Medicine and Health Sciences Commons^™

16th Annual Pancreatic Cancer And Related Diseases Patient Symposium, Charles Yeo, Md, Facs, Adam C. Mueller, Md, Phd, Harish Lavu, Md, Facs, Theresa Yeo, Phd, Aochp, Acnp-Bc, Faanp, Avinoam Nevler, Md, Daniel Lin, Md, Msc, Wilbur Bowne, Md, Ira Sharp, Md

Pancreatic Cancer & Related Diseases Symposium

On November 13, 2021, Charles J. Yeo, MD, FACS, and the multidisciplinary team of clinicians and scientists hosted the 16th Annual Pancreatic Cancer & Related Diseases Symposium.

The video of the event is available here: vimeo.com/646517712/36786afe68.

View our Pancreatic Cancer Program 2021 Update to learn more about Dr. Yeo and the team’s great work!

PROGRAM

Welcome and Program Overview
Charles J. Yeo, MD, FACS
Samuel D. Gross Professor and Chair of Surgery

Advances in FT in Treating Pancreatic Cancer
Adam Mueller, MD, PhD
Instructor, Radiation Oncology

KRAS Mutation Allele Frequency Impacts Prognosis in Pancreatic Ductal Adenocarcinoma Using Next-Generation Sequencing …

Pre-Injury Positive Toxicology Trauma Patient Cohort Analysis Undergoing Surgicalstabilization Of Rib Fractures, Francisco J. Gomez Ortiz, Patrick Greiffenstein

Medical Student Research Poster Symposium

Background: It is commonly known that alcohol and drug abuse predispose trauma patients to clinical management challenges and worse clinical outcomes. The aim of our study was to assess the effects of pre-injury tox-positivity on outcomes from surgical stabilization of rib fracture (SSRF) on trauma patients. Our hypothesis is that patients with a pre-injury positive toxicology status will have more complications and worse clinical outcomes. Methods: This is a retrospective study using the trauma registry at our Level 1 trauma center examining patients who underwent SSRF between Jan 2016 and Jan 2021. Of the 87 patients who underwent SSRF, we …

Comparison Of Regenerative Limb Salvage To Flap-Based Reconstruction Of Complexextremity Wounds: A Randomized Control Trial, Ryan D. Hoffman, Denise Danos, Ann Mckendrick, Frank Lau

Medical Student Research Poster Symposium

Introduction Complex extremity wounds present unique challenges to the reconstructive surgeon. Flap- based limb salvage (fLS) is the standard of care for achieving durable coverage of exposed bone and tendon, but this approach is resource intensive. An alternative technique is regenerative limb salvage (rLS) using dehydrated human amnion/chorion membrane (dHCAM). We previously reported successful rLS case series in adults and children. The goal of this study was to compare rLS to fLS in a multi-centered, prospective, randomized controlled trial (RCT) with a crossover option upon reconstructive failure. Methods Between 2016 and 2018, 48 subjects with complex wounds of the extremities …

Sarcopenia In Lower Extremity Reconstruction, Ryan Hoffman, Suma Maddox, Patrick Palines, Denise Danos, Daniel Womac, Charles Tuggle, Mark Stalder

Medical Student Research Poster Symposium

Introduction: Sarcopenia is linked to poor outcomes throughout the surgical literature and can be assessed on preoperative imaging to potentially aid in risk stratification. This study examined the effects of sarcopenia on surgical morbidity following lower extremity (LE) reconstruction, and also compared two methods of assessment, one of which is novel (“ellipse method”). Methods: A retrospective cohort study of fifty patients receiving free flap-based reconstruction of the LE was performed. Bilateral psoas density and area were quantified at L4 through tracing (“traditional method”) and encircling (“ellipse method”) to calculate Hounsfield Unit average calculation (HUAC). Logistic regression and ROC analysis for …

