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Papers by khuram khan

Surgery for Obesity and Related Diseases, 2017

accepted at p level of 0.05. Analyses were performed by SPSS 24 (IBM inc, Armonk NY). Results: Tw... more accepted at p level of 0.05. Analyses were performed by SPSS 24 (IBM inc, Armonk NY). Results: Twelve patients met our criteria. Ten were female and two were male. Mean age was 40.6 þ/-13.7 years and mean BMI was 34.0 þ/-3.1. Median number of post-removal visits was 4 (2-6). Mean total weight loss was 10.9% at 6 months. Pearson correlation coefficient revealed strong positive correlation between the number of follow up visits with the Registered Dietitian and total body weight loss. (r¼0.692, p¼0.013, R 2 ¼0.478). No serious adverse events were encountered during the examined period. Conclusions: The ORBERA Gastric Balloon System is an effective method for weight loss for patients not meeting the NIH criteria for bariatric surgery. To decrease the risk of recidivism, it is recommended that patients follow-up monthly with a Registered Dietitian during and after removal of the gastric balloon for twelve months. Our data shows direct correlation with percent total body weight loss and adherence to the follow-up regimen at six months. Although our sample size is small, our results suggest the intragastric balloon should not be regarded as a fire and forget solution and patients should be strongly encouraged to follow up during the six month program.

Surgery for Obesity and Related Diseases, 2017

Management of a perforated duodenal ulcer is most commonly performed by laparoscopy and consists ... more Management of a perforated duodenal ulcer is most commonly performed by laparoscopy and consists of suture of the perforation after performing lavage of the peritoneal cavity. In most cases, a flap is created, and an omental flap is usually the preferred choice because of its simplicity and its proximity to the site of duodenal perforation. However, in some cases, the greater omentum cannot be used due to the severity of peritonitis or due to previous surgical removal. We report a laparoscopic technique for surgical repair of a perforated duodenal ulcer using a round ligament flap. The present manuscript and the associated video highlight some important technical aspects to easily perform this procedure.

International Journal of Surgery Case Reports, 2021

Introduction Hundreds of thousands of cholecystectomies and appendectomies are performed in the U... more Introduction Hundreds of thousands of cholecystectomies and appendectomies are performed in the United States annually. Due to the prevalence of cholecystitis and appendicitis, a subset of patients will require both operations. The limited literature describing these patients supports a laparoscopic approach over open surgery; consistent with the advantages of laparotomy over open surgery in the treatment of each condition individually. Case presentation We report two cases where a patient presented with cholecystitis and appendicitis simultaneously. An abdominal computer tomography (CT) scan revealed the presence of the two diagnoses, which was then confirmed by an abdominal ultrasound. A four-access port was utilized for simultaneous appendectomy and cholecystectomy. Discussion A review of the literature indicates that simultaneous infection with appendicitis and cholecystitis is rare, and thus clinical presentation, lab work, and imaging studies are all needed to support such a diagnosis. Potential findings on imaging in these patients may include distended gallbladder with thickened wall and fluid-filled dilated appendix with mural enhancement. In the event that both clinical presentation and further work-up indicate both pathologies, laparoscopic intervention is suitable. A four-access port is deemed the conservative approach to dealing with such cases. Conclusion Finding a single diagnosis responsible for a patient's illness is a high priority in an acute care setting, a concept known as diagnostic parsimony. However, it is inevitable that very common illnesses will be comorbid in a subset of patients, and physicians should be prepared to consider contemporaneous illness in the isolated circumstances it is warranted.

Minimally Invasive Surgery, 2021

Background. Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LS... more Background. Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have comparable weight loss outcomes in a general bariatric population. Objectives. This study aimed to investigate whether similar outcomes can be observed in Hispanic and African American population. Settings. Community Hospital in New York, New York, United States. Methods. The 5-year prospective data of patients who underwent LRYGB and LSG at a single center were retrospectively reviewed. The long-term weight loss outcomes between patients who had LRYGB and LSG were compared after adjusting for age, sex, race, diabetes mellitus, and hypertension with the linear mixed-effects or logistic regression model. Results. Most patients were Hispanic (59.2%) and African American (22.7%). The mean% total weight loss (%TWL) values of patients with BMI <45 kg/m2 who underwent LRYGB and LSG were 73% and 62% after 1 year, 69% and 56% after 2 years, and 71% and 54% after 5 years, respectively....

