Surgery Commons^™

Intertrochanteric Hip Fractures In Octogenarian Patients: Do We Need To Rethink Fixation Strategy?, Shahryar Noordin, Shahbano 1, Tashfeen Ahmad, Idrees Shah

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare outcomes in octogenarians with younger patients up to 1 year after undergoing dynamic hip screw fixation for intertrochanteric fractures to see the effectiveness of the implant.

METHODS:

The retrospective case-control study was conducted at The Aga Khan University and comprised records of patients who underwent dynamic hip screw surgery between January 1, 2010, and December 31, 2012. They were divided into two groups based on their age:. Group A <80 years; and Group B > 80 years. All patients had a one-year follow-up> Data including mortality, morbidity, radiological healing time, postoperative ambulatory status and Harris hip score were recorded.

RESULTS:

Of the …

Adrenalectomy For Solitary Metastasis Of Hepatocellular Carcinoma Post Liver Transplantation: Case Report And Literature Review, Imran K. Jalbani, Nazim Syed Muhammad, Usman Tariq Siddiqui, Farahat Abbas

Department of Surgery Docs

Abstract

Liver transplantation (LT) is the treatment of choice for localized hepatocellular carcinoma (HCC) associated with cirrhosis. Extra hepatic metastasis is the most common cause of death in these patients. There is very little evidence regarding the natural history and treatment options for patients developing HCC recurrence after LT. Surgical resection offers a unique opportunity for solitary metastasis. We report a 61 year old male with solitary right adrenal metastasis 15 months post LT which was managed with open adrenalectomy. The patient is alive and disease free 24 months after the surgery. The case, histo-pathological findings and literature review is …

Traumatic Posterior Tibial Pseudoaneursym: A Rare Late Complication Repaired Conventionally, Farzad Amiri, Md, Zachary Sanford, Constantinous Constantinou, Md

Marshall Journal of Medicine

Posterior tibial artery pseudoaneurysms are extremely rare. They commonly present as a late complication of trauma or iatrogenic injury. Diagnosis can be elusive. Treatment has been described in the context of open primary repair, endovascular stenting, and coil embolization. There has been increasing interest in the use of endovascular treatment options for this type of injury. If left untreated, pseudoaneurysms can rupture, partially thrombose, expand and cause adjacent local compression and compartment syndrome. The following case presented is of a young gentleman with a posterior tibial pseudoaneurysm incidentally discovered after stepping on glass and the management of his posterior tibial …

Could There Be Light At The End Of The Tunnel? Mesocaval Shunting For Refractory Esophageal Varices In Patients With Contraindications To Transjugular Intrahepatic Portosystemic Shunt., Jessica Davis, Albert K Chun, Marie L Borum

Surgery Faculty Publications

Cirrhotic patients with recurrent variceal bleeds who have failed prior medical and endoscopic therapies and are not transjugular intrahepatic portosystemic shunt candidates face a grim prognosis with limited options. We propose that mesocaval shunting be offered to this group of patients as it has the potential to decrease portal pressures and thus decrease the risk of recurrent variceal bleeding. Mesocaval shunts are stent grafts placed by interventional radiologists between the mesenteric system, most often the superior mesenteric vein, and the inferior vena cava. This allows flow to bypass the congested hepatic system, reducing portal pressures. This technique avoids the general …

Amaurosis Fugax Associated With Congenital Vascular Defect, John Giltner, Edward R. Thomas, William K. Rundell

Department of Surgery Faculty Publications

No abstract provided.

The Cutting Edge Summer 2016, Wright State University Department Of Surgery

The Cutting Edge Newsletter

A twelve page newsletter created by the Department of Surgery documenting current affairs of the department. This issue contains features such as faculty news, information on general surgery residencies, a list of scholarly activity, special lectures, and more.

Transoral Incisionless Fundoplication: Current Status., Karim Sami Trad

Surgery Faculty Publications

Purpose of review

Transoral incisionless fundoplication (TIF) performed with the EsophyX device (Redmond, Washington, USA) is a totally endoscopic procedure with the objectives to mechanically repair a defective gastroesophageal valve and to reduce small hiatal hernias. The recent publication of randomized controlled trials and long-term follow-up data offers the opportunity to reevaluate this treatment modality and its role in the management of patients with chronic gastroesophageal reflux disease (GERD).

Recent findings

Randomized controlled trials have confirmed the ability of TIF to eliminate troublesome GERD symptoms, heal esophagitis, and improve distal esophageal acid exposure in appropriately selected patient populations. These studies …

Department Of Surgery Update, July 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.

Comparison Of Ureteric Stone Size, On Bone Window Versus Standard Soft-Tissue Window Settings, On Multi-Detector Non-Contrast Computed Tomography., Hussam Uddin Soomro, Hammad Ather, Basit Salam

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the difference in mean stone size, as measured on bone window vs standard soft-tissue window setting using multi-detector computed tomography (MDCT) in patients with a solitary ureteric stone.