Utilizing Quantitative Covid-19 Serological Testing To Assess Pathophysiologicalimportance Of Complement Activation In Disease Severity, Shivani Jain, Harrison Travis, Meredyth Berard, Alexis Scheurermann, Alison A. Smith

Medical Student Research Poster Symposium

Background. COVID-19, the clinical syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to cause high disease burden in the world. Not enough is known about immunological mechanisms driving COVID-19 disease severity in patients hospitalized in the ICU compared to those who test positive but do not develop severe disease. Extreme activation of the immune system has been linked to disease course complications in COVID-19. The complement system plays a key role in the innate immune response, and it has previously been suggested that it may be driving these disease complications. Immunoglobulin G (IgG) activates the classical complement …

The Effect Of Hernia Size On Length Of Stay And Outcomes In Roboticventral Hernia Repair, Yasmeen Kawji, Leslie Son, Karl Leblanc

Medical Student Research Poster Symposium

Hernia repairs are common procedures that have been performed laparoscopically for many years. However, the Federal Drug Administration approved the Intuitive Surgical robot for use in hernia repair surgeries in 2014. Since then, Our Lady of the Lake’s Surgery Department in Baton Rouge has primarily adopted robotic surgery for elective surgical operations. It has become the standard surgical approach for the institution over the laparoscopic approach, particularly for ventral hernia repair. Using robotic surgery, rather than laparoscopic surgery, allows for better ergonomics in terms of greater surgical dexterity, precision, vision, and ability to close hernia defects. However, one factor that …

Has Enhanced Recovery After Surgery (Eras) Changed Opioid Prescribing Patterns Ingynecologic Surgery, Taylor Lambert, Whitney C. Sternfels, M. Brown, Andrew Chapple, Amelia Jernigan, Tara Castellano, Navya Nair

Medical Student Research Poster Symposium

Introduction: Opioid prescribing for pain management has significantly increased in the United States in the last three decades. Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that has been shown to improve patient outcomes. A component of ERAS is using a multimodal analgesia approach to pain management which emphasizes the use of opioid-sparing analgesics to achieve post-operative pain control. Though ERAS implementation has shown success in reducing inpatient opioid use, evidence in the reduction of post-discharge opioid prescribing patterns is lacking. In this study, we evaluate the effect of implementing an ERAS program on post-operative opioid …

A Prospective, Double-Blinded, Randomized Controlled Trial Of Dehydrated Humanamniotic-Chorionic Membrane For Incisional Hernia Prophylaxis, Mark A. Maier, Tanja Milosavljevic, Frank Lau

Medical Student Research Poster Symposium

Background: Patients undergoing open abdominal surgery face a 3.8 – 15% risk for developing an incisional hernia (IH). In IH, intra-abdominal contents protrude through the abdominal wall, placing patients at risk for bowel obstruction or necrosis, sepsis, and death. Herniorrhaphy is the mainstay of treatment but has a 50% failure rate at 1 year. Prevention of IH formation would reduce patient risk and healthcare cost. However, there exists no standard of care for IH prophylaxis. In a xenograft small animal model and subsequent pilot study of high- risk IH patients, dehydrated human amniotic-chorionic membrane (dHACM) significantly reduced IH formation by …

Local Control Of Pyoderma Gangrenosum, Mark A. Maier, Frank Lau, Alison Smith

Medical Student Research Poster Symposium

Background: Pyoderma gangrenosum (PG) is a rare, chronic, ulcerative disease characterized by nonhealing wounds that worsen with debridement (i.e. pathergy). Its histopathology is classically marked by neutrophil infiltration, there is often no evidence of underlying infection. No consensus exists regarding pathogenesis, diagnosis, or treatment. In a small case series, we previously showed that applying dehydrated human amniotic-chorionic membrane (dHACM) after excisional debridement allows for normal wound healing and successfully closure through skin grafting. We present a case study outlining the treatment used for PG in this trial and methodology for gene analysis. We hypothesize that biomarker identification will predict which …

