Surgery Commons^™

Diagnostic Accuracy Of Clinical Examination In Cervical Spine Injuries In Awake And Alert Blunt Trauma Patients, Manzar Hussain, Gohar Javed

Section of Neurosurgery

Study design: Observational, case series.
Purpose: To determine the sensitivity and specificity of clinical judgment as compared to the use of X-ray images in detecting cervical spine injuries in trauma patients presenting in the emergency department of Aga Khan University Hospital, Karachi.
Overview of literature: Cross-table cervical spine views are important in patients with signs and symptoms relating to cervical spine, but asymptomatic patients constitute a different subgroup. Accuracy of clinical examination in these patients has not been subjected to scrutiny.
Methods: All patients with blunt trauma who presented to the emergency department and underwent cross-table X-rays as part of …

Intracerebral Migration Of Stray Bullet Leading To Sudden And Fatal Worsening, Manzar Hussain, Muhammad Ehsan Bari

Section of Neurosurgery

Gunshot wounds to the cranium are one of the leading cause of death and disability in young adults. Stray bullets are also being increasingly seen in clinical setting. We report a case of a 14-year-old boy who sustained a stray bullet to the cranium during election festivities. He arrived at the health care facility institution nearly 24 hours after the event in good neurological condition. He remained neurologically stable for about 8 hours after his presentation and later on deteriorated due to intracranial bullet migration. This required immediate bifrontal decompressive craniotomy along with right frontal lobectomy. However, the patient could …

Harmonic Scalpel Versus Electrocautery Tonsillectomy: A Comparative Study In Adult Patients, Naeem Sultan Ali, Mubasher Ikram, Shabbir Akhtar, Iqbal Moghira, Ahmad Nawaz, Asif Arain

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVE: To compare harmonic scalpel (HS) tonsillectomy with electrocautery (EC) tonsillectomy in terms of operating time, intra-operative blood loss, post-operative pain and secondary haemorrhage.METHODS: Sixty adult patients subjected to tonsillectomy only, were evaluated in this prospective study. The patients were stratified into 2 groups (30 each) based on the dissecting instrument used (HS vs. EC) at Aga Khan University Hospital Karachi Pakistan from June, 2006 to August, 2008.RESULTS: The mean operative time was less in electrocautery group (EC 3.57 +/- 0.85 minutes Vs HS 4.20 +/- 1.37 minutes; p

Understanding The Context Of Balanced Scorecard Implementation: A Hospital-Based Case Study In Pakistan., F Rabbani, Sabrina Nh Lalji, Farhat Abbas, Sm Wasim Jafri, Junaid A. Razzak, Naheed Nabi, Firdous Jahan, Agha Ajmal, Max Petzold, Mats Brommels, Goran Tomson

Section of Urology

Background: As a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital. Methods: Four clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs …

Triggers Of Blood Transfusion In Percutaneous Nephrolithotomy, Ali Akbar Zehri, Syed Raziuddin Biyabani, Khurram Muthair Siddiqui, Amanullah Memon

Section of Urology

Objective: To determine the triggers of blood transfusion in patients undergoing percutaneous nephrolithotomy (PCNL).
Study Design: Observational study.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 1988 to 2007.
Methodology: The percutaneous surgery database was retrospectively reviewed to identify patients with postoperative haemorrhage and need for blood transfusion. Blood loss was estimated by the postoperative drop in haemoglobin factored by the quantity of any blood transfusion. Various patients and procedure-related factors were assessed for association with total blood loss or blood transfusion requirement using stepwise univariate, forward multivariate regression analysis.
Results: A total of 326 procedures …

Tuberculous Pericardial Abscess With Impending Pericardial Effusion And Cardiac Tamponade, Saulat H. Fatimi, Faheem-Ul-Haq, Fatima Jalil, Marium Muzaffar, Hashim Muhammad Hanif

Section of Cardiothoracic Surgery

The case of a 59 year male with acute tuberculous pericardial abscess who presented with cough, dyspnoea, haemoptysis, signs of Tamponade and a large Pleural Effusion is reported. Performing Pericardiocentesis did not improve his symptoms hence he was subjected to surgery. Acute tuberculous pericardial abscess was the diagnosis made after histopathology which was successfully managed with sternotomy along with drainage of pus.

