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Search Results: 1 - 10 of 18503 matches for " Iskander Al-Githmi "
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Robotic–Assisted Thymectomy in Patients with Nonthymomatous Myasthenia Gravis  [PDF]
Iskander Al-Githmi
Surgical Science (SS) , 2011, DOI: 10.4236/ss.2011.27086
Abstract: Complete removal of the thymus and fatty tissue adherent to pericardium is crucial for treating myasthenia gravis. Our aim was to analyze our surgical and clinical results and early experience of robot-assisted thy-mectomy in patients with nonthymomatous myasthenia gravis. Between January 2008 and October 2010, 8 patients, all women, with nonthymomatous myasthenia gravis underwent robot-assisted thymectomy using a 3-port, left-sided approach. There were no operative mortality; 1 patient had left phrenic nerve injury. Com-plete remission was achieved in 25% of the patients at 18 months’ follow-up. There was no significant agreement between preoperative computed tomography and histopathology finding (kappa = 0.059; P = 0.85) and no significant correlation between age and duration of symptoms (P = 0.51). Robotic-assisted thymec-tomy is promising procedure. It can be performed safely and effectively. With follow-up greater than 12 months, 87.5% of the patients who underwent robot-assisted thymectomy demonstrated clinical improve-ment.
Does Gender Affect the Outcomes of Multiple Valve Heart Surgery?  [PDF]
Iskander Al-Githmi
Open Journal of Thoracic Surgery (OJTS) , 2012, DOI: 10.4236/ojts.2012.21001
Abstract: Background: Multiple valve surgery exposes patients to major morbidity and mortality. Little is known about the effect of gender on the outcomes of multiple valve surgery. Methods: In 69 patients who had multiple valve surgery for rheumatic valvular heart disease, 51 patients had mitral and aortic valve replacement, 9 patients had mitral and aortic valve replacement and tricuspid valve repair, 4 patients had mitral valve replacement and tricuspid valve repair, 4 patients had mitral and tricuspid valve repair, and 1 patient had mitral and tricuspid valve replacement. Outcomes were evaluated with univariate analysis. Results: Women had significantly smaller body surface area and smaller left ventricular end-systolic area than men. Women and men had similar left ventricular ejection fraction and New York Heart Association functional class. Univariate analysis showed that in women (but not men), older age, atrial fibrillation, lower left ventricular ejection fraction, and New York Heart Association functional class II and III were associated with longer hospital and intensive care unit stay. In men (but not women), longer cardiopulmonary bypass time was associated with increased left ventricular end-systolic area at 12 months after surgery. Longer aortic cross-clamp time was associated with increased left ventricular end-systolic area in men but only weakly in women. Conclusion: We concluded that gender is an independent predictor of outcomes after multiple valve heart surgery.
Lung Transplant and Outcomes: A Single-Center Experience  [PDF]
Iskander Al-Githmi
Surgical Science (SS) , 2012, DOI: 10.4236/ss.2012.36062
Abstract: Introduction: Lung transplant is the preferred treatment for several end-stage pulmonary diseases. The first successful human lung transplant was performed by the Toronto Group in 1983 [1]. Objectives: This article discusses our initial experience with single and double lung transplant. Study Design: A retrospective analysis was done on 11 consecutive lung transplants for end-stage pulmonary diseases performed at our institution between 2008 and 2010. Materials and Methods: Major indications were idiopathic pulmonary fibrosis (n = 6), bronchiectasis (n = 2), primary pulmonary hypertension (n = 1), lymphangioleiomyomatosis (n = 1), and scleroderma (n = 1). Results: Two patients (18.2%) died within 30 days of surgery. One- and 2-year survival rates for the recipients were 81.8% and 72.7%. Sepsis caused the deaths of 2 recipients. Conclusions: Although sepsis and chronic rejection limit the benefits, lung transplant gives many patients with end-stage pulmonary disease the ability for a better quality of life.
