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Allan AY, Mughal M, Mohanna PN, Roblin P. Lymphovenous anastomosis using the venous coupler: Primary prevention of lymphoedema. J Plast Reconstr Aesthet Surg 2024; 92:282-284. [PMID: 38583370 DOI: 10.1016/j.bjps.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Anna Yarlini Allan
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
| | - Maleeha Mughal
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Pari-Naz Mohanna
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Paul Roblin
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
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Kapila AK, Mughal M, Roblin P, Mohanna P. Reply to: Early experience with Synovis Flow Coupler and major pitfalls in its use in 18 microsurgical free flaps. J Plast Reconstr Aesthet Surg 2024; 90:330-332. [PMID: 37953081 DOI: 10.1016/j.bjps.2023.10.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 10/27/2023] [Accepted: 10/29/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Ayush K Kapila
- Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, United Kingdom.
| | - Maleeha Mughal
- Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, United Kingdom
| | - Paul Roblin
- Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, United Kingdom
| | - Pari Mohanna
- Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, United Kingdom
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Mughal M, Berner JE, Ho-Asjoe M, See M, Roblin P, Rose V, Mohanna PN. One-stop autologous breast reconstruction: A safe and effective cost-saving pathway. J Plast Reconstr Aesthet Surg 2023; 92:276-281. [PMID: 38582053 DOI: 10.1016/j.bjps.2023.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Patients undergoing autologous breast reconstruction usually require further operations as part of their reconstructive journey. This involves contralateral breast symmetrization and nipple-areola complex (NAC) reconstruction. Restrained access to elective operating space led us to implement a one-stop breast reconstruction pathway. METHODS Patients undergoing contemporaneous contralateral breast symmetrization and immediate NAC reconstruction with free nipple grafts between July 2020 and June 2021 were identified. A retrospective review of our prospectively maintained database was conducted, to retrieve surgical notes, postoperative complications, and length of inpatient stay. A cost analysis was performed considering savings from contralateral symmetrization. RESULTS A total of 50 eligible cases were identified, which had unilateral one-stop breast reconstructions. Complication rates and length of stay were not affected by this approach, with only one free flap being lost for this cohort. This approach resulted in £181,000 being saved for our service over a calendar year. DISCUSSION A one-stop breast reconstruction pathway has proven to be safe and effective in our unit. During these uncertain times, it has streamlined the management of eligible patients, while releasing capacity for other elective operations. Patients avoid having to wait for secondary procedures, finishing their reconstructive pathway earlier. We plan to continue providing this service which has shown to be beneficial clinically and financially.
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Affiliation(s)
- Maleeha Mughal
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom.
| | - Juan Enrique Berner
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Mark Ho-Asjoe
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Marlene See
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Paul Roblin
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Victoria Rose
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Pari-Naz Mohanna
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
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Fletcher J, Drami I, Burns E, Mughal M, West MA, Corr A, Jenkins JT. Open sidewall excision for recurrent rectal cancer with gluteal flap reconstruction - a video vignette. Colorectal Dis 2022; 24:1252-1253. [PMID: 35490346 DOI: 10.1111/codi.16162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Jordan Fletcher
- Complex Cancer Clinic, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Ioanna Drami
- Complex Cancer Clinic, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Elaine Burns
- Complex Cancer Clinic, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Maleeha Mughal
- Department of Plastic and Reconstructive Surgery, Guy's and St Thomas Hospital, London, UK
| | - Malcolm A West
- Complex Cancer Clinic, St Mark's Hospital and Academic Institute, Harrow, UK.,School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alison Corr
- Complex Cancer Clinic, St Mark's Hospital and Academic Institute, Harrow, UK
| | - John T Jenkins
- Complex Cancer Clinic, St Mark's Hospital and Academic Institute, Harrow, UK
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Mughal M, Rose V, Sindali K, Farhadi J, Havard H, Pollock R, Roblin P. Dual pedicle epiphyseal transfer for paediatric bony sarcoma reconstruction: Technique and review of outcomes. J Plast Reconstr Aesthet Surg 2022; 75:2466-2473. [PMID: 35504788 DOI: 10.1016/j.bjps.2021.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 05/14/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Skeletal reconstruction after tumour resection in paediatric patients is challenging. The resultant reconstruction needs to meet the demands of graft incorporation as well as the potential for growth. The vascularised fibular epiphyseal transfer (VFET) offers the potential for both. We retrospectively reviewed eight paediatric patients treated with VFET after bony tumour resection. All patients underwent a dual pedicle transfer with the peroneal artery for the diaphyseal blood supply and the recurrent branch of the anterior tibial artery for the physis. This is the largest series in literature for dual pedicle transfers for bony reconstruction. We present our surgical technique and outcomes in terms of functional limb salvage and growth.
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Affiliation(s)
- Maleeha Mughal
- Department of Plastic Surgery, Guy's & St. Thomas Hospital, London, UK; Department of Plastic Surgery, University Health Network, Toronto, ON, CA.
| | - Victoria Rose
- Department of Plastic Surgery, Guy's & St. Thomas Hospital, London, UK
| | - Katia Sindali
- Department of Plastic Surgery, Guy's & St. Thomas Hospital, London, UK
| | - Jian Farhadi
- Department of Plastic Surgery, Guy's & St. Thomas Hospital, London, UK
| | - Heledd Havard
- Department of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Robin Pollock
- Department of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Paul Roblin
- Department of Plastic Surgery, Guy's & St. Thomas Hospital, London, UK
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Grewal J, Mughal M, Nnaoma C, Montgomery M, Kapoor S. Axillary IABP Migration into SMA. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cooper L, Din AH, O'Connor EF, Rose V, Roblin P, Mughal M. Trainee and trainer experiences and recommendations for plastic surgery training: A qualitative pilot study. JPRAS Open 2021; 31:76-91. [PMID: 34917732 PMCID: PMC8669338 DOI: 10.1016/j.jpra.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background The COVID-19 pandemic has compounded existing training issues for plastic surgeons. The issues that exist result from a complex interplay of system, generational and individual factors, and can be hard to tease out by quantitative means. This pilot study aimed to investigate the perceptions of trainees and trainers of plastic surgical training in the UK. Methods Ten semi-structured interviews were performed using purposive sampling in a central London plastic surgical unit. These were coded into and discussed in four themes: Medical directives and service demands; Sociocultural norms within plastic surgical training; Equity and access; and Plastic surgery training methods. Results This study showed that current plastic surgery training is not optimised for learning or well-being, and that inequities are fostered, to the detriment of the specialty. Investment and planning are required to support our trainers and protect the diversity of our trainee group, with efficient and monitored learning essential to maintain our breadth and competence of practice. Conclusion Expanding this work through a broader study could provide valuable information to contribute to the development of future training schemes and curricula within British plastic surgery.
