Surgery Commons^™

Population-Based Survey Of Lumbar Surgery Beliefs In The United States, Amanda Elyse Mccauley, Zachery Clark Rasmussen

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis: Studies have shown that poor lumbar surgery outcomes may be influenced by a person’s preconceived perceptions of low back surgery (LBS). However, the perceptions of the general population about issues related to lumbar surgery are not known. Therefore, the purpose of this study was to investigate the general population’s perceptions regarding LBS.

Number of Subjects: This study included 262 participants (Average age: 46.1, SD=16.9; 125 Males, 137 Females) who completed the questionnaire from the general population in the Las Vegas area.

Materials/Methods: Questionnaire development involved expert panel feedback from three physical therapists, three spine surgeons, two surgeon assistants/nurses, two …

Chemosensitization Of Hepatocellular Carcinoma To Gemcitabine By Non-Invasive Radiofrequency Field-Induced Hyperthermia, Mustafa Raoof

Dissertations and Theses (Open Access)

Gemcitabine is a potent nucleoside analogue against solid tumors however drug resistance rapidly emerges. Removal of gemcitabine incorporated in the DNA by repair mechanisms could potentially contribute to resistance in chemo-refractory solid tumors. In this study, we evaluated homologous recombination repair of gemcitabine-stalled replication forks as a potential mechanism contributing to resistance. We also studied the effect of hyperthermia on homologous recombination pathway to explain the previously reported synergy between gemcitabine and hyperthermia. We found that hyperthermia degrades and inhibits localization of Mre11 to gemcitabine-stalled replication forks. Furthermore, gemcitabine-treated cells that were also treated with hyperthermia demonstrate a prolonged passage …

Effectiveness Of Premedication At The Time Of Separation From Parent And Mask Induction In Paediatric Patients Coming For Congenital Heart Disease Surgery, Mohammad Hamid, Mansoor Ahmed Khan, Aftab Khatri, Irfan Akhtar

Department of Anaesthesia

OBJECTIVE: To compare the effectiveness of oral midazolam and chloral hydrate on anxiety and sedation at various stages of pre-operative period in congenital heart surgery patients.

STUDY DESIGN: Cross-sectional comparative study.

PLACE AND DURATION OF STUDY: Operating rooms of The Aga Khan University Hospital, Karachi, from October 2009 to December 2010.

METHODOLOGY: Sixty-six patients between the ages of 6 months and 6 years received either chloral hydrate (Group C) or midazolam (Group M) pre-operatively. All congenital heart disease patients coming for cardiac surgeries were included while cases of emergency surgery and those patients in whom premedication was not given were …

The Rationality Of Prescribing Antibiotics After Tonsillectomy, Maqbool Ahmed Baloch, Shabbir Akhtar, Mubasher Ikram, Hassan Nabeel Humayun

Section of Otolaryngology, Head & Neck Surgery

Objective: To compare the antibiotic therapy with the absence of antibiotic therapy in reducing post-tonsillectomy morbidities
Methods: The quasi-experimental study was conducted at the Aga Khan University Hospital, Karachi, from November 2006 to September 2007. It involved 60 patients fulfilling the criteria for recurrent tonsillitis who were divided in two groups based on the different practice of two sets of surgeons. In one group antibiotics were used, while in the other group, no antibiotic was given. Patients filled a questionnaire about pain, post-operative bleeding, day of normal diet intake, day of normal activity and any consultation received during the first …

Adult Ecmo And Gastrointestinal Bleeding From Small Bowel Arteriovenous Malformations: A Novel Treatment Using Spiral Enteroscopy., Konrad Sarosiek, Hitoshi Hirose, Harrison T Pitcher, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

Hemorrhagic complications on extracorporeal membrane oxygenation (ECMO) are common because of the need for anticoagulation to maintain the oxygenator and circuitry. Gastrointestinal bleeding (GIB) is reported to occur in 3-6% of ECMO patients, ¹ requiring frequent transfusions as well as multiple diagnostic and therapeutic interventions. Multiple transfusions can result in volume overload, coagulopathies and infections leading to significant morbidity and mortality. We present the first published case of GIB from an arteriovenous malformation (AVM) treated with a novel therapy termed spiral enteroscopy while the patient remained on venoarterial (VA) ECMO.

John H. Moore Jr., Md Clinical Professor Of Plastic Surgery And Former Alumni Association President

Jefferson Surgical Solutions

John H. Moore Jr., MD, longtime clinical professor of plastic surgery at Jefferson and former president of the Jefferson Medical College (JMC) Alumni Association, died at home on September 26, 2011.

Born in Pittsburgh in 1953, Moore received his bachelor’s degree from the University of Virginia, where he stayed on for his medical degree. After completing his internship at Thomas Jefferson University Hospital in 1980, he completed a general surgery residency. He then participated in a fellowship in hand surgery and microsurgery at Jefferson and completed a plastic surgery residency at the Eastern Virginia Graduate School of Medicine.