Evaluation And Optimization Of Autologous Asymmetric Bilateral Breastreconstruction Techniques, Margaret Mena, Cayley Leblanc, Harel Schwartzberg, Patrick Palines, Mark Stalder

Medical Student Research Poster Symposium

Introduction: Breast reconstruction is an important part of breast cancer management and care. In autologous asymmetric bilateral breast reconstruction, the surgeon’s goal is to achieve a symmetric result despite working on two breasts with asymmetric needs. In addition, the surgeons often use different types of flaps, where a pedicle of the patient’s skin, fat, and blood supply is transferred to the breast. For example, the deep inferior epigastric perforator (DIEP) flap is a common choice for surgeons and uses the blood supply from the deep inferior epigastric artery. This use of the patient’s own tissue allows for a more natural, …

A Survey Of General Surgery Residents In The United States On Global Health Interest,Experiences, And Barriers To International Medical Work, Casey Norlin, Kaylin Beiter, Lance E. Stuke, Tommy Brown, Brett Chapman, Alan Marr, Patrick Greiffenstein, Jonathan Schoen, John P. Hunt, Alison Smith

Medical Student Research Poster Symposium

Purpose Interest in global health experiences amongst medical trainees has not been well-elucidated. No previous study has attempted to capture the number of surgical trainees engaging in these experiences, nor have residents been surveyed regarding barriers to these international experiences. The objectives of this study are to determine the number of residents who have participated in global surgery and to further understand the obstacles residents face when attempting to engage in such experiences. Methods A 24-question anonymous electronic survey was created in REDCap and distributed to General Surgery Program Directors and administrative staff as identified via the Fellowship and Residency …

Late Manifestation Of Covid-19 As Aortic Thrombus After Failure Of Multipleanticoagulation Therapies, Raj Patel, Danielle Sethi, Alykhan Lalani, Malachi Sheahan Iii

Medical Student Research Poster Symposium

The SARS-CoV-2 (COVID-19) pandemic has put a significant strain on the healthcare system, specifically in the way certain complications from this disease are managed. The current database of literature has cited the correlation between COVID-19 and thromboembolic events in the venous system but much less is known about such events in the arterial system. We present a patient with a history of COVID-19 that failed multiple anticoagulation therapies in the setting of extensive aortic and arterial thrombi. Ultimate treatment was open repair with an aortic graft. This case presentation provides clear evidence that the late sequelae of COVID-19 are unknown

Orexin Modulation Of Alcohol Brain Reward And Stress System Interactions, Tanner Reed, Eden Gallegos, Berje Shammassian, Alan Marr, Lance Stuke, Patrick Greiffenstein, Jonathan Schoen, John P. Hunt, Alison Smith

Medical Student Research Poster Symposium

Orexin neuropeptides have been implicated with modulating hunger, circadian rhythm, and reward systems in the human body. Their involvement with reward systems may offer potential clarity in piecing together the uncertain development of alcohol dependence in humans. Regarding brain circuits, the ventral tegmental area (VTA) is well characterized in its mesolimbic reward circuit with the nucleus accumbens. However, it has distinct projections onto central amygdala (CeA) neurons that are not well characterized. These are speculated to play a role in the negative affect associated with alcohol withdrawal in humans with Alcohol Use Disorder (AUD). We have previously demonstrated activation of …

The Effectiveness Of Corticosteroid Injections In The Time Leading Upto A Total Knee Arthroplasty, Sydney Sudderth, Bradley Power, Lauren Saunee, Danielle Sketchler, Jennifer Simkin

Medical Student Research Poster Symposium

Knee pain and disability associated with osteoarthritis (OA) of the knee affects up to 10% of adults above the age of 55 in the USA. Total knee arthroplasty (TKA) is the only curative procedure for knee OA. Therefore, much of the research and procedures focusing on knee OA has been aimed at pain management. Non-operative treatments include intra-articular (IA) injections of corticosteroids to reduce pain and inflammation. Although this is not a curative option, these injections can typically relieve pain for at least two weeks with some studies showing pain reduction for up to 16-24 weeks. The safety and effectiveness …

