Publications by authors named "Paul Ghattas"

4 Publications

  • Page 1 of 1

Large bowel obstruction secondary to gallstones.

J Surg Case Rep 2021 May 18;2021(5):rjab137. Epub 2021 May 18.

Department of Surgery, Lehigh Valley Health Network, Allentown, PA, USA.

Gallstone ileus is a rare complication of cholelithiasis, representing 1% of bowel obstructions. The usual site of obstruction is the ileocecal valve, though other sites have been reported. Here, we present two cases of gallstone ileus within the distal colon requiring surgical intervention. Two elderly females presented with vague abdominal symptoms secondary to large bowel obstruction from gallstone impaction. Both underwent attempted endoscopic retrieval without success. Patient 1 required laparoscopy converted to exploratory laparotomy with colotomy and removal of the stone. Patient 2 required partial colectomy and end colostomy formation due to acute sigmoid inflammation. Gallstone ileus is a rare cause of intestinal obstruction, though incidence increases with age. Cholecystocolonic fistulas allow stones to bypass the ileocecal valve, with the potential for impaction in the colon at the site of a stricture or tortuosity. Surgical intervention may be required in cases not amenable to successful endoscopic retrieval.
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May 2021

Outcomes and Complications After All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients.

Orthop J Sports Med 2017 Mar 13;5(3):2325967117693604. Epub 2017 Mar 13.

Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Background: The safest and most effective technique for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients is currently unknown.

Purpose: To evaluate the functional and patient-reported outcomes of a specific all-epiphyseal ACL reconstruction technique in which the graft, bone tunnels, and fixation do not cross the knee growth plates.

Study Design: Case series; Level of evidence, 4.

Methods: Twenty-seven patients (23 boys, 4 girls; mean age, 11 years; range, 8-15 years) underwent an all-epiphyseal ACL reconstruction with a single femoral transverse epiphyseal tunnel and primarily split tibial epiphyseal tunnels. Outcomes were evaluated in terms of the manual Lachman test, range of motion, pain, return to activity, angular or leg-length deformity on imaging, and International Knee Documentation Committee (IKDC) or Pedi-IKDC score an average of 3.8 years postoperatively, with a minimum 2-year follow-up.

Results: The mean IKDC score was 94 ± 11. There were no growth arrests, but 3 patients had knee overgrowth, and 2 required a subsequent guided growth procedure. The ACL graft failed in 4 patients (15%), and 2 patients had contralateral ACL tears (7%). There were 5 subsequent ipsilateral meniscal tears, 4 of which were retears of a repaired meniscus. Ipsilateral knee reinjury significantly correlated with the number of associated injuries at the time of index surgery ( = .040) and the number of sports played ( = .029).

Conclusion: All-epiphyseal ACL reconstruction resulted in excellent long-term functional outcomes, despite a high rate of complications (48%) and secondary procedures (37%) in this highly active cohort. The incidence of graft failure was similar to other standard ACL reconstruction techniques for patients younger than 20 years.
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March 2017

14-3-3 isoforms bind directly exon B of the 5'-UTR of human surfactant protein A2 mRNA.

Am J Physiol Lung Cell Mol Physiol 2015 Jul 22;309(2):L147-57. Epub 2015 May 22.

Center for Host Defense, Inflammation, and Lung Disease (CHILD), Research Department of Pediatrics, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; and Department of Obstetrics and Gynecology, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania

Human surfactant protein (SP) A (SP-A), an innate immunity molecule, is encoded by two genes, SFTPA1 and SFTPA2. The 5'-untranslated splice variant of SP-A2 (ABD), but not SP-A1 (AD), contains exon B (eB). eB is an enhancer for transcription and translation and contains cis-regulatory elements. Specific trans-acting factors, including 14-3-3, bind eB. The 14-3-3 protein family contains seven isoforms that have been found by mass spectrometry in eB electromobility shift assays (Noutsios et al. Am J Physiol Lung Cell Mol Physiol 304: L722-L735, 2013). We used four different approaches to investigate whether 14-3-3 isoforms bind directly to eB. 1) eB RNA pulldown assays showed that 14-3-3 isoforms specifically bind eB. 2) RNA electromobility shift assay complexes were formed using purified 14-3-3 isoforms β, γ, ε, η, σ, and τ, but not isoform ζ, with wild-type eB RNA. 3 and 4) RNA affinity chromatography assays and surface plasmon resonance analysis showed that 14-3-3 isoforms β, γ, ε, η, σ, and τ, but not isoform ζ, specifically and directly bind eB. Inhibition of 14-3-3 isoforms γ, ε, η, and τ/θ with shRNAs in NCI-H441 cells resulted in downregulation of SP-A2 levels but did not affect SP-A1 levels. However, inhibition of 14-3-3 isoform σ was correlated with lower levels of SP-A1 and SP-A2. Inhibition of 14-3-3 isoform ζ/δ, which does not bind eB, had no effect on expression levels of SP-A1 and SP-A2. In conclusion, the 14-3-3 protein family affects differential regulation of SP-A1 and SP-A2 by binding directly to SP-A2 5'-UTR mRNA.
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July 2015

Treatment of postoperative infection after posterior spinal fusion and instrumentation in a patient with neuromuscular scoliosis.

Am J Orthop (Belle Mead NJ) 2014 Feb;43(2):89-93

Wellmont Orthopaedic Residency Program, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Kingsport, TN.

According to the literature, patients with neuromuscular scoliosis have a higher rate of infection after spinal fusion. No randomized controlled trials have been completed to assess the optimal treatment and related outcomes for patients with infections after posterior spinal fusion. In this article, we examine the data and report a case in which a vacuum-assisted closure (VAC) device was used as definitive treatment for a deep wound infection after posterior spinal fusion and instrumentation in a patient with neuromuscular scoliosis. Our patient, a 17-year-old adolescent girl with progressive neuromuscular scoliosis, underwent posterior spinal fusion with instrumentation and bone graft from T2 to sacrum without complication. One month after surgery, she presented with a draining wound. She underwent repeat surgical irrigation and debridement with subsequent use of a wound VAC. The wound VAC was used for more than 2 months, until skin closure was complete. The deep polymicrobial wound infection was treated successfully and definitively with a wound VAC. This case report suggests that good long-term outcomes can be achieved with use of a wound VAC for definitive closure, with possible avoidance of other secondary surgeries requiring skin grafts or flaps for wound closure.
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February 2014