Robotic Mediastinal Parathyroidectomy in a Patient with Maxillary Giant Cell Tumor  [PDF]
Iskander Al-Githmi
Surgical Science (SS) , 2013, DOI: 10.4236/ss.2013.45049
Abstract:

A 50-year-old woman with a maxillary giant cell tumor had primary hyperparathyroidism from a mediastinal parathyroid adenoma. Computed tomography showed a mildly enhanced, oval soft tissue nodule (2.5 × 1.5 × 1.7 cm) at the anterosuperior mediastinum. Mediastinal parathyroidectomy was performed with a 3-arm surgical robot. After surgery, the plasma parathyroid hormone level decreased markedly (before surgery, 70.5 pg/ml; after surgery, 5.5 pg/ml; normal reference range, 1.6 to 6.9 pg/ml). The 3-dimensional visualization, high-dexterity, and full range of motion of the robotic system provided an efficient and safe surgical procedure for the mediastinal tumor. The purpose of this case study is to show the feasibility and effectiveness of robot assisted dissection for mediastinal parathyroid gland and to demonstrate the giant cell tumor of the bone can regress after resection of parathyroid adenoma.

Is There a Role for Chest Computed Tomography in Patients with Primary Spontaneous Pneumothorax?  [PDF]
Iskander Al-Githmi
Surgical Science (SS) , 2017, DOI: 10.4236/ss.2017.810047
Abstract: Background: Primary spontaneous pneumothorax is a relatively common condition in young adults. Although blebs and bullae are frequently found in patients with primary spontaneous pneumothorax, they are very rarely the actual cause of the pneumothorax. Objective: To assess our experience with chest computed tomography evaluation in patients with recurrent spontaneous pneumothorax as compared to their histopathology findings. Study Design: A prospective study analysis. Materials and Methods: From January 2013 to December 2016, 38 consecutive patients with unilateral recurrent spontaneous pneumothorax underwent video-assisted thoracic surgery. Their chest computed tomography scans were reviewed and compared with their histopathology findings. Results: Thirty-six adult patients with unilateral recurrent spontaneous pneumothorax were included; their mean age was 33.9 years, and they all received video-assisted thoracic surgery and mechanical pleurodesis. Blebs or bullae were present in the chest computed tomography scans of fourteen patients (39%); of those fourteen patients, five (35.7%) had emphysematous changes in histopathology. Seventeen out of the thirty-six (47%) had no blebs or bullae in their chest computed tomography scans; of those seventeen patients, ten (59%) had emphysema like changes and seven (41%) had blebs in their histopathology studies. The remaining five patients (14%) had normal chest computed tomography scans. Conclusions: We conclude that preoperative chest computed tomography is not beneficial in every patient with recurrence of primary spontaneous pneumothorax.
Mediastinoscopy in Assessing Mediastinal Lymphadenopathy and Lung Disease  [PDF]
Iskander Al-Githmi
Open Journal of Thoracic Surgery (OJTS) , 2017, DOI: 10.4236/ojts.2017.74008
Abstract: Background: Mediastinoscopy is the gold standard procedure for the pathological staging and diagnosis of mediastinal diseases. The aim of the study is to describe the significance of anterior cervical Mediastinoscopy in evaluating patients with mediastinal lymphadenopathy and lung parenchymal disease. Material and Methods: From January 2014 until June 2017 we conducted a retrospective study of 52 consecutive patients with mediastinal lymphadenopathy and lung parenchymal disease who underwent anterior cervical Mediastinoscopy. The main indications for cervical Mediastinoscopy were isolated mediastinal lymphadenopathy, undetermined lung mass with mediastinal lymphadenopathy, and the clinical staging of patients with lung cancer. Results: The study subjects consisted of 37 men and 15 women, aged 13 to 87 (mean age 50.8). Eight patients had mediastinoscopy for staging lung cancer, 27 patients had mediastinoscopy to diagnose isolated mediastinal lymphadenopathy, and 17 patients had mediastinoscopy for an undetermined lung parenchymal mass. Among the patients with isolated mediastinal lymphadenopathy, sarcoidosis was diagnosed in 6, tuberculosis in 9, reactive lymph nodes in 4, metastasis in 5 and lymphoma in 3. Lymph node metastasis (N2, N3) was found in 5 patients with lung cancer. There was no surgical-related mortality or morbidity. Conclusions: Mediastinoscopy is a safe and reliable procedure in diagnosing mediastinal diseases and is still the first choice among the investigative modalities in the clinical staging of bronchogenic carcinoma.
