Surgery Commons^™

Neurosurgical Electives: Operating Room Survival Guide, M Shahzad Shamim, Zain A. Sobani

Section of Neurosurgery

No abstract provided.

Long-Term Effect Of Carotid Surgery In Asymptomatic Stenosis., Muhammad Faisal Wadiwala, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Malignant Peripheral Nerve Sheath Tumor (Mpnst): An Overview With Emphasis On Pathology, Imaging And Management Strategies., Timothy C. Beer

Jefferson Hospital Staff Papers and Presentations

MPNSTs are rare malignancies that are classically associated with pre-existing plexiform neurofibromas in neurofibromatosis type 1 (NF-1) patients, but also occur in association with radiation as well as sporadically in patients with no known risk factors. The typical presentation of sporadic MPNST is a new painless enlarging mass. The typical presentation of MPNST in an NF-1 patient is rapid enlargement or new onset of pain associated with a pre-existing plexiform neurofibroma. Although both MPNST and benign neurofibromas share in common the absence of neurofibromin function due to loss of both NF-1 alleles, malignant transformation to MPNST requires several additional aberrations, …

Short-Term Complications After Bilateral Internal Mammary Artery Grafting--A Retrospective Study, Hashim Muhammad Hanif, Zeb Ijaz Saeed, Adil Sheikh, Syed Shahabuddin, Hasanat Sharif

Section of Cardiothoracic Surgery

Objectives: To analyze our experience of conducting Bilateral Internal Mammary Artery (BIMA) grafting, using both pedicled and free grafts for coronary revascularization, assessing the safety and efficacy of the procedure and comparing any differences observed between the two techniques of harvesting the grafts.Methods: A retrospective cross sectional study was conducted in July 2010 in which all 48 patients undergoing bilateral internal mammary artery grafting for coronary bypass surgery at the Aga Khan University Hospital from 1996 to 2010 were reviewed and evaluated. The main outcome measures were perioperative mortality and early morbidity with particular reference to cerebrovascular accidents, sternal wound …

Grading Complication Following Radical Cystectomy And Ileal Conduit For Bladder Cancer Using Clavien Grading System, Syed Johar Raza, M Hammad Ather, Faisal Aziz Khan, Zaheer Alam

Section of Urology

Objective: To determine the 30-day complication rate of radical cystectomy and urinary diversion using a validated system.
Study Design: An analytical descriptive study.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 1990 to 2010.
Methodology: Patients who had undergone ileal conduit (IC) formation, following radical cystectomy (RC) for muscle invasive transitional cell carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, complications were noted and graded according to the modified Clavien grading system (CG). Results were presented using descriptive statistics.
Results: Of all the RC performed at this hospital 89 patients received …

Analysis Of Bar Deformation Under Sternum Forces During Surgical Correction Of Pectus Excavatum In Children, Rohit N. Nikam

Mechanical & Aerospace Engineering Theses & Dissertations

Pectus excavatum (PE) also known as sunken or funnel chest is the most common chest wall deformity and affects 1 in every 1,000 children. In PE patients, the middle lower portion of the sternum is depressed producing concave appearance of the anterior part of the chest wall. This problem can be corrected with minimally invasive surgery developed by Dr. Donald Nuss in 1986. A specially made steel bar is implanted to lift the sternum to its normal position. This technique has been modified several times to improve safety and effectiveness of the bar placement and removal. One of the significant …

Development And Validation Methodology Of The Nuss Procedure Surgical Planner, Krzysztof J. Rechowicz

Computational Modeling & Simulation Engineering Theses & Dissertations

Pectus excavatum (PE) is a congenital chest wall deformity which is characterized, in most cases, by a deep depression of the sternum. A minimally invasive technique for the repair of PE (MIRPE), often referred to as the Nuss procedure, has been proven to be more advantageous than many other PE treatment techniques. The Nuss procedure consists of placement of a metal bar(s) underneath the sternum, thereby forcibly changing the geometry of the ribcage. Because of the prevalence of PE and the popularity of the Nuss procedure, the demand to perform this surgery is greater than ever. Therefore, a Nuss procedure …

