Surgery Commons^™

Getting Started: Identifying Funding Opportunities With Jefferson Resources, Molly Gerber, Avp, Gary Kaplan, Dana Marcus

Department of Surgery, Faculty Development Sessions

Section 1: Philanthropy Basics

Section 2: Fundraising for Research

Section 3: Information Resources

36 PowerPoint slides

Duration Of Posttraumatic Amnesia Predicts Neuropsychological And Global Outcome In Complicated Mild Traumatic Brain Injury., Tessa Hart, Thomas A. Novack, Nancy Temkin, Jason Barber, Sureyya S. Dikmen, Ramon Diaz-Arrastia, Joseph Ricker, Dale C. Hesdorffer, Jack Jallo, Nancy H. Hsu, Ross Zafonte

Department of Neurosurgery Faculty Papers

OBJECTIVES: Examine the effects of posttraumatic amnesia (PTA) duration on neuropsychological and global recovery from 1 to 6 months after complicated mild traumatic brain injury (cmTBI).

PARTICIPANTS: A total of 330 persons with cmTBI defined as Glasgow Coma Scale score of 13 to 15 in emergency department, with well-defined abnormalities on neuroimaging.

METHODS: Enrollment within 24 hours of injury with follow-up at 1, 3, and 6 months.

MEASURES: Glasgow Outcome Scale-Extended, California Verbal Learning Test II, and Controlled Oral Word Association Test. Duration of PTA was retrospectively measured with structured interview at 30 days postinjury.

RESULTS: Despite all having a …

Should Family Presence Be Allowed During Cardiopulmonary Resuscitation?, Karen J. Brasel, John W. Entwistle Iii, Md, Phd, Robert M. Sade

Department of Surgery Faculty Papers

No abstract provided.

Bleeding With Direct Oral Anticoagulants Vs Warfarin: Clinical Experience., John Eikelboom, Geno J. Merli

Department of Surgery Faculty Papers

The risk of bleeding in the setting of anticoagulant therapy continues to be re-evaluated following the introduction of a new generation of direct oral anticoagulants (DOACs). Interruption of DOAC therapy and supportive care may be sufficient for the management of patients who present with mild or moderate bleeding, but in those with life-threatening bleeding, a specific reversal agent is desirable. We review the phase 3 clinical studies of dabigatran, rivaroxaban, apixaban, and edoxaban in patients with nonvalvular atrial fibrillation, in the context of bleeding risk and management.

Parental Refusal Of Surgery In An Infant With Tricuspid Atresia., Alexander A. Kon, Angira Patel, Steven Leuthner, John Lantos

Manuscripts, Articles, Book Chapters and Other Papers

We present a case of a fetal diagnosis of tricuspid atresia (TA). The pregnant woman and her husband requested that the baby be treated with only palliative care. The cardiologist did not think it would be appropriate to withhold life-prolonging surgery once the infant was born. The neonatologist argued that outcomes for TA are similar to those for hypoplastic left heart syndrome, and the standard practice at the institution was to allow parents to choose surgery or end-of-life care for those infants. The team requested an ethics consultation to assist in determining whether forgoing life-prolonging interventions in this case would …

Descriptive Epidemiology Of Karachi Road Traffic Crash Mortality From 2007 To 2014, Rashid Jooma, Masood Ali Shaikh

Department of Surgery Docs

Abstract

According to World Health Organization's estimate for Pakistan, there were 25,781 (95% CI: 20,979-30582) Road Traffic Collision (RTC) fatalities in year 2013. The Road Traffic Injury Research and Prevention Center, collects RTC data on injuries and fatalities from five major public and private hospitals' emergency departments in Karachi. For the eight-year period, from 2007-2014, 9129 fatalities were recorded. Males accounted for 8008 (87.7%) all RTC fatalities. Highest number of fatalities were recorded in the 21-25 age group with 1329 (15.3%) fatalities, while fatalities in 16-30 years old, recorded 3446 (39.7%) of all fatalities out of the total 8684 records …

Catamenial Pneumothorax: A Case Report., Hina Inam, Sumera Inam,, Munaim Tahir

Department of Surgery Docs

Abstract

Catamenial pneumothorax (CP) is a rare and complex clinical condition caused by endometrial tissues, commonly found in reproductive women (age 15-49 years).Its diagnosis is often delayed or overlooked by clinicians, which may result in recurrent hospitalizations and other complications. A case of Catamenial pneumothorax is presented of a 38-year-old young married woman, admitted to hospital with signs and symptoms including chest pain and shortness of breath that started with her menstrual period. Right pneumothorax was observed in the Chest x-ray. Patient underwent Video-assisted thoracoscopic surgery (VATS). Patient was kept under observation, and was discharged when stable with no pain.Catamenial …

Compact Heat Exchanger For Veno-Venous Perfusion-Induced Systemic Hyperthermia Systems, Dongfang Wang, Joseph B. Zwischenberger

Surgery Faculty Patents

A compact heat exchanger for vena-venous perfusion-induced hyperthermia includes an integral pneumatic pump and a hollow tubule heat exchange array. A vena-venous perfusion-induced hyperthermia system incorporating the compact heat exchanger is described. The heat exchanger provides a compact, efficient design allowing a lesser heat exchanging surface area and lesser required pumping power compared to conventional systems. In turn, the system provides a shorter blood circuit compared to conventional systems, allowing maintaining a lower blood temperature than such conventional systems while supplying sufficiently heated blood to patient visceral organs to provide a therapeutic effect, such as in supplementing chemotherapy drugs.