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Affiliation(s)
- Lilli Cooper
- Plastic Surgery Department, St Thomas' Hospital, London, SE17EH
| | - Asmat H Din
- Plastic Surgery Department, St Thomas' Hospital, London, SE17EH
| | | | - Victoria Rose
- Plastic Surgery Department, St Thomas' Hospital, London, SE17EH
| | - Paul Roblin
- Plastic Surgery Department, St Thomas' Hospital, London, SE17EH
| | - Maleeha Mughal
- Plastic Surgery Department, St Thomas' Hospital, London, SE17EH
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8
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Cooper L, Din AH, Fitzgerald O'Connor E, Roblin P, Rose V, Mughal M. Augmented Reality and Plastic Surgery Training: A Qualitative Study. Cureus 2021; 13:e19010. [PMID: 34824927 PMCID: PMC8610414 DOI: 10.7759/cureus.19010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective The coronavirus disease 2019 (COVID-19) pandemic has led to many challenges in face-to-face teaching and training in plastic surgery. However, it has also proved to be an incubator for many technological solutions. Augmented reality (AR) platforms may offer a safe, equitable, and efficient means to provide training in plastic surgery. This study aimed to explore the user's experience of AR as an educational intervention during the COVID-19 pandemic in the United Kingdom (UK). Materials and methods The Proximie® AR platform (Proximie Limited, London, UK) has been in use in a UK plastic surgical department for facilitating webinars, visual libraries, and streamed procedures. The experience of a range of trainers and trainees was qualitatively explored through 10 individual interviews. Data-emergent theme analysis was also performed. Results AR was well-received in the context of COVID-19 and training in general as a means to enable theatre access, and visual revision, remotely. The potential for its use in remote coaching and telementoring was also discussed. Recommendations were made by the users to optimise the experience both from the trainer and learner perspectives. Data were presented pertaining to the following themes: surgical AR as a substitute for hands-on learning; surgical AR and theoretical learning; considerations specific to streamed procedures using Proximie®; considerations in the use of technology in general. Conclusion Harnessing novel technologies in surgical education offers an exciting opportunity, fast-tracked by COVID-19, but applicable beyond it. Though this study includes a small sample size, its findings suggest that AR platforms may offer a uniquely interactive remote educational experience in surgical training. Strategies and suggestions for its use are discussed, as well as broader considerations in using technology in surgical education.
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Affiliation(s)
- Lilli Cooper
- Plastic and Reconstructive Surgery, Guy's and St Thomas' NHS Foundation Trust, London, GBR
| | - Asmat H Din
- Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, GBR
| | | | - Paul Roblin
- Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, GBR
| | - Victoria Rose
- Plastic and Reconstructive Surgery, Guy's and St Thomas' NHS Foundation Trust, London, GBR
| | - Maleeha Mughal
- Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, GBR
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9
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Sleiwah A, Mohanna P, AsJoe M H, Roblin P, Uppal L, Mughal M. Heads up reconstructive microsurgery: Utilisation of the three-dimensional microscope in microvascular procedures. J Plast Reconstr Aesthet Surg 2021; 75:893-939. [PMID: 34844881 DOI: 10.1016/j.bjps.2021.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Since the earliest use of microscopes in surgery, several modifications have been made to improve the ergonomics of movement and posture, increase the resolution, and expand the visual field. The three-dimensional microscopes are latest innovation in this field. Despite the wider use of 3D microscopes in other specialities, their use in the reconstructive microsurgery in the United Kingdom is still limited. Reconstructive microsurgeons are highly skilled surgeons that are trained to operate utilising the microscope for long hours. This poses an occupational risk with a specific pattern of work-related conditions. AIMS AND METHODS We aim in this report to demonstrate our experience utilising 3D microscopes in small cohort of patients matched to a control of patients operated utilising the traditional microscopes. Patients were matched by age, comorbidities, oncologic procedures. This was complemented by a survey completed by the operating surgeons. RESULTS Nine patients were included in each group. There was no significant difference in operative or ischemia time and no significant post-operative complications in both groups. The surgeons reported better ergonomics, improved staff engagement, and a better teaching experience when utilising the 3D microscopes compared to traditional microscopes. CONCLUSION The utilisation of the 3D microscopes in reconstructive microsurgery has shown to provide comfort, improve ergonomics of movement and posture without significant clinical implications in this series.
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Affiliation(s)
- A Sleiwah
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - P Mohanna
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ho AsJoe M
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P Roblin
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Uppal
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Mughal
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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10
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Berner JE, Mughal M, Mohanna PN, Kothari A, Hamed H, See M, Ho-Asjoe M, Roblin P, Rose V. Free nipple grafts for immediate autologous breast reconstruction: Expediting the reconstructive journey. J Plast Reconstr Aesthet Surg 2021; 74:3443-3476. [PMID: 34697003 DOI: 10.1016/j.bjps.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Juan Enrique Berner
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Maleeha Mughal
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom.
| | - Pari-Naz Mohanna
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Ashutosh Kothari
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Hisham Hamed
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Marlene See
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Mark Ho-Asjoe
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Paul Roblin
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Victoria Rose
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
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11
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Mughal M, Kaur I, Waxman S, Gandhi H, Kakadia M, Khakwani Z, Okoh A, Shah K, Obaid A, Sirpal V, Azad S, Jaffery A, Jagdey H, Tawfik I, Alam M. Clinical outcomes in COVID-19 patients with in-hospital cardiac arrest – an insight from multi-centre data. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In general, rates of in-hospital cardiac arrest are reportedly 9 to 10 arrests per 1000 admissions, with survival rates of approximately 20–25%. Data regarding clinical characteristics and outcomes in patients with COVID-19 who received in-hospital CPR (cardiopulmonary resuscitation) are limited. This information can help guide end-of-life care conversations between families and health care workers based on real-world experience.
Purpose
To observe the outcomes (survival to discharged alive from the hospital) in critically sick COVID-19 patients who experienced in-hospital cardiac arrest.
Methods
This is a multi-centre institutional review board (IRB) approved retrospective study. The RT-PCR confirmed adult COVID-19 patients consecutively admitted from March 1st to April 30, 2020, were included. Data were extracted manually using the hospital's electronic medical record. The final date of follow-up to monitor clinical outcomes was January 2021.
Results
A total of 721 patients were admitted to the hospital. Of these, only 64 (8.87%) patients had “no CPR” orders.Cardiac arrest occurred in 141 (19.5%) patients. The mean duration of beginning of resuscitation was less than a minute and the mean duration of CPR was 19 minutes. The median age was 65 years; 62.4% were male. The most common co-morbidities were hypertension (66%) and diabetes mellitus (56%). The initial rhythm was non-shockable in 93.7% of patients [asystole in 48.4% and Pulseless Electrical Activity (PEA) in 45.3% of patients]. Only six (4.2%) patients had pulseless ventricular tachycardia and three (2.1%) patients had ventricular fibrillation. A total of eight patients (5.6%) survived and were discharged from the hospital; six (4.25%) had non-shockable and two (0.82%) had shockable initial rhythms. The median age of those who survived was 60 years (Figure 1).