In 1987, …

News In Brief

Jefferson Surgical Solutions

Alejandro Perez, MD, has joined the Jefferson Vascular Center at Methodist Hospital with a dual faculty appointment in the Departments of Medicine and Surgery at Thomas Jefferson University. Dr. Perez completed his residency and fellowship training in vascular medicine at the Cleveland Clinic. He specializes in deep vein thrombosis, pulmonary embolism and hyperbaric oxygen therapy.

Ehyal Shweiki, MD, FACS, has joined the Division of Acute Care Surgery. Dr. Shweiki is fellowship-trained in both cardiothoracic surgery (University of Louisville) and surgical critical care (Washington University/Barnes Jewish Hospital). He also holds an MS in Bioethics. He will serve patients at our …

Zhi Ven Fong, Jmc ’12 Secretary, Gibbon Surgical Society

Jefferson Surgical Solutions

Born and raised in Kuala Lumpur, Malaysia, Zhi Ven Fong spent his first two years of medical school at the International Medical University (IMU) in Malaysia before coming to Philadelphia to study at Jefferson Medical College. And while medical school alone would be enough to keep most students busy, Zhi, 23, has seized every opportunity to build his skills and knowledge as a physician scientist.

“I aspire to be a leader in an academic field like surgery, so I realized I needed experience in research,” Zhi says. “After consulting with senior students, I reached out to Dr. Ernest Rosato, who …

Building A Legacy Of Hope Against Ovarian Cancer

Jefferson Surgical Solutions

Cancer – let alone a rare form of ovarian cancer – wasn’t on Sandy Parvin’s radar when her 11-year-old daughter Sarah was nauseous and vomiting for a few days in the spring of 2005.

“Honestly, we thought she had the flu,” Sandy said. The virus had been going around so Sandy took her daughter to their family physician.

The doctor sent Sarah to the hospital to get some IV fluids. It quickly turned into a parent’s worst nightmare. Sarah was put on a heart monitor and four physicians were there asking questions. Her calcium levels were far too high.

“They …

Gerald A. Isenberg, Md, Facs

Jefferson Surgical Solutions

As Professor of Surgery, Division of Colorectal Surgery; Director, Surgical Undergraduate Education, Jefferson Medical College (JMC); Program Director, Colorectal Residency Program, Thomas Jefferson University Hospital; and Chair, Curriculum Committee, JMC, Gerald A. Isenberg, MD, FACS, is equally focused on – and passionate about – clinical practice and medical education.

Indeed, as he reflects on his career at Jefferson, which spans nearly 25 years, Dr. Isenberg is appreciative of the opportunity to build a busy and vibrant colorectal surgery practice. But he clearly also values his experiences as an educator – particularly the many opportunities to lead and innovate.

In years …

Jefferson Researchers Identify Potential Diagnostic, Prognostic Tools For Pancreatic Cancer

Jefferson Surgical Solutions

When it comes to diagnosing and treating cancer, early detection is important. While other cancers can be identified through routine screenings, pancreatic cancer has been notoriously difficult to diagnose early. After pancreatic cancer is diagnosed, the optimal course of treatment is not always clear.

Hwyda Arafat, MD, PhD, Associate Professor of Surgery at Thomas Jefferson University and co-director of the Jefferson Pancreatic, Biliary and Related Cancers Center, and Jordan M. Winter, MD, Assistant Professor of Surgery, are working to change that.

Together with Mon-Li Chu, PhD, Professor and Vice Chair of the Department of Dermatology and Cutaneous Biology, Dr. Arafat …

Overview

Jefferson Surgical Solutions

Charles J. Yeo, MD, FACS

Samuel D. Gross Professor and

Chair, Department of Surgery

In this issue, Surgical Solutions focuses on our trauma expertise, recent progress in bench research, the contributions of Dr. Gerald Isenberg, insights from medical student Zhi Ven Fong, and pays tribute to Dr. John Moore. A very busy issue!

I was moved by a recent editorial in the New England Journal of Medicine dated February 16, 2012. In the piece entitled “What We Talk About When We Talk About Health Care Costs”, Peter Neumann of Tufts University quotes from the American College of Physicians Ethics Manual, …

Surgeon Speaks

Jefferson Surgical Solutions

Kris Kaulback, MD, FACS

Assistant Professor,

Division of Acute Care Surgery at Jefferson

Medical Director, Trauma Center at Paoli Hospital

Following a major, multisystem trauma, being seen by a trauma center within 60 minutes can mean the difference between life and death. Thanks to Paoli Hospital’s accredited Level II trauma center, which opened on October 1, 2010, more people in Chester County are receiving critical care within the “golden hour.”

As Kris Kaulback, MD, FACS, explains, Paoli earned accreditation by addressing the extensive standards outlined by the Pennsylvania State Trauma Foundation (PSTF). Accreditation reflects the resources available at Paoli around …

A Comparative Analysis Of Toluidine Blue With Frozen Section In Oral Squamous Cell Carcinoma, Montasir Junaid, Moaz M. Choudhary, Zain A. Sobani, Ghulam Murtaza, Sadaf Qadeer, Naeem S. Ali, Mumtaz J. Khan, Anwar Suhail

Department of Surgery Docs

Background:Surgical excision of the primary tumor with safe margins remains the mainstay of treatment for oral cavity squamous cell carcinoma (OSCC). The standard of care for assessment of intraoperative margins is frozen section histopathology. Unfortunately the facility is not available at most centers in limited resource countries. Toluidine blue, a metachromatic dye, has been well described in clinical identification of malignant and premalignant lesion in the oral cavity. Considering this we decided to explore intraoperative use of toluidine blue staining, in comparison with frozen sections, for the assessment of tumor-free margins.