Cureus, 2020

Diaphragmatic injuries can be a direct result of penetrating thoracoabdominal trauma such as guns... more Diaphragmatic injuries can be a direct result of penetrating thoracoabdominal trauma such as gunshot or stab wounds. Diaphragmatic rupture can lead to herniation of intra-abdominal organs into the thoracic cavity. Diagnosis can be difficult as the results of a physical exam can be unremarkable. A CT scan of the chest is diagnostic for diaphragmatic injuries. In most emergency cases, diaphragmatic injuries are managed with laparotomy where CT was diagnostic. We report a rare case of a 25-year-old man with right diaphragmatic injury sustained after a stab wound to the right liver managed successfully with laparoscopy.

Obesity Surgery, 2020

Background Bariatric surgery is associated with improved renal dysfunction in general population ... more Background Bariatric surgery is associated with improved renal dysfunction in general population studies. The study examined the effects of bariatric surgery on renal function in a predominantly Hispanic and African American population at a community hospital in New York, USA. Methods This retrospective study analyzed prospectively collected bariatric surgical data from 2247 patients (89% female) who underwent bariatric surgery at a single center. Changes in glomerular filtration rate (eGFR), urine albumin–creatinine ratio (UACR), micro- and macroalbuminuria, and hyperfiltration, which were measured preoperatively and then yearly for 3 years postoperatively, were evaluated with t tests and logistic regression analysis, after adjusting for confounding variables. The mean age of the patients at surgery was 37.1 years; the mean preoperative body mass index was 45 ± 7 kg/m 2 . Results The results obtained 3 years postoperatively showed the following significant improvements compared with the preoperative values: mean UACR decreased from 40.3 to 11.1 mg/g, mean eGFR improved from 79.4 to 87.3 mL/min, the prevalence of microalbuminuria decreased from 13.7 to 6.2%, the prevalence of macroalbuminuria decreased from 2.5 to 0%, and the prevalence of hyperfiltration decreased from 4.4 to 2.7% (all P < .0001). In adjusted multivariate regression analysis, these results remained significant after adjusting for age, sex, race, type of surgery, and presence of diabetes mellitus or hypertension. Conclusion In this large study at an inner-city hospital, bariatric surgery was associated with significant improvements in renal dysfunction parameters. These results could assist with informed decisions regarding indications for bariatric surgery.

Surgery for Obesity and Related Diseases, 2019

Cureus, 2019

The chondroid syringoma is an extremely rare skin tumor most commonly found in the area of the he... more The chondroid syringoma is an extremely rare skin tumor most commonly found in the area of the head and neck region. Its rarity, potential for malignancy, and frequent misdiagnosis for other more common tumors can impart unique challenges in diagnosis and management. Diagnosis is usually revealed by excision followed by histologic examination. We report a case of a 42-year-old male with no prior medical history diagnosed with chondroid syringoma of the forehead and review the relevant literature.

Case Reports in Critical Care, 2019

Methemoglobinemia is a rare complication in clinical practice. It is most commonly seen in patien... more Methemoglobinemia is a rare complication in clinical practice. It is most commonly seen in patients undergoing endoscopic procedures, including EGDs, laryngoscopies, bronchoscopies, and nasogastric tube insertions. This is thought to be a disease seen almost exclusively in patients with genetic predispositions to develop it; the increasing use of topical anesthetics during procedures has made methemoglobinemia a disease entity that every clinical provider should be able to recognize and treat. Clinically, patients become cyanotic with mild oxygen derangements on pulse oximetry, in the range of 84 to 90%. Paradoxically, these patients demonstrate normal to supranormal oxygen levels in the blood on blood gas analysis. We report a case of 34-year-old female postoperative Roux-en-Y gastric bypass patient who developed hypoxia and cyanosis after a routine EGD procedure to relieve a food impaction. Differentials of aspiration and pulmonary embolism were plausible; stat blood gas analysis ...