Sulfatase 2 Facilitates Lymphangiogenesis In Breast Cancer By Regulating Vegf-D., Chenfang Zhu, Xiaoliang Qi, Xin Zhou, Xin Nie, Yan Gu

Surgery Faculty Publications

In our previous studies, sulfatase 2 (Sulf2) was found to upregulate vascular endothelial growth factor-D (VEGF-D) expression in breast cancer. As VEGF-D plays an important role in lymphangiogenesis, we hypothesized that Sulf2 facilitates lymphangiogenesis in breast cancer by regulating VEGF-D. To evaluate the functions of Sulf2 on lymphangiogenesis in breast cancer, proliferation, apoptosis, cell cycle, cell mobility and tube-formation of lymphatic endothelial cells (LECs) were measured in vitro. Lymphangiogenesis in nude mouse ears and breast cancer xenografts were examined in vivo. Furthermore, the expression levels of related signaling pathway genes were screened and verified in LECs. We found that Sulf2 …

Awake Craniotomy For Brain Tumours In Pakistan: An Initial Case Series From A Developing Country, Saad Akhtar Khan, Karim Rizwan Nathani, Badar Uddin Ujjan, Muhammad Danish Barakzai, Ather Enam, Faraz Shafiq

Section of Neurosurgery

Awake craniotomy offers safe resection of brain tumours in eloquent area. Aga Khan University Hospital, Karachi, recently started the programme in Pakistan, and the current study was planned to assess our experience of the first 16 procedures. The retrospective study comprised all such procedures done from November 2015 to May 2016. Pre-operative and post-operative variables were analysed. Of the 16 patients, 11(68.75%) were males and 5(31.25%) were females. The overall median age was 37 years (interquartile range[IQR]: 23-62 years). The most common presenting complaint was seizures 8(50%), followed by headache6(38%). The common pathologies operated include oligodendroglioma and glioblastoma. Pre-operative mean …

Comparison Of The Prevalence And Characteristics Of Inpatient Adverse Events Using Medical Records Review And Incident Reporting, William Macharia, Charles Muteshi, Sikolia Wanyonyi, Abraham Mukaindo, Ahmed Ismail, Herman Ekea, Abdallah Abdulkarim, John Tole, Anthony Ngugi

Paediatrics and Child Health, East Africa

No abstract provided.

Paediatric Traumatic Brain Injury: Presentation, Prognostic Indicators And Outcome Analysis From A Tertiary Care Center In A Developing Country, Badar Uddin Ujjan, Muhammad Waqas, Muhammad Babar Khan, Dr Saqib Kamran Bakhshi, Muhammad Ehsan Bari

Section of Neurosurgery

Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children worldwide. This study was conducted to report the presentation, management, outcomes and prognostic indicators in a large series of patients from a tertiary care centre in a developing country. It is a review of prospectively collected data of paediatric patients with TBI admitted at our centre between July 2010 and December 2013. A total of 291 patients with a mean age of 7.2±5.0 years were dichotomised into survivors and non-survivors, and variables were compared between the two groups. The mean post-resuscitation Glasgow coma scale (GCS) score …

Department Of Surgery Update, October 2016, Wright State University Department Of Surgery

Department of Surgery Updates

A three page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, scholarly activity, and more.

Exploring Patient And Family Satisfaction In Pediatric Neurological Surgery, Randa R. Barsoom, Todd A. Maugans, James F. Burrows, Paul Rosen

Student Papers, Posters & Projects

Introduction Patient and family satisfaction during outpatient visits is correlated with a continuance of care and likelihood to recommend the practice to others. Additionally, patient-family satisfaction can determine the success of the practice and influence medical outcomes. Utilizing a well-validated surveys instrument, patient and family satisfaction can be explored in the office setting. Methods During a consecutive 36 month period, a standardized and validated patient satisfaction survey instrument was provided to the family members of patients who presented to two pediatric neurosurgery clinics associated with Nemours Children's Health System. The completed surveys were analyzed statistically to identify correlations between overall …

