Medicine and Health Sciences Commons^™

Comparative Effectiveness Of Endovascular Vs Surgical Arteriovenous Fistulas: A Preliminary Analysis, Melissa M. Cruz, James J. Fitzgibbon, Patrick Heindel, Mohamad Hussain

Research Symposium

Purpose: The objective of this study was to compare the efficacy and safety of endovascular arteriovenous fistula (endoAVF) creation versus open surgical AVF (openAVF) for hemodialysis access across centers participating in the Dialysis Access Learning and Innovation Collaborative (DiAL-In Collaborative) in the United States. In this preliminary analysis, we report the baseline characteristics and clinical profile of patients enrolled at a single center.

Materials and Methods: A retrospective cohort study was conducted in chronic kidney disease patients who underwent creation of an upper arm autogenous vascular access for hemodialysis (2018-2022) at the Brigham and Women’s Hospital in Boston, MA. Data …

Fragmenting Projectiles: A Case Report And Literature Review Of The G2 Radically Invasive Projectile, Matthew Bernard, Christine M. Dahlhausen, Andrew M. Kirk, Andrew Bernard

School of Medicine Publications and Presentations

Innovations in projectile design present unique challenges for trauma surgeons when treating gunshot victims. The G2 Radically Invasive Projectile (G2 Research, Winder, Georgia, USA) (G2RIP) is a frangible, rapidly expanding bullet resulting in a distinct pattern of injury consisting of diffuse hemorrhage with multicavity trauma as well as unique radiographic features of the projectile. To efficiently manage patients injured by the G2RIP, trauma surgeons must be aware of these distinct characteristics, and of previous patterns in effective management such as liberal damage control and extensive use of CT. Understanding previous presentation and management of patients injured by the G2RIP can …

Oncoplastic Nipple Sparing Mastectomy And Immediate Reconstruction In Non-Ideal Candidates, Aaron I. Dadzie, Paul Berry

Research Symposium

Background: Mastectomies have long been used as a surgical treatment for malignant and benign disorders of the breast, both as a therapy and prophylaxis in high-risk patients. A nipple-sparing mastectomy (NSM) allows for removal of most of the glandular and ductal tissues while preserving the surface architecture of the nipple-areola complex (NAC). In satisfactory surgical candidates, this procedure allows for superior aesthetic outcomes compared to other mastectomy techniques and minimizes the need for additional procedures to reconstruct the nipple. Here, we summarize the established treatment standards and suggest an expansion of the established surgical techniques and selection criteria of NSM …

From The Borders Edge To The Brink Of Death: A Case Of A Traumatic Pancreatic Injury And Whipple Procedure In The Rio Grande Valley, Valentine S. Alia, Ed W. Alvarado, Edward M. Diaz, Daniel Albo, Roger Galindo

School of Medicine Publications and Presentations

The traumatic pancreatoduodenectomy, also known as the traumatic Whipple, is a specialized surgical procedure often reserved for extreme cases in which an individual suffers traumatic injuries to the pancreas, duodenum, or periampullary structures. Traditionally, a Whipple procedure is a complex surgery involving the removal of the head of the pancreas, duodenum, and a portion of both the bile duct and stomach, for the management of pancreatic head cancer. In underserved communities where limited access to healthcare is coupled with a higher incidence of trauma, the lack of specialized and supportive care for patients suffering from pancreatic injuries may lead to …

Use Of Point Of Care Ultrasound In The Pre-Op Evaluation Of Dialysis Patients Needing Creation Of Permanent Arteriovenous Access – Preliminary Study, Urvashi Mathur, Sotero Peralta

Research Colloquium

Background: Non-invasive ultrasound evaluation is part of the preoperative evaluation of patients needing creation of arteriovenous access. This study requires patients to return for an additional visit for imaging or visit an outpatient imaging facility. These visits produce delays in surgery and increase costs in healthcare. Point of care ultrasound examination at the same time of initial physician visit, allows to decrease cost, improvement of anatomical planning, and decrease timing of surgery.

