Surgery Commons^™

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 …

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 …

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 …

Frequency Of Color Blindness In Pre-Employment Screening In A Tertiary Health Care Center In Pakistan, Shaukat Ali Chhipa, Farzeen K. Hash, Shehreen Ali, Mustafa Kama, Khabir Ahmed

Department of Surgery Docs

Abstract

OBJECTIVE:

To describe the frequency of color vision deficiency among Pakistani adults presenting for pre-employment health screening in a tertiary care hospital.

METHODS:

The cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, and the data was collected for color vision deficiency, age, gender, and job applied for from pre-employment examination during 2013-2014. IBM SPSS 20 was used for statistical analysis.

RESULTS:

Three thousand four hundred and thirty seven persons underwent pre-employment screening during 2013 and 2014; 1837 (53.44%) were males and 1600 (46.65%) females. The mean age was 29.01 (±6.53) years. A total of 0.9% …

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 …

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 …

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.

Preventive Gabapentin Versus Pregabalin To Decrease Postoperative Pain After Lumbar Microdiscectomy: A Randomized Controlled Trial, Mohsin Qadeer, Muhammad Waqas, Muhammad Jawad Rashid, Ather Enam, Salman Sharif, Ghulam Murtaza

Section of Neurosurgery

Study design: Randomized controlled trial.
Purpose: The purpose of this study was to compare pregabalin and gabapentin for mean postoperative visual analog score (VAS) for pain in patients undergoing single-level lumbar microdiscectomy for intervertebral disc prolapse at a tertiary care hospital.
Overview of literature: Pregabalin has a superior pharmacokinetic profile and analgesic effect at lower doses than gabapentin; however, analgesic efficacy must be established during the perioperative period after lumbar spine surgery.
Methods: This randomized controlled trial was carried out at our institute from February to October 2011 on 78 patients, with 39 participants in each study group. Patients undergoing …

Frequent Mild Head Injury Promotes Trigeminal Sensitivity Concomitant With Microglial Proliferation, Astrocytosis, And Increased Neuropeptide Levels In The Trigeminal Pain System., Ashley L. Tyburski, Lan Cheng, Soroush Assari, Kurosh Darvish, Melanie B Elliott

Department of Neurosurgery Faculty Papers

BACKGROUND: Frequent mild head injuries or concussion along with the presence of headache may contribute to the persistence of concussion symptoms.

METHODS: In this study, the acute effects of recovery between mild head injuries and the frequency of injuries on a headache behavior, trigeminal allodynia, was assessed using von Frey testing up to one week after injury, while histopathological changes in the trigeminal pain pathway were evaluated using western blot, ELISA and immunohistochemistry. RESULTS: A decreased recovery time combined with an increased mild closed head injury (CHI) frequency results in reduced trigeminal allodynia thresholds compared to controls. The repetitive CHI …

Enhancement Of Fracture Healing In The Rat, Modulated By Compounds That Stimulate Inducible Nitric Oxide Synthase: Acceleration Of Fracture Healing Via Inducible Nitric Oxide Synthase., R A Rajfer, A Kilic, Andrew S Neviaser, L M Schulte, S M Hlaing, J Landeros, M G Ferrini, E Ebramzadeh, S-H Park

Orthopaedic Surgery Faculty Publications

OBJECTIVES: We investigated the effects on fracture healing of two up-regulators of inducible nitric oxide synthase (iNOS) in a rat model of an open femoral osteotomy: tadalafil, a phosphodiesterase inhibitor, and the recently reported nutraceutical, COMB-4 (consisting of L-citrulline, Paullinia cupana, ginger and muira puama), given orally for either 14 or 42 days.

MATERIALS AND METHODS: Unilateral femoral osteotomies were created in 58 male rats and fixed with an intramedullary compression nail. Rats were treated daily either with vehicle, tadalafil or COMB-4. Biomechanical testing of the healed fracture was performed on day 42. The volume, mineral content and bone density …

Prone Position: Does It Help With Acute Respiratory Distress Syndrome (Ards) Requiring Extracorporeal Membrane Oxygenation (Ecmo)?, Nava Azimzadeh, Michael Baram, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