Pancreaticoduodenectomy: A Developing Country Perspective, Khawaja Muhammad Inam Pal, Hassaan Bari, Sana Nasim

Section of General Surgery

Objective: To review retrospectively, the resultsof Whipple's procedure from 1986 to December 2009 at the Aga Khan University Hospital.
Methods: Patient's case notes were reviewed to extract information related to demographics, clinical and laboratory data, operative procedure and post operative period. Surgical mortality was defined as death within 30 days of procedure.
Results: Hundred and twenty one patients underwent a successful pancreaticoduodenectomy during this period. There were 78 males and 43 females. Most presented with clinical features of obstructive jaundice. Perioperative evaluation in the majority included an abdominal ultrasound and contrast enhanced CT scan. A preoperative ERCP was performed in …

Porcelain Fused To Metal (Pfm) Crowns And Caries In Adjacent Teeth, Durr-E-Sadaf, Zubair Ahmad

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To assess the discrepancies in marginal integrity and contact points of Porcelain Fused to Metal (PFM) crowns and its association with caries in adjacent teeth.

STUDY DESIGN: Cross-sectional study.

PLACE AND DURATION OF STUDY: Dental Section of the Aga Khan University Hospital, Karachi, from January to August 2009.

METHODOLOGY: Ninety six (96) patients with PFM crowns on maxillary and mandibular premolars and molars were included in this study. Single unit PFM crowns that were part of fixed bridge with at least one natural adjacent tooth were studied. PFM crown with no adjacent tooth or badly broken down teeth were …

Audit Of Postoperative Nausea And Vomiting In Paediatric Day Case Surgery, Fauzia N. Minai, Faraz Shafiq, Azhar Rehman

Department of Anaesthesia

OBJECTIVE: To assess the incidence of PONV, delay in discharge or unplanned admissions in paediatric surgical cases done at the Surgical Day Care Unit at Aga Khan University between January and July 2009.

METHODS: All paediatric ASA 1-2 cases, from 6 months to 18 years of age undergoing day case surgeries at the Surgical day care unit were included in this retrospective audit. Data was collected on a designed form filled with information from preoperative, intraoperative and postoperative recovery forms. Any relevant data was also noted from nurses notes in recovery room and step down unit. Episodes of vomiting, delay …

Ercc1 And Rrm1 As Predictors Of Survival And Response In Pancreatic Ductal Adenocarcinoma Treated With Gemcitabine-Based Chemotherapy, Thomas Holdbrook, Kathleen D. Danenberg, Suneeta Satti, Jessica Kline, Charles J. Yeo, Jonathan R. Brody, Peter Mccue, Agnieszka K. Witkiewicz

Department of Surgery Faculty Papers

Conclusion:

In this study, we used RT-PCR and IHC to analyze RRM1 and ERCC1 mRNA and protein expression in PDA specimens. PDA patients with low expression of RRM1 by IHC derived benefit from gemcitabine-based chemotherapy. Assessment of RRM1 mRNA expression was limited by the small sample size. Low ERCC1 expression by RT-PCR was associated with a 2.5 times higher risk of mortality than high expression (p=0.031). There was no association between ERCC1 expression by IHC and survival; however, agreement between mRNA and protein expression was poor for ERCC1. This study demonstrates the ERCC1 and RRM1 expression have an impact on …

Results Of Re-Excision For Inadequate Margins Following Partial Mastectomy For Carcinoma Of The Breast, Aaron D. Bleznak Md, Facs, Christine W. Du Md, Samuel Steerman Md, Elizabeth Dellers Md

Department of Surgery

No abstract provided.

Value Analysis: Perioperative Link In The Supply Chain, Gwenda L. Petrohoy Msn, Med, Rn, Cnor, Aaron D. Bleznak Md, Facs, Susan Toomey Cmrp

Department of Surgery

No abstract provided.

Intradiploic Epidermoid Cyst Overlying The Torcula: A Surgical Challenge, Amad Naseer Khan, Salema Khalid, Ather Enam

Medical College Documents

Intradiploic tumours are rare, slow growing tumours that can present in many different ways, including a painless lump, tenderness, headache and rarely with focal neurological signs. The authors present the case of a gentleman in whom the tumour presented in an unusual location and presented a surgical challenge. The major take home message from this case report is that an epidermoid cyst overlying the torcula is to be approached with great caution and care and is without doubt a surgical challenge.

Current Management Of Complicated Pneumonia In Children, Sherman J. Alter, Elizabeth H. Ey, Mark Warren, Jeffrey C. Pence

Department of Surgery Faculty Publications

No abstract provided.

