21 results on '"Selim G. Gebran"'
Search Results
2. Differences in Facial Fracture Patterns in Pediatric Nonaccidental Trauma
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Michael P. Grant, Selim G. Gebran, Yvonne M. Rasko, Adekunle Elegbede, Marcus Ottochian, Ledibabari M. Ngaage, Philip J. Wasicek, Arthur J. Nam, and Fan Liang
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Child abuse ,medicine.medical_specialty ,business.industry ,Retrospective cohort study ,Context (language use) ,030206 dentistry ,General Medicine ,Condyle ,Head trauma ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,Interquartile range ,Maxilla ,Accidental ,Medicine ,030223 otorhinolaryngology ,business - Abstract
BACKGROUND The purpose of this study was to characterize differences in facial fracture injury patterns among pediatric patients at highest risk of abusive head trauma/nonaccidental trauma (age ≤ 5 years). METHODS Using the National Trauma Databank from 2007 to 2015, patients (age ≤ 5 years) suffering facial fractures were included. Demographics and injury characteristics were compared between those sustaining accidental versus nonaccidental trauma (NAT). RESULTS Over 9 years 9741 patients were included with 193 patients (2.0%) suffering NAT. Nonaccidental trauma patients were younger (median [interquartile range]; 0 [0, 2] versus 3 [1, 4], P
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- 2020
3. Insurance Coverage Criteria for Bariatric Surgery: A Survey of Policies
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Michael P. Grant, Ledibabari M. Ngaage, Mark D. Kligman, Brooks J. Knighton, Arthur J. Nam, Fan Liang, John A. Rose, Yvonne M. Rasko, Selim G. Gebran, and Stephen M. Kavic
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Adult ,Male ,Reoperation ,Pediatric Obesity ,medicine.medical_specialty ,Adolescent ,Endocrinology, Diabetes and Metabolism ,Center of excellence ,Bariatric Surgery ,030209 endocrinology & metabolism ,Comorbidity ,Mandatory Programs ,Insurance Coverage ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Weight loss ,Surveys and Questionnaires ,Weight Loss ,Weight management ,medicine ,Humans ,Reimbursement ,Aged ,Insurance, Health ,Nutrition and Dietetics ,business.industry ,Health Policy ,Age Factors ,Health Care Costs ,Middle Aged ,United States ,Checklist ,Obesity, Morbid ,Surgery ,Weight Reduction Programs ,Scale (social sciences) ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Weight Loss Surgery ,Psychosocial - Abstract
Bariatric surgery remains underutilized at a national scale, and insurance company reimbursement is an important determinant of access to these procedures. We examined the current state of coverage criteria for bariatric surgery set by private insurance companies. We surveyed medical policies of the 64 highest market share health insurance providers in the USA. ASMBS guidelines and the CMS criteria for pre-bariatric evaluation were used to collect private insurer coverage criteria, which included procedures covered, age, BMI, co-morbidities, medical weight management program (MWM), psychosocial evaluation, and a center of excellence designation. We derive a comprehensive checklist for pre-bariatric patient evaluation. Sixty-one companies (95%) had defined pre-authorization policies. All policies covered the RYGB, and 57 (93%) covered the LAGB or the SG. Procedures had coverage limited to center of excellence in 43% of policies (n = 26). A total of 92% required a BMI of 40 or above or of 35 or above with a co-morbidity; however, 43% (n = 23) of policies covering adolescents (n = 36) had a higher BMI requirement of 40 or above with a co-morbidity. Additional evaluation was required in the majority of policies (MWM 87%, psychosocial evaluation 75%). Revision procedures were covered in 79% (n = 48) of policies. Reimbursement of a second bariatric procedure for failure of weight loss was less frequently found (n = 41, 67%). A majority of private insurers still require a supervised medical weight management program prior to approval, and most will not cover adolescent bariatric surgery unless certain criteria, which are not supported by current evidence, are met.
