Surgery Commons^™

An Evidence Based Guide To A Safe Intraoperative Approach Of Avoiding Iatrogenic Lesions During Difficult Laparoscopic Cholecystectomies, Cosmin Alec Moldovan, Roxana M. Duncea, Florin Dan Ungureanu, Vladimir Belis

Journal of Mind and Medical Sciences

Introduction: Although there are many sources for iatrogenic lesions during laparoscopic cholecystectomy, only a few stand out as being one of the most difficult to predict due to their nature of being very hard to diagnose before surgery. Materials and Methods: a short guide of cases with an evidence-based approach to avoid laparoscopic iatrogenic lesions. Results: these cases have been classified and presented into 3 main groups: cases with abnormal arterial layout, cases with heavy alteration of the normal anatomy, and cases with anomalies of the main biliary pathway. Conclusions: while not a complete guide covering …

Trends In Management Of Radial Head And Olecranon Fractures., Matthew Motisi, Jennifer Kurowicki, Derek D Berglund, Jacob J Triplet, Shanell Disla, Timothy Niedzielak, Jonathan C Levy

Surgery Articles

BACKGROUND: Advancement in surgical techniques and implants has improved the ability to manage radial head and olecranon fractures. However, trends in management of these fractures are largely unstudied.

OBJECTIVE: This purpose of this study is to evaluate management trends for these common fractures.

METHODS: A retrospective review of a comprehensive Humana database was performed using Pearl Diver supercomputer (Warsaw, IN, USA) for radial head and neck (RHNF) and olecranon fractures (OF) between 2007 and 2014. Treatment methods including open reduction internal fixation (ORIF), radial head arthroplasty (RHA), and non-operative treatment were reviewed. Total reported incidence of office visits and utilization …

Driving Simulators – More Than A Video Game!, William D. Mcquilken B.A., Judith M. Schultz B.A.

Department of Surgery

Background: This study aimed to investigate teenager, young adult, and adult knowledge levels on distracted and impaired driving through the use of educational driving simulators. The distracted and impaired driving simulators were customized to instruct participants on the dangers of driving distracted or impaired utilizing consequence videos. The simulators were taken to high schools, colleges/universities, and businesses over a four year period where we hypothesized that they would play a significant role in raising knowledge about the dangers and penalties of these risky driving behaviors and would also help to increase seat belt usage.

Setting: High schools, colleges / universities, …

Total Parenteral Nutrition In Patients Following Pancreaticoduodenectomy: Lessons From 1184 Patients, Cullen Worsh, Talar Tatarian, Md, Pgy-4, Awinder Singh, Michael J. Pucci, Md, Jordan M Winter, Md, Charles J. Yeo, Md, Harish Lavu, Md

Department of Surgery Posters

Poster presented at Sigma XI Student Research Day at Thomas Jefferson University.

Background:

Total parenteral nutrition (TPN) has historically been used conservatively in the management of patients after pancreaticoduodenectomy (PD).

In this study, we evaluate the indications for and outcomes associated with TPN use in a high-volume pancreatic surgery center.

Advocacy Efforts In Trauma And Acute Care Surgery: Learning To Walk, Lewis J. Kaplan, Erik Barquist, Donald Jenkins, Orlando C. Kirton

Abington Jefferson Health Papers

No abstract provided.

Low Cost Quality Initiatives For Management Of Neurosurgical Patients In Developing Nations: Perspective From A Tertiary Care Centre In Pakistan, Hamid Hussain Rai, Muhammad Waqas, Muhammad Shahzad Shamim

Section of Neurosurgery

Background: Targeting resources on cost-effective care strategies is pertinent for developing nations, specifically for already burdened specialties such as neurosurgery, where without state support and insurance companies, expenses are borne by the patient themselves.
Methods: This was a descriptive review of literary work published by the section of neurosurgery at Aga Khan University Hospital, Pakistan. We searched PubMed and CiNAHL databases to identify articles, which were then critically analyzed and discussed from a perspective of low-cost quality care.
Results: We demonstrate the cost effectiveness of three initiatives, namely, blood ordering protocol for elective spine arthrodesis, nonoperative management being superior to …

Osborne's Ligament: A Review Of Its History, Anatomy, And Surgical Importance., Andre Granger, Juan P Sardi, Joe Iwanaga, Thomas J Wilson, Lynda Yang, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

When discussing the pathophysiology of ulnar neuropathy, Geoffrey Vaughan Osborne described a fibrous band that can be responsible for the symptoms seen in this disorder. In this paper, we take a glimpse at the life of Osborne and review the anatomy and surgical significance of Osborne's ligament. This band of tissue connects the two heads of the flexor carpi ulnaris and thus forms the roof of the cubital tunnel. To our knowledge, no prior publication has reviewed the history of this ligament, and very few authors have studied its anatomy in any detail. Therefore, the aim of the present paper …

Stop The Radiation! Decreasing Ct Scan Utilization In Pediatric Trauma Patients., Catherine Zimel, Taylor Iobst, Carly Crowder, Heather Geist, Keith A. Thatch Md, Marybeth Browne Md

Department of Surgery

No abstract provided.