Methods: We reviewed the UTRGV Vascular Surgery Database from January to December 2020, for patients who has elective outpatient arteriovenous access creation, in which has pre-operative evaluation with …

Penile Calciphylaxis In An End Stage Renal Disease Patient., Juan Enrique Garcia Lopez, Alain Velazquez Blanco, Aileen Aguilar, Sareena Siyas, Daniel Ibarias Paz, Mays Abdulazeez, Jesus Garza-Tamez, Desmond Adamu

Research Colloquium

Background: Penile Calciphylaxis occurs in about 1–4% of hemodialysis patients worldwide. Associated mortality rates are very high, and hyperparathyroidism is the second most frequently associated disorder. Addressing the resulting metabolic imbalance, and surgical intervention guided by findings of radiological studies may improve quality of life. The pathogenesis is thought to be mediated by vascular smooth muscle cells which differentiate into osteoblast-like cells. Decrease in vascular calcification inhibitory proteins fetuin-A and matrix Gla is found in patients on dialysis causing systemic medial calcification of arterioles, leading to epidermal ischemia, tissue infarction, and ulceration.

Case presentation: 47-year-old male with history of coronary …

Diaphragmatic Rupture Due To Closed Thoracobdominal Trauma: A Case Report, Juan Rosales Martínez, Manlio F. Lara Duck, Antonio Gutiérrez Sierra, Netzahualcoyotl Mayek Pérez

Research Symposium

Background. Diaphragmatic injuries (DI) represent less than 1% of traumatic injuries; they are a marker of severe trauma due to associated injuries, although they often go undiagnosed as they remain hidden. If undetected, delayed herniation and strangulation of the abdominal organs into the chest cavity will result as the defect in the diaphragm is not repaired. DI occurs from penetrating or blunt trauma. The former occurs in approximately 67% of cases; direct injury to the diaphragm caused by automobile accidents has been reported. The remaining third is due to falls and crush injuries. Blunt trauma causes larger tears, even bilateral. …

Analyzing The Effects Of Body Mass Index In Total Hip Arthroplasty Cases. Does It Influence Patient Characteristics, Operative Planning, And Postoperative Outcomes?, Cesar A. Sevilla Jr, Vanessa Elena Lopez, Mauricio Burbano, Michael Sander

MEDI 9331 Scholarly Activities Clinical Years

Background: Total hip arthroplasty (THA) is one of the most performed orthopaedic procedures commonly used for the treatment of osteoarthritis (OA). There are several underlying factors that lead to the formation of this condition. Not only is obesity one of the main contributors, but it is also a modifiable risk factor and one of the leading causes of end-stage arthrosis of the hip. Though there have been advancements in agricultural and health technologies, rates of obesity continue to rise causing similar increases in the demands for hip replacement surgeries. Therefore, we sought to investigate the effects of BMI on …

Understanding The Burden Of Traumatic Injuries At The United States-Mexico Border: A Scoping Review Of The Literature, Benjamin A. Keller, Jeffrey Skubic, Monica Michelle Betancourt-Garcia, Romeo C. Ignacio, Jason S. Radowsky, Alan H. Tyroch, Carlos Palacio Lascano, Bellal Joseph, Collin Stewart, Aaron Silva

School of Medicine Publications and Presentations

The United States-Mexico border is the busiest land crossing in the world and faces continuously increasing numbers of undocumented border crossers. Significant barriers to crossing are present in many regions of the border, including walls, bridges, rivers, canals, and the desert, each with unique features that can cause traumatic injury. The number of patients injured attempting to cross the border is also increasing, but significant knowledge gaps regarding these injuries and their impacts remain. The purpose of this scoping literature review is to describe the current state of trauma related to the US–Mexico border to draw attention to the problem, …

Synchronous Gastrointestinal Metastatic Large Cell Neuroendocrine Tumor And Metastatic Colon Adenocarcinoma: Case Report, Hari Movva, Giri Movva, Christian Pena, Vijian Dhevan

School of Medicine Publications and Presentations

This article reports a case involving a synchronous silent metastatic rectal adenocarcinoma and metastatic large cell neuroendocrine tumor of the cecum and ascending colon. The patient presented with left sided abdominal pain and hematochezia with a noncontributory family, social, and medical history. This case presents a rare pathology not only due to the low incidence of synchronous gastrointestinal malignancies, but due to the unusual silent patient presentation.