Conclusions
Our study showed that critically sick patients with COVID-19 have a high rate of cardiac arrest and poor outcomes in those who received CPR. A non-shockable initial rhythm indicates that non-cardiac reasons might be playing a major role. These include acute respiratory insufficiency, severe sepsis, or multiorgan failure. These data should inform end-of-life care discussions between providers and patients' families.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Mughal
- Monmouth Medical Center, Long Branch, United States of America
| | - I Kaur
- Monmouth Medical Center, Long Branch, United States of America
| | - S Waxman
- Newark Beth Israel Medical Center, The Department of Medicine, Section of Cardiology, Newark, United States of America
| | - H Gandhi
- Monmouth Medical Center, Long Branch, United States of America
| | - M Kakadia
- Monmouth Medical Center, Long Branch, United States of America
| | - Z Khakwani
- Newark Beth Israel Medical Center, The Department of Medicine, Section of Cardiology, Newark, United States of America
| | - A Okoh
- Newark Beth Israel Medical Center, The Department of Medicine, Section of Cardiology, Newark, United States of America
| | - K Shah
- St. Luke's University Hospital, Bethlehem, United States of America
| | - A Obaid
- Monmouth Medical Center, Long Branch, United States of America
| | - V Sirpal
- Monmouth Medical Center, Long Branch, United States of America
| | - S Azad
- Monmouth Medical Center, Long Branch, United States of America
| | - A Jaffery
- Monmouth Medical Center, Long Branch, United States of America
| | - H Jagdey
- Bronx-Lebanon Hospital Center, Bronx NY, United States of America
| | - I Tawfik
- Monmouth Medical Center, Long Branch, United States of America
| | - M Alam
- Baylor College of Medicine, The Department of Medicine, Section of Cardiology, Houston, United States of America
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Shah K, Thyagaturu H, Mughal M, Gandhi H, Harmouch F, Modi V, Kothari J, Shirani J. Impact of gastrointestinal hemorrhage on hospital outcomes of patients with hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with hypertrophic cardiomyopathy (HCM) may be at relatively high risk of gastrointestinal hemorrhage (GIH) due to acquired von Willebrand disease (aVWD) and anticoagulation for atrial fibrillation among others factors.
Purpose
We aimed to evaluate impact of GIH on in-hospital outcomes of patients with HCM.
Methods
The National Inpatient Sample reported 45,305 admissions for adults with HCM during a two-year period (2016–2017). Among them, 1,490 patients (3.3%) also had GIH. Baseline characteristics and in-hospital outcomes of the two groups were compared. Multivariable logistic regression analysis was used to assess the independent impact of GIH on in-hospital outcomes of HCM patients.
Results
Out of 45,305 HCM patients, 1490 (3.2%) also had concomitant diagnosis of GIH. HCM patients with GIH were older (70±9 vs 66±23 years), were more often male (64% vs 61%), and had higher prevalence of prior myocardial infarction (12% vs 7%, p<0.001) and cirrhosis (7.1% vs 2.6%, p<0.001) while being less often obese (15% vs 22%, p=0.01) or having a history of congestive heart failure (30% vs 36%, p=0.03) [Table 1]. Hospital mortality was significantly higher among those with GIH (6.4% vs 3.5%, p<0.001). Multivariable logistic regression analysis identified GIH as an independent predictor of higher in-hospital mortality [adjusted odds ratio (aOR)=1.60, 95% confidence interval (CI)=1.02–2.63, p=0.001], hypovolemic shock (aOR=5.17, 95% CI=2.5–10.6, p<0.001), mean length of stay (Δ +2.4 days, p<0.001) and mean hospital cost (Δ +$21,162, p=0.004).
Conclusion
Adults with HCM and GIH are older, less often obese with higher prevalence of cirrhosis and prior myocardial infarction. Presence of GIH is an independent predictor of higher mortality, hypovolemic shock, length of stay and hospital cost in HCM adults admitted to hospital.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- K Shah
- St. Luke's University Hospital, Bethlehem, United States of America
| | - H Thyagaturu
- Bassett Medical Center, Cooperstown, United States of America
| | - M Mughal
- Monmouth Medical Center, Long Branch, United States of America
| | - H Gandhi
- Monmouth Medical Center, Long Branch, United States of America
| | - F Harmouch
- St. Luke's University Hospital, Bethlehem, United States of America
| | - V Modi
- St. Luke's University Hospital, Bethlehem, United States of America
| | - J Kothari
- St. Luke's University Hospital, Bethlehem, United States of America
| | - J Shirani
- St. Luke's University Hospital, Bethlehem, United States of America
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Shah K, Thyagaturu H, Harmouch F, Gandhi H, Mughal M, Modi V, Kothari J, Shirani J. Impact of cardiac rhythm abnormality on hospital outcomes of patients with hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Serious cardiac arrhythmias [atrial fibrillation/flutter (AFF), and ventricular tachycardia/fibrillation (VTF)] are associated with adverse outcomes in general population of patients with hypertrophic cardiomyopathy (HCM).
Purpose
We aimed to evaluate the impact of such rhythm abnormalities on in-hospital outcomes of adults with HCM.
Methods
The National Inpatient Sample reported 45,305 admissions for adults with HCM during a two-year period (2016–2017). Among them, 21,220 patients (47%) also had AFF and/or VTF. Baseline characteristics and in-hospital outcomes of the two groups were compared. Multivariable logistic regression analysis was used to assess the independent impact of rhythm abnormalities on in-hospital outcomes of HCM patients.
Results
HCM patients with arrhythmias were older (68±26 vs 64±29 years), were more often male (43% vs 36%), and had higher prevalence of congestive heart failure (45% vs 28%), chronic kidney disease (27% vs 22%), hyperlipidemia (52% vs 48%), obstructive sleep apnea (17% vs 13%), chronic obstructive pulmonary disease (22% vs 18%) and thyroid disease (19% vs 16%) [Table 1, all p<0.001]. Hospital mortality was significantly higher among those with arrhythmias (4.7% vs 2.7%, p<0.05). Multivariate logistic regression analysis identified arrhythmias as an independent predictor of in-hospital mortality (adjusted odds ratio=1.51, 95% confidence interval=1.19–1.91, p=0.001), increased mean length of stay (Δ +0.75 days, p<0.001) and increased mean total hospital cost (Δ +$18,263, p<0.001).
