Surgery Commons^™

Major Perioperative Morbidity Does Not Affect Long-Term Survival In Patients Undergoing Esophagectomy For Cancer Of The Esophagus Or Gastroesophageal Junction., Brent T Xia, Ernest L Rosato, Karen A Chojnacki, Albert G. Crawford, Benny Weksler, Adam C. Berger

Department of Surgery Faculty Papers

INTRODUCTION: The incidence of cancer of the esophagus/GE junction is dramatically increasing but continues to have a dismal prognosis. Esophagectomy provides the best opportunity for long-term cure but is hampered by increased rates of perioperative morbidity. We reviewed our large institutional experience to evaluate the impact of postoperative complications on the long-term survival of patients undergoing resection for curative intent.

METHODS: We identified 237 patients who underwent esophagogastrectomy, with curative intent, for cancer between 1994 and 2008. Complications were graded using the previously published Clavien scale. Survival was calculated using Kaplan-Meier methodology and survival curves were compared using log-rank tests. …

Surgical Management Of Pediatric Gastroesophageal Reflux Disease, Hope T. Jackson, Timothy D. Kane

Surgery Faculty Publications

No abstract provided.

Faculty And Staff Updates, Department Of Surgery, January 2013, Wright State University Department Of Surgery

Department of Surgery Updates

A one page newsletter created by the Department of Surgery documenting changes to the department. This issue contains news about the faculty and staff, important dates, committee meetings, a message from the chair, and more.

Multi-Modality Assessment Of Language Function, Erik Carmen Brown

Wayne State University Dissertations

The work presented as part of this dissertation represents a multi-modality study of language structure and function. The primary functional modality employed is task-related electrocorticography (ECoG). This is complemented by discussion and evaluation of previously published functional magnetic resonance imaging (fMRI) data. Language-related structure is explored using diffusion-weighted magnetic resonance imaging in conjunction with ECoG data. The scientific questions pursued are broad and include reevaluation of previously proposed theories.

We start by taking the first steps in validating our naming-related ECoG approach by comparing our results from a small cohort of patients to the clinical gold-standard technique of electrical brain …

Autoclaved Tumor Bone For Skeletal Reconstruction In Paediatric Patients: A Low Cost Alternative In Developing Countries, Masood Umer, Hafiz Muhammad Umer, Irfan Qadir, Haroon Rashid, Rabia Awan, Raza Askari, Shamvil Ashraf

Section of Orthopaedic Surgery

We reviewed in this series forty patients of pediatric age who underwent resection for malignant tumors of musculoskeletal system followed by biological reconstruction. Our surgical procedure for reconstruction included (1) wide en bloc resection of the tumor; (2) curettage of tumor from the resected bone; (3) autoclaving for 8 minutes (4) bone grafting from the fibula (both vascularized and nonvascularized fibular grafts used); (5) reimplantation of the autoclaved bone into the host bone defect and fixation with plates. Functional evaluation was done using MSTS scoring system. At final followup of at least 18 months (mean 29.2 months), 31 patients had …

Traumatic Pancreatic Injury: An Elusive Diagnosis: Experience From A Developing Country Urban Trauma Referral Centre, Ayaz Ahmed Memon, Hasnain Zafar, Rushna Raza, Ghulam Murtaza

Section of General Surgery

Objective: To determine the frequency of pancreatic injury in patients presenting with trauma and to review the mechanism of injury, management, subsequent complications and in-hospital mortality rate associated with these patients.
Methods: The retrospective study included all patients over 18 years of age presenting with pancreatic injury due to trauma at the Aga Khan University Hospital, Karachi, between January 1990 and December 2009. Patients with iatrogenic pancreatic injury were excluded. The severity of the injury was assessed using the Injury Severity Score, while it was graded according to the scale defined by the American Association for the Surgery of Trauma. …

Midterm Results Of Bovine Jugular Vein Conduit For Right Ventricular Outflow Tract Reconstruction, Shazia Samad Mohsin, Maria Tariq Siddiqui, Abdul Sattar Shaikh, Mehnaz Atiq, Muneer Amanullah

Department of Paediatrics and Child Health

Objective: To evaluate the midterm results of Contegra conduit.
Methods: The retrospective study comprised patient record at Aga Khan University Hospital, Karachi, of conduits implanted between May 2007 and June 2012. Data collection was made from the clinical notes and from serial echocardiograms by a single cardiologist. The last followup echocardiography was done at the time of data collection in June 2012. SPSS 19 was used for statistical analysis.
Results: A total of 18 conduits had been implanted (16-22mm) during the study period. Median age at the time of surgery was 9 years (range: 2.5-16 years). Early mortality was seen …

Oesophageal Duplication Cyst Presenting As Haemoptysis, Noureen Afzal, Syeda Ezz-E-Rukhshan Adil, Ammara Mushtaq, Arshalooz Rahman, Muneer Amanullah