Can A Post-Discharge Telephone Call Reduce Hospital Readmission After Colorectal Surgery? A Prospective Study, Daniel Mandel, Karen Zaghiyan, Phillip Fleshner

NYMC Student Posters

BACKGROUND: Hospital readmission after major colorectal surgery is a major economic burden and a benchmark of quality care by government agencies. We hypothesized that a post-discharge telephone follow-up (TFU) could reduce readmission after abdominal colorectal surgery.

METHODS: Consecutive patients undergoing abdominal colorectal surgery over the 4-month period ending Oct 2016 were prospectively evaluated. A structured TFU call during the 4-day period after hospital discharge evaluating the patient’s clinical status and possible interventions to avoid readmission was conducted by a second-year medical student, supervised by two board certified colorectal surgeons. Readmission rates were compared to a control group undergoing …

Pancreaticoduodenectomy In A Patient With Previous Left Ventricular Assist Device: A Case Report With Specific Emphasis On Peri-Operative Logistics., Juan Mejia, Mei Dong, Okechukwu Ojogho

Articles, Abstracts, and Reports

To the best of our knowledge this is the first case of this nature described in the literature. Sharing the authors experience with this case, particularly the technical challenges and post-operative management may aid other physicians facing similar scenarios. In this report, we describe a pancreaticoduodenectomy for pancreatic adenocarcinoma in a patient with a previous left ventricular assist device (LVAD). A multidisciplinary approach, particularly close involvement of the advanced heart failure, mechanical heart and pancreas surgery teams was key to the success of this case. Major abdominal surgery in the setting of previous LVAD should be considered carefully, however, the …

Outpatient Percutaneous Release Of Trigger Finger: A Cost Effective And Safe Procedure, Marij Zahid, Aurangzeb Qureshi, Rizwan H. R, Haroon Rashid, Pervaiz M. Hashmi

Section of Orthopaedic Surgery

Introduction: Trigger finger is a common cause of pain and disability of the hand. Percutaneous release results in earlier functional recovery and patient satisfaction. This is a rapid and cost-effective method which saves a surgical procedure and results in better functional outcome.
Materials and Methods: This is a prospective observational study conducted on fifty-two fingers and thumbs in 52 patients treated from 1st July 2014 till 31st December 2014, in the Orthopaedic Section, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. All the baseline characteristics of the patients, like demographics, symptoms, Quinell's criteria and functional outcome were recorded. The …

Establishment Of Site Specific Multi-Disciplinary Tumour Boards In Pakistan: Sharing Experience Of Neuro Oncology Team Based At A Tertiary Care University Hospital, Muhammad Waqas, Ahmed Nadeem Abbasi

Section of Neurosurgery

No abstract provided.

Bone Morphogenic Proteins Are A Good Choice For Select Spinal Surgeries And Merit Further Research., Doniel Drazin, Eric Choi, Alfredo Garcia, Tarush Rustagi

Articles, Abstracts, and Reports

No abstract provided.

Surgical Site Infection And Transfusion Rates Are Higher In Underweight Total Knee Arthroplasty Patients., Jorge Manrique, Antonia F. Chen, Md, Mba, Miguel M. Gomez, Mitchell Maltenfort, Phd, William J. Hozack Md

Rothman Institute Papers

BACKGROUND: Underweight (UW) patients undergoing total hip arthroplasty have exhibited higher complication rates, including infection and transfusion. No study to our knowledge has evaluated UW total knee arthroplasty (TKA) patients. We, therefore, conducted a study to investigate if these patients are at increased risk for complications, including infection and transfusion.