Conclusion
Adults with HCM and AFF and/or VTF are older and have higher prevalence of comorbid conditions. Presence of such rhythm abnormalities is an independent predictor of higher mortality, length of stay and total cost in HCM adults admitted to hospital.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- K Shah
- St. Luke's University Hospital, Bethlehem, United States of America
| | - H Thyagaturu
- Bassett Medical Center, Cooperstown, United States of America
| | - F Harmouch
- St. Luke's University Hospital, Bethlehem, United States of America
| | - H Gandhi
- Monmouth Medical Center, Long Branch, United States of America
| | - M Mughal
- Monmouth Medical Center, Long Branch, United States of America
| | - V Modi
- St. Luke's University Hospital, Bethlehem, United States of America
| | - J Kothari
- St. Luke's University Hospital, Bethlehem, United States of America
| | - J Shirani
- St. Luke's University Hospital, Bethlehem, United States of America
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Mughal M, Sleiwah A, Townley W. Balancing Training Opportunities and Patient Outcomes: A Single Surgeon's Experience. Ann Plast Surg 2021; 87:440-445. [PMID: 34559712 DOI: 10.1097/sap.0000000000002727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Microvascular free tissue transfer is the criterion standard of reconstruction post-oncological resections of the head and neck region. We present a consultant's first 200 consecutive microvascular head and neck reconstructions in independent practice. A retrospective analysis of a prospectively collected database of all head and neck reconstructions performed in the first 3 years of practice was performed. These included 200 consecutive microvascular head and neck reconstructions performed by a single surgeon at a tertiary referral center. We review the results and complications in this series and discuss factors significant for successful outcomes in head and neck reconstruction. We also highlight that different parts of the surgery in the majority of cases were performed by a trainee under the supervision of the senior surgeon and thus discuss the need for training future plastic surgeons with an interest in head and neck reconstruction.
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Affiliation(s)
| | - Aseel Sleiwah
- From the Department of Plastic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
| | - William Townley
- From the Department of Plastic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
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15
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Sleiwah A, Mughal M, Thomas N, Roblin P, Townley W, Jeannon JP. Locally Advanced Scalp Tumors: Clinical and Survival Outcomes of a Tertiary Unit. Ann Plast Surg 2021; 87:271-277. [PMID: 34397516 DOI: 10.1097/sap.0000000000002673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Locally advanced nonmelanoma skin cancers of the head and neck are well described in the current literature. However, data about clinical and survival outcomes are lacking. We present survival data from a tertiary head and neck cancer unit in London. METHODS A retrospective analysis of data collected from a single institution was conducted. All patients with locally advanced cutaneous scalp carcinomas invading the skull between 2011 and 2019 were included. Data included patient demographics, tumor, comorbidities, interventions, flap survival, and metal work exposure. Survival outcomes were examined using Kaplan-Meier analysis. RESULTS Twenty-three patients were identified. The mean age was 72 years. Eighteen patients were male, and 5 were female. Five patients were immunosuppressed. Nineteen patients underwent outer cortex drill-down/full-thickness calvarial resection, followed by reconstruction with free tissue transfer. Six patients had titanium mesh reconstruction after segmental skull resections. Three patients underwent further surgery because of exposed metalwork. Disease-free survival at 3 years after surgery was 60%. CONCLUSIONS Locally advanced nonmelanoma skin cancers invading the bone are sporadic. There are little published data on clinical and survival outcomes in this group. Despite the nature of these skin lesions, a high degree of local control can be obtained by extensive surgical resection, outer table drill-down, and calvarial resection. We conclude that aggressive management of the bony invasion improves disease-free survival and improves local control.
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Affiliation(s)
- Aseel Sleiwah
- From the Plastic Surgery Department, Guy's & St Thomas Hospital
| | - Maleeha Mughal
- From the Plastic Surgery Department, Guy's & St Thomas Hospital
| | | | - Paul Roblin
- From the Plastic Surgery Department, Guy's & St Thomas Hospital
| | - William Townley
- From the Plastic Surgery Department, Guy's & St Thomas Hospital
| | - Jean-Pierre Jeannon
- Ear, Nose and Throat Department, Guy's & St Thomas Hospital, London, United Kingdom
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16
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Abstract
Vascularised epiphysial fibula bone transfers in the paediatric population provides a solution to growth suppression in extremity reconstruction. We report a case of an anatomical variant to the epiphysial blood supply that has never been reported in literature. A 6-year-old girl underwent a free vascularised fibula flap for reconstruction of her right humerous following osteosarcoma resection. While identifying and dissecting the recurrent epiphysial branch, a large branch from the peroneal artery was identified which directly entered the head of the fibula. No dominant supply from the anterior tibial (AT) vessels to the head of the fibula was seen. This led to the need for a bipedicled flap with diaphyseal supply from the AT vessels and the epiphysial transfer based on the peroneal artery. The patient made an uneventful recovery from the procedure. The same technique may be used by surgeons that may encounter this unique variant in clinical practice.
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Affiliation(s)
| | - Maleeha Mughal
- Plastic Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | | | - Paul Roblin
- Plastic Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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17
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Mughal M, Sindali K, Man J, Roblin P. 'Fat chance': a review of adipose tissue engineering and its role in plastic and reconstructive surgery. Ann R Coll Surg Engl 2021; 103:245-249. [PMID: 33682428 DOI: 10.1308/rcsann.2020.7031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Soft tissue reconstruction remains a continuing challenge for plastic and reconstructive surgeons. Standard methods of reconstruction such as local tissue transfer and free autologous tissue transfer are successful in addressing soft tissue cover, yet they do not come without the additional morbidity of donor sites. Autologous fat transfer has been used in reconstruction of soft tissue defects in different branches of plastic surgery, specifically breast and facial defect reconstruction, while further maintaining a role in body contouring procedures. Current autologous fat transfer techniques come with the drawbacks of donor-site morbidity and, more significantly, resorption of large amounts of fat. Advancement in tissue engineering has led to the use of engineered adipose tissue structures based on adipose-derived stem cells. This enables a mechanically similar reconstruct that is abundantly available. Cosmetic and mechanical similarity with native tissue is the main clinical goal for engineered adipose tissue. Development of novel techniques in the availability of natural tissue is an exciting prospect; however, it is important to investigate the potential of cell sources and culture strategies for clinical applications. We review these techniques and their applications in plastic surgery.