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- 2019
4. Contemporary Characterization of Injury Patterns, Initial Management, and Disparities in Treatment of Facial Fractures Using the National Trauma Data Bank
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Marcus Ottochian, Fan Liang, Michael P. Grant, Philip J. Wasicek, Selim G. Gebran, Ledibabari M. Ngaage, Yvonne M. Rasko, Jonathan J. Morrison, Arthur J. Nam, and Yuanyuan Liang
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Multivariate analysis ,Adolescent ,Databases, Factual ,Traumatic brain injury ,Psychological intervention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Intervention (counseling) ,medicine ,Humans ,Young adult ,030223 otorhinolaryngology ,Facial Injuries ,Aged ,Skull Fractures ,business.industry ,030206 dentistry ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Hospitalization ,medicine.anatomical_structure ,Otorhinolaryngology ,Multivariate Analysis ,Abdomen ,Female ,Surgery ,business - Abstract
Contemporary description of facial fracture patterns and factors associated with early operative intervention at trauma centers is lacking. The purpose of this study was to characterize injuries and initial treatment patterns of patients suffering from facial fractures.Using the National Trauma Databank from 2007 to 2015, patients suffering from facial fractures were included. Demographics, injury characteristics, and outcomes including operative interventions were assessed.Over 9 years, 626,270 patients were included: 74.5% were male, 39.0% suffered traumatic brain injury (TBI), and 23.3% severe noncraniofacial injuries (chest, abdomen, and/or extremity Abbreviated Injury Score ≥3). A total of 537,594 (85.8%) patients were admitted and 184,206 (34.3%) underwent operations for their facial injuries during the index hospitalization. The frequency and patterns of fractures varied by age, sex, race, and mechanism of injury. Operative intervention rates were highest for mandible (63.2%) and lowest for orbit fractures (1.0%). Multiple regression revealed that multiple factors were independently associated with the odds of early fracture repair including: female versus male (odds ratio [95% confidence interval]: 0.96 [0.94-0.98]), age65 versus18 years (0.62 [0.59-0.64]), non-white race (0.95 [0.94-0.97]), uninsured versus Medicaid (0.88 [0.86-0.90]), hospital bed size (600 vs ≤200 beds, 1.67 [1.61-1.73]), TBI (0.70 [0.69-0.71]), and C-spine injury (0.93 [0.90-0.96]).Facial fractures are common among many demographic cohorts, and multiple patient and injury-specific factors influenced fracture patterns and management. Early operative intervention was highest for mandible fractures and lowest for orbit fractures. Multiple factors including age, sex, insurance status, hospital characteristics, and race/ethnicity were independently associated with early operative intervention, highlighting disparities in care.
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- 2019
5. Characterization of Age-Related Injury Patterns and Surgical Treatment of Pediatric Facial Fractures
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Adekunle Elegbede, Philip J. Wasicek, Fan Liang, Jonathan J. Morrison, Michael P. Grant, Selim G. Gebran, Yvonne M. Rasko, Ledibabari M. Ngaage, Yuanyuan Liang, Marcus Ottochian, and Arthur J. Nam
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Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Databases, Factual ,Population ,Poison control ,Cohort Studies ,03 medical and health sciences ,Age Distribution ,0302 clinical medicine ,Trauma Centers ,Injury prevention ,Humans ,Medicine ,Craniofacial ,Child ,030223 otorhinolaryngology ,education ,Surgical repair ,education.field_of_study ,Skull Fractures ,business.industry ,Trauma center ,Accidents, Traffic ,Infant, Newborn ,Infant ,030206 dentistry ,General Medicine ,Plastic Surgery Procedures ,Confidence interval ,Hospitalization ,Otorhinolaryngology ,Child, Preschool ,Accidental Falls ,Female ,Surgery ,business ,Cohort study - Abstract