Initial Single Surgeon Evaluation Comparing C-Arm Fluoroscopy With The Cirq Robotic Assistance Device For Instrumentation Of The Thoracolumbar Spine, Sohum K. Desai, Jennifer Adams

MEDI 9331 Scholarly Activities Clinical Years

Objective

To compare our experience with pedicle screw insertion of the thoracolumbar spine utilizing the Cirq robot assistance device compared with traditional paradigm using fluoroscopy.

Methods

We prospectively collected data of patients undergoing pedicle screw instrumentation in the thoracolumbar spine performed by a single surgeon at three different centers. One center took delivery of the Cirq robotic assistance device. Remaining two centers used C-arm fluoroscopy. Demographic information, diagnosis, total OR time, intraoperative complications, unexpected return to the operating room, and hospital readmissions within 90 days was compared between the two cohorts.

Results

A total of 166 screws were placed during …

Challenges In Closing The Gap Between Evidence And Practice: International Survey Of Institutional Surgical Stabilization Of Rib Fractures Guidelines, Jeff Choi, Avanti Badrinathan, Ryan Shine, Cecilia Benz, Alyssa Toia, Sarahann Whitbeck, Mark Kryskow, Thomas White, Jordan Kirsch

School of Medicine Publications and Presentations

Background: Surgical stabilization of rib fractures (SSRF) has gained increasing interest over the past decade, yet few candidates who could benefit from SSRF undergo operative management. We conducted an international survey of institutional SSRF guidelines comparing congruence between practice and contemporary evidence. We hypothesized that few guidelines reflect comprehensive evidence to facilitate standardized patient selection, operation, and post-operative management.

Methods: A request for institutional rib fracture guidelines was distributed from the Chest Wall Injury Society. SSRF-specific guideline contents were extracted using a priori-designed extraction sheets and compared against 28 SSRF evidence-based recommendations outlined by a panel of 14 international experts. …

Giant Gastroduodenal Duplication Cyst With Juxta-Pancreatic Communication, Jhon F. Martinez Paredes, Daniel G. Plata-Diaz, Adriana Pinilla

School of Medicine Publications and Presentations

Enteric duplication cysts are rare congenital malformations with a low incidence and there are only a few reports in the literature. Their clinical presentation varies according to the location and the type of duplication. T heir overall prognosis is good if early surgical intervention is provided. We report a 2-month-old boy who presented with a case of a giant gastroduodenal duplication cyst with a juxta-pancreatic communication and was successfully treated surgically. It is imperative to be aware of this rare congenital malformation that can present clinically with a wide range of non-specific symptoms that can cause significant morbidity and mortality …

Endoscopic Outcomes In Patients With Aerd Treated With Topical Antibiotics And Intranasal Corticosteroids, Jhon F. Martinez Paredes, Garret Choby, Michael Marino, Devyani Lal, Osarenoma Olomu, Razan Alfakir, Janalee K. Stokken, Erin O’Brien, Angela M. Donaldson

School of Medicine Publications and Presentations

Background: Identifying effective therapy for recalcitrant chronic rhinosinusitis with nasal polyposis (CRSwNP) is a major challenge; and subtypes such as aspirin-exacerbated respiratory disease (AERD) are even more difficult to treat. Evidence on topical antibiotics use in (CRSwNP) is lacking. Current consensus guidelines recommend against its routine use, but recent reviews show some benefit when managing recalcitrant disease after endoscopic sinus surgery (ESS).

Objective: Evaluate the effect of culture-directed topical antibiotics on sinonasal outcomes in AERD patients with a positive perioperative sinonasal bacterial culture who have undergone ESS.

Methods: A retrospective cohort study of AERD patients with positive sinonasal culture, who …

The Virtual Peripheral Nerve Academy: Education For The Identification And Treatment Of Peripheral Nerve Disorders, Erica B. Lee, Allison Podsednik, Kimberly Khoo, Amal Cheema, Raysa Cabrejo, Chen Shen, Joseph Rosen, A Lee Dellon

School of Medicine Publications and Presentations

Millions of people around the globe suffer peripheral nerve injuries caused by trauma and medical disorders. However, medical school curricula are profoundly deficient in peripheral nerve education. This lack of knowledge within the healthcare profession may cause inadequate patient care. We developed the Virtual Peripheral Nerve Academy (VPNA) as a reusable virtual learning environment to provide medical students with detailed education on the peripheral nervous system (PNS). Students are introduced to the PNS through virtual 3D rendering of the human body, wherein they visualize individual nerves through dissection and observe normal motor and sensory function associated with each nerve. PNS …