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Affiliation(s)
- M Mughal
- St Thomas' Hospital, London, UK.,University College London, London, UK
| | | | - J Man
- St Thomas' Hospital, London, UK
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18
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Clarke C, Shah R, Mughal M. Podcasts in plastic surgery, why we should start listening. J Plast Reconstr Aesthet Surg 2020; 74:1633-1701. [PMID: 33451947 DOI: 10.1016/j.bjps.2020.12.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Cameron Clarke
- Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
| | - Rushabh Shah
- Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Maleeha Mughal
- Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
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19
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Mughal M, Din AH, O'Connor EF, Roblin P, Rose V. Breaking down training barriers: A novel method of delivering plastic surgery training through augmented reality. J Plast Reconstr Aesthet Surg 2020; 74:1101-1160. [PMID: 33199227 DOI: 10.1016/j.bjps.2020.10.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/18/2020] [Accepted: 10/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Maleeha Mughal
- Consultant Plastic Surgeon, Guy's & St. Thomas' Hospitals, United Kingdom.
| | - Asmat H Din
- Consultant Plastic Surgeon, Guy's & St. Thomas' Hospitals, United Kingdom; Consultant Plastic Surgeon, Kings College Hospital, United Kingdom
| | - Edmund Fitzgerald O'Connor
- Consultant Plastic Surgeon, Guy's & St. Thomas' Hospitals, United Kingdom; Consultant Plastic Surgeon, Kings College Hospital, United Kingdom
| | - Paul Roblin
- Consultant Plastic Surgeon, Guy's & St. Thomas' Hospitals, United Kingdom
| | - Victoria Rose
- Consultant Plastic Surgeon, Guy's & St. Thomas' Hospitals, United Kingdom; Consultant Plastic Surgeon, Kings College Hospital, United Kingdom
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20
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Frondelius L, Jauhiainen L, Niskanen O, Mughal M, Sairanen A. Can on-farm animal welfare explain relative production differences between dairy herds? Anim Welf 2020. [DOI: 10.7120/09627286.29.4.449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to investigate factors responsible for between-herd variation in milk production, when genetic variation is controlled. Quantitative information regarding farms' production environment and animal welfare, as evaluated annually by veterinarians and health and
feeding records, were the factors studied. Principal component analysis was used to reduce the production environment variables as well as the welfare data. Two linear regression models were devised. The first model used welfare indicators and veterinary treatments to predict the difference
between herds' observed and potential milk yield. The second model explained the residual of the first model by feeding and animal-based indicator data. Together, these two models explained 62% of the variance in milk yield differences between herds. Specifically, feeding of the herd was the
most important factor, accounting for 67%, followed by the production environment/animal welfare (30%) and finally animal health, assessed through veterinary treatments, explained the remaining 3% of the variance. A poor welfare rating adversely affected milk production. Similarly, a low score
for fatness at slaughter, poor milk quality and high mortality all showed a clear negative association with production. It was found that while feeding remains a major factor, production environment and animal welfare also have significant roles to play when it comes to production. Notably,
those farms with major animal welfare problems were shown to display milk yield below the Finnish average.
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21
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Sleiwah A, Nair G, Mughal M, Lancaster K, Ahmad I. Perioral pressure ulcers in patients with COVID-19 requiring invasive mechanical ventilation. Eur J Plast Surg 2020; 43:727-732. [PMID: 32952306 PMCID: PMC7490473 DOI: 10.1007/s00238-020-01737-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/01/2020] [Indexed: 12/13/2022]
Abstract
Background Facial pressure ulcers are a rare yet significant complication. National Institute for Health and Care Excellence (NICE) guidelines recommend that patients should be risk-assessed for pressure ulcers and measures instated to prevent such complication. In this study, we report case series of perioral pressure ulcers developed following the use of two devices to secure endotracheal tubes in COVID-19 positive patients managed in the intensive care setting. Methods A retrospective analysis was conducted on sixteen patients identified to have perioral pressure ulcers by using the institutional risk management system. Data parameters included patient demographics (age, gender, comorbidities, smoking history and body mass index (BMI)). Data collection included the indication of admission to ITU, duration of intubation, types of medical devices utilised to secure the endotracheal tube, requirement of vasopressor agents and renal replacement therapy, presence of other associated ulcers, duration of proning and mortality. Results Sixteen patients developed different patterns of perioral pressure ulcers related to the use of two medical devices (Insight, AnchorFast). The mean age was 58.6 years. The average length of intubation was 18.8 days. Fourteen patients required proning, with an average duration of 5.2 days. Conclusions The two devices utilised to secure endotracheal tubes are associated with unique patterns of facial pressure ulcers. Measures should be taken to assess the skin regularly and avoid utilising devices that are associated with a high risk of facial pressure ulcers. Awareness and training should be provided to prevent such significant complication. Level of evidence: Level IV, risk/prognostic study.
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Affiliation(s)
- Aseel Sleiwah
- Department of Plastic Surgery, Guy's & St. Thomas' Hospital, 3rd Floor, Lambeth Wing, Westminster Bridge, London, SE1 7EH UK
| | | | - Maleeha Mughal
- Department of Plastic Surgery, Guy's & St. Thomas' Hospital, 3rd Floor, Lambeth Wing, Westminster Bridge, London, SE1 7EH UK
| | - Katie Lancaster
- Department of Plastic Surgery, Guy's & St. Thomas' Hospital, 3rd Floor, Lambeth Wing, Westminster Bridge, London, SE1 7EH UK
| | - Imran Ahmad
- Department of Plastic Surgery, Guy's & St. Thomas' Hospital, London, UK.,King's College London, London, UK
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22
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Halliday LJ, Doran SLF, Sgromo B, Viswanath YKS, Tucker O, Patel B, Jambulingam PS, Dawas K, Mercer S, Baker C, Mughal M, Hanna GB, Moorthy K. Variation in esophageal anastomosis technique-the role of collaborative learning. Dis Esophagus 2020; 33:5610077. [PMID: 31665408 DOI: 10.1093/dote/doz072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Centralization of care has improved outcomes in esophagogastric (EG) cancer surgery. However, specialist surgical centers often work within clinical silos, with little transfer of knowledge and experience. Although variation exists in multiple dimensions of perioperative care, the differences in operative technique are rarely studied. An esophageal anastomosis workshop was held to identify areas of common and differing practice within the operative technique. Surgeons showed videos of their anastomosis technique by open and minimally invasive surgery. Each video was followed by a discussion. Surgeons from 10 different EG cancer centers attended. Eight key technical differences and learning points were identified and discussed: the optimum diameter of the gastric conduit; avoiding ischemia in the gastric conduit; minimizing esophageal trauma; the use of an esophageal mucosal collar; omental wrapping; intraoperative leak testing; ideal diameter of the circular stapler and the growing use of linear stapled anastomoses. The workshop received positive feedback from participants and on 2 years follow-up, 40% stated that they believed that the learning of tips and techniques during the workshop has contributed to lowering their anastomotic leak rate. Many differences exist in surgical technique. The reasons for, and crucially the significance of, these differences must be discussed and examined. Workshops provide a forum for peer-to-peer collaborative learning to reflect on one's own practice and improve surgical technique. These changes can, in turn, generate incremental improvements in patient care and postoperative outcomes.