METHODS: A case-control study was conducted using a prospectively collected institutional database. Twenty-seven TKA patients were identified as UW (body mass index [BMI] < 18.5 kg/m

RESULTS: The average BMI was 17.1 kg/m

CONCLUSIONS: Our study demonstrates that UW TKA patients have a higher likelihood of developing SSI and requiring blood transfusions. The …

A Structured Blood Conservation Program In Pediatric Cardiac Surgery, A Budak, Kevin Mccusker, S Gunaydin

NYMC Faculty Publications

OBJECTIVE: The limitation of alternative transfusion practices in infants increases the benefits of blood conservation. We analyzed the efficacy of a structured program to reduce transfusions and transfusion-associated complications in cardiac surgery

PATIENTS AND METHODS: Our pediatric surgery database was reviewed retrospectively, comparing outcomes from two different time periods, after the implementation of an effective blood conservation program beginning in March 2014. A total of 214 infants (8.1±3.4 months) who underwent biventricular repair utilizing CPB (Group 1 – Blood conservation) were studied in a 12-month period (March 2014-February 2015) after the implementation of the new program, and compared with 250 …

Open-Label Phase I Clinical Study To Assess The Safety And Efficacy Of Cilostazol In Patients Undergoing Internal Carotid Artery Stent Placement, A E. Hassan, H Zacharatos, M Grigoryan, Muhammed Suri, Adnan Qureshi

Articles

BACKGROUND:

One-month dual antiplatelet treatment, with aspirin and clopidogrel, following internal carotid artery stent placement is the current standard of care to prevent in-stent thrombosis. Cilostazol, an antiplatelet drug, has been demonstrated to have a safety profile comparable to aspirin and clopidogrel.

OBJECTIVE:

To evaluate the safety and clinical efficacy of cilostazol and aspirin therapy following internal carotid artery stent placement up to 1 month postprocedure.

METHODS:

A phase I open-label, nonrandomized two-center prospective study was conducted. All subjects received aspirin (325 mg/day) and cilostazol (200 mg/day) 3 days before extracranial stent placement. Two antiplatelet agents were continued for 1 …

Technical Considerations In Revision Anterior Cruciate Ligament Reconstruction For Operative Techniques In Orthopaedics, Jeremy M. Burnham, Elmar Herbst, Thierry Pauyo, Thomas Pfeiffer, Darren L. Johnson, Freddie H. Fu, Volker Musahl

Orthopaedic Surgery and Sports Medicine Faculty Publications

As the incidence of anterior cruciate ligament (ACL) reconstruction continues to increase, the rate of revision surgery continues to climb. Revision surgery has inherent challenges that must be addressed to achieve successful results. The cause of the primary ACL reconstruction failure should be determined and careful preoperative planning should be performed to address the cause(s) of failure. Each patient undergoing revision surgery should undergo a thorough history and physical examination, receive full-length alignment radiographs, lateral radiographs, 45° flexion weight-bearing posteroanterior radiographs, and patellofemoral radiographs. The 3-dimensional computed tomography scan should be performed to assess tunnel position and widening. Magnetic resonance …

A Meta-Analysis Of Neuropsychological Tests Utilized In Evaluations For Post-Operative Cognitive Dysfunction In Adult Surgery Patients, Joanna H. Swartz

Doctor of Psychology (PsyD)

Cognitive dysfunction post-surgery has a significant impact on patients’ quality of life during recovery and afterward. Several studies have been completed on post-operative cognitive dysfunction (POCD), but since studies are varied in their methodologies and designs a metaanalysis is helpful to synthesize the current available research. The present study took a metaanalysis approach to examine neuropsychological tests most sensitive to POCD in adult surgery patients, and determine implications this would have for developing a battery of tests to evaluate for POCD pre and post-surgery. Although some assessment batteries have been proposed for certain populations (e.g., cardiac patients), little research has …

Giant Ganglioneuroma In A 5-Year Child, Hamza Abdur Rahim Khan, Fazal Wahab Khan, Saulat H. Fatimi

Department of Surgery Docs

ABSTRACT We report a 5-year boy presenting with pain in the lower chest and upper abdomen. On evaluation with computed tomography scan of the chest, he was found to have a large 16 x 14 cm posterior mediastinal mass compressing the inferior vena cava and liver, and shifting the heart to the opposite side. Tumor was approached via right postero-lateral thoracotomy and dissected off from esophagus, heart, inferior vena cava and lungs. The entire tumor was resected without any complications. Postoperative course was unremarkable. Resection of the tumor was successful. The histopathology showed it to be giant ganglioneuroma with no …

Every Child, Every Time: Universal Child Abuse Screening Increases Awareness And State Reporting (Poster)., Lauren Dudas Md, Gwenda L. Petrohoy, Debra Esernio-Jenssen Md, Cheryl Lansenderfer Bsn, Joseph J. Stirparo Md, Michele Dunstan, Marybeth Browne Md

Department of Surgery

No abstract provided.