Surgery Commons^™

Strategies For The Management Of Postoperative Anemia In Elective Orthopedic Surgery, Taylor D. Steuber, Meredith L. Howard, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use. Data Sources: A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesisstimulating agents, and erythropoietin. Study Selection and Data Extraction: All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery …

Minimally Invasive Surgery In Pediatric Trauma: One Institution's 20-Year Experience, Gustavo Stringel, Min Li Xu, Joseph Lopez

NYMC Faculty Publications

BACKGROUND: Minimally invasive surgery (MIS) for trauma in pediatric cases remains controversial. Recent studies have shown the validity of using minimally invasive techniques to decrease the rate of negative and nontherapeutic laparotomy and thoracotomy. The purpose of this study was to evaluate the diagnostic accuracy and therapeutic options of MIS in pediatric trauma at a level I pediatric trauma center.

METHODS: We reviewed cases of patients aged 15 years and younger who had undergone laparoscopy or thoracoscopy for trauma in our institution over the past 20 years. Each case was evaluated for mechanism of injury, computed tomographic (CT) scan findings, …

On The Dead End Of Current Research On Burnout's Prevalence, Renzo Bianchi, Irvin Sam Schonfeld, Eric Laurent

Publications and Research

Dimou et al. (2016) concluded that >50% of surgeons experience burnout. For three reasons, we think that such conclusions are unwarranted. First, there are no consensual or binding diagnostic criteria for burnout. Second, recent research (e.g., Bianchi, Schonfeld, & Laurent, 2015) suggests that burnout is actually a depressive syndrome. Finally, we note that researchers’ recommendations about stress-reducing organizational changes often remain incantatory because they insufficiently consider the economic issues and macrosocial power relationships that can hamper the recommendations’ implementation. Current practices in burnout research have led to an accumulation of results, the clinical meaning of which is obscure.

Application Of Medical Student Research Objectives In An International Medical Elective: Voluntary Medical Male Circumcision In Swaziland, Alison M. Bales, David J. Dennis, Robert C. Siska, Michael A. Schneider, Echo Vanderwal, Harry Vanderwal, Mary C. Mccarthy

Department of Surgery Faculty Publications

No abstract provided.

Neurosurgery Concepts: Key Perspectives On Intrathecal Fluorescein For Detecting Intraoperative Cerebrospinal Fluid Leak During Endoscopic Endonasal Surgery, Spinal Intraarterial Chemotherapy, Oligoastrocytoma Classification By In Situ Molecular Genetics, And Prenatal Myelomeningocele Closure And The Need For Cerebrospinal Fluid Shunt Placement., Anand V Germanwala, Winward Choy, Jonathan H. Sherman, Sandi Lam, Isaac Yang, Zachary A Smith

Neurological Surgery Faculty Publications

No abstract provided.

High Pati Score Is Associated With Increase Mortality In Patients With Penetrating Abdominal Injuries: A Retrospective Review, Syed Zohaib Gulzar Naqvi, Shahrukh Effendi, Hasnain Zafar

Section of General Surgery

Background: Worldwide, injuries due to violence constitute eighth leading cause of death. Penetrating abdominal injuries account for third most common area involved. Inliterature PATI has been utilized to estimate the severity of abdominal trauma, decision making regarding repairing the damage and even risk of post-operative complications. We aimed and intended to use PATI score (penetrating abdominal trau-ma index) as a more accurate method of quantifying the extent of damage in patients with the penetrat-ing abdominal trauma and association of high PATI score (>25) with mortality.
Objective: To determine the association of mortality in patient with penetrating abdominal trauma with …

Response To The Comments: "Prospective Case Control Evaluation Of Epidural Midazolam For Improving Pain And Ambulation After Microdiscectomy", Muhammad Shahzad Shamim

Section of Neurosurgery

No abstract provided.

Primary Anaplastic Pleomorphic Xanthoastrocytoma In Adults. Case Report And Review Of Literature, Usama Khalid Choudry, Saad Akhtar Khan, Amjad Qureshi, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Pleomorphic xanthoastrocytoma (PXA) classified as a low Grade (WHO II) astrocytic neoplasm. It is known for its relatively favorable prognosis. It most commonly occurs in young adults. Malignant progression in PXA has been frequently reported since its first description in 1979; however, the presentation of a primary anaplastic PXA tumor with an aggressive clinical course in adults is rare especially in the later age group.
Case description: We present a case of primary anaplastic PXA in a 53 year old male that manifested with an early recurrence pattern at 9 weeks. Treatment performed was surgical excision and external beam …

Preoperative Incidence Of Penile Abnormalities Found During Voluntary Male Medical Circumcision In Swaziland, Anthony R. Oddo, Elizabeth Ruedrich, Christopher Zust, Lindsey Marugg, Echo Vanderwal, Rebekah Sartori, Mary C. Mccarthy

Department of Surgery Faculty Publications

No abstract provided.