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Affiliation(s)
- L J Halliday
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - S L F Doran
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - B Sgromo
- Oxford Oesophago Gastric Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Y K S Viswanath
- Department of Surgery, James Cook University Hospital, Middlesborough, UK
| | - O Tucker
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - B Patel
- Upper GI Surgery Unit, The Royal London Hospital, London, UK
| | - P S Jambulingam
- Department of Upper GI Surgery, Luton and Dunstable Hospital, Luton, UK
| | - K Dawas
- Upper Gastrointestinal Surgery, University College London, London, UK
| | - S Mercer
- Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - C Baker
- Upper GI Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Mughal
- Upper Gastrointestinal Surgery, University College London, London, UK
| | - G B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - K Moorthy
- Department of Surgery and Cancer, Imperial College London, London, UK
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23
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Mughal M, Gabuniya N, Roblin P, Jeannon JP, Townley W. Synchronous scalp tumour resection and latissimus dorsi flap raise: A time efficient approach to scalp and craniotomy reconstruction. J Plast Reconstr Aesthet Surg 2020; 73:1357-1404. [PMID: 32205052 DOI: 10.1016/j.bjps.2020.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/19/2020] [Accepted: 02/09/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Maleeha Mughal
- Guy's & St. Thomas Hospital, London, UK; Division of Plastic Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada.
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24
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O'Neill AC, Mughal M, Saggaf MM, Wisniewski A, Zhong T, Hofer SOP. A structured pathway for accelerated postoperative recovery reduces hospital stay and cost of care following microvascular breast reconstruction without increased complications. J Plast Reconstr Aesthet Surg 2019; 73:19-26. [PMID: 31628082 DOI: 10.1016/j.bjps.2019.06.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/16/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Accelerated recovery protocols have proved effective in many surgical procedures but are infrequently applied in breast reconstruction. In this study, we evaluate the impact of a structured pathway for accelerated postoperative recovery in patients undergoing microvascular breast reconstruction at a high-volume center. METHODS We describe our care pathway for patients undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction at our center. We compared length of stay (LOS), complication rates, readmission rates, and cost of inpatient care before (pre-protocol (Pre-P)) and after (post-protocol (Post-P)) the implementation of the protocol. RESULTS Patients in the Post-P group (n = 198) had a significant reduction in mean LOS as compared to those in the Pre-P (n = 183) group (3.6 +/- 0.85 vs. 4.7 +/-1.04 days, p = 0.006). There was no significant difference in the rates of major (Pre-P 16.9% vs. Post-P 14.7%, p = 0.71) or minor (Pre-P 21.3% vs. 17.1%, p = 0.22) postoperative complications between groups. The readmission rates were also similar (Pre-P 6.5% vs. Post-P 4.5, p = 0.69). Implementation of the protocol resulted in a significant reduction in the mean cost of in-patient care. CONCLUSION A simple protocol for accelerated and streamlined postoperative recovery effectively reduces LOS and patient care costs following DIEP flap breast reconstruction without compromising patient safety.
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Affiliation(s)
- Anne C O'Neill
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada. anne.o'
| | - Maleeha Mughal
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
| | - Moaath M Saggaf
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
| | - Agnes Wisniewski
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
| | - Toni Zhong
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
| | - Stefan O P Hofer
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
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Abstract
Topical negative pressure is widely used in the management of superficial wounds. The use of this technology in the management of oesophageal perforations is becoming increasingly common. This systematic review aims to capture available evidence about its use in this setting. Medline and Embase were searched using MeSH terms and free text: esophageal perforation; esophageal injury; vacuum assisted closure; vacuum therapy device; esophagus; wounds penetrating; esophageal perforation; wound healing; negative pressure wound therapy. Searches were carried out between April and November 2015. Case series, cohort trials and controlled trials were included. Additional studies were found by hand searching reference lists. Eleven studies met the inclusion criteria with 180 patients. Nine of the studies were case series and two were retrospective comparisons of negative pressure with stents or clips. Healing of the perforation occurred in 163/179 patients and the overall mortality was 12.8%. Compared with published data on mortality from oesophageal perforation, the application of negative pressure appears to be beneficial. The studies are, however, limited to case series and retrospective cohort studies. The number of patients in each study is small and in the absence of randomized trials demonstrating a lack of bias firm conclusions cannot be made.
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Affiliation(s)
- N J Newton
- Gastrointestinal Services, University College Hospital, London
| | - A Sharrock
- Centre for Blast Injury Studies Imperial College, London
| | - R Rickard
- Academic Department of Military Surgery and Trauma Royal Centre for Defence Medicine, Birmingham, UK
| | - M Mughal
- Gastrointestinal Services, University College Hospital, London
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Markar S, Wiggins T, Antonowicz S, Lagergren J, Mughal M, Hanna G. Breath volatile organic compound analysis for the diagnosis of oesophago-gastric cancer; multi-centre blinded validation clinical trial. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30095-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Marlborough F, Bhat W, Saleh D, Mughal M, Teoh V, Smith I. Decline in facial trauma exposure for plastic surgical trainees? A survey of referrals of facial trauma in the UK. J Plast Reconstr Aesthet Surg 2014; 68:277-8. [PMID: 25455283 DOI: 10.1016/j.bjps.2014.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/25/2014] [Accepted: 10/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Fergal Marlborough
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK.
| | - Waseem Bhat
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK
| | - Daniel Saleh
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK
| | - Maleeha Mughal
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK
| | - Victoria Teoh
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK
| | - Ian Smith
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK
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Buissink C, Thompson J, Voet M, Sanderud A, Kamping L, Savary L, Mughal M, Rocha C, Hart G, Parreiral R, Martin G, Hogg P. The influence of experience and training in a group of novice observers: A jackknife alternative free-response receiver operating characteristic analysis. Radiography (Lond) 2014. [DOI: 10.1016/j.radi.2014.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mughal M, Chang C, Southern SJ. Re: Lee HJ, Kim PT, Jeon IH, et al. Osteophyte excision without cyst excision for a mucous cyst of the finger. J Hand Surg Eur. 2014, 39: 258-61. J Hand Surg Eur Vol 2014; 39:906-7. [PMID: 25236534 DOI: 10.1177/1753193414546443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Mughal
- Pinderfield's General Hospital, Wakefield, UK
| | - C Chang
- Pinderfield's General Hospital, Wakefield, UK
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Grenader T, Plotkin Y, Mohammadi B, Dawas K, Hashemi M, Mughal M, Bridgewater J. Predictive Value of the Neutrophil Lymphocyte Ratio in Peritoneal and/or Metastatic Disease at Staging Laparoscopy for Gastric and Oesophageal Adenocarcinoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Soldin M, Mughal M, Al-Hadithy N. National Commissioning Guidelines: Body contouring surgery after massive weight loss. J Plast Reconstr Aesthet Surg 2014; 67:1076-81. [DOI: 10.1016/j.bjps.2014.04.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/28/2014] [Indexed: 11/30/2022]
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Mughal M, Ching D, Soldin M. External traction sutures to facilitate exposure in abdominoplasty: a novel technique. J Plast Reconstr Aesthet Surg 2014; 67:1306-7. [PMID: 24934100 DOI: 10.1016/j.bjps.2014.03.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 03/30/2014] [Indexed: 11/15/2022]
Affiliation(s)
- M Mughal
- Department of Plastic Surgery, St. George's Hospital, London, UK.