Delayed Presentation Of Forgotten Thyroid Goiter - 25 Years After Thyroidectomy, Fazal Wahab Khan, Ayesha Muhammad, Mohsin Abbas, Syed Usman Bin Mahmood, Benish Fatima, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Forgotten goiter is a rare occurrence (2 - 16% of retrosternal thyroid cases) that depicts recurrence of retrosternal thyroid mass due to growth of remnant thyroid tissue overlooked during an initial thyroidectomy. The patient is a 59-year female who presented with dyspnea and stridor 25 years after total thyroidectomy. She was diagnosed as having a mediastinal mass on radiographic imaging. There were only localized pressure symptoms due to mass effect. The mass was excised employing an extra-cervical approach and using a partial sternotomy. The profuse extension of thyroid tissue, adherent to vital structures in the thorax and the extra-cervical thyroidectomy …

Evaluation And Management Of Sleep Disorders In The Hand Surgery Patient., Michael P. Gaspar, Patrick M. Kane, Sidney M. Jacoby, Patrick S. Gaspar, A. Lee Osterman

Department of Orthopaedic Surgery Faculty Papers

Despite posing a significant public health threat, sleep disorders remain poorly understood and often underdiagnosed and mismanaged. Although sleep disorders are seemingly unrelated, hand surgeons should be mindful of these because numerous conditions of the upper extremity have known associations with sleep disturbances that can adversely affect patient function and satisfaction. In addition, patients with sleep disorders are at significantly higher risk for severe, even life-threatening medical comorbidities, further amplifying the role of hand surgeons in the recognition of this condition.

Rotational Mal-Alignment After Reamed Intramedullary Nailing For Tibial Shaft Fracture, Sher Khan, Yasir Mohib, Rizwan Haroon Rashid, Haroon Rashid

Department of Surgery Docs

Abstract

Intra-medullary (IM) nailing is standard of care for unstable tibial shaft fractures. Malrotation is very common but it is under-recognised, inpart because of variation in normal anatomy and partly due to difficulty in accurately assessing rotation. This study was planned to evaluate the frequency of rotational mal-alignment after reamed tibia IMnailing. This cross-sectional study was conducted at Aga khan University Hospital, Karachi, and comprised patients with tibia shaft fractures managed with IMnailing from January to December 2014. All the patients were assessed intra-operatively for rotational alignment using the knee and ankle fluoroscopic images. There were 81 patients with a …

Two Incision Mini Open Carpal Tunnel Release- A Minimally Invasive Alternative To Endoscopic Release, Pervaiz Hashmi, Rizwan Haroon Rashid, Moiz Ali, Yasir Mohib, Naveed Baloch

Department of Surgery Docs

Abstract

Surgical techniques for carpal tunnel release are constantly evolving to reduce complications. This retrospective study was planned to identify the outcome and complications associated with a new operating technique for release of carpal tunnel using two incisions. It was conducted at the Aga Khan University Hospital, Karachi, and comprised patients undergoing surgical release of carpal tunnel syndrome (CTS) between January 2011 and December 2014. Of the 54 patients,38(70.4%) cases were of right-sided CTS. The mean operating time was 12.5±4.9 minutes. Complete relief from symptoms was observed in all the patients and the only complication noted was superficial infection in …

Bacterobilia In Acute Cholecystitis: Bile Cultures' Isolates, Antibiotic Sensitivities And Antibiotic Usage. A Study On A Pakistani Population, Yousaf Bashir Hadi, Muhammad Waqas, Hafiz Muhammad Umer,, Ammar Alam, Abdul Rehman Alvi, Muhammad Rizwan Khan, Amir Hafeez Shariff

Department of Surgery Docs

Acute cholecystitis is one of the most common acute surgical conditions. Laparoscopic cholecystectomy remains the mainstay of treatment. In patients managed non-operatively, antibiotics play an important role in the treatment of cholecystitis. The current retrospective observational study was conducted at a tertiary care hospital in Karachi, and comprised medical records of patients admitted between 2008 and 2014with acute cholecystitis and in whom bile cultures were obtained. Of the 509 patients with a mean age of 51.15 ± 13.4years, early laparoscopic cholecystectomy (within 72hours) was performed on 473(92.9%) cases, while the rest underwent percutaneous cholecystostomy. Bile cultureswere positive in 171(33.6%) patients. …

Age Estimation Of A Sample Of Pakistani Population Using Coronal Pulp Cavity Index In Molars And Premolars On Orthopantomogram, Sheikh Bilal Badar, Rabia Ghafoor, Farhan Raza Khan, Muhammad Hasan Hameed

Department of Surgery Docs

The aim of the present study was to assess the validity of tooth-coronal index (TCI) in the age estimation. This retrospective charts review was conducted at the Aga Khan University Hospital, Karachi from January 2016 to March 2016, and comprised 315 teeth of 80 individuals. The teeth were analysed on Orthopantomogram. TCI was calculated for unrestored mandibular premolars and molars. Pearson's correlation was applied to assess correlation between chronological age and TCI. Besides, 30(37.5%) subjects were male and 50(62.5%) female, and 140(44.4%) teeth were of male subjects and 175(55.6%) were of females. The mean correlation coefficient between chronological age and …