Pyoderma Gangrenosum Following Bilateral Deep Inferior Epigastric Perforator Flaps, Eric Clayman, Kristen Marcet, Lauren Kuykendall, Dunya M. Atisha

Surgery Faculty Publications

Pyoderma gangrenosum (PG) is an atypical ulcerative cutaneous condition, with an estimated six cases per million people per year in the United States.[1] One-half of patients have idiopathic disease, and it is most commonly associated with underlying systemic inflammatory conditions or hematologic malignancies.[1] [2] There have been several reported cases of PG following breast reduction procedures; however, postsurgical PG (PSPG) is rarely seen following autologous tissue breast reconstruction.[3]

In this article, the authors report the clinical course, treatment, and outcome of a patient diagnosed with PSPG following a delayed breast reconstruction with …

Is Therapeutic Play Effective At Reducing Preoperative Anxiety In Children Age 4 Through 12?, Samantha L. Mclaughlin

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not therapeutic play is effective at reducing preoperative anxiety in children age 4 through 12.

STUDY DESIGN: Three single blind, randomized controlled trials that were published between 2008 and 2010 and published in the English language.

DATA SOURCES: Each of the three studies that evaluate the effectiveness of therapeutic play in pediatric populations were found using the PubMed database based on their relevance to the clinical question and their inclusion of patient oriented outcomes.

OUTCOMES MEASURED: These three articles compared anxiety and stress levels in preoperative therapeutic …

Hematologic Outcomes After Total Splenectomy And Partial Splenectomy For Congenital Hemolytic Anemia., Brian R Englum, Jennifer Rothman, Sarah Leonard, Audra Reiter, Courtney Thornburg, Mary Brindle, Nicola Wright, Matthew M Heeney, C Jason Smithers, Rebeccah L Brown, Theodosia Kalfa, Jacob C Langer, Michaela Cada, Keith T Oldham, J Paul Scott, Mukta Sharma, Andrew M Davidoff, Kerri Nottage, Kathryn Bernabe, David B Wilson, Sanjeev Dutta, Bertil Glader, Shelley E Crary, Melvin S Dassinger, Levette Dunbar, Saleem Islam, Manjusha Kumar, Fred Rescorla, Steve Bruch, Andrew Campbell, Mary Austin, Robert Sidonio, Martin L Blakely, Henry E Rice, Splenectomy In Congenital Hemolytic Anemia Consortium, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

Purpose: The purpose of this study was to define the hematologic response to total splenectomy (TS) or partial splenectomy (PS) in children with hereditary spherocytosis (HS) or sickle cell disease (SCD).

Methods: The Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium registry collected hematologic outcomes of children with CHA undergoing TS or PS to 1 year after surgery. Using random effects mixed modeling, we evaluated the association of operative type with change in hemoglobin, reticulocyte counts, and bilirubin. We also compared laparoscopic to open splenectomy.

Results: The analysis included 130 children, with 62.3% (n=81) undergoing TS. For children with HS, all …

A Microfluidic-Based Tactile Sensor For Palpating Mice Tumor Tissues, Yichao Yang, Garett Johnson, Dean Krusienski, Siqi Guo, Cheng Lin, Zhili Hao

Mechanical & Aerospace Engineering Faculty Publications

In light of the need of tissue palpation for Robotics-assisted Minimally Invasive Surgery (RMIS), this paper presents a microfluidic-based tactile sensor for palpating mice tissues for tumor localization. The core of the sensor is a 3x3 sensing-plate/transducer array built into a single polydimethylsiloxane (PDMS) microstructure, with a transducer spacing of 3.75mmx1.5mm. Mounted on a robot, the sensor is pressed against a tissue region with a pre-defined indentation depth pattern, and consequently the stiffness distribution across the tissue region translates to the deflection distribution of the sensing-plate array and is captured by the transducer array underneath as resistance changes. Thus, the …

Atresia Of The Descending Aorta In A Young Woman Requiring Bypass Graft, Ammarah Mashhood, Taimur Asif Ali, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Congenital aortic atresia is a malformation accounting for 4 - 6% of all congenital heart diseases in children. Left ventricular outflow obstruction due to atresia is common at the aortic valve but rarely has atresia been identified in the descending aorta. We report the case of a 25-year woman who was evaluated for headache and uncontrolled hypertension. CTscan chest showed a short atretic segment in the descending aorta at the isthmus, distal to the takeoff of the subclavian artery. She underwent surgery; a 22 mm Dacron graft was taken and jump graft was placed between the arch of the aorta …