| | - D Ching
- St Georges Medical School, St. George's Hospital, London, UK
| | - M Soldin
- Department of Plastic Surgery, St. George's Hospital, London, UK; Department of Plastic Surgery Kingston Hospital, London, UK
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Abstract
INTRODUCTION Perineal defects are commonly encountered in an oncological setting although they may also present as a result of trauma and infection (eg following Fournier's gangrene). Reconstruction of these poses functional as well as aesthetic challenges. Skin coverage and tissue volume may both be required in addition to anogenital preservation or reconstruction. General prerequisites of an adequate reconstruction of perineal defects include provision of skin cover, well vascularised tissue to fill the dead space (reducing fluid collection and infection), vulvovaginal reconstruction and no faecal or urinary contamination. METHODS A literature search was performed using PubMed and MEDLINE ® . The search terms included 'perineal defects', 'perineal reconstruction', 'perforator flaps for perineum', 'vulval flaps', 'secondary healing of wound' and 'vacuum assisted closure'. Backward chaining of reference lists from retrieved papers was also used to expand the search. FINDINGS Modern developments have led to an increased expectation in improved quality of life as the main goal of reconstruction, therefore necessitating surgery with less morbidity and early return to normal activity. Progress in microsurgical procedures has been the main recent advance in perineal reconstruction and, in future, refinements in perforator flap design and tissue engineering techniques will lead to even better reconstructions.
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Affiliation(s)
- M Mughal
- Royal Free London NHS Foundation Trust, UK; Royal Free Hospital, Pond Street, London NW3 2QG, UK.
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Mughal M, Mathew P, Hastings H. Ulnar nerve compression at the cubital tunnel in a tetraplegic patient after biceps-to-triceps transfer via the medial route. J Hand Surg Eur Vol 2013; 38:1010-1. [PMID: 23719173 DOI: 10.1177/1753193413491704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Mughal
- Indiana Hand to Shoulder Center Indiana, USA
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Abstract
Introduction Perineal defects are commonly encountered in an oncological setting although they may also present as a result of trauma and infection (eg following Fournier’s gangrene). Reconstruction of these poses functional as well as aesthetic challenges. Skin coverage and tissue volume may both be required in addition to anogenital preservation or reconstruction. General prerequisites of an adequate reconstruction of perineal defects include provision of skin cover, well vascularised tissue to fill the dead space (reducing fluid collection and infection), vulvovaginal reconstruction and no faecal or urinary contamination. Methods A literature search was performed using PubMed and MEDLINE®. The search terms included ‘perineal defects’, ‘perineal reconstruction’, ‘perforator flaps for perineum’, ‘vulval flaps’, ‘secondary healing of wound’ and ‘vacuum assisted closure’. Backward chaining of reference lists from retrieved papers was also used to expand the search. Findings Modern developments have led to an increased expectation in improved quality of life as the main goal of reconstruction, therefore necessitating surgery with less morbidity and early return to normal activity. Progress in microsurgical procedures has been the main recent advance in perineal reconstruction and, in future, refinements in perforator flap design and tissue engineering techniques will lead to even better reconstructions.
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Affiliation(s)
- M Mughal
- Royal Free London NHS Foundation Trust, UK
| | - RJ Baker
- Royal Free London NHS Foundation Trust, UK
| | - A Muneer
- University College London Hospitals NHS Foundation Trust, UK
| | - A Mosahebi
- Royal Free London NHS Foundation Trust, UK
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Abstract
INTRODUCTION Perineal defects are commonly encountered in an oncological setting although they may also present as a result of trauma and infection (eg following Fournier's gangrene). Reconstruction of these poses functional as well as aesthetic challenges. Skin coverage and tissue volume may both be required in addition to anogenital preservation or reconstruction. General prerequisites of an adequate reconstruction of perineal defects include provision of skin cover, well vascularised tissue to fill the dead space (reducing fluid collection and infection), vulvovaginal reconstruction and no faecal or urinary contamination. METHODS A literature search was performed using PubMed and MEDLINE ® . The search terms included 'perineal defects', 'perineal reconstruction', 'perforator flaps for perineum', 'vulval flaps', 'secondary healing of wound' and 'vacuum assisted closure'. Backward chaining of reference lists from retrieved papers was also used to expand the search. FINDINGS Modern developments have led to an increased expectation in improved quality of life as the main goal of reconstruction, therefore necessitating surgery with less morbidity and early return to normal activity. Progress in microsurgical procedures has been the main recent advance in perineal reconstruction and, in future, refinements in perforator flap design and tissue engineering techniques will lead to even better reconstructions.
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Affiliation(s)
- M Mughal
- Royal Free London NHS Foundation Trust, UK; Royal Free Hospital, Pond Street, London NW3 2QG, UK.
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Mughal M, Mathew P, Hastings H. Iatrogenic injury to the ulnar nerve during primary repair of medial ulnar collateral ligament in complex elbow fracture dislocations. J Hand Surg Eur Vol 2013; 38:686-7. [PMID: 22719013 DOI: 10.1177/1753193412449579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M. Mughal
- Indiana Hand to Shoulder Center, Indiana, USA
| | - P. Mathew
- Indiana Hand to Shoulder Center, Indiana, USA
| | - H. Hastings
- Indiana Hand to Shoulder Center, Indiana, USA
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Markeson DB, Mughal M, Subramanian P, Iyer S. The simple wire interosseous fixation technique (SWIFT) for reattachment of FDP avulsions with a large bony fragment. Tech Hand Up Extrem Surg 2012; 16:220-224. [PMID: 23160556 DOI: 10.1097/bth.0b013e31826ce920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Avulsion injuries of the flexor digitorum profundus tendon can be with or without a bony fragment. Types 3, 4, and 5 injuries often have a sizeable bony fragment. In the past, they have been repaired with either a screw, plate, or pull-out wire with a dorsal button, often in combination with a K wire to immobilize the distal interphalangeal joint. We illustrate with 2 cases a simple technique for secure repair of the flexor digitorum profundus avulsions with a bony fragment. In contrast to previously described techniques, our technique involves minimal dissection, has a significantly reduced risk of fracture to the bony fragment, is completely internalized thereby reducing the risk of postoperative infection and allows immediate mobilization.
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Affiliation(s)
- Daniel B Markeson
- Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Wexham, Slough, Berkshire, UK.