Department of Paediatrics and Child Health

Duplications of the alimentary tract include a variety of cysts, diverticula, and tubular malformations, all believed to have embryological origin. The cysts are most commonly found in children, and the diagnosis is made in infancy in the majority of patients. We report a case of a two-and-a-half year old child, presenting with the history of repeated episodes of haematemesis. Upper GI endoscopy was unremarkable and the chest x-ray showed no pathology. Computed tomography (CT) angiogram revealed soft tissue density lesion in the right chest at the level of T6. Right thoracotomy suggested a cystic mass close to the oesophagus which …

William Edwards Ladd, M.D. (1880-1967): The Description Of His Bands., Pei-Wen Lim, Md, Niels D. Martin, Md, Barry A. Hicks, Md, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

In the early 20th century, an established surgical specialty catering to pediatric surgery did not exist, and pediatric surgical ailments were operated on by general surgeons. With his devotion to childhood diseases and his unique thinking in surgical development, William E. Ladd would become a leading figure in America by pioneering the field of pediatric surgery.

Tuberculosis Verrucosa Cutis In A Patient With Keloid Over Ear Lobule, Muhammad Sohail Halim, Sadaf Qadeer Ahmed, Montasir Junaid, Muhammad Rizwan Bashir

Section of Otolaryngology, Head & Neck Surgery

Tuberculosis (TB) is a global health problem with predominance in resource-poor countries. Extrapulmonary TB constitutes approximately 10% of the cases and can present as different forms depending on the route of entry. Cutaneous TB is a small subset of the extrapulmonary TB. Cutaneous TB can either be of primary origin or secondary origin or it can be a part of a systemic infection. TB verrucosa cutis (TBVC) is the exogenous reinfection of TB in a previously sensitised patient. Routine cultures do not have a high yield in TBVC due to the paucibacillary nature of the organism. Here we are presenting …

Fishing-Injury-Related Flexor Tenosynovitis Of The Hand: A Case Report And Review, Danny A. Young-Afat, Deniz Dayicioglu, John C. Oeltjen, Audene P. Garrison

Surgery Faculty Publications

Hand infections occurring after fishing and other marine-related activities may involve uncommon bacteria that are not susceptible to the conventional or empiric antibiotic therapy used to treat soft tissue infections. Therefore appropriate treatment is often delayed and could lead to severe hand damage. An illustrative case of fishing-related injury leading to complicated tenosynovitis and horseshoe abscess caused by Mycobacterium marinum and its treatment course is outlined. Laceration of the skin during boating is fairly common. Because of the rarity of some of the bacteria, referrals to the appropriate specialist including hand surgeons and infectious disease specialists should occur in early …

Scheduling In Mohs Micrographic Surgery Clinics, Stephen Vincent Steidle

Open Access Theses

Mohs Micrographic Surgery (MMS) is a surgical method used for the excision of aggressive skin cancers in areas of high cosmetic importance, such as the face and hands. The practice has been gaining popularity worldwide for its low recurrence rates and cosmetic results. Current clinics though are plagued by extreme wait times and an overall poor patient experience. In this paper we look to explore this problem by applying systems engineering principles including optimization and scheduling with the goal of improving the patient experience. Currently, little literature exists exploring the difficulties associated with scheduling for MMS clinic which primarily revolve …

Targeting And Killing Of Glioblastoma With Activated T Cells Armed With Bispecific Antibodies, Ian M. Zitron, Archana Thakur, Oxana Norkina, Geoffrey R. Barger, Lawrence G. Lum, Sandeep Mittal

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Since most glioblastomas express both wild-type EGFR and EGFRvIII as well as HER2/neu, they are excellent targets for activated T cells (ATC) armed with bispecific antibodies (BiAbs) that target EGFR and HER2.

Methods

ATC were generated from PBMC activated for 14 days with anti-CD3 monoclonal antibody in the presence of interleukin-2 and armed with chemically heteroconjugated anti-CD3×anti-HER2/neu (HER2Bi) and/or anti-CD3×anti-EGFR (EGFRBi). HER2Bi- and/or EGFRBi-armed ATC were examined for in vitro cytotoxicity using MTT and ⁵¹Cr-release assays against malignant glioma lines (U87MG, U118MG, and U251MG) and primary glioblastoma lines.