BACKGROUND Presentation of pediatric facial fractures varies widely and many injuries are encountered infrequently by most practitioners. This study summarizes injury patterns in a large cohort of facial fractures and their subsequent surgical management. METHODS Demographic and clinical characteristics of patients 18 years of age or younger admitted between 2009 and 2015 to trauma centers participating in the National Trauma Data Bank were examined. Craniofacial fractures and reconstructive procedures performed at index admission were selected based on ICD-9 and AIS codes. A multivariable analysis was used to determine independent determinants of surgical repair. RESULTS Out of 60,094 pediatric patients evaluated in the US emergency departments, 48,821 patients were admitted and underwent open treatment (n = 8364; 17.1%) or closed treatment (n = 4244; 8.7%) of facial fractures. Falls were the most common mechanism of injury in infants and toddlers (
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- 2019
6. Patterns of Coverage in Pediatric Bariatric Surgery
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Michael Ha, Selim G. Gebran, Brooks J. Knighton, Yvonne M. Rasko, Ledibabari M. Ngaage, and Cynthia T. Yusuf
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medicine.medical_specialty ,business.industry ,Medicine ,Surgery ,business - Published
- 2021
7. Surgical Treatment and Visual Outcomes of Adult Orbital Roof Fractures
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Michael P. Grant, Joseph Lopez, Philip J. Wasicek, Selim G. Gebran, Paul N. Manson, Adekunle Elegbede, Yvonne M. Rasko, Arthur J. Nam, and Fan Liang
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Adult ,Male ,medicine.medical_specialty ,genetic structures ,Adolescent ,medicine.medical_treatment ,Population ,Visual impairment ,030230 surgery ,Conservative Treatment ,Time-to-Treatment ,03 medical and health sciences ,Fracture Fixation, Internal ,Young Adult ,0302 clinical medicine ,Postoperative Complications ,Trauma Centers ,medicine ,Internal fixation ,Humans ,education ,Surgical treatment ,Orbital Fractures ,Reduction (orthopedic surgery) ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,Hematoma ,business.industry ,Incidence ,Trauma center ,Middle Aged ,eye diseases ,Surgery ,Open Fracture Reduction ,Treatment Outcome ,030220 oncology & carcinogenesis ,Orbital roof ,Optic Nerve Injuries ,Cohort ,Female ,medicine.symptom ,business ,Tomography, X-Ray Computed ,Orbit - Abstract
Background Fractures of the orbital roof require high-energy trauma and have been linked to high rates of neurologic and ocular complications. However, there is a paucity of literature exploring the association between injury, management, and visual prognosis. Methods The authors performed a 3-year retrospective review of orbital roof fracture admissions to a Level I trauma center. Fracture displacement, comminution, and frontobasal type were ascertained from computed tomographic images. Pretreatment characteristics of operative orbital roof fractures were compared to those of nonoperative fractures. Risk factors for ophthalmologic complications were assessed using univariable/multivariable regression analyses. Results In total, 225 patients fulfilled the inclusion criteria. Fractures were most commonly nondisplaced [n = 118 (52.4 percent)] and/or of type II frontobasal pattern (linear vault involving) [n = 100 (48.5 percent)]. Eight patients underwent open reduction and internal fixation of their orbital roof fractures (14.0 percent of displaced fractures). All repairs took place within 10 days from injury. Traumatic optic neuropathy [n = 19 (12.3 percent)] and retrobulbar hematoma [n = 11 (7.1 percent)] were the most common ophthalmologic complications, and led to long-term visual impairment in 51.6 percent of cases. Conclusions Most orbital roof fractures can be managed conservatively, with no patients in this cohort incurring long-term fracture-related complications or returning for secondary treatment. Early fracture treatment is safe and may be beneficial in patients with vertical dysmotility, globe malposition, and/or a defect surface area larger than 4 cm2. Ophthalmologic prognosis is generally favorable; however, traumatic optic neuropathy is major cause of worse visual outcome in this population. Clinical question/level of evidence Risk, III.
