Surgery Commons^™

Anaesthetic Management Of Two Patients With Beta-Thalassaemia Intermedia, Shahnawaz Ali, Fauzia Khan

Department of Anaesthesia

There is paucity of literature regarding the anaesthetic management of patients with thalassaemia intermedia. In this case study, the anaesthetic management and concerns in two children with thalassaemia intermedia aged eleven and nine years undergoing herniotomy and splenectomy respectively is reported. Both children had unanticipated difficulty in airway management and high intraoperative blood pressure trends. These cases are representative of the range of problems seen in children with thalassaemia intermedia.

Soft Tissue Profile Response In Extraction Versus Non-Extraction Orthodontic Treatment, Munizeh Khan, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

Objective: To compare changes occurring in the soft tissue profile with orthodontic treatment in extraction versus nonextraction cases, and to determine the hard and soft tissue parameters that show significant correlations to understand the factors influencing the response to tooth movement. Study Design: Quasi-experimental. Place and Duration of Study: Dental Section, The Aga Khan University Hospital, Karachi, from 2005 to 2008. Methodology: Pre- and post-treatment lateral cephalographs of 34 subjects were assessed. For half of the patients (n=17), treatment included the extraction of 4 premolars, whereas the other half were treated by the non-extraction approach. Incisal and soft tissue effects …

The Effectiveness Of Training Nurses In Breast Cancer Awareness At A Tertiary Hospital: An Experimental Study, Miriam Mutebi

Master of Medicine in General Surgery

Background: Breast cancer is characterized by late presentation and significant morbidity and mortality in developing countries. Breast screening aids in early detection of breast cancer. The nursing health worker is uniquely placed to provide advocacy and screening in a resource limited environment. Objectives: To assess the effectiveness of an abbreviated training program in breast cancer awareness on nurses at a tertiary hospital, the Aga Khan University Hospital, Nairobi. Methods: Using a statistical tool, the Solomon Model, 79 nurses were identified and divided into experimental and control groups. An abbreviated training intervention in breast cancer awareness was administered to the experimental …

A Randomized Controlled Trial Of The Effect Of Additional Ultrasound Therapy To Analgesia Treatment Protocol For Acute Low Back Pain At Akuh (N), Shamshudin Mohammedali

Master of Medicine in General Surgery

Background: Acute low back pain is a common condition that is encountered by many physicians. Varied treatments are instituted in its management with no defined standard protocol in our institution. Additional physiotherapy has had minimal impact in terms of pain control and the time to return to work in the available literature. Controversy remains regarding effectiveness of ultrasound physiotherapy and its role in management of acute low back pain. Objective: To investigate the effectiveness of the addition of ultrasound physiotherapy to analgesia in patients with acute low back pain at the Aga Khan University Hospital, Nairobi. Methods: A randomized controlled …

Late Onset Postpneumonectomy Empyema Presenting 24 Years After Pneumonectomy, Saulat Hasnain Fatimi, Umair Khalid, Sanna Fatima, Taimur Saleem

Section of Cardiothoracic Surgery

Empyema is a devastating complication that is rarely seen in the postpneumonectomy setting. A 56-year-old man presented to us 24 years after pneumonectomy with a 15 days history of chest pain and shortness of breath. Physical examination revealed a fluctuant swelling at the thoracotomy site. Computed tomography scan showed a large fluid density mass in the left pneumonectomy space. Needle aspiration and video assisted thoracoscopic surgery was carried out and culture of the aspirated fluid grew Pseudomonas aeruginosa. The patient was discharged with the chest tubes in place. At 2 months follow-up, the patient presented with fever and continuous copious …

Giant Unresectable Lymphangioma Of The Trunk Managed Via Intra-Tumour Injections Of Bleomycin, Umair Khalid, Saulat Hasnain Fatimi, Taimur Saleem

Section of Cardiothoracic Surgery

Surgical excision was once considered the mainstay of treatment for lymphangiomas. However, that paradigm is now changing with sclerotherapy emerging as a viable alternative. A 22-year-old girl presented with a mucopurulent and painful discharge from an extensive wound in the trunk. Chest roentogram showed a large soft tissue abnormality with multiple calcifications in the right upper abdomen and lower thorax. Magnetic resonance imaging revealed an extensive lobulated mass measuring 27 x 19 cm. Due to the extensive involvement of tissues, surgical excision did not appear to be a favourable option in this case. Local injections of bleomycin were successfully administered; …

Modification And Implementation Of Nccn Guidelines On Prostate Cancer In The Middle East And North Africa Region., Waleed A. Hassen, Farrok A. Karsan, Farhat Abbas

Department of Surgery Docs

Abstract

A prostate cancer committee was established to modify the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Prostate Cancer for adaptation and implementation in the Middle East and North Africa (MENA) region. The objective was to enhance the multidisciplinary approach to the treatment of prostate cancer. The committee, comprising regional experts in the fields of urologic, medical, and radiation oncology, reviewed the 2009 version of the NCCN Guidelines on Prostate Cancer and suggested modifications based on the unique needs of the regions determined through published evidence and local expertise. The committee identified several areas in the NCCN Guidelines …