Post-Traumatic Apexogenesis Of Immature Non-Vital Permanent Incisors, Robia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Injury to an immature permanent tooth may result in cessation of dentin deposition and root maturation leaving an open root apex and thin dentinal walls that are prone to fracture. Endodontic treatment is often complicated and protracted with an uncertain prognosis frequently resulting in pre-mature tooth loss. There are several advantages of promoting apexogenesis in immature teeth with open apices. It encourages a longer and thicker root to develop thus decreasing the propensity of long term root fracture. This case report highlights the role of Hertwig root sheath and dental papilla in continued root formation of immature permanent tooth, even …

Giant Cell Reparative Granuloma Of Temporal Bone: Case Report Of A 62-Year-Old Male, Muhammad Waqas, Naeem Sultan Ali, Muhammad Zubair Tahir, Syed Ather Enam, Zeeshan-Ud-Din, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Giant cell reparative granuloma (GCRG) is an uncommon non‑neoplastic reactive tumor which occurs almost exclusively within the mandible and maxilla. GCRG of the temporal bone is a rare condition. It has been found to affect predominantly adolescents and adults (age: 10‑25 years). We report a case of a 62‑year‑old male with GCRG of left temporal bone who presented to us with progressive left temporal swelling for 3 months. It was associated with hearing loss. There was no history of trauma. A non‑contrast computed tomography scan brain showed a locally destructive lesion involving squamous temporal bone closely related to the left …

Mcdowell, Ephraim, 1771-1830 - Relating To (Sc 2551), Manuscripts & Folklife Archives

Manuscript Collection Finding Aids

Finding aid and scans (Click on "Additional Files" below) for Manuscripts Small Collection 2551. First day of issue cover for stamp celebrating the 150th anniversary of the first successful ovariotomy, performed by Ephraim McDowell. Includes a brief printed history of the surgery, as well as a printed letter from the Danville, Kentucky Chamber of Commerce announcing the commemorative stamp.

Psoas Abscess - A Teaching File, Adina Feinberg, Vivian Mcalister

Data and Test Instruments

Case Report: A 43-year-old woman presented to the emergency room at University Hospital, London Health Sciences Centre with an eight-day history of lower back pain. She had presented one-week prior with similar symptoms and was treated conservatively for sciatica. Since then, her pain had progressively increased

Prospective Case Control Evaluation Of Epidural Midazolam For Improving Pain And Ambulation After Microdiscectomy, Muhammad Shahzad Shamim, S. Ather Enam, Muhammad Zubair Tahir, Mueenullah Khan

Section of Neurosurgery

Objective: To evaluate midazolam as an epidural analgesic in patients undergoing single-level microdiscectomy.
Methods: This prospective case control study was carried out at the Aga Khan University Hospital, Karachi, from January 20 to September 20, 2007, on patients undergoing microdiscectomy. Cases (group A) received midazolam with saline, while controls (group B) received saline only, placed intra-operatively over involved nerve root. Post-operatively, patients were monitored for various variables. Data was analysed using SPSS 13.0 and groups were compared using student's t-test for continuous variables and chi square for categorical variables. P-value <0.05 was considered significant.
Results: Patients in group A ambulated earlier (p = 0.005) …

Incidental Finding Of A Giant Aortic Root Aneurysm And Its Repair, Saulat H. Fatimi, Roheena Zainab Panni, Awais Ashfaq

Section of Cardiothoracic Surgery

The prevalence of aortic aneurysms is 3-4% in individuals more than 65 years. Age and haemodynamic factors play an important role in the development of aortic aneurysms. Most patients with aortic aneurysms are asymptomatic at the time of discovery. Thoracic aneurysms are usually found incidentally after chest radiographs or other imaging studies. The most common complications of thoracic aortic aneurysms are acute rupture or dissection. Some patients present with tender or painful nonruptured aneurysms. Patients are thought to be at increased risk for rupture and should undergo surgical repair on an emergent basis We document a case of a 66-year-old …

A Step Backward For Italy's Meritocracy., Ignazio Roberto Marino

Department of Surgery Faculty Papers

Italian scientists have long lamented the lack of resources, political attention, and meritocracy in assigning taxpayers’ money.