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- 2020
8. The Prevalence of Blood-Borne Pathogens in Maxillofacial Trauma Patients
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Joseph Lopez, Jordan P. Steinberg, Fan Liang, Michael P. Grant, Yvonne M. Rasko, Arthur J. Nam, Selim G. Gebran, Y. Wu, Philip J. Wasicek, and Ledibabari M. Ngaage
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Facial trauma ,Adult ,Male ,medicine.medical_specialty ,Population ,HIV Infections ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Blood-Borne Pathogens ,Prevalence ,Humans ,Medical history ,030223 otorhinolaryngology ,education ,Retrospective Studies ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Incidence ,Trauma center ,030206 dentistry ,General Medicine ,Hepatitis C ,Odds ratio ,Hepatitis B ,medicine.disease ,Otorhinolaryngology ,Surgery ,Female ,Maxillofacial Injuries ,business - Abstract
BACKGROUND Blood-borne pathogen infections (BPIs), caused by the human immunodeficiency virus, hepatitis C and hepatitis B viruses pose an occupational hazard to healthcare workers. Facial trauma reconstruction surgeons may be at elevated risk because of routine use of sharps, and a higher than average incidence of BPIs in the trauma patient population. METHODS The authors retrospectively reviewed health records of patients admitted to a level 1 trauma center with a facial fracture between January 2010 and December 2015. Patient demographics, medical history, mechanism of injury, type of fracture, and procedures performed were documented. The authors detemined the frequency of human immunodeficiency virus, hepatitis B, and hepatitis C diagnosis and utilized univariable/multivariable analyses to identify risk factors associated with infection in this population. RESULTS In total, 4608 consecutive patients were included. Infections were found in 4.8% (n = 219) of patients (human immunodeficiency virus 1.6%, hepatitis C 3.3%, hepatitis B 0.8%). 76.3% of BPI patients in this cohort were identified by medical history, while 23.7% were diagnosed by serology following initiation of care. 39.0% of all patients received surgical treatment during initial hospitalization, of whom 4.3% had a diagnosed BPI. History of intravenous drug use (odds ratio [OR] 6.79, P
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- 2020
9. Differences in Facial Fracture Patterns in Pediatric Nonaccidental Trauma
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Philip J, Wasicek, Selim G, Gebran, Adekunle, Elegbede, Ledibabari M, Ngaage, Yvonne, Rasko, Marcus, Ottochian, Fan, Liang, Michael P, Grant, and Arthur J, Nam
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Databases, Factual ,Skull Fractures ,Fractures, Multiple ,Accidents ,Child, Preschool ,Infant, Newborn ,Craniocerebral Trauma ,Humans ,Infant ,Child Abuse ,Facial Injuries ,Retrospective Studies - Abstract
The purpose of this study was to characterize differences in facial fracture injury patterns among pediatric patients at highest risk of abusive head trauma/nonaccidental trauma (age ≤ 5 years).Using the National Trauma Databank from 2007 to 2015, patients (age ≤ 5 years) suffering facial fractures were included. Demographics and injury characteristics were compared between those sustaining accidental versus nonaccidental trauma (NAT).Over 9 years 9741 patients were included with 193 patients (2.0%) suffering NAT. Nonaccidental trauma patients were younger (median [interquartile range]; 0 [0, 2] versus 3 [1, 4], P 0.001), and more frequently were insured by Medicaid (76.7% versus 41.9%, P 0.001). NAT patients were more likely to sustain mandible fractures (38.9% versus 21.1%, P 0.001), but less likely to sustain maxilla (9.8% versus 18.3%, P = 0.003), or orbital fractures (31.1% versus 53.4%, P 0.001). Nonaccidental trauma patients had fewer instances of multiple facial fracture sites (8.9% versus 22.6%, P 0.001). Among those sustaining mandible fractures, NAT patients were more likely to sustain condylar fractures (75.8% versus 48.4%, P 0.001), but less likely to sustain subcondylar fractures (0% versus 13.2%, P = 0.002), or angle fractures (1.6 versus 8.7%, P = 0.048).Differences exist in facial fracture patterns in accidental versus nonaccidental trauma within the pediatric population at highest risk for abusive head trauma. Specifically, NAT is associated with fractures of the mandibular condyle and involve fewer facial fracture sites. In the appropriate context, presence of these fractures/patterns should increase suspicion for NAT.