Methods:

After obtaining clearance from the in-house ethical …

External Iliac Artery Stenting: High Incidence Of Concomitant Revascularization Procedures, Vance L. Smith, Laura Peterson, Jean E. Starr, Bhagwan Satiani

Department of Surgery Faculty Publications

Objectives: To review immediate results, patency rates, hemodynamic success, and incidence of concomitant procedures with external iliac artery stenting (EIAS). Methods: Demographic features, category and clinical grade, Trans-Atlantic Inter-Society Consensus II classification lesion type, pre- and postprocedure ankle–brachial indices, and primary patency were compared between group 1 (EIAS without distal revascularization) and group 2 (EIAS with concomitant distal revascularization).Results: No mortality and a 100% immediate technical success rate was recorded in group 1 (n = 12) and group 2 (n = 24). Eleven patients (30.6%) also had stenting of the adjacent common iliac artery. Two thirds …

Sir William Osler, M.D., C.M., Jonathan Sarik, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Sir William Osler impacted medical education and the practice of medicine like few other physicians. As a writer, he authored nearly 1500 publications and lent his name to numerous eponyms. As a teacher he educated vast numbers of students and through his legacy impacted countless more. Sir William Osler (Fig. 1) epitomized what a physician should be throughout his professional life.

Thickened Ascending Aortic Wall Mimicking Intramural Hematoma., Kentaro Yamane, Hitoshi Hirose, Benjamin A. Youdelman, James Diehl

Department of Surgery Faculty Papers

A 45-year-old Hispanic woman presented with a 3-day history of ‘‘burning’’ chest pain. A computed tomo- graphic angiogram of the chest revealed the ascending aorta had a maximum diameter of 40 mm with marked thickening of the aortic wall (Figure 1), which we con- cluded was an intramural hematoma. On entering the pericardium, a milky-white plaque-like area on the ascending aorta was encountered (Figure 2). The ascending aorta was firm to palpation. Intraoperative transesophageal echocardiography and epiaortic ultra- sound showed a hyperechoic aortic wall with no find- ings compatible with aortic dissection. The ascending aorta had an irregular surface contour, …

Microaesthetics Of The Smile: Extraction Vs. Non-Extraction, Sanam Tauheed, Attiya Shaikh, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To compare microaesthetics in pre- and post-orthodontic cases, treated with non-extraction and extraction treatment and assessed whether the achieved microaesthetic parameters are comparable to the proposed norms.

STUDY DESIGN: Quasi-experimental study.

PLACE AND DURATION OF STUDY: Orthodontic Clinic, the Aga Khan University Hospital, Karachi, from January 2005 to December 2009.

METHODOLOGY: Orthodontic records of 31 cases treated with non-extraction therapy and 26 cases treated with extraction of upper first premolars were selected. Patients were of Pakistani origin, aged between 12 to 30 years. Microaesthetics was assessed by measuring maxillary central incisor crown width-height ratio, connectors between the maxillary anterior …

Short Term Results Of Ligament Reconstruction And Tendon Interposition Resection Arthroplasty For Basal Joint Arthritis, Kashif Abbas, Pervaiz Hashmi, Hasnain Raza

Section of Orthopaedic Surgery

Carpometacarpal (CMC) joint of the thumb is the second most common site afflicted by osteoarthritis. Non surgical measures forms the first line of treatment with aim of preventing progression of disease, however, surgery becomes an option when symptoms are refractory to nonsurgical methods. Different procedures have been described in literature. Ligament reconstruction with tendon interposition (LRTI) is the most commonly performed procedure in North America for this problem. The Aim of study was to evaluate early results of ligament reconstruction and tendon interposition for CMC joint arthritis. This is a case series of ten patients operated in a tertiary care …

A Progressive Postresection Walking Program Significantly Improves Fatigue And Health-Related Quality Of Life In Pancreas And Periampullary Cancer Patients., Theresa Yeo, Sherry A Burrell, Patricia K Sauter, Eugene P Kennedy, Harish Lavu, Benjamin E Leiby, Charles Yeo

College of Nursing Faculty Papers & Presentations

BACKGROUND: As patients with pancreas and periampullary cancer (PPC) experience improved survival rates and longevity, the focus shifts toward living life while surviving cancer. Fatigue is the most commonly reported symptom in all cancer patients. Exercise has been found to effectively decrease fatigue levels and improve physical functioning in cancer patients.

STUDY DESIGN: One hundred two patients with resected PPC consented to participate in this study and were randomized to either an intervention group (IG) or a usual care group (UCG). Subjects completed visual analog scales, the FACIT-Fatigue Scale and the Short Form-36v2 after surgery and again 3 to 6 …