Management Of Devastating Ocular Trauma--Experience Of Maxillofacial Surgeons Deployed To A Forward Field Hospital, M. J. Ansell, J. Breeze, Vivian C. Mcalister, M. D. Williams

Surgery Publications

Combat-related eye injuries continue to increase in frequency and are generally secondary to Improvised Explosive Devices. Many ocular injuries are potentially preventable by the wearing of ballistic eye protection. The management of penetrating eye trauma is normally outside the routine practice of maxillofacial surgeons in the UK. The aim of this paper is to describe the surgical techniques used in the modern management of devastating ocular trauma including selected case examples managed by British military maxillofacial surgeons deployed to Afghanistan.

Optimal Technical Management Of Stump Closure Following Distal Pancreatectomy: A Retrospective Review Of 215 Cases., Lisa J. Harris, Hamid Abdollahi, Timothy Newhook, Patricia K. Sauter, Albert G. Crawford, Karen A. Chojnacki, Ernest L. Rosato, Eugene P. Kennedy, Charles J. Yeo, Adam C. Berger

Department of Surgery Faculty Papers

BACKGROUND: Pancreatic fistula (PF) is a major source of morbidity following distal pancreatectomy (DP). Our aim was to identify risk factors related to PF following DP and to determine the impact of technique of transection and stump closure.

METHODS: We performed a retrospective review of 215 consecutive patients who underwent DP. Perioperative and postoperative data were collected and analyzed with attention to PF as defined by the International Study Group of Pancreatic Fistula.

RESULTS: PF developed in 36 patients (16.7%); fistulas were classified as Grade A (44.4%), B (44.4%), or C (11.1%). The pancreas was transected with stapler (n = …

Initial Experience With A Miniaturized Multiplane Transesophageal Probe In Small Infants Undergoing Cardiac Operations., Sinai C. Zyblewski, Girish S. Shirali, Geoffrey A. Forbus, Tain-Yen Hsia, Scott M. Bradley, Andrew M. Atz, Meryl S. Cohen, Eric M. Graham

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: There has been reluctance to use intraoperative transesophageal echocardiography (TEE) in small infants. We assessed the utility and safety of a new miniaturized multiplane micro-TEE probe in small infants undergoing cardiac operations.

DESCRIPTION: Hemodynamic and ventilation variables were prospectively recorded before and after micro-TEE insertion and removal in infants weighing 5 kg or less undergoing cardiac operations.

EVALUATION: The study included 42 patients with a mean weight of 3.6 +/- 0.9 kg (range, 1.7 to 5 kg). All probe insertions were successful. There were no complications or clinically significant changes in hemodynamic or ventilation variables. Information provided by TEE …

Correlation Of C2 Fractures And Vertebral Artery Injury., Tao Ding, Mitchell Maltenfort, Huilin Yang, Harvey Smith, John Ratliff, Alexander Vaccaro, D Greg Anderson, James Harrop

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Retrospective review of prospectively collected data.

SUMMARY OF BACKGROUND DATA: Vertebral artery injuries (VAI) occur commonly after cervical spine trauma. No study has yet examined the association between VAI and specific variants of C2 fractures.

OBJECTIVE: To evaluate the incidence of VAI (as defined by magnetic resonance imaging/angiography [MRI/A]) in subtypes of C2 fractures. To define the association between the incidence, morphology, and severity of C2 fractures, based on fracture angulation and comminution, and the occurrence of VAI.

METHODS: Patients admitted to the hospital with C2 fractures between October 2006 and December 2008 to a tertiary care referral …

Intricacies In The Surgical Management Of Appendiceal Mucinous Cystadenoma: A Case Report And Review Of The Literature., Muhammad Rizwan Khan, Rashida Ahmed, Taimur Saleem

Department of Surgery Docs

Introduction:Mucinous cystadenoma is a type of mucocele of the appendix that is rarely encountered in clinical practice. Dogmatic consensus on the optimal surgical modus operandi of appendicular mucocele is lacking in the literature and this remains a subject of controversy. There is little agreement with regard to the best procedure (right hemicolectomy versus appendectomy) or the best surgical approach (laparoscopic versus laparotomy). Case Presentation: We report the case of a 70-year-old Asian woman from Karachi who presented with pain in the right iliac fossa for 15 days. On physical examination, a mobile and firm mass was palpable in the …

In-Theater Peritoneal Dialysis For Combat-Related Renal Failure, Joseph S. Pina, Soraya Moghadam, Howard M. Cushner, Greg J. Beilman, Vivian C. Mcalister

