Publications by authors named "Ghazi Elshafie"

6 Publications

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Is the use of dual antiplatelet therapy following urgent and emergency coronary artery bypass surgery associated with increased risk of cardiac tamponade?

J Clin Transl Res 2021 Apr 13;7(2):229-233. Epub 2021 Mar 13.

Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Hull, UK.

Background And Aim: Cardiac tamponade is a recognized post-cardiac surgery complication, resulting in increased morbidity and mortality. The 2016 American College of Cardiology and American Heart Association Guidelines recommended the use of Dual Antiplatelet Therapy (DAPT) in the management of patients undergoing urgent or emergency coronary artery bypass grafting (CABG). The effect of DAPT on cardiac tamponade rates was investigated in comparison to aspirin monotherapy (AMT).

Materials And Methods: Prospectively collected data from a tertiary cardiac surgery center was analyzed to identify the patients who underwent urgent and emergency CABG between January 2015 and January 2018. The patients were categorized as aspirin monotherapy (AMT) and Dual Antiplatelet Therapy (DAPT) groups. The primary outcome was total cardiac tamponade rate and secondary outcomes were length of hospitalization and 30-days and 1-year mortality.

Results: A total of 246 eligible patients were included across both arms and compared for confounding variables. Cardiac tamponade was observed in 9 (7.3%) and 8 (6.5%) of AMT and DAPT groups, respectively (P=0.802). The average hospital stay in days was similar in both groups (AMT=8.4 vs. DAPT=8.1, P=0.82), whereas tamponade patients experienced a significantly longer hospitalization when compared to non-tamponade patients (9.8 vs. 8.1 days, P=0.047). The 30-days and 1-year mortality were similar in both groups and were 0.8% and 1.6%, respectively.

Conclusion: Overall, this study demonstrated that DAPT in urgent or emergency CABG patients is not associated with an increased risk of cardiac tamponade, length of hospital stay or mortality.

Relevance For Patients: This study demonstrated that the use of DAPT in patients undergoing CABG as an urgent or emergency procedure following myocardial infarction is not associated with an increased risk of bleeding and has many associated benefits.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177840PMC
April 2021

The Effect of Benign and Malignant Pleural Disease on Chest Wall Mechanics.

Am J Respir Crit Care Med 2017 Jul;196(2):241-242

1 Heart of England National Health Service Foundation Trust Birmingham, United Kingdom.

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http://dx.doi.org/10.1164/rccm.201611-2241LEDOI Listing
July 2017

Measuring changes in chest wall motion after lung resection using structured light plethysmography: a feasibility study.

Interact Cardiovasc Thorac Surg 2016 10 16;23(4):544-7. Epub 2016 Jun 16.

Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK School of Clinical and Experimental Medicine, The Medical School, University of Birmingham, Birmingham, UK

Objectives: We describe the use of structured light plethysmography (SLP)-a novel, non-contact, light-based technique for measuring tidal breathing-among a cohort of patients undergoing lung resection. In this feasibility study, we examined whether changes in chest wall motion or in asynchrony between regions of the thoraco-abdominal wall could be identified after surgery.

Methods: Fifteen patients underwent wedge resection (n = 8) or lobectomy (n = 7). All patients underwent two SLP assessments (before surgery and on Day 1 post-surgery). Each assessment captured data during 5 min of quiet (tidal) breathing.

Results: When data were averaged across all patients, motion on the operated side of the thorax was significantly reduced after surgery (mean change from presurgery ± standard deviation: -14.7 ± 16.5%, P = 0.01), while motion on the non-operated side increased (15.9 ± 18.5%, P = 0.01). Thoraco-abdominal asynchrony also increased (mean change ± standard deviation: 43.4 ± 55.1%, P = 0.01), but no significant difference was observed in right-left hemi-thoracic asynchrony (163.7 ± 230.3%, P = 0.08). When analysed by resection type, lobectomy was associated with reduced and increased motion on the operated and non-operated side, respectively, and with an increase in both right-left hemi-thoracic and thoraco-abdominal asynchrony. No significant changes in motion or asynchrony were identified in patients who underwent wedge resection.