Phenytoin Versus Leviteracetam For Seizure Prophylaxis After Brain Injury - A Meta Analysis, Syed Nabeel Zafar, Abdul Ahad Khan, Asfar Ayaz Gauri, Muhammad Shahzad Shamim

Section of Neurosurgery

Background: Current standard therapy for seizure prophylaxis in Neuro-surgical patients involves the use of Phenytoin (PHY). However, a new drug Levetiracetam (LEV) is emerging as an alternate treatment choice. We aimed to conduct a meta-analysis to compare these two drugs in patients with brain injury.
Methods: An electronic search was performed in using Pubmed, Embase, and CENTRAL. We included studies that compared the use of LEV vs. PHY for seizure prophylaxis for brain injured patients (Traumatic brain injury, intracranial hemorrhage, intracranial neoplasms, and craniotomy). Data of all eligible studies was extracted on to a standardized abstraction sheet. Data about baseline …

Improving Health Care Quality And Safety: The Development And Assessment Of Laparoscopic Surgery Instrumentation, Practices And Procedures, Bernadette Mccrory

Department of Mechanical and Materials Engineering: Dissertations, Theses, and Student Research

Adverse events due to medical errors are a leading cause of death in the United States exceeding the mortality rates of motor vehicle accidents, breast cancer and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors since they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. In order to mitigate errors and protect patients, a multidisciplinary approach was taken …

Giant Pulmonary Bulla With Mediastinal Shift In A 12 1/2 Year Old Girl, Saulat H. Fatimi, Asif Jafferani, Awais Ashfaq

Section of Cardiothoracic Surgery

Pulmonary bulla in children represent interesting entities. Mostly congenital bronchopulmonary foregut malformations and acquired cysts like pneumatocoeles have also been described. We present a case of a 12 1/2 years old girl with acute onset respiratory distress symptoms harbouring a huge pulmonary cyst exhibiting mass effects, resulting in mediastinal deviation. Following initial workup, cyst excision was carried out which revealed presence of fungal hyphae that was susceptible to Fluconazole therapy post operatively. The case points out how a pulmonary cyst can present in older children with symptoms of respiratory distress and mass effects.

Coronary Artery Bypass Grafting After Percutaneous Coronary Intervention, Syed Shahabuddin, Syed Ahmed Sami, Junaid Alam Ansari, Shazia Perveen, Shumaila Furnaz, Saulat H. Fatimi, Hasanat Sharif

Section of Cardiothoracic Surgery

Following percutaneous intervention (PCI), restenosis, progression of disease and multi-vessel involvement may require further intervention in the form of surgical revascularization. Patients with coronary artery bypass grafting (CABG) done after PCI were evaluated to find out the reason for the need of surgical revascularization. Over a period of 12 months, 610 patients underwent CABG. Out of them, 34 patients had previous PCI/stenting. Coronary risk factors including hypertension in 85%, diabetes mellitus in 60%, dyslipidemia in 60%, tobacco use in 50% and a positive family history was present in 53% of the patients. All patients were symptomatic. Multi-vessel disease was present …

Comparison Of Different Craniofacial Patterns With Pharyngeal Widths, Sarwat Memon, Mubassar Fida, Attiya Shaikh

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To compare different craniofacial patterns with pharyngeal widths.

STUDY DESIGN: Cross-sectional analytical study.

PLACE AND DURATION OF STUDY: Orthodontic Clinic at the Aga Khan University Hospital, Karachi, from June 2002 to June 2010.

METHODOLOGY: Data were collected using pre-treatment records including orthodontic files and pre-treatment lateral cephalographs of 360 orthodontic patients. The inclusion criteria were subjects of Pakistani origin, aged between 14-20 years and having no pharyngeal pathology or complaints of nasal obstruction at the initial visit. The sample comprised a total of 360 subjects divided into 2 groups: skeletal Class I (n=180) and skeletal Class II (n=180) subdivided …

Management Of Sexual Disorders In Spinal Cord Injured Patients., Vafa Rahimi-Movaghar, Alexander R Vaccaro

Department of Neurosurgery Faculty Papers

Spinal cord injured (SCI) patients have sexual disorders including erectile dysfunction (ED), impotence, priapism, ejaculatory dysfunction and infertility. Treatments for erectile dysfunction include four steps. Step 1 involves smoking cessation, weight loss, and increasing physical activity. Step 2 is phosphodiesterase type 5 inhibitors (PDE5I) such as Sildenafil (Viagra), intracavernous injections of Papaverine or prostaglandins, and vacuum constriction devices. Step 3 is a penile prosthesis, and Step 4 is sacral neuromodulation (SNM). Priapism can be resolved spontaneously if there is no ischemia found on blood gas measurement or by Phenylephrine. For anejaculatory dysfunction, massage, vibrator, electrical stimulation and direct surgical biopsy …