The Role Of Fat Grafting And Adipose-Derived Stem Cells In Breast Reconstruction, Krishna S. Vyas

Theses and Dissertations--Clinical and Translational Science

Fat grafting is a common surgical procedure that involves the transfer of fat from one area of the body to another in order to improve contour deformities, such as in breast reconstruction. Advantages of the technique include using autologous tissue rather than a foreign body and the added benefit of having liposuction to remove fat from an undesirable location. Although adipose tissue could be the ideal soft tissue filler, fat grafting is plagued by tremendous variability in long-term retention, with volume survival rates of 20-80%, resulting in suboptimal outcomes and repetitive procedures.

The mechanisms contributing to long-term fat graft survival …

The Impact Of The Introduction Of The Pecarn Head Ct Rules On The Utilisation Of Head Ct Scans For Children With Mild Head Injury At The Aga Khan University Hospital, Nairobi., Isaac Oluoch Kobe

Master of Medicine in General Surgery

Background: Head injury is the most common cause of childhood morbidity and mortality worldwide. Mild head injury comprises 90% of cases of head injury in children. Head CT scans are few, expensive and have the side effect of ionizing radiation whose effect is potentiated in children and also associated risk of sedation that is often required when doing CT scans in young children. The decision to order CT scans of the head is thus made on the basis of clinical decision rules of which the PECARN CT head rule has been found to be most sensitive and useful. Objectives: Primary: …

Artificial Disc Replacement As An Alternative To Lumbar Spinal Function In The Treatment Of Chronic Low Back Pain, Jennifer Polniak

Physician Assistant Scholarly Project Posters

Chronic low back pain leads to activity limitations for the patient and widespread burdens on health care systems. Lumbar fusion has been the “gold standard” surgery for severe chronic low back pain non-responsive to conservative treatment, however it has been associated with continued limitations in spinal mobility. This study was executed in order to compare an alternative surgical intervention, artificial disc replacement, with lumbar spinal fusion in the treatment of chronic low back pain in terms of long term spinal function. Literature searches of trials, guidelines and systematic reviews within the past 5 years were completed exploring surgical procedures, associated …

Successful Management Of A Stab Wound To The Left Ventricle, Jaleed Ahmad Gillani, Hamza Ar Khan, Omar Irfan, Saulat H. Fatimi

Section of Cardiothoracic Surgery

A 24 year old male presented to the emergency room with a 2 hour history of knife stab wound. He was haemodynamically stable with good bilateral air entry. However on X-ray an enlarged cardiac silhouette was seen. The patient suddenly became hypotensive and on suspicion of cardiac tamponade a catheter was introduced in pericardial space, but the measure was unsuccessful and he was rushed to the Operating Room. During the surgery a 2 cm long laceration was identified in the mid-left ventricular (LV) wall less than 1mm away from the Left Anterior Descending (LAD) Artery. The Left Anterior Descending Vein …

Myxoid Liposarcoma Originating In The Anterior Mediastinum, Mohammad Harisullah Khan, Ramsha Kashif, Hamza Abdur Rahim Khan, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Myxoidliposarcomas ofthe head and neck aremostly metastaticin nature, with the primarylesion usually in lower extremities or retroperitoneum. Primary mediastinal liposarcomas are even rare Although there have been previous cases reporting their incidence, there is no evidence of any case comprising of both the neck and the mediastinal region yet. We here present a case of a 43 year old male with a primary liposarcoma of the myxoid subtype originating in the anterior mediastinumThis is the first time such a case haspres ented in literature. The patient presented with a right sided neck swelling associated with pain and shortness of breath …

Outcomes Experienced By Patients Presenting With Ventral Hernias And Morbid Obesity In A Surgical Clinic, Margaret A. Plymale

DNP Projects

Surgeons generally agree that morbid obesity is a contraindication to ventral hernia repair surgery due to risk of adverse outcomes. The purpose of this study was to describe the experience of patients with ventral hernia complicated by morbid obesity by reviewing a population of patients that were seen by a surgical service to determine the characteristics of those patients that had favorable and unfavorable outcomes. A retrospective medical record review was conducted of new patients with ventral hernias and morbid obesity (body mass index (BMI ) ≥ 40 kg/m²) seen by one surgical service over a two and …