Combined Oral Contraceptives Bringing To Light May-Thurner Syndrome, Dina Alnabwani, Nagapratap Ganta, Smriti Kochhar, Veera Jayasree Latha Bommu, Reham Majzoub, Sharon Hechter, Priya Patel, Pramil Cheriyath

School of Medicine Publications and Presentations

May-Thurner syndrome (MTS) is a relatively uncommon clinical condition characterized by venous blockage in the left lower leg. Compression of the left common iliac vein by the right common iliac artery and the underlying vertebral body causes obstruction. We report a case of MTS with extensive venous thrombosis in a 44-year-old female who remained clinically silent until she used combined oral contraceptive pills (OCPs) for more than three years.

Endovascular Treatment Of Acute Ischemic Stroke With The Penumbra System In Routine Practice: Complete Registry Results, Osama O. Zaidat, Johanna T. Fifi, Ashish Nanda, Benjamin Atchie, Keith Woodward, Arnd Doerfler, Alejandro Tomasello, Inder Paul Singh, Wondwossen G. Tekle, Ameer E. Hassan

School of Medicine Publications and Presentations

Background and purpose: The purpose of the COMPLETE (International Acute Ischemic Stroke Registry With the Penumbra System Aspiration Including the 3D Revascularization Device) registry was to evaluate the generalizability of the safety and efficacy of the Penumbra System (Penumbra, Inc, Alameda) in a real-world setting.

Methods: COMPLETE was a global, prospective, postmarket, multicenter registry. Patients with large vessel occlusion-acute ischemic stroke who underwent mechanical thrombectomy using the Penumbra System with or without the 3D Revascularization Device as frontline approach were enrolled at 42 centers (29 United States, 13 Europe) from July 2018 to October 2019. Primary efficacy end points were …

Surgical Stabilization Versus Nonoperative Treatment For Flail And Non-Flail Rib Fracture Patterns In Patients With Traumatic Brain Injury, Jonne T. H. Prins, Esther M. M. Van Lieshout, Francis Ali-Osman, Zachary M. Bauman, Eva-Corina Caragounis, Jeff Choi, D. Benjamin Christie Iii, Peter A. Cole, William B. Devoe, Julie Whitis

School of Medicine Publications and Presentations

Purpose

Literature on outcomes after SSRF, stratified for rib fracture pattern is scarce in patients with moderate to severe traumatic brain injury (TBI; Glasgow Coma Scale ≤ 12). We hypothesized that SSRF is associated with improved outcomes as compared to nonoperative management without hampering neurological recovery in these patients.

Methods

A post hoc subgroup analysis of the multicenter, retrospective CWIS-TBI study was performed in patients with TBI and stratified by having sustained a non-flail fracture pattern or flail chest between January 1, 2012 and July 31, 2019. The primary outcome was mechanical ventilation-free days and secondary outcomes were in-hospital outcomes. …

Clinical Symptoms Contributing To Zenker's Diverticulum Repair: A Retrospective Review, Jhon F. Martinez Paredes, Razan Al Fakir, Amy L. Rutt

School of Medicine Publications and Presentations

Objective: Zenker's diverticulum (ZD) is usually associated with dysphagia and other symptoms due to the interrelated functions of several systems. Surgical management of ZD is effective for all sizes of diverticula, but not all patients decide to undergo surgery. The purpose of this study was to determine the relationship between clinical presentation and patients' decision to undergo surgical repair.

Subjects and methods: This is a retrospective study including 165 patients with ZD treated over the last 11 years. Data collection includes patients' chief complaints and symptoms, medical history, findings on radiologic swallow evaluations, and patients' decision to undergo surgery. Pearson …

Adipose Tissue Uses In Peripheral Nerve Surgery, Allison Podsednik, Raysa Cabrejo, Joseph Rosen

School of Medicine Publications and Presentations

Currently, many different techniques exist for the surgical repair of peripheral nerves. The degree of injury dictates the repair and, depending on the defect or injury of the peripheral nerve, plastic surgeons can perform nerve repairs, grafts, and transfers. All the previously listed techniques are routinely performed in human patients, but a novel addition to these peripheral nerve surgeries involves concomitant fat grafting to the repair site at the time of surgery. Fat grafting provides adipose-derived stem cells to the injury site. Though fat grafting is performed as an adjunct to some peripheral nerve surgeries, there is no clear evidence …