Minimally Invasive Mediastinal Parathyroidectomy: An Effective and Safe Technique in Patients with Ectopic Primary Hyperparathyroidism  [PDF]
Iskander Al-Githmi
Open Journal of Thoracic Surgery (OJTS) , 2017, DOI: 10.4236/ojts.2017.74010
Abstract: Introduction: Primary hyperparathyroidism is a disease commonly caused by a single parathyroid adenoma in 80% - 85% of cases, and is less frequently caused by parathyroid hyperplasia. In approximately 2% of cases, the ectopic parathyroid adenoma is located within the mediastinum. Safely targeted parathyroidectomy is the gold standard procedure for surgical management of primary hyperparathyroidism. We reviewed our surgical experience using video-assisted thoracic surgery and a robotic technique for surgical resection of mediastinal parathyroid adenoma, caused by primary hyperparathyroidism. Materials and Methods: From July 2010 to September 2016, six consecutive patients with symptomatic primary hyperparathyroidism were evaluated with neck ultrasound computed tomography (CT), technetium-99 sestamibi scintigraphy, and selective venous sampling with a measurement of parathyroid hormone levels. Four patients underwent video-assisted thoracic parathyroidectomy and two patients had robotic-assisted parathyroidectomy. Results:? In six patients, there were four women and two men with a mean age of 47.5 years (ranging from 31 - 60 years). The mediastinal parathyroid adenomas were successfully localized by preoperative imaging studies in five patients. Only in one patient, we were unable to localize the parathyroid adenoma. All parathyroid adenomas were successfully resected without any complications. Conclusions: We found that minimally invasive mediastinal parathyroidectomy is promising, safe, and effective
Uniportal Video-Assisted Thoracoscopic Surgery and Outcomes for Recurrent Primary Spontaneous Pneumothorax: Single-Institution Experience  [PDF]
Iskander Al-Githmi
Surgical Science (SS) , 2018, DOI: 10.4236/ss.2018.93013
Abstract: Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the treatment of primary spontaneous pneumothorax. Strong evidence suggests that Uniportal VATS procedures are technically feasible and safe with excellent outcomes comparable to conventional VATS approach. Objectives: This article aims to discuss our experience with uniportal thoracoscopic approach as a valuable option in patients with recurrent spontaneous pneumothorax. Study Design: A retrospective study analysis between January 2014 and December 2016. Materials and Methods: From January 2014 to December 2016, 22 consecutive patients with unilateral recurrent spontaneous pneumothorax were to undergo uniportal video-assisted thoracic surgery (uniportal VATS). Their chronic residual postoperative pain, hospital stay and recurrence rate were analyzed. Results: Twenty-two patients with unilateral recurrent spontaneous pneumothorax were included; all received uniportal video-assisted thoracic surgery (uniportal VATS) and mechanical pleurodesis. Conclusions: We conclude that uniportal video-assisted thoracic surgery (uniportal VATS) demonstrated benefits to patients with primary spontaneous pneumothorax a safe, effective and also faster recovery, and decreased postoperative pain and short hospital stay.
A Note on Standard Goal Programming with Fuzzy Hierarchies: A Sequential Approach  [PDF]
Maged George Iskander
American Journal of Operations Research (AJOR) , 2016, DOI: 10.4236/ajor.2016.61009
Abstract:

In the paper [Standard goal programming with fuzzy hierarchies: a sequential approach, Soft Computing, First online: 22 March 2015], it has been assumed that the normalized deviations should lie between zero and one. In some cases, this assumption may not be valid. Therefore, additional constraints must be incorporated into the model to ensure that the normalized deviations should not exceed one. This modification is illustrated by the given numerical example.

Tacit Knowledge Generation and Inter-Organizational Memory Development in a Supply Chain Context
Iskander Zouaghi
Journal of Systemics, Cybernetics and Informatics , 2011,
Abstract: In recent years, particular attention has been paid to knowledge management and organizational learning in general and tacit knowledge management and organizational memory in particular. This interest is driven by saturation of various markets, innovation speed and increasingly uncertain environments that have led companies to organize and structure themselves as parts of supply chains, by focusing on their core competencies and outsourcing non value-added and less strategic activities. Developing distinctive competencies under such circumstances comes from tacit knowledge learning, creation and memorization. In this paper, we first analyze tacit knowledge from different perspectives; we show how individuals and organizations can learn from tacit knowledge and how they also create new relational and collaborative tacit knowledge from individual, organizational and inter-organizational learning. We then explore how this knowledge can be capitalized into inter-organizational memory which is independent of individuals and organizations within the supply chain.
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