Surgery Publications

BACKGROUND: Complications of renal failure may prevent timely evacuation of injured soldiers. Conventional renal replacement therapy is not available in forward surgical units. METHODS: Records of in-theater improvised peritoneal dialysis (IPD) in level III hospitals or forward surgical units in Iraq or Afghanistan were reviewed to determine the following: cause of renal failure and associated injuries; type of dialysate, peritoneal access, and exchange technique; and patient outcome. These data were used to propose method for IPD using commonly available materials. RESULTS: IPD is described in four patients. Abdominal or chest drains were used with either improvised dextrose-electrolyte solution or commercial …

In–Theater Peritoneal Dialysis For Combat-Related Renal Failure, Joseph Pina, Soraya Moghadam, Howard Cushner, Greg Beilman, Vivian Mcalister

Data and Test Instruments

BACKGROUND: Complications of renal failure may prevent timely evacuation of injured soldiers. Conventional renal replacement therapy is not available in forward surgical units. METHODS: Records of in-theater improvised peritoneal dialysis (IPD) in level III hospitals or forward surgical units in Iraq or Afghanistan were reviewed to determine the following: cause of renal failure and associated injuries; type of dialysate, peritoneal access, and exchange technique; and patient outcome. These data were used to propose method for IPD using commonly available materials. RESULTS: IPD is described in four patients. Abdominal or chest drains were used with either improvised dextrose-electrolyte solution or commercial …

Pregnancy Outcomes With Exposure To The Mycophenolic Acid Products (Mpa), To Dung K. Nguyen, Faith Carlin, Lisa A. Coscia, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Reports to NTPR to date continue to reveal an increased incidence of birth defects in transplant recipients maintained on MPA products during gestation compared to those not maintained on these agents.

Structural birth defects consisting of microtia (ear deformity) and facial defects suggest a pattern of malformations.

Evaluation of the higher incidence of non-viable outcomes requires further study in this cohort.

Centers are encouraged to report all pregnancy exposures in transplant recipients to the NTPR.

Acute Mesenteric, Portal And Inferior Vena Cava, Venous Thrombosis, Anticoagulation, Abdul Rehman Alvi, Shahida Bibi, Zia Ur Rehman, Sameullah Khan Niazi

Section of Cardiothoracic Surgery

The prevalence and clinical spectrum of acute mesenteric venous thrombosis (AMVT) in Pakistan is largely unknown. The authors report two patients with acute mesenteric, portal and inferior vena cava venous thrombosis confirmed on CT imaging. The diagnoses were established within 24 hours of presentation and both patients were successfully treated with therapeutic heparin during hospital admission and continued on oral warfarin because of hypercoagulable state. The protocol that we currently use is evidence based and is leading to optimal outcome.

Solid-Organ Transplant Recipients And Breastfeeding While On Immunosuppression, Schweta Arakali, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

The relatively small amount of drug transferred in breast milk and the lack of reported adverse effects along with the known benefits of breastfeeding may outweigh the risk of drug exposures in the transplant population.

The threshold for determining the level of exposure of an immunosuppressive agent that is acceptable is not known at present.

Continued study and follow-up of all breast-fed transplant recipient offspring is warranted.

Centers are encouraged to report all pregnancies in transplant recipients to the NTRR.

Immunosuppressive Therapy For Autoimmune Disease And Pregnancy Outcomes, Karolina Paziana, Faith Carlin, Lisa A. Corcia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Cyclosporine exposure during pregnancy in the transplant population does appear to be associated with premature delivery and low infant birthweight.

Data from the NPR show that cyclosporine exposure during pregnancy in women with psoriasis does not appear to be associated with low gestational age or low infant birthweight.

Maternal comorbidities or other factors, such as multiple drug regimens, likely play a role in the higher rates of premature delivery and low birthweight infants in the kidney transplant population.

Further investigation is warranted to evaluate the impact of comorbidities and other factors on pregnancy outcomes of women taking Neoral®.

Pregnancy Outcomes In Female Liver Recipients Transplanted Under The Age Of 21, Carlo B. Ramirez, Warren R. Maley, Cataldo Doria, Lisa A. Coscia, Michael J. Moritz, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions: Liver recipients transplanted under the age of 21 are able to maintain pregnancy with 75% resulting in a livebirth. Pregnancy, potential risks for mother and newborn, and long-term maternal survival should be discussed with the recipient and the parents of the recipient. Transplant centers are encouraged to report pregnancy outcomes in these recipients to the NTPR.

Pregnancy Outcomes In Pancreas-Kidney Vs. Kidney-Alone Diabetic Female Transplant Recipients, Lyuba Gitman, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

The high incidences of hypertension, preeclampsia, and infection during pregnancy underscore the high-risk nature of pregnancy in both pancreas-kidney and kidney alone recipients.

Although overall offspring outcomes are similar in both PK and K groups, pregnancy in PK recipients may be associated with higher incidences of maternal infections and overall graft loss.

Centers are encouraged to report all pregnancies in transplant recipients to the NTPR.