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Mughal M, Mohan AT, Branford OA, Dewar D. Securing fingertip dressings: The new ‘cinch pink’ technique. J Plast Reconstr Aesthet Surg 2012; 65:e167-8. [DOI: 10.1016/j.bjps.2011.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022]
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Soni M, Mughal M, Kirkby G. The subluxated lens: a patient's perspective. Eye (Lond) 2006; 20:1308-10. [PMID: 16410817 DOI: 10.1038/sj.eye.6702161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Leaper DJ, Irving M, Bancewicz J, Mughal M. Server abdominal sepsis. Br J Surg 2005. [DOI: 10.1002/bjs.1800730839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- D J Leaper
- Department of Surgery, University of Bristol, Bristol, UK
| | - M Irving
- Department of Surgery, University of Manchester, Hope Hospital, Salford, UK
| | - J Bancewicz
- Department of Surgery, University of Manchester, Hope Hospital, Salford, UK
| | - M Mughal
- Department of Surgery, University of Manchester, Hope Hospital, Salford, UK
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Zar T, Sharar Z, Mughal M, McClintock C. Severe hepatitis due to HBV-HDV coinfection. Conn Med 2001; 65:649-52. [PMID: 11766551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Quadruple hepatic infections are not uncommon in human immunodeficiency virus (HIV) infected patients. Hepatotropic viruses behave differently in immunocompromised patients resulting in varied clinical and serological outcomes. Delta hepatitis, an important cause of acute hepatitis in intravenous drug abusers (IVDAs) and HIV-infected patients, can present as coinfection or superinfection clinically, which influences the prognosis. Prevention of hepatitis D virus (HDV) coinfection is possible with hepatitis B virus (HBV) vaccination. No definitive medical treatment for HDV infection is known to be successful. Interestingly, liver transplantation carries a higher success rate in HDV/HBV infection then in HBV infection alone.
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Affiliation(s)
- T Zar
- University of Connecticut, Primary Care Internal Medicine Program, Farmington, USA
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Shah M, Moogerfeld MS, Ahmed J, Mughal M, Aziz K. Metastatic cervical cancer with unusual presentation: a case report. Conn Med 2001; 65:523-5. [PMID: 11678057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Carcinoma of the cervix is rare in the United States thanks to widespread use of screening Pap smears. A 60-year-old female with right upper quadrant pain, diarrhea, and urinary incontinence was found to have stage IV B cervical cancer. Computerized tomography (CT) was of value in diagnosis. Like mammography, which improves survival by detecting malignant disease at an early stage, the Pap test is central in preventing the development of invasive cervical cancer.
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Affiliation(s)
- M Shah
- Integrated Internal Medicine/Primary Care Program, University of Connecticut, Farmington, USA
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Abstract
Eversion of the rectum during restorative proctocolectomy with stapled ileal pouch-anal anastomosis (IPAA) remains a controversial surgical manoeuvre because of concern that it may impair anal sphincter function and adversely affect outcome. We have reviewed the long-term results in 41 patients whose operation included formation of a 20 cm J-pouch with stapled IPAA by the technique of rectal eversion. At median follow-up of 4 years (range 1-6 years), 4 pouches (10%) had been removed (2 for pelvic sepsis, 1 for rectovaginal fistula and 1 for Crohn's disease). In 34 patients with functioning pouches in situ, median stool frequency was 5 per 24 h (range 2-10). 11 patients (33%) regularly had to evacuate their pouch at night and 4 (12%) used antidiarrhoeal medication. No patients reported major incontinence; 2 (6%) had minor leakage, and in another 2 minor leakage had now ceased. 4 patients had had episodes of pouchitis. These favourable results offer no support for the contention that rectal eversion substantially worsens the long-term results of restorative proctocolectomy.
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Affiliation(s)
- D J DeFriend
- Department of Surgery, University Hospital of South Manchester, Chorley Hospital, Lancs, England
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Carlson GL, Gray P, Barber D, Shaffer JL, Mughal M, Irving MH. Total parenteral nutrition modifies the acute phase response to Crohn's disease. J R Coll Surg Edinb 1994; 39:360-4. [PMID: 7532715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Measurements of the acute phase proteins, C-reactive protein (CRP) and orosomucoid are widely used to monitor the activity of Crohn's disease. The effect of TPN upon the levels of acute phase proteins is unknown. Serum levels of CRP and orosomucoid were measured simultaneously over a four year period in 13 patients receiving TPN for Crohn's disease, nine patients with noninflammatory causes of intestinal failure, and 16 patients with Crohn's disease treated without TPN. An acute phase response was found with a similar frequency in both groups of patients with Crohn's disease (73.6% and 83.9% for Crohn's with and without TPN respectively), but was less prevalent in patients receiving TPN for non-inflammatory causes of intestinal failure (56.1%, P < 0.01). In this latter group, the acute phase response consisted primarily of an isolated elevation of orosomucoid (78.4%), compared with patients with Crohn's disease alone (21.1%, P < 0.001) and with Crohn's disease and TPN (46.6%, P < 0.05). Liver function abnormalities were seen on 68.8% of occasions in patients with noninflammatory causes of intestinal failure who had elevated levels of orosomucoid, compared with 34.9% of occasions on which orosomucoid levels were normal (P < 0.001). TPN may lead to isolated elevation of serum levels of orosomucoid, reducing the value of this acute phase protein in monitoring the activity of Crohn's disease in patients receiving TPN.
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Affiliation(s)
- G L Carlson
- Department of Surgery, University of Manchester, Hope Hospital, Salford, UK
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Mughal M. A cheap laparoscopic surgery trainer. Ann R Coll Surg Engl 1992; 74:256-7. [PMID: 1416677 PMCID: PMC2497604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Abstract
To investigate extraesophageal anomalies in infants with esophageal atresia, preoperative plasma gastrin was measured in 12 infants. The median plasma gastrin was 32 ng/L (interquartile range, 24 to 44). There was significant correlation with birth weight (rs = .73, P less than .05) and gestational age (rs = .74, P less than .05). Within this group 9 infants of greater than 36 weeks' gestation were matched to a group of 20 control infants without esophageal atresia. Infants with esophageal atresia had a significantly lower median plasma gastrin (38 ng/L v 55 ng/L, P less than .05). This may indicate preexisting vagal abnormalities in esophageal atresia unrelated to surgical intervention.
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Affiliation(s)
- M Davenport
- Sub Department of Paediatric Surgery, St Mary's Hospital, Manchester, England
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Abstract
Two commercially available kits have been used to create 25 percutaneous tracheostomies, 20 using the Cook system and five using the Rapitrac system. The operation time and complication rates of these tracheostomies have been compared with those for 16 conventional tracheostomies performed for similar indications. Median operating times were 60 (range 30-105) min for conventional tracheostomy, 15 (range 8-70) min for Cook and 5 (range 3-15) min for Rapitrac systems (P less than 0.001). A significantly higher proportion of patients in the Rapitrac group had complications compared with the other two groups (P less than 0.05). The complication rate for the Cook group compared favourably with that for the conventional tracheostomy group. The Cook system of percutaneous tracheostomy is a simple, rapid and safe alternative to conventional tracheostomy.
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Affiliation(s)
- D J Leinhardt
- University Department of Surgery, Hope Hospital, Salford, UK
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