Candida Pericarditis Presenting With Cardiac Tamponade And Multiple Organ Failure After Combined Damage Control Thoracotomy And Laparotomy With Splenectomy In A Trauma Patient: Case Report And Review Of Literature, R. A. Siller, Jeffrey Skubic, J. L. Almeda, Adolfo E. Kaplan

School of Medicine Publications and Presentations

Candida pericarditis is a rare condition which has previously been described after cardiothoracic surgery and immunosuppressive states (Geisler et al., 1981; Eng et al., 1981; Kraus et al., 1988; Kaufman et al., 1988; Tang et al., 2009; Glower et al., 1990; Carrel et al., 1991; Rabinovici et al., 1997; Canver et al., 1998; Farjah et al., 2005; Gronemeyer et al., 1982 [1-11]). We describe the case of a 19-year-old male blunt trauma patient, who survived a damage control thoracotomy and laparotomy with splenectomy, who later developed a loculated Candida pericardial effusion, complicated with cardiac tamponade and multiple organ failure, and …

Endovascular Thrombectomy In Patients With Large Core Ischemic Stroke: A Cost-Effectiveness Analysis From The Select Study, Amrou Sarraj, Elena Pizzo, Kyriakos Lobotesis, James C. Grotta, Ameer E. Hassan, Michael G. Abraham, Spiros Blackburn, Arthur L. Day, Mark J. Dannenbaum, William Hicks

School of Medicine Publications and Presentations

Background It is unknown whether endovascular thrombectomy (EVT) is cost effective in large ischemic core infarcts.

Methods In the prospective, multicenter, cohort study of imaging selection study (SELECT), large core was defined as computed tomography (CT) ASPECTS(CTP) ischemic core volume (rCBF

Results From 361 patients enrolled in SELECT, 105 had large core on CT or CTP (EVT 62, MM 43). 19 (31%) EVT vs 6 (14%) MM patients achieved modified Rankin Scale (mRS) score 0–2 (OR 3.27, 95% CI 1.11 to 9.62, P=0.03) with a shift towards better mRS (cOR 2.12, 95% CI 1.05 to 4.31, P=0.04). Over the projected …

Intradural Extramedullary Primary Central Nervous System Melanoma Of The Craniovertebral Junction During Pregnancy: Observations And Outcomes, Fabiola Valenzuela, Sohum Desai

School of Medicine Publications and Presentations

Background: Primary central nervous system (CNS) melanoma is a rare lesion derived from neural crest precursors. While its management is analogous to metastatic spinal melanoma, the literature does not describe this entity clearly in pregnant patients and the unique implications it presents. Here, we describe the case of a pregnant patient who presented with primary CNS melanoma of the cervical spine.

Case Description: A 27-year-old pregnant patient presented with a 3-month history of neck and interscapular pain. MRI of the cervical spine demonstrated a ventral intradural extramedullary mass adjacent to the C2-C3 vertebral bodies causing severe cord compression. The patient …

Outcome After Surgical Stabilization Of Rib Fractures Versus Nonoperative Treatment In Patients With Multiple Rib Fractures And Moderate To Severe Traumatic Brain Injury (Cwis-Tbi), Jonne T. H. Prins, Esther M. M. Van Lieshout, Francis Ali-Osman, Zachary M. Bauman, Eva-Corina Caragounis, Jeff Choi, D. Benjamin Christie Iii, Peter A. Cole, William B. Devoe, Julie Whitis

School of Medicine Publications and Presentations

Background: Outcomes after surgical stabilization of rib fractures (SSRF) have not been studied in patients with multiple rib fractures and traumatic brain injury (TBI). We hypothesized that SSRF, as compared with nonoperative management, is associated with favorable outcomes in patients with TBI.

