single nucleotide polymorphisms (SNPs) in an immune regulator gene, indoleamine-2,3-dioxygenase-2 (IDO2), and an increased risk of FPC.

STUDY DESIGN: Germline DNA from patients who underwent resection for pancreatic ductal adenocarcinoma (n = 79) was sequenced for the IDO2 SNPs R248W and Y359Stop. Genotypes resulting in inactivation of IDO2 (Y325X homozygous, R248W homozygous) were labeled as homozygous, and the other genotypes …

What Are Biofilms?, Noreen J. Hickok

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Recurrent Vulvar Carcinoma: Complex Surgical Treatment Via Perineal Excision And Reconstruction With Musculocutaneous Flap, Dragoș Popa, Cosmin V. Obleagă, Ștefan Paitici, Stelian Ș. Mogoanta, Ionică D. Vîlcea, Pouya Pourgolafshan, Cristian Gheorghe, Manuela I. Vasile, Raluca Câmpeanu, Cecil S. Mirea

Journal of Mind and Medical Sciences

Vulvar cancer is a malignant disease having a low frequency and with well-established surgical and oncological treatments based on the stage of the disease. The most important therapeutic problem encountered is represented by cases of perineal local regional recurrence, which are common in patients with large primary tumors and can occur even if the margins of the resection had no tumoral invasion.

We present a case study of a 64-year-old patient diagnosed one year ago with squamous vulvar carcinoma (G3) for which a vulvectomy was performed after neoadjuvant radiotherapy. The patient later developed local recurrence with invasion of the anal …

Unmodifiable Variables Related To Thyroid Cancer Incidence, Cornelia Nitipir, Lucian Alecu, Iulian Slavu, Raluca Tulin, Radu C. Jecan, Cristina Orlov, Silviu Pituru, Dana L. Stanculeanu, Razvan Hainarosie, Anca P. Stoian, Adrian Tulin

Journal of Mind and Medical Sciences

The incidence of thyroid cancer is significantly different between male and female patients. Thyroid cancer is also the only form of cancer where age can be considered a staging variable. Identifying biological prognostic factors such as age or sex is important as it helps select an optimal personalized therapy. The present analysis is an observational, prospective study that enrolled all patients with thyroid disease who were operated upon at a single center. The study aimed to determine the most frequent age at presentation, the predominance of one sex over the other, the incidence of malignant thyroid disease, and the relative …

Does Sex Of The Patient Play A Role In Survival For Msi Colorectal Cancer?, Adrian Tulin, Iulian Slavu, Raluca Tulin, Lucian Alecu, Radu C. Jecan, Cristina Orlov, Cristian I. Iaciu, Dana L. Stanculeanu, Razvan Hainarosie, Silviu Pituru, Anca Pantea Stoian, Cornelia Nitipir

Journal of Mind and Medical Sciences

Microsatellite instability (MSI) is a feature of colorectal tumors that develops as a result of inactivation of the DNA mismatch repair system. It is found in about 15% of all colorectal cancers and is an important prognostic molecular marker when assessing patients with colorectal cancer. It can influence prognosis and treatment decisions in both the advanced and early stages. Although in early stages this marker suggests a favorable prognosis and presents an important argument against adjuvant treatment in stage II disease, in metastatic stages it no longer associated with such an optimistic outcome. The present trial is a prospective, single-center …

Depression And Breast Cancer; Postoperative Short-Term Implications, Razvan V. Scaunasu, Ștefan Voiculescu, Bogdan Popescu, Roxana Popa, Denisa Bălălău, Laura Răducu, Cristina N. Cozma, Cristian R. Jecan

Journal of Mind and Medical Sciences

Introduction. Pre and postoperative psychological status is an important aspect in patients diagnosed with breast cancer, having a great impact on their quality of life. Considering the high incidence, mortality rate, and the added effect on self-image, breast cancer is considered a major stressor for women worldwide, almost 50% of these experiencing psychological distress. Methods. Our study retrospectively analysed the relationship between preoperative diagnosed depression and the number of medical care days, on patients diagnosed with breast cancer and admitted for surgical treatment in Colțea Clinical Hospital between 2017 and 2018. Results. We had 62 patients scheduled for breast cancer …