Kuwait Chapter of Arabian Journal of Business and Management Review, 2017

Case reports in surgery, 2018

Duodenal diverticulum is a rare disease that can be easily missed. The incidence of duodenal dive... more Duodenal diverticulum is a rare disease that can be easily missed. The incidence of duodenal diverticulum diagnosed by upper GI study is approximately 5%. Autopsy results show that 22% of the population have duodenum diverticulum. Most patients with duodenal diverticulum are asymptomatic. However, complications like inflammation, perforation with retroperitoneal abscess, sepsis, pancreatitis, bile duct obstruction, and bleeding can occur. Approximately 162 cases of perforated duodenal diverticulum have been reported in the literature. We present a rare case of an 82-year-old female with perforation of a duodenal diverticulum caused by small bowel obstruction; in addition to this, there was a synchronous colonic tumor. Diagnosis and management of this rare disorder are controversial. Nonoperative management is advocated in some cases. Some of the cases require early aggressive surgical intervention. The mortality rate remains approximately 45% in all these patients.

Journal of emergencies, trauma, and shock

Scrotal loss from Fournier's gangrene can be a devastating injury with esthetic and functiona... more Scrotal loss from Fournier's gangrene can be a devastating injury with esthetic and functional consequences. Local reconstructive options can be limited by the presence of infection or the loss of neighboring tissue from debridement. Integra bilayer matrix wound dressing is a well-established reconstructive modality, but only one report exists of its use in scrotal reconstruction and this was not in the setting of Fournier's gangrene. We report the successful use of Integra and a subsequent split-thickness skin graft for reconstruction of the anterior scrotum and coverage of the exposed testes in a 43-year-old man who developed Group A Streptococcus necrotizing fasciitis of his right lower extremity, groin, and scrotum requiring serial operative debridements. Stable testicular coverage was achieved with closely matched skin and minimal donor-site morbidity. Further study and a larger sample size will be necessary to better understand the advantages and disadvantages of scrot...

Journal of burn care & research : official publication of the American Burn Association, Jan 16, 2018

Pediatric burns in the urban environment present special problems. Inner-city communities may be ... more Pediatric burns in the urban environment present special problems. Inner-city communities may be unique with hardships due to various socioeconomic factors. There is lack of literature analyzing pediatric burns in the inner-city, and there has been no report to date reviewing Harlem New York City, one of the most challenged areas in the nation. The aim of this study is to understand the pre-hospital circumstances, socioeconomic factors and management of pediatric burns admitted to our hospital. A retrospective review was performed including all patients aged 0-18 years admitted to the burn care unit from January 2006-May 2017. Data collected includes demographics, burn mechanism, total burn surface area (TBSA), first aid response, socioeconomic factors such as parental supervision, single parenting, caregiver financial and employment status, child protective service reporting. A total of 177 patients were included with majority being toddlers. Most common burn type was scald and ave...

Korean journal of neurotrauma, 2018

Spinal cord injuries are debilitating and life threatening. Paraplegia due to direct traumatic gu... more Spinal cord injuries are debilitating and life threatening. Paraplegia due to direct traumatic gunshot injury to the spinal cord is common. The most common cause of spinal cord injury is road traffic accidents. This is followed by spinal cord injury due to a fall from a height. Most of the spinal cord injuries due to gunshot wounds occur as a result of direct traumatic effects. We present a rare case of a 49-year-old male with trauma. He developed paraplegia after a gunshot wound injury to the neck and contusion to the spinal cord, with no direct trauma. Paraplegia due to direct gunshot injury can have many different outcomes. In our case, the patient was managed conservatively, and the outcome was favorable.

Head & Neck, 2009

Background. In this study, we tested the ability of a novel poly(adenosine diphosphate ribose) po... more Background. In this study, we tested the ability of a novel poly(adenosine diphosphate ribose) polymerase (PARP) inhibitor, 10-(4-methyl-piperazin-1-ylmethyl)-2H-7-oxa-1,2-diaza-benzo[de]-anthracen-3-one (GPI-15427), to enhance the effect of radiotherapy in a xenograft model of human head and neck squamous cell carcinoma (HNSCC). Methods. Human xenograft HNSCC tumors were established in female nude mice: animals were treated with orally administered GPI-15427 at varied doses prior to tumor irradiation. In vitro and in vivo apoptosis analyses and neutral singlecell gel electrophoresis (comet) assay were performed, with the ''tail moment'' calculated to evaluate DNA double-strand break damage. Results. Orally administered GPI-15427 given before radiation therapy significantly reduced tumor volume, and cells demonstrated significantly elevated mean tail moments (indica-tive of DNA damage) and enhanced apoptosis both in vitro and in vivo, compared with radiation-alone and control groups. Conclusions. Use of the PARP-1 inhibitor GPI-15427 induced significant sensitization to radiotherapy, representing a promising new treatment in the management of HNSCC.

