Surgery Commons^™

Anaesthetic Management Of Abdominal Hysterectomy In Patient With Congenital Sinus Node Dysfunction, Dileep Kumar, Faisal Shamim

Department of Anaesthesia

A 45 years old woman having dysfunctional uterine bleeding was scheduled for total abdominal hysterectomy with bilateral salpingo-oophorectomy under general anaesthesia. On pre-operative anaesthesia assessment, she was found to have junctional rhythm at rate of 44 beats/minute with bigeminies and pre-mature ventricular contractions on ECG. On further evaluation, she was diagnosed as having congenital sinus node dysfunction on the basis of 24 hours Holter monitoring. She was asymptomatic, no prior comorbidity and belonged to functional class one. General anaesthesia was successfully managed by vigilance, invasive monitoring, standby transcutaneous and transvenous pacemakers; use of cardiostable and vagolytic anaesthetic agents like Etomidate, …

Magnesium, A Drug Of Diverse Use, Mohammad Irfan Akhtar, Hameed Ullah, Mohammad Hamid

Department of Anaesthesia

Magnesium has evolved as a drug with diverse clinical applications. Mg++ is an important caution and its homeostasis is very important for normal body functioning. The physiological role of Mg is due to its calcium channel blocking properties at smooth muscle, skeletal muscle and conduction system levels. The analgesic properties are due to NMDA receptor blocking action. Mg++ is beneficial in acute Myocardial Infarction, protection during open heart surgery and treatment and prevention of heart rhythm disturbances. Mg has an established role in the management of preeclampsia and eclampsia. Magnesium prevents or controls convulsions by blocking neuromuscular transmission and decreasing …

Autoimmune Enteropathy With A Cd8+ Cd7- T-Cell Small Bowel Intraepithelial Lymphocytosis: Case Report And Literature Review, Shrinivas Bishu, Violeta Arsenescu, Eun Y. Lee, H. David Vargas, Willem J. S. De Villiers, Razvan Arsenescu

Surgery Faculty Publications

Background

Adult onset autoimmune enteropathy (AIE) is a rare condition characterized by diarrhea refractory to dietary therapy diagnosed in patients with evidence of autoimmune conditions. Auto-antibodies to gut epithelial cells and other tissues are commonly demonstrated. Despite increasing awareness, the pathogenesis, histologic, immunologic and clinical features of AIE remain uncertain. There remains controversy regarding the diagnostic criteria, the frequency and types of auto-antibodies and associated autoimmune conditions, and the extent and types of histologic and immunologic abnormalities. CD4+ T-cells are thought to at least responsible for this condition; whether other cell types, including B- and other T-cell subsets are involved, …

Non-Operative Management Is Superior To Surgical Stabilization In Spine Injury Patients With Complete Neurological Deficits: A Perspective Study From A Developing World Country, Pakistan, Muhammad Shahzad Shamim, Syed Faizan Ali, Ather Enam

Section of Neurosurgery

Background: Surgical stabilization of injured spine in Patients with complete spinal cord injury is a common practice despite the lack of strong evidence supporting it. The aim of this study is to compare clinical outcomes and cost-effectiveness of surgical stabilization versus conservative management of spinal injury in Patients with complete deficits, essentially from a developing country's point of view.
Methods: A detailed analysis of Patients with traumatic spine injury and complete deficits admitted at the Aga Khan University Hospital, Pakistan, from January 2004 till January 2010 was carried out. All Patients presenting within 14 days of injury were divided in …

Adherence To The European Society Of Cardiology (Esc) Guidelines For Chronic Heart Failure - A National Survey Of The Cardiologists In Pakistan, Sana Shoukat, Saqib A. Gowani, Ather M. Taqui, Rameez Ul Hassan, Zain A. Bhutta, Anum I. Malik, Sajjad A. Sherjeel, Quratulanne Sheheryar, Sajid H. Dhakam

Section of Neurosurgery

Background:The aims of this study were to evaluate the awareness of and attitudes towards the 2005 European Society of Cardiology (ESC) guidelines for Heart Failure (HF) of the cardiologists in Pakistan and assess barriers to adherence to guidelines.
Methods: A cross-sectional survey was conducted in person from March to July 2009 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta and Peshawar). A validated, semi-structured questionnaire assessing ESC 2005 Guidelines for HF was used to obtain information from cardiologists. It included questions about awareness and relevance of HF guidelines (See Additional File 1). Respondents' management …

Causes Of Death In Canadian Forces Members Deployed To Afghanistan And Implications On Tactical Combat Casualty Care Provision., D Pannell, R Brisebois, M Talbot, V Trottier, J Clement, N Garraway, Vivian Mcalister, H Tien