Results

EGFRBi-armed ATC killed up to 85% of U87, …

Open Tracheostomy After Aborted Percutaneous Approach Due To Tracheoscopy Revealing Occult Tracheal Wall Ulcer, John Schweiger, Collin Sprenker, Devanand Mangar, Rachel Karlnoski, Naga Pullakhandam, Enrico M. Camporesi

Surgery Faculty Publications

Tracheostomy is a common procedure for intensive care patients requiring prolonged mechanical ventilation. In this case report, we describe a 78-year-old female patient admitted for an aneurysm of the cerebral anterior communicating artery. Following immediate endovascular coiling, she remained ventilated and was transferred to the neurological intensive care unit. On postoperative day ten, a percutaneous tracheostomy (PCT) was requested; however, a large ulcer or possible tracheoesophageal fistula was identified on the posterior tracheal wall following bronchoscopic assessment of the trachea. Therefore, the requested PCT procedure was aborted. An open tracheostomy in the operating room was completed; however, due to the …

An Unusual Combination Of Extra-Adrenal Pheochromocytoma And Arteriovenous Malformation Of The Ureter In A Young Adult, Ali Khawaja, Wajahat Aziz, Syed Muhammad Nazim, Farhat Abbas

Section of Urology

We present a case of a 24-year-old gentleman who presented with painless pan haematuria for 2 weeks. During the workup, he was diagnosed to have a retrocaval mass after a CT scan while cystoscopy revealed a polypoidal pulsating lesion in the left ureter. After surgical manipulation of the retrocaval mass, the blood pressure of the patient raised to 260/130 mm Hg. It was completely resected and diagnosed as extra-adrenalpheochromocytoma (paraganglioma) after histopathology. The lesion in the ureter was completely excised and fulgurated and diagnosed as anarteriovenous malformation. To the best of our knowledge, this is the first patient to be …

Renal Arteriovenous Malformation: An Unusual Cause Of Recurrent Haematuria, Mazhar Ali, Wajahat Aziz, Farhat Abbas

Section of Urology

A 54-year-old woman presented with gross painless haematuria. Initial workup showed no abnormality except mild hydronephrosis on CT scan. Cystoscopy and retrograde pyelography did not find any gross lesion and her urine cytology was also negative. She had recurrent haematuria so her CT was reviewed with the radiologist with clinical suspicion of arteriovenous malformation (AVM) which was suggested by relatively increased contrast density in the hemiazygous vein and renal vein in the arterial phase. She underwent angioembiolisation of left renal AVM after which her haematuria settled.

Validation Of The Ottawa Ankle Rules At A Tertiary Teaching Hospital: A Cross-Sectional Study, Mark Karanja Tharao

Master of Medicine in General Surgery

Introduction: Ankle joint and foot injuries are among the commonest injuries seen at the Accident and Emergency Department of any hospital. Within the United States it is the second most common musculoskeletal injury seen by physicians. Assessment of these injuries is done clinically and when deemed necessary a radiograph is requested. Studies have shown that radiographs are ordered in over 95% of cases yet the prevalence of fractures is in the range of 15-20%. This means that more than 80% of patients are exposed to unnecessary radiation. The Ottawa ankle rules have been designed to reduce the need for performing …

Advanced Augmented Reality Telestration Techniques With Applications In Laparoscopic And Robotic Surgery, Stephen Dworzecki

Wayne State University Dissertations

The art of teaching laparoscopic or robotic surgery currently has a primary reliance on an expert surgeon tutoring a student during a live surgery. During these operations, surgeons are viewing the inside of the body through a manipulatable camera. Due to the viewpoint translation and narrow field of view, these techniques have a substantial learning curve in order to gain the mastery necessary to operate safely. In addition to moving and rotating the camera, the surgeon must also manipulate tools inserted into the body. These tools are only visible on camera, and pass through a pivot point on the body …

Transatrial Access For Left Atrial Pressure (Lap) Monitoring Line Placement In Arterial Switch Operation (Aso) In Neonates, Mohammad Irfan Akhtar, Mohammad Hamid, Muneer Amanullah, Khalid Ahsan

Department of Anaesthesia

Left Atrial pressure monitoring is a useful and accurate method to guide Left ventricle filling in the patients who undergo Arterial switch operation for transposition of great arteries. We have used a different technique in three TGA patients for LA pressure monitoring line placement. After cleaning and draping,right internal jugular vein (rt IJV) located through 22G venous cannula, guide wire was put in followed by sliding the 22Gx8cm vygon arterial catheter over the guide wire into the right atrium that was directed transatrially into LA by the operating surgeon during atrial septum repair. The catheter was secured by silk on …

The Role Of Bridging Therapy In Hepatocellular Carcinoma, Roberto Galuppo, Angie Mccall, Roberto Gedaly

Surgery Faculty Publications

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver accounting for 7% of all cancers worldwide. Most cases of HCC develop within an established background of chronic liver disease. For that reason, liver resection is only possible in selected patients. Liver transplantation has become the treatment of choice in patients with HCC, end-stage liver disease, and significant portal hypertension. Shortage of organ donors has resulted in overall increase of waiting list time with increased risk of dropout due to tumor progression. Neoadjuvant therapies have emerged as an alternative to control tumor growth in patients while waiting. The …