Developmental Biology, 2003

During development, inferior olivary axons cross the floor plate and project from the caudal to t... more During development, inferior olivary axons cross the floor plate and project from the caudal to the rostral hindbrain, whence they grow into the cerebellar plate. We have investigated the axon guidance signals involved in the formation of this projection in vitro. When the cerebellar plate was grafted ectopically along the margin of the hindbrain in organotypic cultures, inferior olivary axons could pathfind to the ectopic cerebellum, establishing a topographically normal projection. Following rostrocaudal reversal of a region of tissue in the axon pathway between the inferior olive and the cerebellum, olivary axons still navigated towards the cerebellum. Moreover, olivary axons could cross a bridging tissue explant (spinal cord) to reach a cerebellar explant. In collagen gel cultures of inferior olive explants, olivary axon outgrowth increased significantly in the presence of cerebellar explants and axons deflected towards the cerebellar tissue. These results show that the cerebellum is a source of diffusible axon guidance signals for olivary axons. We also found that, in organotypic cultures, olivary axons which had crossed the floor plate showed an increased tendency to respond to cerebellar cues. Taken together, these results indicate that the cerebellum is the source of cues that are chemoattractant and growth-promoting for inferior olivary axons; prior exposure to the floor plate increases responsiveness to these cues.

Bariatric Nursing and Surgical Patient Care, 2008

The growth of bariatric surgery over the past decade has been fueled by patient demand. There are... more The growth of bariatric surgery over the past decade has been fueled by patient demand. There are several surgical procedures used for morbid obesity. The two most popular are the laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB). ...

Urology case reports, 2018

Acute appendicitis is the most common surgical emergency in the United States. However, unusual c... more Acute appendicitis is the most common surgical emergency in the United States. However, unusual causes of appendicitis need to be considered in patients with significant co-morbidities like our patient with history of prostate cancer. Cases of acute appendicitis due to metastatic prostate cancer are rare, with only a few cases reported in the literature. We report a case of a 72 year old male with a history of metastatic prostate cancer that caused acute appendicitis prompting surgical intervention.

Surgery for Obesity and Related Diseases, 2017

accepted at p level of 0.05. Analyses were performed by SPSS 24 (IBM inc, Armonk NY). Results: Tw... more accepted at p level of 0.05. Analyses were performed by SPSS 24 (IBM inc, Armonk NY). Results: Twelve patients met our criteria. Ten were female and two were male. Mean age was 40.6 þ/-13.7 years and mean BMI was 34.0 þ/-3.1. Median number of post-removal visits was 4 (2-6). Mean total weight loss was 10.9% at 6 months. Pearson correlation coefficient revealed strong positive correlation between the number of follow up visits with the Registered Dietitian and total body weight loss. (r¼0.692, p¼0.013, R 2 ¼0.478). No serious adverse events were encountered during the examined period. Conclusions: The ORBERA Gastric Balloon System is an effective method for weight loss for patients not meeting the NIH criteria for bariatric surgery. To decrease the risk of recidivism, it is recommended that patients follow-up monthly with a Registered Dietitian during and after removal of the gastric balloon for twelve months. Our data shows direct correlation with percent total body weight loss and adherence to the follow-up regimen at six months. Although our sample size is small, our results suggest the intragastric balloon should not be regarded as a fire and forget solution and patients should be strongly encouraged to follow up during the six month program.

Surgery for Obesity and Related Diseases, 2017

Management of a perforated duodenal ulcer is most commonly performed by laparoscopy and consists ... more Management of a perforated duodenal ulcer is most commonly performed by laparoscopy and consists of suture of the perforation after performing lavage of the peritoneal cavity. In most cases, a flap is created, and an omental flap is usually the preferred choice because of its simplicity and its proximity to the site of duodenal perforation. However, in some cases, the greater omentum cannot be used due to the severity of peritonitis or due to previous surgical removal. We report a laparoscopic technique for surgical repair of a perforated duodenal ulcer using a round ligament flap. The present manuscript and the associated video highlight some important technical aspects to easily perform this procedure.