National Early Warning Score (News): Medical Surgical Unit Pilot, Electronic Hospital-Wide Roll-Out, And Unit Educational Case Studies, Leslie Farrington, Rn, Bsn, Ccrn, Mackenzie Brown, Rn, Bsn, Molly Cody, Rn, Bsn, Megan Greco, Rn, Bsn, Cecille Lamorena Bsn, Rn, Ccrn-K, Crystal Martinez, Rn, Bsn, Jacoba Walsh, Rn, Bsn, Elizabeth Winokur, Phd, Rn, Cen

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Smoke Evacuation In The Operating Room, Kristina Macalalag Salacup, Rn, Bsn, Cnor

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Perioperative Outcomes Of A Hydrocortisone Protocol After Endonasal Surgery For Pituitary Adenoma Resection, Tyler D. Alexander, Ms, Sarah Collopy, Michael Karsy, Md, Phd, Msc, Chandala Chitguppi, Md, Christopher J. Farrell, Md, James J. Evans, Md

Health Equity and Quality Improvement (HEQI) Summit

Adrenal insufficiency after transsphenoidal resection of pituitary adenoma (PA) can be seen in 1-12% of cases. In PA, the use of postoperative cortisol measurement and supplementation remains controversial. It is unclear whether postoperative cortisol supplementation has a measurable effect on improving outcomes in patients with pituitary adenoma undergoing endoscopic transsphenoidal surgery (ETS). The objective of the study was to evaluate a postoperative steroid treatment protocol in patients with PA undergoing ETS.

Perioperative Vte Chemical Prophylaxis At Jefferson Hospital: A Retrospective Review Of The Department Of Surgery, Walker Lyons, Md, Matthew Metzinger, Mba, Cphq, Tyler Grenda, Md, Craig Binney, Mba, Scott Cowan, Md

Health Equity and Quality Improvement (HEQI) Summit

Only 26.1% of patients are receiving perioperative VTE chemical prophylaxis for elective cases in the Department of Surgery

Postoperative Aspiration Pneumonia (Popna) Prevention Protocol, R. Lamm, Md, D. Pace, Md, B. Till, Md, B. Creisher, J. Curran, E. Foecke Munden, J. Williamson, Iii, S. Cowan, Md, C. Costanzo, Md, Harish Lavu, Md

Health Equity and Quality Improvement (HEQI) Summit

• Postoperative pneumonia increases morbidity, mortality, length of stay, and hospital costs up to $12,000-$40,000 per patient
• TJUH Center City ranked in the top 3rd - 4th quartile of pulmonary complications on the 2020 National Surgical Quality Improvement Program perioperative review
• ICOUGH protocol: widely accepted, standardized set of post-operative interventions to reduce pneumonia incidence
• Survey design: measure ICOUGH compliance before and after implementation of resident note checklist in EPIC

Reforming The Pre-Operative Clearance Process In The Covid-19 Era, Ritam Ghosh, Md, René Daniel, Md, Jesse Edwards, Md, Catriona Harrop, Md, Janeen Duckworth, Msn, Amy Della Penna, Msn

Health Equity and Quality Improvement (HEQI) Summit

The problem at hand was increasing cancellation rates, increasing frustration amongst physicians, and lack of communication which guided our interventions

Some of the interventions used to improve the process are:

• PAT practioners routinely checking laboratory tests after the initial visit
• PAT practioners routinely documenting addendums in medical record in order to improve transparency and medical record
• Two step verification process: residents/surgeons going through medical record and communicating to PAT practioners if clearance was not ironclad
• Consulting physicians (i.e. cardiologists) with improved communication and documentation with PAT practioners in the event of additional testing necessary prior to clearance
• PAT physicians communicate …

Infliximab As Rescue Therapy In Pediatric Severe Colitis, Kayla B. Briggs

Research Days

Background: Infliximab has been shown to be effective in achieving clinical remission in patients with ulcerative colitis (UC) refractory to conventional therapy. However, there is conflicting data in the literature regarding its effectiveness as rescue therapy in acute severe colitis. Furthermore, most studies were conducted in adults, and pediatric onset of inflammatory bowel disease (IBD) is associated with more severe disease that may be less amenable to rescue therapy.