Methods: A multicenter, retrospective cohort study was performed in patients with rib fractures and TBI between January 2012 and July 2019. Patients who underwent SSRF were compared to those managed nonoperatively. The primary outcome was mechanical ventilation-free days. Secondary outcomes were intensive care unit length of stay and hospital length of stay, tracheostomy, occurrence of complications, neurologic outcome, …

Complications And Comorbidities In Hispanic Patients Who Develop Traumatic And Nontraumatic Acute Compartment Syndrome, Jorge Alejandro Bernal, Annelyn Torres-Reveron, Jose Andres Gonzales

School of Medicine Publications and Presentations

Acute compartment syndrome (ACS) is a medical emergency that remains under-recognized and understudied. This study aimed to identify risk factors for the traumatic and non-traumatic presentation of ACS within a majority Hispanic population. A four-year retrospective analysis of medical records in a single institution revealed 26 with traumatic and 21 non-traumatic patients presenting with ACS. Traumatic ACS occurred in younger males following fractures, as previously described in the field. After controlling for age differences, non-traumatic ACS occurred in older patients with multiple comorbidities, increased use of statins, and anticoagulants as compared to the traumatic ACS group. A large proportion (80%) …

The Key To Simplified Management Of An Undescended Parathyroid Adenoma [La Clave Para El Manejo Simplificado De Un Adenoma Paratiroideo No Descendido], Humberto Ruiz-Hernández, Joyce Meza-Venegas, Samuel K. Snyder

School of Medicine Publications and Presentations

Undescended parathyroid adenoma is a rare cause of primary hyperparathyroidism that happens < 1% of cases. If not suspected, it can lead to a negative bilateral parathyroid exploration and extensive iatrogenic trauma. We propose that with proper imaging the correct diagnosis can be established to simplify surgical management. We describe two cases of patients who underwent a targeted neck exploration due to an undescended parathyroid adenoma diagnosed with an appropriate preoperative imaging protocol. With an appropriate imaging protocol for primary hyperparathyroidism and parathyroid hormone aspirates, an undescended parathyroid adenoma can be primarily diagnosed to guide a focused parathyroidectomy

-

El adenoma paratiroideo no descendido ocasiona hiperparatiroidismo primario en <1% de los casos. Si no se sospecha, puede llevar a exploraciones negativas y trauma iatrogénico extenso. Proponemos que, con un protocolo imagenológico adecuado, se puede realizar un diagnóstico correcto, simplificando el abordaje quirúrgico. Describimos dos casos en que se realizó una exploración de cuello dirigida debido a un adenoma paratiroideo no descendido diagnosticado con un protocolo de imagen preoperatorio apropiado. Un protocolo de imagen apropiado para hiperparatiroidismo primario y aspirados de PTH pueden diagnosticar de manera inicial un adenoma paratiroideo no descendido para guiar una paratiroidectomía dirigida.

Intraoperative Icg-Nir Fluorescence Angiography Visualization Of Testicular Perfusion In Operations For Testicular Torsion, Colton D. Wayne, Mohammad A. Emran, Leon Smith-Harrison, P. Stephen Almond, Haroon I. Patel, Shannon Koehler

MEDI 9331 Scholarly Activities Clinical Years

Purpose: Indocyanine Green (ICG) near-infrared (NIR) fluorescence angiography is used in assessing testicular perfusion after reduction of testicular torsion to assess tissue viability.

Introduction: Determination of viability of a testicle after reduction of a testicular torsion has been performed by numerous methods including visual assessment, Doppler ultrasound, and cutting the testicular capsule. Each of these has limitations, are not always reproducible, and may involve damage to the testicle and confusion of capsular blood flow for internal perfusion. A possible alternative to these methods is the use of ICG-NIR fluorescence angiography. ICG was FDA-approved in 1959 and has been …

Meeting The Educational Needs Of An Increasingly Diverse Surgical Workforce, Minerva Angelica Romero Arenas

School of Medicine Publications and Presentations

To the Editor Yeo et al¹ evaluated factors associated with American Board of Surgery (ABS) examination pass rates in a cohort of categorical surgical residents from the internship (2007) to eligibility/certification. They found that first-time ABS pass rate was associated with nonmodifiable factors, such as nonwhite race/ethnicity, sex (women), and having children.¹ Additionally, Hispanic residents were less likely to attempt the ABS examinations at all. We must place these findings in the context of diversity in surgery, or rather, the lack thereof. The cohort included only 55 Hispanic residents, most of whom did pass the ABS examinations (n …