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- 2020
10. Orbital Injuries From Self-Inflicted Gunshots: Patterns, Management, and Visual Outcomes
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Ryan Dunlow, Philip J. Wasicek, Carolyn Drogt, Yvonne M. Rasko, Adekunle Elegbede, Ledibabari M. Ngaage, Arthur J. Nam, Selim G. Gebran, Michael P. Grant, and Fan Liang
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medicine.medical_specialty ,Visual acuity ,genetic structures ,Visual Acuity ,Discharged alive ,03 medical and health sciences ,0302 clinical medicine ,Eye Injuries ,Quality of life ,Median follow-up ,medicine ,Humans ,Orbital Fractures ,Retrospective Studies ,business.industry ,Trauma center ,Retrospective cohort study ,General Medicine ,eye diseases ,Surgery ,Ophthalmology ,medicine.anatomical_structure ,030221 ophthalmology & optometry ,Optic nerve ,Quality of Life ,sense organs ,medicine.symptom ,business ,Orbit (anatomy) - Abstract
PURPOSE Self-inflicted facial gunshots (SIGSWs) typically result in a spectrum of severe injuries to facial structures, including the orbit and globe. Roughly three-quarters of those who arrive to the hospital will survive their injuries, and recidivism is typically low. Therefore, effective management is paramount to preserve vision, and long-term quality of life. The objective of this study is to characterize the common injuries to the orbit, globe, and periocular structures following SIGSWs, their management, and their eventual visual and reconstructive outcomes. METHODS Retrospective review of trauma registry records at a Level 1 trauma center for patients who presented alive following SIGSWs involving the globe and/or orbit from 2007 to 2016. RESULTS Of the 47 patients who presented with SIGSWs to the orbit, 33 (70%) were discharged alive from the hospital. Management strategies for these patients fell into 3 groups, based on the involved structures: i) Open globe injuries (Type I: n = 12, 34%) ii) Orbital fractures with preserved globe and optic nerve (Type II: n = 15, 43%), and iii) Optic nerve injuries with preserved globe (Type III: n = 8, 23%). Compared with Type II and III injuries, patients who had Type I injuries were more likely to die prior to hospital discharge (46% vs. 20% vs. 12%, p = 0.04), undergo ophthalmologic intervention (73% vs. 6% vs. 11%, p = 0.01), and more surgery (6 vs. 3 vs. 0.5 mean surgeries, p < 0.001). Type II injuries most frequently underwent debridement and reconstruction of the bony orbit. Type III and Type I injuries were associated with worse initial and final visual acuity, with the majority (100% and 75%, respectively) having No Light Perception (NLP) on initial exam, and no visual recovery during the follow-up period (median follow up= 25 months). CONCLUSIONS Management and visual outcomes of orbital injuries from SIGSWs is determined by whether the globe and optic nerve are preserved. Open globe injury by itself is associated with higher mortality and significant permanent vision loss.
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- 2019
11. Factors influencing the local cure rate of hidradenitis suppurativa following wide local excision
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Y. Wu, Fan Liang, Ronald P. Silverman, Arthur J. Nam, Erin M. Rada, Ledibabari M. Ngaage, Shealinna Ge, Selim G. Gebran, and Yvonne M. Rasko
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Moderate to severe ,Adult ,Male ,medicine.medical_specialty ,Cure rate ,medicine.medical_treatment ,Dermatology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Recurrence ,medicine ,Humans ,Hidradenitis suppurativa ,030212 general & internal medicine ,Retrospective Studies ,Wound Healing ,Maryland ,business.industry ,Wide local excision ,Gold standard ,Mean age ,Original Articles ,Skin Transplantation ,medicine.disease ,Hidradenitis ,Surgery ,Hidradenitis Suppurativa ,Female ,business ,Body mass index - Abstract
Wide local excision is the gold standard and only potential curative therapy for recalcitrant hidradenitis suppurativa. However, high recurrence rates persist even post-surgery with little known on the influencing factors for remission. We evaluated the effect of patient, disease, and operative factors on local cure rate of moderate to severe hidradenitis following wide local excision. We performed a retrospective chart review for all patients who had undergone surgical excision of hidradenitis at a university hospital from 2012 to 2018. We identified 79 patients with a total of 220 operative sites. The majority were obese (mean body mass index [BMI] 32.5), female (71%), African-American (84%), and had a mean age of 31 years. A quarter of operative sites experienced a recurrence (n = 56). Patients who achieved remission had a significantly lower number of affected regions than those who experienced a recurrence (2.3 vs 3.6, P = .0023). Additionally, recurrence rate differed significantly between body locations (P = .0440). Smoking, BMI, Hurley grade, closure method, and excision size did not influence local cure rate. Surgical excision remains a worthy management option for hidradenitis patients with three quarters achieving remission after a single operation. Number of affected regions and location of hidradenitis may play a factor in recurrence.