PATIENTS AND METHODS:

In all, 60 patients presenting to the emergency and outpatient departments of a University Hospital from May 2015 to October 2015 and fulfilling the inclusion criteria were included in the study. A 64-slice MDCT was used to assess the locations and size of the ureteric stones. A consultant radiologist independently analysed the MDCT scans of all the patients. The mean difference in stone size was …

In-Vitro Comparison Of Micro-Leakage Between Nanocomposite And Microhybrid Composite In Class V Cavities Treated With The Self-Etch Technique, Syeda Mahvish Hussain, Farhan Raza Khan

Department of Surgery Docs

Abstract

BACKGROUND:

When a light cure composite resin is used to restore a class V lesion, certain stresses are generated at the tooth-restoration interface. If these stresses exceed the bond strength of the restorative material, microscopic gaps are formed which eventually cause micro-leakage at the tooth-restoration interface. The objective of the present study was to compare the micro-leakage values at the tooth-restoration interface using dye penetration method between a Nano filled and a Micro hybrid light cured composite resin in class V cavities using the self-etch technique.

METHODS:

Sixty class V cavities were made coronal to the cemento-enamel junction in …

Outcomes After Pediatric Fundoplication: Defining The Redo Population, J E. Baerg, E E. Perrone, R A. Vannix, D L. Thorpe, A Gasior, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

Objective: The aims were to compare outcome variables in children with gastroesophageal reflux disease (GERD) and one Nissen fundoplication to children with redo fundoplications and define the pediatric redo population. Methods: After IRB approval (#5100277), a case control study was conducted of children younger than 18 years, from two children’s hospitals, with one Nissen fundoplication (control group) or a redo performed between January 1995 and March 2011. Complete data were collected by phone calls to caregivers in December 2012. Only redo operations performed after recurrence of GERD symptoms and wrap herniation into the mediastinum confirmed by contrast radiograph were included. …

Outcomes Of External Repair Of Heartmate Ii™ Lvad Percutaneous Leads, Jay D. Pal, Claudius Mahr, Jason W. Smith, Todd F. Dardas, Jay Pinette, David J. Farrar, Nahush A. Mokadam

The VAD Journal

Background: The HeartMate II Left Ventricular Assist Device (LVAD) receives power via a percutaneous lead connected to an external controller and batteries. At times, this lead can be damaged during normal wear, as well as by traumatic fracture, which may jeopardize the functionality of the LVAD. If there is significant internal damage, surgical replacement of the LVAD is required. However it is possible to repair externally damaged leads by replacing the distal portion of the lead to avoid pump replacement. We report the overall experience and outcomes in patients with external lead repairs.

Methods: A procedure for full …

Cannabinoid Receptor Type-2 Modulates Nociceptive Signaling Molecules In A Model Of Post-Concussion Headache, Jarred M. Stratton, Lan Cheng, Ashley L. Tyburski, Jessica Perino, Melanie B Elliott

Department of Neurosurgery Posters

Abstract

The goal of this study was to investigate the role of the cannabinoid receptor type-2 (CB₂R) in the trigeminal pain pathway in a model of post-concussion headache. Sprague Dawley rats were randomized to receive either a repeated mild closed head injury (CHI) or served as incision controls. Changes in CGRP, nNOS, and IBA-1 were assessed in the trigeminal nucleus caudalis (TNC) and trigeminal ganglia via IHC. A subset of CHI rats received either a cannabinoid receptor type 2 (CB₂R) anti-inflammatory agonist (JWH133), an NSAID (Ketorolac), or vehicle and underwent von Frey testing for trigeminal allodynia. …

Outcomes And National Trends For The Surgical Treatment Of Lumbar Spine Trauma., Doniel Drazin, Miriam Nuno, Faris Shweikeh, Alex R. Vaccaro, Eli Baron, Terrence T. Kim, J. Patrick Johnson

Department of Orthopaedic Surgery Faculty Papers

Introduction. Operative treatment of lumbar spine compression fractures includes fusion and/or cement augmentation. Our aim was to evaluate postoperative differences in patients treated surgically with fusion, vertebroplasty, or kyphoplasty. Methods. The Nationwide Inpatient Sample Database search for adult vertebral compression fracture patients treated 2004-2011 identified 102,316 surgical patients: 30.6% underwent spinal fusion, 17.1% underwent kyphoplasty, and 49.9% underwent vertebroplasty. Univariate analysis of patient and hospital characteristics, by treatment, was performed. Multivariable analysis was used to determine factors associated with mortality, nonroutine discharge, complications, and patient safety. Results. Average patient age: fusion (46.2), kyphoplasty (78.5), vertebroplasty (76.7) (p < .0001). Gender, race, household income, hospital-specific characteristics, and insurance differences were found (p ≤ .001). Leading comorbidities were hypertension, osteoporosis, and diabetes. Risks for higher mortality (OR 2.0: CI: 1.6-2.5), nonroutine discharge (OR 1.6, CI: 1.6-1.7), complications (OR 1.1, CI: 1.0-1.1), and safety related events (OR 1.1, CI: 1.0-1.1) rose consistently with increasing age, particularly among fusion patients. Preexisting comorbidities and longer in-hospital length of stay were associated with increased odds of nonroutine discharge, complications, and patient safety. Conclusions. Fusion patients had higher rates of poorer outcomes compared to vertebroplasty and kyphoplasty cohorts. Mortality, nonroutine discharge, complications, and adverse events increased consistently with older age.