High-Frequency Ultrasound For Intraoperative Margin Assessments In Breast Conservation Surgery: A Feasibility Study, Timothy E. Doyle, Rachel E. Factor, Christina L. Ellefson, Kristina M. Sorensen, Brady J. Ambrose, Jeffrey B. Goodrich, Vern P. Hart, Scott C. Jensen, Hemang Patel, Leigh A. Neumayer

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

In addition to breast imaging, ultrasound offers the potential for characterizing and distinguishing between benign and malignant breast tissues due to their different microstructures and material properties. The aim of this study was to determine if high-frequency ultrasound (20-80 MHz) can provide pathology sensitive measurements for the ex vivo detection of cancer in margins during breast conservation surgery.

Methods

Ultrasonic tests were performed on resected margins and other tissues obtained from 17 patients, resulting in 34 specimens that were classified into 15 pathology categories. Pulse-echo and through-transmission measurements were acquired from a total of 57 sites on the …

The Living Textbook Project For Affordable Higher Education, Dayanjan S. Wijesinghe

Surgery Presentations

A blue print for ensuring that community college education remains affordable to the future generations via elimination of the cost of textbooks.

Intravenous Ascorbic Acid To Prevent And Treat Cancer-Associated Sepsis?, Thomas E. Ichim, Boris Minev, Todd Braciak, Brandon Luna, Ron Hunninghake, Nina A. Mikirova, James A. Jackson, Michael J. Gonzalez, Jorge R. Miranda-Massari, Doru T. Alexandrescu, Constantin A. Dasanu, Vladimir Bogin, Janis Ancans, R. Brian Stevens, Boris Markosian, James Koropatnick, Chien-Shing Chen, Neil H. Riordan

Department of Surgery Faculty Publications

The history of ascorbic acid (AA) and cancer has been marked with controversy. Clinical studies evaluating AA in cancer outcome continue to the present day. However, the wealth of data suggesting that AA may be highly beneficial in addressing cancer-associated inflammation, particularly progression to systemic inflammatory response syndrome (SIRS) and multi organ failure (MOF), has been largely overlooked. Patients with advanced cancer are generally deficient in AA. Once these patients develop septic symptoms, a further decrease in ascorbic acid levels occurs. Given the known role of ascorbate in: a) maintaining endothelial and suppression of inflammatory markers; b) protection from sepsis …

Mass Casualty Training Exercise At The Canadian Surgery Forum

Data and Test Instruments

On September 18, 2011 second year Schulich School of Medicine and Dentistry students helped run the first mass casualty training exercise, directed by Dr. Vivian McAlister, Division of General Surgery, at the Canadian Surgery Forum held this year at the London Convention Centre.

Composite Tissue Allotransplantation To Treat Veterans With Complex Amputation Injuries, Vivian Mcalister, Ray Kao, Brian Church, Markus Besemann, Rob Stiegelmar

Data and Test Instruments

Amputee rehabilitation may be limited by complexity of injury (e.g. bilateral arm amputation), associated injury (e.g. colostomy) or by the level of amputation (e.g. high above knee). Our objective is to assess the potential for composite tissue allotransplantation (CTA) to overcome these barriers. Medical literature was searched and programs were surveyed regarding the current status of CTA. Results CTA remains an experimental reconstructive option that involves a large collaborative (physiatry, orthopaedic, plastic and transplant surgeons). Limb transplantation has evolved out of limb reimplantation surgery and organ transplantation. Approximately 10 programs world wide, with almost a decade of experience, report 90% …

Do Older Patients Utilize Excess Health Care Resources After Liver Transplantation?, Neil Shankar, Mamoon Albashir, Paul Marotta, William Wall, Vivian Mcalister, Natasha Chandok

Data and Test Instruments

INTRODUCTION: Liver transplantation is a highly effective treatment for end-stage liver disease. However, there is debate over the practice of liver transplantation in older recipients (age ≥ 60 years) given the relative shortage of donor grafts, worse post-transplantation survival, and concern that that older patients may utilize excess resources postoperatively, thus threatening the economic feasibility of the procedure. AIM: To determine if patients ≥ 60 years of age utilize more health resources following liver transplantation compared with younger patients. MATERIAL AND METHODS: Consecutive adult patients who underwent primary liver transplantation (n = 208) at a single center were studied over …