International Journal of Surgery Case Reports, 2021

Introduction Hundreds of thousands of cholecystectomies and appendectomies are performed in the U... more Introduction Hundreds of thousands of cholecystectomies and appendectomies are performed in the United States annually. Due to the prevalence of cholecystitis and appendicitis, a subset of patients will require both operations. The limited literature describing these patients supports a laparoscopic approach over open surgery; consistent with the advantages of laparotomy over open surgery in the treatment of each condition individually. Case presentation We report two cases where a patient presented with cholecystitis and appendicitis simultaneously. An abdominal computer tomography (CT) scan revealed the presence of the two diagnoses, which was then confirmed by an abdominal ultrasound. A four-access port was utilized for simultaneous appendectomy and cholecystectomy. Discussion A review of the literature indicates that simultaneous infection with appendicitis and cholecystitis is rare, and thus clinical presentation, lab work, and imaging studies are all needed to support such a diagnosis. Potential findings on imaging in these patients may include distended gallbladder with thickened wall and fluid-filled dilated appendix with mural enhancement. In the event that both clinical presentation and further work-up indicate both pathologies, laparoscopic intervention is suitable. A four-access port is deemed the conservative approach to dealing with such cases. Conclusion Finding a single diagnosis responsible for a patient's illness is a high priority in an acute care setting, a concept known as diagnostic parsimony. However, it is inevitable that very common illnesses will be comorbid in a subset of patients, and physicians should be prepared to consider contemporaneous illness in the isolated circumstances it is warranted.

Minimally Invasive Surgery, 2021

Background. Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LS... more Background. Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have comparable weight loss outcomes in a general bariatric population. Objectives. This study aimed to investigate whether similar outcomes can be observed in Hispanic and African American population. Settings. Community Hospital in New York, New York, United States. Methods. The 5-year prospective data of patients who underwent LRYGB and LSG at a single center were retrospectively reviewed. The long-term weight loss outcomes between patients who had LRYGB and LSG were compared after adjusting for age, sex, race, diabetes mellitus, and hypertension with the linear mixed-effects or logistic regression model. Results. Most patients were Hispanic (59.2%) and African American (22.7%). The mean% total weight loss (%TWL) values of patients with BMI <45 kg/m2 who underwent LRYGB and LSG were 73% and 62% after 1 year, 69% and 56% after 2 years, and 71% and 54% after 5 years, respectively....

Cureus, 2020

Diaphragmatic injuries can be a direct result of penetrating thoracoabdominal trauma such as guns... more Diaphragmatic injuries can be a direct result of penetrating thoracoabdominal trauma such as gunshot or stab wounds. Diaphragmatic rupture can lead to herniation of intra-abdominal organs into the thoracic cavity. Diagnosis can be difficult as the results of a physical exam can be unremarkable. A CT scan of the chest is diagnostic for diaphragmatic injuries. In most emergency cases, diaphragmatic injuries are managed with laparotomy where CT was diagnostic. We report a rare case of a 25-year-old man with right diaphragmatic injury sustained after a stab wound to the right liver managed successfully with laparoscopy.

Obesity Surgery, 2020

Background Bariatric surgery is associated with improved renal dysfunction in general population ... more Background Bariatric surgery is associated with improved renal dysfunction in general population studies. The study examined the effects of bariatric surgery on renal function in a predominantly Hispanic and African American population at a community hospital in New York, USA. Methods This retrospective study analyzed prospectively collected bariatric surgical data from 2247 patients (89% female) who underwent bariatric surgery at a single center. Changes in glomerular filtration rate (eGFR), urine albumin–creatinine ratio (UACR), micro- and macroalbuminuria, and hyperfiltration, which were measured preoperatively and then yearly for 3 years postoperatively, were evaluated with t tests and logistic regression analysis, after adjusting for confounding variables. The mean age of the patients at surgery was 37.1 years; the mean preoperative body mass index was 45 ± 7 kg/m 2 . Results The results obtained 3 years postoperatively showed the following significant improvements compared with the preoperative values: mean UACR decreased from 40.3 to 11.1 mg/g, mean eGFR improved from 79.4 to 87.3 mL/min, the prevalence of microalbuminuria decreased from 13.7 to 6.2%, the prevalence of macroalbuminuria decreased from 2.5 to 0%, and the prevalence of hyperfiltration decreased from 4.4 to 2.7% (all P < .0001). In adjusted multivariate regression analysis, these results remained significant after adjusting for age, sex, race, type of surgery, and presence of diabetes mellitus or hypertension. Conclusion In this large study at an inner-city hospital, bariatric surgery was associated with significant improvements in renal dysfunction parameters. These results could assist with informed decisions regarding indications for bariatric surgery.