Introduction: Lung protective ventilation therapy with low tidal volume-high PEEP is the standard treatment for the patients with acute respiratory distress syndrome (ARDS). Oscillators are occasionally used for salvage ventilation in cases where poor compliance restricts the use of traditional ventilation with ARDS. In addition to ventilator therapy, prone positioning has been used to improve oxygenation. We presented a challenging case of ARDS, which failed medical management extracorporeal membrane oxygenation (ECMO) support and oscillatory ventilation. Prone positioning was initiated which improved oxygenation, respiratory compliance and posterior atelectasis. Case presentation: A 41-year-old morbid obese female developed ARDS due to influenza pneumonia. …

Tailored Metabolic Workup For Urolithiasis – The Debate Continues, Hammad Ather, Imran Siddiqui, Tahmeena Siddiqui, M Nasir Sulaiman

Department of Surgery Docs

Abstract

Urolithiasis is one of the commonest afflictions of the urinary tract. Stones are of various chemical compositions, some share some common etiology; but most are specific to the structure and composition of stone. In view of highly recurrent nature of this condition, it is logical to have strategies for prevention. However, due to multiple factors most patients receive no or fragmented information on prevention. The current controversy is to the extent of metabolic workup in adult first time stone former. This requires longitudinal studies to show benefit in prevention strategies. Patients at high risk can have recurrence in weeks …

Hepatitis C Virus Seroprevalence In The General Female Population Of 9 Countries In Europe, Asia And Africa, Gary M. Clifford, Tim Waterboer, Bolormaa Dondog, You Lin Qiao, Dimitri Kordzaia, Doudja Hammouda, Namory Keita, , Nahid Khodakarami, Syed Ahsan Ali, Ang Tshering Sherpa, Witold Zatonski

Department of Surgery Docs

Abstract

BACKGROUND:

New oral treatments with very high cure rates have the potential to revolutionize global management of hepatitis C virus (HCV), but population-based data on HCV infection are missing in many low and middle-income countries (LMIC).

METHODS:

Between 2004 and 2009, dried blood spots were collected from age-stratified female population samples of 9 countries: China, Mongolia, Poland, Guinea, Nepal, Pakistan, Algeria, Georgia and Iran. HCV antibodies were detected by a multiplex serology assay using bead-based technology.

RESULTS:

Crude HCV prevalence ranged from 17.4% in Mongolia to 0.0% in Iran. In a pooled model adjusted by age and country, in …

Hookworm Infestation As A Cause Of Melena And Severe Anaemia In Farmer, Marvi Tariq, Syeda Maria Muzammil, Fareed Ahmed Sheikh, K. M. Inam Pal

Department of Surgery Docs

Abstract

Hookworm infections remain a major cause of morbidity in the developing world. Prevalence is highest in agricultural areas, where use of waste water for irrigation and poor hygiene increases infection rates among farmers. Infections present with gastrointestinal symptoms and chronic anaemia, and there are usually no signs of overt blood loss.
The following report describes a case of melena in a middle-aged farmer, where the diagnosis of hookworm infestation was delayed due to the unusual presentation. The patient underwent multiple blood transfusions before referral to the Aga Khan University Hospital (AKUH), Karachi and was managed conservatively with mebendazole at …

Superior Septal Approach Versus Left Atrial Approach For Mitral Valve Replacement: A Retrospective Cohort Study, Tooba Ansar, Taimur Asif Ali, Saneeha Shahid, Saulat H. Fatimi, Ghulam Murtaza

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the outcomes of superior septal approach and left atrial approach for mitral valve replacement.

METHODS:

This retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients who had undergone isolated mitral valve replacement from May 2003 to April 2012. Cases were reviewed for the outcomes [primary: loss of normal sinus rhythm; secondary: complications, residual defect and mortality]. Patients with prior history of dysrhythmia, low ejection fraction (<30%), emergency/redo mitral valve replacement and concomitant coronary artery bypass grafting were excluded. SPSS 19 was used for data analysis.