Objectives/Goal: We reviewed our experience with pediatric severe colitis and report outcomes following attempted rescue therapy with infliximab.

Methods/Design: A retrospective review was conducted of patients with UC or indeterminate colitis …

Unique Evaluation And Management Considerations For Adolescents With Late Gynecologic And Colorectal Issues In The Setting Of Anorectal Malformations, Wendy Jo Svetanoff

Research Days

Background: Females born with anorectal malformations (ARMs) and bladder exstrophy have a greater incidence of Mullerian and genital anomalies requiring early gynecologic assessment and frequent surgical intervention. However, there is little guidance for management considerations of pubertally identified Mullerian anomalies in these patients

Objectives/Goal: We sought to assess the unique colorectal, gynecologic, and psychological issues present during the adolescent years.

Methods/Design: A retrospective review was performed of 10-25 year old female patients born with an ARM, cloaca, or exstrophy that presented to our multidisciplinary clinic between 2009 and 2019. Data abstracted included the presenting problem, history, imaging studies, psychological evaluation, …

Reconsidering Perioperative Antibiotic Use In Elective Laparoscopic Cholecystectomy, Kayla B. Briggs

Research Days

Background: As rates of antimicrobial resistance increase, the use of prophylactic perioperative antibiotics (PPA) has been questioned in cases with a low risk of surgical site infection (SSI). In laparoscopic cholecystectomy performed for biliary dyskinesia, hyperkinetic gallbladder, and gallbladder polyps, the use of PPA varies with no widely accepted practice pattern.

Objectives/Goal: We examined institutional PPA usage and SSI rates for elective laparoscopic cholecystectomy to determine if PPAs are indicated.

Methods/Design: Following IRB approval, children/2010 and 8/2020 for symptomatic cholelithiasis, biliary dyskinesia, hyperkinetic gallbladder, and/or gallbladder polyps were included. Several surgeons changed practice to selective PPA use in 2016, decreasing …

Psychosocial Factors Affecting Quality Of Life In Patients With Anorectal Malformations And Hirschsprung’S Disease – A Qualitative Systematic Review, Wendy Jo Svetanoff

Research Days

Background: While great strides have been made in surgical techniques and bowel management therapies for patients with anorectal malformations (ARM) and Hirschsprung’s disease (HSCR), little is known about psychosocial and behavioral factors that impact the quality of life at each stage of development.

Objectives/Goal: We aimed to perform a qualitative literature review to highlight the psychosocial, emotional, and behavioral themes that affect the quality of life as patients born with congenital colorectal disease.

Methods/Design: A systematic literature review of all articles published between 1980-2019 was performed in the PubMed and CINAHL databases. Inclusion criteria included articles that reported on the …

The Power Of Outpatient Botulinum Injections In Preventing Hirschsprung Associated Enterocolitis, Wendy Jo Svetanoff

Research Days

Background: Hirschsprung associated enterocolitis (HAEC) is a potentially life-threatening complication, where the child often presents with obstructive symptoms. Failure of the internal anal sphincter (IAS) to relax is thought to play a role in these symptoms. Botulinum toxin (BT) injections assist in temporarily relieving obstructive symptoms due to IAS achalasia in patients with Hirschsprung’s disease following surgical pull-through. The use of BT may play a role in preventing HAEC episodes related to IAS dysfunction.

Objectives/Goal: Our aim was to determine the effect of scheduled outpatient Botulinum injections on the development of HAEC.