Data and Test Instruments

BACKGROUND: As part of its contribution to the Global War on Terror and North Atlantic Treaty Organization's International Security Assistance Force, the Canadian Forces deployed to Kandahar, Afghanistan, in 2006. We have studied the causes of deaths sustained by the Canadian Forces during the first 28 months of this mission. The purpose of this study was to identify potential areas for improving battlefield trauma care. METHODS: We analyzed autopsy reports of Canadian soldiers killed in Afghanistan between January 2006 and April 2008. Demographic characteristics, injury data, location of death within the chain of evacuation, and cause of death were determined. …

The Role 3 Multinational Medical Unit At Kandahar Airfield 2005-2010., R Brisebois, P Hennecke, R Kao, Vivian Mcalister, J Po, R Stiegelmar, H Tien

Data and Test Instruments

In late 2005, Canadian Forces Health Services (CFHS) was tasked with the command of the NATO Role 3 Multinational Medical Unit (R3MMU) on Kandahar Airfield in southern Afghanistan. Preparations drew on past experience and planning. Eight complete hospital contingents were trained and deployed in rotation. Near-reality simulation training was undertaken with the combat brigade, including complete deployment of the field hospital in the exercise area. Standard operating procedures (SOP) were developed and applied by each rotation so successfully that they were adopted by the new command in late 2009. The Canadian period at R3MMU had the highest survival rate ever …

Utilization Profile Of The Trauma Intensive Care Unit At The Role 3 Multinational Medical Init At Kandahar Airfield Between May 1 And Oct. 15, 2009., Sha K, Pirie S, Compton L, Vivian Mcalister, Brian Church, Ray Kao

Data and Test Instruments

Background: In the war against the Taliban, Canada was the lead North Atlantic Treaty Organization (NATO) nation to provide medical and surgical care to NATO soldiers, Afghanistan National Army soldiers, Afghanistan Nation Police, civilians working in and outside Kandahar Airfield and Afghanistan civilians at the Role 3 Multinational Medical Unit (R3MMU) from February 2006 to October 2009. Methods: We obtained data from the Joint Theatre Trauma Registry between May 1 and Oct. 15, 2009; 188 patients were admitted to the R3MMU intensive care unit (ICU). We analyzed the ICU data according to types and causes of trauma, mechanical ventilation prevalence, …

Principles Of Combat Surgical Care In A Staged Evacuation System, Vivian Mcalister, Rob Stiegelmar, Brian Church, Ray Kao

Data and Test Instruments

Background: The NATO hospital classification of hospitals describes an orderly transfer of patients with severe injuries through a series of increasingly sophisticated hospitals as they are brought from the point of injury to their home hospital. Forward hospital surgery is restricted to damage control and resuscitation while definitive surgery is performed at home by the destination surgical team. In reality many patients enter the hospital chain higher up and some receive definitive surgery as they proceed through the chain of evacuation. The purpose of this paper is to determine if clear doctrine exists to guide the performance of surgery on …

The Gross Clinic, The Agnew Clinic, And The Listerian Revolution., Caitlyn M. Johnson, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Thomas Eakins was an American artist whose unique and prolific style set him apart from other artists of the late 19th century.1 He chose to portray his subjects with intense objectivity, never deviating from reality. Even during his era when art was expected to be always beautiful, demonstrating Victorian morals of decency and decorum, Eakins chose to paint the naked truth.1 Walt Whitman was noted to have said, ‘‘I never knew of but one artist, and that’s Tom Eakins, who would resist the temptation to see what they ought to be rather than what it is.’’2 It was Eakins’ rigid …

Robert Milton Zollinger, M.D., Teacher, Surgeon, Soldier, And Farmer., Fiona M. Chory, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

From Humble roots, Dr. Robert Milton Zollinger worked his way to a position in history among the giants of American surgery. He was born on September 4, 1903, in the central Ohio town of Millersport, the son of Elmira and William Zollinger. Neither of his parents had a high school education, but they supported education and always expressed a confidence that young Robert would be successful at anything he attempted.1 He had aspirations of attending West Point, a dream that was never fulfilled when he decided to be a surgeon. On being informed of his son’s intentions, Zollinger’s father bestowed …

Anaesthesia As A Career Choice In A Developing Country; Effect Of Clinical Clerkship, Fauzia Khan, Fauzia Nasim Minai, Shahla Siddiqui

Department of Anaesthesia

OBJECTIVE: To explore the fourth year medical student's knowledge regarding anaesthesia as a specialty, their attitude towards anaesthesia as a career choice and the effect of clinical clerkship on these.