RESULTS:

Of the 78 patients, 52(66.67%) were of superior septal approach and 26(33.33%) of left atrial approach. Both groups were comparable for …

Prospects And Limitations Of Improving Skeletal Growth In A Mouse Model Of Spondyloepiphyseal Dysplasia Caused By R992c (P.R1192c) Substitution In Collagen Ii., Machiko Arita, Jolanta Fertala, Cheryl Hou, James Kostas, Andrzej Steplewski, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Skeletal dysplasias form a group of skeletal disorders caused by mutations in macromolecules of cartilage and bone. The severity of skeletal dysplasias ranges from precocious arthropathy to perinatal lethality. Although the pathomechanisms of these disorders are generally well defined, the feasibility of repairing established aberrant skeletal tissues that developed in the presence of mutant molecules is currently unknown. Here, we employed a validated mouse model of spondyloepiphyseal dysplasia (SED) that enables temporal control of the production of the R992C (p.R1192C) collagen II mutant that causes this disease. Although in our earlier studies we determined that blocking the expression of this …

Re-Structuring University Hospital’S Internship Program Using Kern’S Six-Step Model Of Instructional Design, M. Tariq, Muhammad Shahzad Shamim, Amna Subhan Butt, Sana Saeed, Zia Ur Rehman, Barkat Virani, Asghar Ashraf, Irum Qamar, Farah Qamar, Raheela Mohsin Rizvi, Swaleha Tariq, Qurratulain Naeem

Department of Surgery Docs

Abstract Background: Internship is a phase of training wherein a graduate learns in the context of practice, acquiring skills under supervision so that he/she may become capable of functioning independently. We are reporting the process of curriculum restructuring for strengthening the Internship Program at this university hospital. Methodology: We used Kerns’ six-step model to evaluate and restructure the internship curriculum. Step 01: Problem Identification & General need assessment- Thorough literature review revealed Internship as the crucial year of training that needs to be fashioned around the competencies required to make good doctors

Inferior Stemi Complicated By Retroperitoneal Hemorrhage Due To Ruptured Aaa, Farley B. Neasman Iii, Melissa D. Lester, Nepal C. Chowdhury

Marshall Journal of Medicine

When patients present with life threatening conditions, a rapid cost-benefit analysis prioritizes care and commits treatment to a certain course that, in the case of ST Elevation Myocardial Infarction (STEMI) treated with drug-eluting stents (DES), could be fatal if there is any deviation. Antiplatelet therapy is vital and secondary concerns (i.e. bleeding diatheses) may accept suboptimal outcomes – in rare cases, another life-threatening condition may be unmasked, the treatment for which runs directly counter to the first. We present a case of STEMI with high clot burden treated with multiple DES, complicated by retroperitoneal hemorrhage due to a ruptured abdominal …

Rectal Colonic Mural Hematoma Following Enema For Constipation While On Therapeutic Anticoagulation., Rebecca M. Rentea, Charles H. Fehring

Manuscripts, Articles, Book Chapters and Other Papers

Causes of colonic and recto-sigmoid hematomas are multifactorial. Patients can present with a combination of dropping hemoglobin, bowel obstruction and perforation. Computed tomography imaging can provide clues to a diagnosis of intramural hematoma. We present a case of rectal hematoma and a review of current management literature. A 72-year-old male on therapeutic anticoagulation for a pulmonary embolism, was administered an enema resulting in severe abdominal pain unresponsive to blood transfusion. A sigmoid colectomy with end colostomy was performed. Although rare, colonic and recto-sigmoid hematomas should be considered as a possible diagnosis for adults with abdominal pain on anticoagulant therapy.

Hic1 (Hypermethylated In Cancer 1) Sumoylation Is Dispensable For Dna Repair But Is Essential For The Apoptotic Dna Damage Response (Ddr) To Irreparable Dna Double-Strand Breaks (Dsbs)., Sonia Paget, Marion Dubuissez, Vanessa Dehennaut, Joe Nassour, Brennan T Harmon, Nathalie Spruyt, Ingrid Loison, Corinne Abbadie, Brian R Rood, Dominique Leprince

Surgery Faculty Publications

The tumor suppressor gene HIC1 (Hypermethylated In Cancer 1) encodes a transcriptional repressor mediating the p53-dependent apoptotic response to irreparable DNA double-strand breaks (DSBs) through direct transcriptional repression of SIRT1. HIC1 is also essential for DSB repair as silencing of endogenous HIC1 in BJ-hTERT fibroblasts significantly delays DNA repair in functional Comet assays. HIC1 SUMOylation favours its interaction with MTA1, a component of NuRD complexes. In contrast with irreparable DSBs induced by 16-hours of etoposide treatment, we show that repairable DSBs induced by 1 h etoposide treatment do not increase HIC1 SUMOylation or its interaction with MTA1. Furthermore, HIC1 SUMOylation …