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- 2019
12. Sir Harold Delf Gillies—The Surgeon Artist
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Arthur J. Nam and Selim G. Gebran
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Painting ,business.industry ,media_common.quotation_subject ,Perspective (graphical) ,Art history ,030230 surgery ,03 medical and health sciences ,Friendship ,0302 clinical medicine ,Facet (psychology) ,030220 oncology & carcinogenesis ,Medicine ,Surgery ,business ,media_common - Abstract
Harold Gillies, a plastic surgeon who created the discipline of plastic surgery and trained hundreds of young surgeons, was foremost an artist. In a short historical perspective, we illustrate this facet of the Gillies' life through a friendship with the British ecologist William Sladen and a painting that Gillies drew during their encounters.
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- 2019
13. Sir Harold Delf Gillies-The Surgeon Artist
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Selim G, Gebran and Harold, GIllies
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England ,Humans ,Paintings ,History, 20th Century ,Surgery, Plastic ,Facial Injuries - Abstract
Harold Gillies, a plastic surgeon who created the discipline of plastic surgery and trained hundreds of young surgeons, was foremost an artist. In a short historical perspective, we illustrate this facet of the Gillies' life through a friendship with the British ecologist William Sladen and a painting that Gillies drew during their encounters.
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- 2019
14. The changing paradigm of ethics in uterus transplantation: a systematic review
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Samantha Ike, Gerald Brandacher, Ledibabari M. Ngaage, Christian J. Vercler, Carisa M. Cooney, Erin M. Rada, Richard J. Redett, Liza Johannesson, Adekunle Elegbede, Fan Liang, Yvonne M. Rasko, and Selim G. Gebran
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medicine.medical_specialty ,media_common.quotation_subject ,Uterus ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Social Justice ,Uterus transplantation ,Medicine ,Childbirth ,Humans ,Ethics, Medical ,Justice (ethics) ,media_common ,Transplantation ,business.industry ,Beneficence ,Bioethics ,Clinical equipoise ,medicine.anatomical_structure ,Family medicine ,030211 gastroenterology & hepatology ,Female ,business ,Autonomy - Abstract
The first uterus transplantation was performed in 2000. As key milestones are reached (long-lasting graft survival in 2011, and first birth from a transplanted womb in 2014), the ethical debate around uterus transplant evolves. We performed a systematic review of articles on uterus transplantation. Ethical themes were extracted and categorized according to four bioethical principles. Papers were divided into time periods separated by key events in uterus transplant history: Phase I (first technical achievement, 2002-2011), Phase II (clinical achievement, 2012-2014), and Phase III (after the first childbirth, 2015-2018). Eighty-one articles were included. The majority of ethics papers were published in Phase III (65%, P < 0.0001), that is after the first birth. Eighty percent of papers discussed nonmaleficence making it the most discussed principle. The first birth acted as a pivotal point: nonmaleficence was discussed by a lower proportion of articles (P = 0.0073), as was beneficence (P = 0.0309). However, discussion of justice increased to become the most discussed principle of the time period (P = 0.0085). The ethical debate surrounding uterus transplantation has evolved around landmark events that signify scientific progress. As safety and efficacy become evident, the focus of ethical debate shifts from clinical equipoise to socioeconomic challenges and equitable access to uterus transplantation.