Conclusions: SLP was able to detect changes in chest wall motion and asynchrony after thoracic surgery. Changes in this small group of patients were consistent with the side of the incision and were most apparent in patients undergoing lobectomy.
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http://dx.doi.org/10.1093/icvts/ivw185DOI Listing
October 2016

Chest wall mechanics before and after diaphragm plication.

J Cardiothorac Surg 2016 Feb 2;11:25. Epub 2016 Feb 2.

Heart of England Foundation Trust, Birmingham, B9 5SS, UK.

Background: Following diaphragmatic plication for unilateral paralysis, the effect on global chest wall function are unknown. Our hypothesis was that chest wall function would improve in both sides of the chest after plication of the paralysed side.

Case Presentation: Using Optoelectronic Plethysmography, total and regional chest wall volumes were measured in one patient before and after left diaphragmatic plication. Volumes were recorded at quiet breathing. Respiratory capacity improved during quiet breathing when measured before and 6 months after surgery. These improvements occur at the abdominal-rib cage level in both operated and contralateral. Prior to surgery the abdominal rib cage motion was out of phase to the upper rib cage and abdominal compartment in both sides of the chest. Synchrony of all three compartments was restored after plication.

Conclusion: This physiological study is the first published data in humans to show improvement in chest wall motion both in operated and contralateral side following diaphragmatic plication for unilateral paralysis.
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http://dx.doi.org/10.1186/s13019-016-0419-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736549PMC
February 2016

Surgery corrects asynchrony of ribcage secondary to extra-thoracic tumor but leads to expiratory dysfunction during exercise.

J Cardiothorac Surg 2015 Dec 18;10:187. Epub 2015 Dec 18.

Department of Thoracic Surgery, Heart of England NHS foundation trust, Bordesley Green East, Birmingham, West Midlands, B9 5SS, UK.

Background: The effect of chest wall tumours on chest wall mechanics is uncertain even less is known about the effects of resection and reconstruction. Our aim is to study how chest wall mechanics are altered in chest wall sarcoma and to determine the effect of chest wall reconstruction on chest wall kinetics.

Case Presentation: Using Optoelectronic Plethysmography (OEP), total and regional chest wall volumes were measured in a patient with unilateral extra-thoracic chest wall sarcoma, before and 5 months after resection and reconstruction, during quiet breathing and exercise using cycle ergometry. During quiet breathing the unilateral tumour was associated with reduced in motion of the lower rib cage and abdominal compartments on both sides of the chest as well as asynchronous motion of the contralateral lower rib cage. Surgery corrected these abnormalities in quiet breathing. But during exercise there was a reduction in the upper rib cage motion compared to pre-operative measures from 0.43+/-0.06 to 0.36 +/- 0.02 L postoperatively (p <0.05). This impairment was characterised by a significant increase in the end expiratory volume on the operated side of the chest 5 months after surgery by 6.5 +/- 0.6 and 5.7 +/- 0.7 % during 50 and 100 % exercise respectively (p <0.0001) a finding that was not replicated in the non-operated side.

Conclusion: This physiological study demonstrates the negative effect of chest wall tumours on global chest wall mechanics during quiet breathing and exercise and shows that surgery reverses this abnormality, but only at rest.
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http://dx.doi.org/10.1186/s13019-015-0355-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684600PMC
December 2015

Port Site Herniation of the Small Bowel following Laparoscopic-Myomectomy: A case report.

Sultan Qaboos Univ Med J 2010 Apr 17;10(1):106-13. Epub 2010 Apr 17.

Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.

Bowel herniation, through fascial defects secondary to laparoscopic surgery at the site of trocar entry, is a rare, but potentially serious, complication. Closure of the fascia at port sites measuring 10mm or more has been highly recommended to avoid such complications. We report a case of a small bowel which herniated and strangulated through the port site immediately after laparoscopic myomectomy. Resection of the strangulated bowel with primary anastomosis was required to manage this complication. We present this case report with literature review to discuss the risk factors and the methods to prevent such a complication post laparoscopic surgery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074648PMC
April 2010