Methods/Design: A retrospective review between July 2010 – …

Mini-Ace® Low-Profile Appendicostomy Button, Joseph Lopez

Research Days

Purpose: Malone antegrade continence enemas (MACE) provide a conduit in which the patient can achieve improved continence, be clean of stool, and gain independence in maintaining bowel function. The Mini-ACE® is a low-profile balloon button that is used to facilitate administration of antegrade enemas. We sought to describe our practice and short-term outcomes.

Methods: We present our experience using the Mini-ACE® at Children’s Mercy – Kansas City from April 2019 to September 2020. Patient demographics, colorectal diagnoses, tube sizes, flush regimens, patient experience and outcomes were examined.

Results: Thirty patients were included; 18 (60%) were male. The average age at …

Bar Removal Following Minimally Invasive Pectus Excavatum Repair – Does Removal At 2 Years Affect Recurrence Or Satisfaction Rates?, Wendy Jo Svetanoff

Research Days

Background: Some patients with pectus excavatum require bar removal despite having the bar in for less than three years after minimally invasive placement (MIRPE). It is unknown whether early removal is associated with a higher recurrence rate or lower cosmetic satisfaction.

Objectives/Goal: The aim of this study was to review post-operative outcomes, specifically recurrence rate, and patient satisfaction in patients who underwent bar removal prior to three years.

Methods/Design: A retrospective review was performed of patients who underwent MIRPE between October 2006 and June 2017 and had bar removal less than 3 years after repair. Demographics, reason for bar removal, …

Pre-Hospital Traumatic Cardiopulmonary Arrest In Children At A Level 1 Pediatric Trauma Center, Kayla B. Briggs

Research Days

Background: The survival of traumatic cardiopulmonary arrest (TCA) requiring pre-hospital cardiopulmonary resuscitation (P-CPR) is abysmal across age groups.

Objectives/Goal: We aim to describe the patterns of injury, pre-hospital interventions, and outcomes of children suffering from TCA leading to P-CPR at our institution to support standardized guidelines addressing the termination of prolonged resuscitation attempts in children.

Methods/Design: Following IRB approval, retrospective review was conducted to identify children ages 0-17 years who suffered TCA leading to P-CPR at our institution between 5/1/2009–3/1/2020. For analysis, patients were stratified into those still undergoing CPR at arrival and those who attained pre-hospital return of spontaneous …

Setting A Threshold For Discharge Antibiotics In Children With Perforated Appendicitis: A Study Update, Kayla B. Briggs

Research Days

Background: To address concerns of antibiotic overutilization, normal white blood cell count (WBC) for age was previous l criteria for discontinuing antibiotics at discharge in perforated appendicitis. Retrospective review suggested a decrease in threshold for additional antibiotic administration to a discharge WBC(IAA).

Objectives/Goal: The purpose of our study is to determine if lowering the threshold for additional antibiotic administration decreased the rate of IAA after laparoscopic appendectomy for perforated appendicitis in children who were not discharged with additional antibiotics.

Methods/Design: Following IRB approval, prospective data was retrospectively reviewed. Children with perforated appendicitis identified during laparoscopic appendectomy at our institution between …

Leveraging Collaboration In Pediatric Multidisciplinary Colorectal Care Using A Telehealth Platform, Joseph Lopez

Research Days

Purpose: Pediatric colorectal problems require complex multidisciplinary care. The COVID-19 health crisis has substantially shifted how this healthcare delivery can safely take place. We sought to track the characteristics of in-person (IP) and telehealth (TH) visits and subsequent satisfaction and utilization in this quality improvement project.

Methods: We present the multidisciplinary clinic experience from October 1, 2019 to August 31, 2020 in which patient volume, visit time length, patient satisfaction survey results, and frequencies of colorectal diagnoses seen before (October 1, 2019 through January 31, 2020) and during the present pandemic (February 1, 2020 through August 31, 2020). Microsoft Teams …