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- 2019
15. Panniculectomy at the time of bariatric surgery: a propensity score-matched analysis of outcomes in the MBSAQIP database
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Philip J. Wasicek, Ledibabari M. Ngaage, Selim G. Gebran, Arthur J. Nam, Mark D. Kligman, and Yvonne M. Rasko
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medicine.medical_specialty ,Reconstructive surgery ,medicine.medical_treatment ,Bariatric Surgery ,030209 endocrinology & metabolism ,computer.software_genre ,Accreditation ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Weight loss ,Panniculectomy ,medicine ,Humans ,Propensity Score ,Retrospective Studies ,Database ,Abdominoplasty ,business.industry ,Odds ratio ,Quality Improvement ,Confidence interval ,Surgery ,Obesity, Morbid ,Treatment Outcome ,Body contouring ,Propensity score matching ,Quality of Life ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,computer - Abstract
Background Body contouring in the postbariatric surgery patient improves quality of life and daily function. Objectives To determine the risk profile of panniculectomy when performed in select patients at the time of bariatric surgery. Setting Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) participating centers. Methods We examined the MBSAQIP database (2016-2017), in which data on 379,544 bariatric surgeries are reported. Concurrent panniculectomy procedures were identified by Current Procedural Technology (CPT) codes. Patient characteristics and in-hospital as well as 30-day complications were compared between the body contouring group and propensity score-matched bariatric surgery controls. Results One hundred twenty-four patients met inclusion criteria and were matched to 248 controls. An infra-umbilical panniculectomy was performed in the majority of patients (n = 94, 75.8%). Most patients received an open rather than laparoscopic bariatric surgery (n = 87, 70.2%). There were no statistically significant differences between 30-day mortality (1.9%), wound complications (11.5%), readmission (12.5%) and reoperation (5.8%) between the 2 groups (P > .05). Wound complications occurred in 11.5% of patients and were associated with prolonged hospital stay (odds ratio 4.65, 95% confidence interval 1.99–10.86, P 50 (odds ratio 3.19, 95% confidence interval 1.02–9.96, P = .046). Conclusion In select patients, panniculectomy at the time of bariatric surgery was not associated with increased in-hospital or 30-day adverse outcomes compared with matched bariatric surgery controls. This procedure may be performed in select patients, with awareness that revision surgery may be needed once weight loss stabilizes.
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- 2019
16. Panniculectomy at the time of living donor renal transplantation: An 8-year experience
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Devinder P. Singh, Joseph R. Scalea, Selim G. Gebran, Jonathan S. Bromberg, Kashyap Komarraju Tadisina, Adekunle Elegbede, Silke V. Niederhaus, B. Masters, Yvonne M. Rasko, Arthur J. Nam, Stephen T. Bartlett, Ledibabari M. Ngaage, and Erin M. Rada
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,030230 surgery ,Kidney Function Tests ,Living donor ,Body Mass Index ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Preoperative Care ,medicine ,Panniculectomy ,Living Donors ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,Obesity ,education ,Aged ,Retrospective Studies ,Transplantation ,education.field_of_study ,business.industry ,Abdominoplasty ,Immunosuppression ,Middle Aged ,Readmission rate ,Prognosis ,Kidney Transplantation ,Combined approach ,Surgery ,Kidney Failure, Chronic ,Female ,business ,Body mass index ,Follow-Up Studies ,Glomerular Filtration Rate - Abstract
Panniculectomy can be performed as a prophylactic procedure preceding transplantation to enable obese patients to meet criteria for renal transplantation. No literature exists on combined renal transplant and panniculectomy surgery (LRT-PAN). We describe our 8-year experience performing LRT-PAN. A retrospective chart review of all patients who had undergone LRT-PAN from 2010 to 2018 was conducted. Data were collected on patient demographics, allograft survival and function, and postoperative course. Fifty-eight patients underwent LRT-PAN. All grafts survived, with acceptable function at 1 year. Median length of stay was 4 days with a mean operative duration of 363 minutes. The wound complication rate was 24%. Ninety-day readmission rate was 52%, with medical causes as the most common reason for readmission (45%), followed by wound (32%) and graft-related complications (23%). Body mass index, diabetes status, and previous immunosuppression did not influence wound complication rate or readmission (P = .7720, P = .0818, and P = .4830, respectively). Combining living donor renal transplant and panniculectomy using a multidisciplinary team may improve access to transplantation, particularly for the obese and postobese population. This combined approach yielded shorter-than-expected hospital stays and similar wound complication rates, and thus should be considered for patients in whom transplantation might otherwise be withheld on the basis of obesity.