METHODS: This survey was conducted in the Department of Anaesthesia of a university medical centre in a developing country. One hundred and fifty year four medical students rotating in anaesthesia were enrolled. They were asked to fill a structured questionnaire before (pre) and after (post) their anaesthesia rotation. The questionnaire sought information on their perception of anaesthesia as a specialty, role of anaesthetists clerkship duration, and reasons for considering or …

An Organ Culture System To Model Early Degenerative Changes Of The Intervertebral Disc., Ravi K Ponnappan, Dessislava Z Markova, Paul Jd Antonio, Hallie B Murray, Alexander R Vaccaro, Irving M Shapiro, D Greg Anderson, Todd J Albert, Makarand V Risbud

Department of Orthopaedic Surgery Faculty Papers

ABSTRACT: INTRODUCTION: Back pain, a significant source of morbidity in our society, is related to the degenerative changes of the intervertebral disc. At present, the treatment of disc disease consists of therapies that are aimed at symptomatic relief. This shortcoming stems in large part from our lack of understanding of the biochemical and molecular events that drive the disease process. The goal of this study is to develop a model of early disc degeneration using an organ culture. This approach is based on our previous studies that indicate that organ culture closely models molecular events that occur in vivo in …

Download The Full Pdf Of Jefferson Surgical Solutions Fall 2011, Volume 6, Number 2

Jefferson Surgical Solutions

Download the full PDF of Jefferson Surgical Solutions Fall 2011, Volume 6, Number 2.

Koniaris Heads Expanding Multi-Disciplinary Surgical Program At Methodist Hospital

Jefferson Surgical Solutions

Leonidas Koniaris, MD, FACS, is the newly appointed Chief of Surgery at Methodist Hospital in South Philadelphia, an affiliate of Jefferson that now has the strongest presence of full-time Jefferson faculty surgeons to date. One of the oldest hospitals in the Philadelphia region, Methodist has been treating patients continuously since 1892. Professor of Surgery and Vice Chair of the Department of Surgery at Jefferson Medical College, Dr. Koniaris is leading the effort to help what he describes as “an already great local hospital become an even more essential and integral partof this vibrant community.” Dr. Koniaris replaces Melvin Moses, MD, …

The Surgeon Speaks: Leonidas Koniaris, Md, Facs

Jefferson Surgical Solutions

Leonidas Koniaris, MD, FACS Chief of Surgery, Methodist Hospital Vice Chair of Surgery, Jefferson Medical College

The professionalism and work ethic of the Methodist hospital staff are second-to none, and the dedication to superb patient care is a top priority. Over the next three to five years, our focus is to take this existing gem in the Jefferson brand and continue to develop it into a strong top-tier facility.

We have been fortunate to have the support of hospital leadership in meeting our goals and embracing change. Several initiatives – a new endovascular suite and multidisciplinary breast care clinic, coupled …

Overview

Jefferson Surgical Solutions

The academic year 2011/2012 is now four months old, and we are off to a splendid start! We (a) have welcomed several new faculty members and a bolus of categorical interns (see below), (b) had a leadership transition at our Methodist Hospital, (c) are in growth mode at Methodist with initiatives in General Surgery, Vascular Surgery, Wound Care and Surgical Oncology (see the cover story), and (d) with the leadership of Dr. Nicholas Cavarocchi have seen remarkable growth in our adult ECMO program with outstanding clinical results and several research projects brought to fruition. Exciting times again this year at …

Surgeon-Led Ecmo Treatment Improves Survival Rates In Surgical Cardiac Care Unit

Jefferson Surgical Solutions

The Jefferson Surgical Cardiac Care Unit (SCCU), reorganized in July 2010, delivers the best survival rates in Pennsylvania for patients plagued by serious lung and/or heart dysfunction. Nicholas Cavarocchi, MD, FACS, FCCP, the SCCU Director and Associate Professor of Surgery, leads a highly trained team that uses extracorporeal membrane oxygenation (an ECMO machine) to provide respiratory and cardiac support to patients whose lungs and/or hearts cannot function on their own. Because of the excellent outcomes – 70 to 80 percent survival rates for patients with life-threatening situations, up from a previous zero-based survival rate – Dr. Cavarocchi believes the Jefferson …

Meet Our Surgical Interns

Jefferson Surgical Solutions

We have welcomed an amazing new group of categorical interns, selected from over one thousand applicants to our program. These doctors, who recently matched with Jefferson Medical College (JMC), started on June 20, 2011. Just a few months into their Jefferson surgical residency, we have all noticed their dedication to patient care, their energy and their excitement in joining the Jefferson community.

Meet Our Surgical Interns

Please welcome (from left to right):

• Christine Feldmeier, MD, JMC
• James Crawford, MD, New York University
• Kate Holoyda, MD, University of Wisconsin
• Vishen Sooppan, MD, SUNY Upstate - Syracuse
• Caitlyn Johnson, MD, JMC
• Jonathan …

National Transplantation Pregnancy Registry Celebrates 20th Anniversary

Jefferson Surgical Solutions

This year marks the 20th anniversary of the National Transplantation Pregnancy Registry (NTPR). Established at Jefferson, this unique registry is a voluntary study, in which transplant recipients (both men and women) report their experiences with conception, pregnancy, childbirth, and the health of the recipient. The NTPR was founded by Principal Investigator Vincent Armenti, MD, PhD, a Jefferson alumnus and former transplant fellow with a dual faculty appointment as Professor in the Department of Surgery (Transplantation Division) and the Department of Pathology, Anatomy, and Cell Biology.

Dr. Armenti’s interest was sparked two decades ago when a transplant recipient told him she …