Surgery Commons^™

Bomb Blast In A Tertiary Care Hospital, The Challenges Faced During Management Of Victims In A Resource Limited Country, Rizwan Sultan, Hasnain Zafar, Umar B, Khabir Ahmed

Department of Surgery Docs

Abstract Introduction: A bomb blast in a hospital results in a many fold increase in the casualties. The affected health care in the region is the next challenge faced by the administration of the city. We discuss the challenges faced after a bomb blast in the civil hospital of Quetta, Pakistan on 8 August 2016. Methods: A retrospective review of the medical records of patients who were transferred by air to the Aga Khan University Hospital Karachi over a period of 86 h after the blast in Quetta. Results: Seventy-five patients were received in three separate waves; those received in …

The Many Guises Of Primary Hyperparathyroidism… An Unchanged Scenario, Tasnim Ahsan, Uzma Erum, K. M. Inam Pal, Rukhshanda Jabeen, Saima Ghaus Qureeshi, Urooj Lal Rehman, Zeenat Banu

Department of Surgery Docs

Abstract

OBJECTIVE:

To study the causes, characteristics and outcome of treatment of patients with primary hyperparathyroidism.

METHODS:

This retrospective cohort analysis was conducted at the Jinnah Postgraduate Medical Centre, Karachi, and comprised data of patients with primary hyperparathyroidism between 2004 and 2014. .SPSS 17 was used for data analysis.

RESULTS:

Of the 25 patients,1(4%)was male and 24(96%) were female. The overall mean age was 41.72±15.9 years, with a mean duration of symptoms of 4.1±3.3 years. The mean pre-operative parathyroid hormone level was 879.48±793.51 pg/ml. Skeletal manifestations were reported in 17(68%) patients, whereas 4(16%) patients had renal stone disease. Besides, 2(8.0%) …

Genomic Contraindications For Heart Transplantation., Danton S. Char, Gabriel Lázaro-Muñoz, Aliessa Barnes, David Magnus, Michael J. Deem, John Lantos

Manuscripts, Articles, Book Chapters and Other Papers

Genome sequencing raises new ethical challenges. Decoding the genome produces new forms of diagnostic and prognostic information; however, the information is often difficult to interpret. The connection between most genetic variants and their phenotypic manifestations is not understood. This scenario is particularly true for disorders that are not associated with an autosomal genetic variant. The analytic uncertainty is compounded by moral uncertainty about how, exactly, the results of genomic testing should influence clinical decisions. In this Ethics Rounds, we present a case in which genomic findings seemed to play a role in deciding whether a patient was to be listed …

Appendicular Mass – A Rare Form Of Tuberculosis, Petrisor Banu, Vlad D. Constantin, Florian Popa, Mircea Bratucu, Teodora Vladescu, Cristian Balalau

Journal of Mind and Medical Sciences

Tuberculosis is in the top 10 causes of death worldwide, being one of the most deadly infectious diseases. It is estimated that one of three people from the entire earth population has a latent infection with M tuberculosis. This aerobic bacterium possesses the ability to persist in host tissues for years and to begin replication once immunity declines.

The lungs are most frequent site of infection as the Mycobacterium tuberculosis is carried by aerosol droplets and is commonly transmitted by respiratory route. The second way of transmission is by contaminated food.

Intestinal contamination coexists with pulmonary tuberculosis and only 10% …

The Prevalence Of High Dysplastic Colonic Adenomatous Polyps In A 3 Year Endoscopic Retrospective Study From A Single Clinical Center, Alexandru C. Septimiu, Cosmin A. Moldovan, Florin D. Ungureanu

Journal of Mind and Medical Sciences

Introduction: Many colon neoplastic tumors come from the malignancy of adenomatous polyps (70%-90%) that were not timely diagnosed in order to be resected. Materials and Methods: We conducted a retrospective study regarding the incidence of adenomatous polyps during 1.000 consecutive colonoscopies performed in our Upper and Lower Digestive Endoscopy Laboratory during a three-year period. Results: During these colonoscopies, some targeted polyps were biopsied or completely removed and the samples had been sent to a complete anatomopathological examination. Taking into consideration the results, the polyps were classified after the histological type and the form of dysplasia, in order …

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.

Diastolic Dysfunction In Coronary Artery Disease, Sarwat Hashmi, H R. Ahmad, Hasanat Sharif, Syedah Saira Bokhari

Department of Biological & Biomedical Sciences

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 …