Surgery for Obesity and Related Diseases, 2019

Cureus, 2019

The chondroid syringoma is an extremely rare skin tumor most commonly found in the area of the he... more The chondroid syringoma is an extremely rare skin tumor most commonly found in the area of the head and neck region. Its rarity, potential for malignancy, and frequent misdiagnosis for other more common tumors can impart unique challenges in diagnosis and management. Diagnosis is usually revealed by excision followed by histologic examination. We report a case of a 42-year-old male with no prior medical history diagnosed with chondroid syringoma of the forehead and review the relevant literature.

Case Reports in Critical Care, 2019

Methemoglobinemia is a rare complication in clinical practice. It is most commonly seen in patien... more Methemoglobinemia is a rare complication in clinical practice. It is most commonly seen in patients undergoing endoscopic procedures, including EGDs, laryngoscopies, bronchoscopies, and nasogastric tube insertions. This is thought to be a disease seen almost exclusively in patients with genetic predispositions to develop it; the increasing use of topical anesthetics during procedures has made methemoglobinemia a disease entity that every clinical provider should be able to recognize and treat. Clinically, patients become cyanotic with mild oxygen derangements on pulse oximetry, in the range of 84 to 90%. Paradoxically, these patients demonstrate normal to supranormal oxygen levels in the blood on blood gas analysis. We report a case of 34-year-old female postoperative Roux-en-Y gastric bypass patient who developed hypoxia and cyanosis after a routine EGD procedure to relieve a food impaction. Differentials of aspiration and pulmonary embolism were plausible; stat blood gas analysis ...

Kuwait Chapter of Arabian Journal of Business and Management Review, 2017

Case reports in surgery, 2018

Duodenal diverticulum is a rare disease that can be easily missed. The incidence of duodenal dive... more Duodenal diverticulum is a rare disease that can be easily missed. The incidence of duodenal diverticulum diagnosed by upper GI study is approximately 5%. Autopsy results show that 22% of the population have duodenum diverticulum. Most patients with duodenal diverticulum are asymptomatic. However, complications like inflammation, perforation with retroperitoneal abscess, sepsis, pancreatitis, bile duct obstruction, and bleeding can occur. Approximately 162 cases of perforated duodenal diverticulum have been reported in the literature. We present a rare case of an 82-year-old female with perforation of a duodenal diverticulum caused by small bowel obstruction; in addition to this, there was a synchronous colonic tumor. Diagnosis and management of this rare disorder are controversial. Nonoperative management is advocated in some cases. Some of the cases require early aggressive surgical intervention. The mortality rate remains approximately 45% in all these patients.

Journal of emergencies, trauma, and shock

Scrotal loss from Fournier's gangrene can be a devastating injury with esthetic and functiona... more Scrotal loss from Fournier's gangrene can be a devastating injury with esthetic and functional consequences. Local reconstructive options can be limited by the presence of infection or the loss of neighboring tissue from debridement. Integra bilayer matrix wound dressing is a well-established reconstructive modality, but only one report exists of its use in scrotal reconstruction and this was not in the setting of Fournier's gangrene. We report the successful use of Integra and a subsequent split-thickness skin graft for reconstruction of the anterior scrotum and coverage of the exposed testes in a 43-year-old man who developed Group A Streptococcus necrotizing fasciitis of his right lower extremity, groin, and scrotum requiring serial operative debridements. Stable testicular coverage was achieved with closely matched skin and minimal donor-site morbidity. Further study and a larger sample size will be necessary to better understand the advantages and disadvantages of scrot...

Journal of burn care & research : official publication of the American Burn Association, Jan 16, 2018

Pediatric burns in the urban environment present special problems. Inner-city communities may be ... more Pediatric burns in the urban environment present special problems. Inner-city communities may be unique with hardships due to various socioeconomic factors. There is lack of literature analyzing pediatric burns in the inner-city, and there has been no report to date reviewing Harlem New York City, one of the most challenged areas in the nation. The aim of this study is to understand the pre-hospital circumstances, socioeconomic factors and management of pediatric burns admitted to our hospital. A retrospective review was performed including all patients aged 0-18 years admitted to the burn care unit from January 2006-May 2017. Data collected includes demographics, burn mechanism, total burn surface area (TBSA), first aid response, socioeconomic factors such as parental supervision, single parenting, caregiver financial and employment status, child protective service reporting. A total of 177 patients were included with majority being toddlers. Most common burn type was scald and ave...