Medicare Reimbursement For Total Joint Arthroplasty: The Driving Forces., Eric M. Padegimas, Kushagra Verma, Benjamin Zmistowski, Richard H. Rothman, James J. Purtill, Michael Howley

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Total joint arthroplasty is a large and growing part of the U.S. Medicare budget, drawing attention to how much providers are paid for their services. The purpose of this study was to examine the variables that affect total joint arthroplasty reimbursement. Along with standard economic variables, we include unique health-care variables. Given the focus on value in the Affordable Care Act, the model examines the relationship of the quality of care to total joint arthroplasty reimbursement. We hoped to find that reimbursement patterns reward quality and reflect standard economic principles.

METHODS: Multivariable regression was performed to identify variables that …

The (R)- Isomer Of Isometheptene Decreases Trigeminal Sensitivity In A Rat Model Of Primary Headache, Jessica Perino, Ms, Nathan T. Fried, Phd, Michael L. Oshinsky, Phd, Bruce Daugherty, Phd, Mba, Seth Lederman, Md, Melanie B Elliott, Phd

Department of Neurosurgery Posters

Introduction

Isometheptene is thought to be the active ingredient of the commonly known headache medication, Midrin. Previously, we found only the (R) enantiomer to be effective in alleviating headache behavior in two models of headache compared to the (S) enantiomer.

Experiments using electrical and mechanical stimulation of the dura in animals with no history of head pain have been used to elucidate the mechanisms of the trigeminovascular system at the level of the trigeminal ganglion, trigeminal nucleus caudalis, periaqueductal gray, and the thalamus. The limitation of these acute models is that electrical and mechanical stimulation of the dural blood vessels …

Medical Student And Resident Foley Catheterization Training Program To Decrease Post-Operative Catheter Associated Urinary Tract Infections, Peter J. Altshuler, Adam P. Johnson, Md, Mph, Danica Giugliano, Md, Gerald A. Isenberg, Md, Scott W. Cowan, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objective:

Determine whether a more comprehensive medical student urinary catherer training curriculum can be successful in decreasing post-operative CAUTI rates in general and vascular surgery patient populations.

Primary target:

Reduce post-operative UTI rates by 0.5% over 6 months

Secondary targets:

Achieve 100% medical student confidence in Foley catheter placement, understanding indications and contraindications to urinary catheterization.

Improve objective performance of urinary catheterization skills as determined by objective clinical skills exam (OSCE) scores.

Screening For Venous Thromboembolism In Asymptomatic Trauma Patients: Effective In High Risk Patients, Seth Stake, Bs, Adam Wallace, Bs, Deepika Koganti, Md, Pgy-4, Adam P. Johnson, Md, Mph, Joshua A. Marks, Md, Scott W. Cowan, Md, Murray Cohen, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Hypothesis:

Through data analysis of a large cohort of trauma patients, a clinically applicable protocol can be developed based on various predisposing factors for VTE in asymptomatic patients. By isolating the factors that make these patients high risk for VTE, we can effectively lower the incidence of PE in hospitalized trauma patients.

Redefining Budd-Chiari Syndrome: A Systematic Review, N. Shin, Y. Kim, H. Xu, H. Shi, Q. Zhang, Byung-Boong Lee, +6 Additional Authors

Surgery Faculty Publications

AIM: To re-examine whether hepatic vein thrombosis (HVT) (classical Budd-Chiari syndrome) and hepatic vena cava-Budd Chiari syndrome (HVC-BCS) are the same disorder.

METHODS: A systematic review of observational studies conducted in adult subjects with primary BCS, hepatic vein outflow tract obstruction, membranous obstruction of the inferior vena cava (IVC), obliterative hepatocavopathy, or HVT during the period of January 2000 until February 2015 was conducted using the following databases: Cochrane Library, CINAHL, MEDLINE, PubMed and Scopus.

RESULTS: Of 1299 articles identified, 26 were included in this study. Classical BCS is more common in women with a pure hepatic vein obstruction (49%-74%). …

James Mann, M.D. (1759-1832): Military Surgeon For The "Second War Of Independence"., Eliza C. Anderson, Md, Scott W. Cowan, Md, Charles J. Yeo, Md

Department of Surgery Gibbon Society Historical Profiles

The War of 1812 is remembered for the Burning of Washington, and Francis Scott Key’s “The Star Spangled Banner,” but little else. It was a poorly funded war of relatively short duration and nebulous resolution. Under such circumstances, it is understandable that the “Second War of Independence” failed to produce many notable military or medical advancements. However, one surgeon took it upon himself to recount his experiences in the field. For his dedication to the art and science of medicine, James Mann deserves recognition.