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- 2018
17. A191 Insurance Coverage Criteria for Bariatric Surgery
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Mark D. Kligman, Yvonne M. Rasko, John Rose, Stephen M. Kavic, Arthur J. Nam, Fan Liang, Selim G. Gebran, Ledibabari M. Ngaage, and Brooks J. Knighton
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medicine.medical_specialty ,business.industry ,Medicine ,Surgery ,business ,Insurance coverage - Published
- 2019
18. Low-dose Computed Tomography Scans for Postoperative Evaluation of Craniomaxillofacial Fractures
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Adekunle Elegbede, Silviu Diaconu, David Dreizin, Ryan Dunlow, Selim G. Gebran, Ledibabari M. Ngaage, Emmanuel C. Obusez, Colton H. L. McNichols, Yvonne M. Rasko, Fan Liang, Michael P. Grant, and Arthur J. Nam
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Surgery ,Research & Technology Abstracts - Published
- 2019
19. Isolated Orbital Fractures Are Associated With Cranial and Cervical Spine Injuries
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Paul N. Manson, Yvonne M. Rasko, Michael P. Grant, Ryan Dunlow, Selim G. Gebran, Macey Yates, Camille Bulte, Adekunle Elegbede, Arthur J. Nam, Ledibabari M. Ngaage, and Fan Liang
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medicine.medical_specialty ,Posters ,business.industry ,medicine ,Surgery ,Radiology ,Orbital Fracture ,business ,Cervical spine - Published
- 2019
20. A 12-year review of patient-reported outcomes after reduction mammoplasty in patients with high body mass index
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Adekunle Elegbede, Ledibabari M. Ngaage, Arthur J. Nam, Sheri Slezak, Selim G. Gebran, Yvonne M. Rasko, Chinezimuzo Ihenatu, and Jennifer Bai
- Subjects
Adult ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Mammaplasty ,medicine.medical_treatment ,patient-related outcomes ,MEDLINE ,Observational Study ,Reduction Mammoplasty ,Body Mass Index ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Patient satisfaction ,Surveys and Questionnaires ,medicine ,body mass index (BMI) ,Humans ,In patient ,Obesity ,Patient Reported Outcome Measures ,030212 general & internal medicine ,breast reduction ,Aged ,Retrospective Studies ,Maryland ,business.industry ,satisfaction ,nutritional and metabolic diseases ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Patient Satisfaction ,030220 oncology & carcinogenesis ,Female ,mammoplasty ,business ,Body mass index ,Research Article - Abstract
Patients with increased body mass index (BMI) are often denied reduction mammoplasty due to concern for high morbidity. There is a paucity of evidence identifying high BMI as a predictor of poor long-term outcomes in reduction mammoplasty. In this study, we investigated the influence of BMI on long-term patient satisfaction following reduction mammoplasty. All patients undergoing reduction mammoplasty over a 12-year period at a single institution were included in the study. A retrospective chart review was conducted to extract demographics, operative data, and postoperative course including complications. Patients were classified into 4 categories based on BMI (normal (
- Published
- 2019
21. Abstract QS6
- Author
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Yuanyuan Liang, Yvonne M. Rasko, Marcus Ottochian, Ledibabari M. Ngaage, Selim G. Gebran, Michael P. Grant, Adekunle Elegbede, Fan Liang, Philip J. Wasicek, Jonathan J. Morrison, and Arthur J. Nam
- Subjects
Facial trauma ,medicine.medical_specialty ,Text mining ,PSRC 2019 Abstract Supplement ,business.industry ,Emergency medicine ,lcsh:Surgery ,Medicine ,Surgery ,lcsh:RD1-811 ,business ,medicine.disease - Published
- 2019
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