Korean journal of neurotrauma, 2018

Spinal cord injuries are debilitating and life threatening. Paraplegia due to direct traumatic gu... more Spinal cord injuries are debilitating and life threatening. Paraplegia due to direct traumatic gunshot injury to the spinal cord is common. The most common cause of spinal cord injury is road traffic accidents. This is followed by spinal cord injury due to a fall from a height. Most of the spinal cord injuries due to gunshot wounds occur as a result of direct traumatic effects. We present a rare case of a 49-year-old male with trauma. He developed paraplegia after a gunshot wound injury to the neck and contusion to the spinal cord, with no direct trauma. Paraplegia due to direct gunshot injury can have many different outcomes. In our case, the patient was managed conservatively, and the outcome was favorable.

Head & Neck, 2009

Background. In this study, we tested the ability of a novel poly(adenosine diphosphate ribose) po... more Background. In this study, we tested the ability of a novel poly(adenosine diphosphate ribose) polymerase (PARP) inhibitor, 10-(4-methyl-piperazin-1-ylmethyl)-2H-7-oxa-1,2-diaza-benzo[de]-anthracen-3-one (GPI-15427), to enhance the effect of radiotherapy in a xenograft model of human head and neck squamous cell carcinoma (HNSCC). Methods. Human xenograft HNSCC tumors were established in female nude mice: animals were treated with orally administered GPI-15427 at varied doses prior to tumor irradiation. In vitro and in vivo apoptosis analyses and neutral singlecell gel electrophoresis (comet) assay were performed, with the ''tail moment'' calculated to evaluate DNA double-strand break damage. Results. Orally administered GPI-15427 given before radiation therapy significantly reduced tumor volume, and cells demonstrated significantly elevated mean tail moments (indica-tive of DNA damage) and enhanced apoptosis both in vitro and in vivo, compared with radiation-alone and control groups. Conclusions. Use of the PARP-1 inhibitor GPI-15427 induced significant sensitization to radiotherapy, representing a promising new treatment in the management of HNSCC.

Developmental Biology, 2003

During development, inferior olivary axons cross the floor plate and project from the caudal to t... more During development, inferior olivary axons cross the floor plate and project from the caudal to the rostral hindbrain, whence they grow into the cerebellar plate. We have investigated the axon guidance signals involved in the formation of this projection in vitro. When the cerebellar plate was grafted ectopically along the margin of the hindbrain in organotypic cultures, inferior olivary axons could pathfind to the ectopic cerebellum, establishing a topographically normal projection. Following rostrocaudal reversal of a region of tissue in the axon pathway between the inferior olive and the cerebellum, olivary axons still navigated towards the cerebellum. Moreover, olivary axons could cross a bridging tissue explant (spinal cord) to reach a cerebellar explant. In collagen gel cultures of inferior olive explants, olivary axon outgrowth increased significantly in the presence of cerebellar explants and axons deflected towards the cerebellar tissue. These results show that the cerebellum is a source of diffusible axon guidance signals for olivary axons. We also found that, in organotypic cultures, olivary axons which had crossed the floor plate showed an increased tendency to respond to cerebellar cues. Taken together, these results indicate that the cerebellum is the source of cues that are chemoattractant and growth-promoting for inferior olivary axons; prior exposure to the floor plate increases responsiveness to these cues.

Bariatric Nursing and Surgical Patient Care, 2008

The growth of bariatric surgery over the past decade has been fueled by patient demand. There are... more The growth of bariatric surgery over the past decade has been fueled by patient demand. There are several surgical procedures used for morbid obesity. The two most popular are the laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB). ...

Urology case reports, 2018

Acute appendicitis is the most common surgical emergency in the United States. However, unusual c... more Acute appendicitis is the most common surgical emergency in the United States. However, unusual causes of appendicitis need to be considered in patients with significant co-morbidities like our patient with history of prostate cancer. Cases of acute appendicitis due to metastatic prostate cancer are rare, with only a few cases reported in the literature. We report a case of a 72 year old male with a history of metastatic prostate cancer that caused acute appendicitis prompting surgical intervention.