Medicine and Health Sciences Commons^™

An Algorithm To Prevent Missed Bowel Injuries In Blunt And Penetrating Abdominal Trauma Patients, Ashley Clement, Logan Gold, Lance Stuke, Patrick Greiffenstein, Jonathan Schoen, John Hunt, Alan Marr, Monique St. Romain, Alison Smith

Medical Student Research Poster Symposium

Background: Bowel injuries from trauma require immediate recognition and operative intervention. Missed bowel result in significant morbidity and mortality such as infection, enterocutaneous fistulas, additional surgeries, prolonged hospitalization, and mortality. Clinical and diagnostic expertise are limited as significant blunt bowel and/or mesenteric injuries can be evasive to detect with current imaging modalities, and physical exam findings can be unreliable. Current guidelines for the management of patients with a possible bowel injury do not offer clear direction. Objective: The objective of this study was to develop decision-making algorithms to identify patients at high risk for missed bowel injuries. Methods: A retrospective …

Local Control Of Pyoderma Gangrenosum, Cameron J. Fontenot, Mark A. Maier, Nicholas Taylor, Alison A. Smith, Frank Lau

Medical Student Research Poster Symposium

Background: Pyoderma gangrenosum (PG) is a rare, non-infectious neutrophilic dermatosis that presents as painful, ulcerative, non-healing wounds. Pathergy, defined as hyperreactivity of the skin following minor trauma, is one of the hallmarks of PG. Currently, there is no consensus involving the diagnosis, treatment, and management of PG. A recent case report demonstrated that the use of a dehydrated human amnion/chorion membrane (dHACM) following surgical debridement in a single patient promoted wound healing. However, the physiologic mechanism underlying the effects of PG wound treatment with dHACM remains unknown. Objective: The objective of this study is to characterize and compare PG wounds …

Medical Therapy And Sinus Surgery For The Treatment Of Chronic Rhinosinusitis: Indications For Louisiana Medicaid, Hayden J. Guidry, Sanket Dhruva, Rita Redberg

Medical Student Research Poster Symposium

Background: Chronic rhinosinusitis (CRS) is common and incurs a significant human and economic cost. CRS is defined as symptomatic inflammation of the paranasal sinuses and nasal cavities lasting longer than 12 weeks. Treatments include medical therapy such as saline irrigation, nasal corticosteroids, oral antibiotics, biologics, and other agents as well as procedures such as balloon ostial dilation and functional endoscopic sinus surgery (FESS). In an analysis of Louisiana Medicaid’s expenditures for calendar year 2019, there were 1,102 distinct recipients of sinus surgery (either balloon ostial dilation or FESS) for a total of $2,382,366 in professional services expenditures. Objective: This study …

Prospective Observational Registry Study Of Myriad™ Matrix And Myriad™ Morcells In Soft Tissue Reconstruction, Tyler Hernandez, Cameron Fontenot, Cayley Leblanc, Paige Deville, Frank Lau, Alison Smith

Medical Student Research Poster Symposium

Soft tissue reconstruction is a procedure that is fundamental to the practice of surgery. Due to the paramount importance of soft tissue repair, the need to improve this procedure through the use of modernized technologies is ever-present. Myriad Matrix is an intact extracellular matrix (ECM) that is available in a 3-layer or a 5-layer configuration. It is derived from ovine (sheep) forestomach tissue and retains the innate biological structure of the native ECM-associated macromolecules, including elastin, fibronectin, glycosaminoglycans, and laminin. When rehydrated with wound exudate or sterile saline, Myriad Matrix transforms into a malleable and compliant sheet that naturally incorporates …

Risk Of Malignancy Following Radiofrequency Ablation Of Thyroid Nodules, Peter P. Issa, M Omar, C P. Issa, Y Buti, M Hussein, M Aboueisha, A Abdelhady, M Shama, G S. Lee, E Toraih, Emad Kandil

Medical Student Research Poster Symposium

Radiofrequency ablation (RFA) is a safe and effective treatment of symptomatic benign thyroid nodules. However, some publications have cautioned against the use of RFA in Bethesda III, IV, and V thyroid nodules due to risk of developing follicular thyroid cancer. Unfortunately, these studies lack in statistical power due to small sample size. We aim to investigate the pathological changes following RFA of Bethesda III, IV, and V thyroid nodules. Patients treated by RFA with pre-operative and post-operative fine needle aspiration (FNA) were included. Nondiagnostic nodules were subsequently subjected to ThyGeNEXT and ThyraMIR testing. The FNA results following RFA were compared …

Solid Organ Pseudoaneurysms In Patients With High-Grade Traumatic Injuries: A Case Series, Shivani Jain, Harrison Travis, Meredyth Berard, Alexis Scheurermann, Alison A. Smith

Medical Student Research Poster Symposium

Objectives: Blunt abdominal trauma affects 25% of all patients admitted with traumatic injuries. Although relatively rare (occurring in 2-10% of cases of solid organ injury), the development of solid organ (splenic, hepatic, or renal) pseudoaneurysms (PSA), particularly after initial imaging, can pose a significant threat to patients. If untreated, these PSAs may rupture and lead to lifethreatening hemorrhage. Despite this risk, the use of follow-up imaging after initial CT for blunt abdominal trauma remains controversial and has not been widely embraced. This case series shares experiences at two hospitals, a level 1 and level 2 trauma center, with 47 cases …

Neurologic Outcomes Of Vasopressor Use In Patients With Traumatic Spine Cord Injury, Zohaib Lakhani, Brock Lingle, Ina Du, Emily Noel, Alison Smith

Medical Student Research Poster Symposium

The incidence of spinal cord injury is approximately 54 cases per million persons in the United States, with motor vehicle collisions and falls representing the primary etiologies. The National Spinal Cord Injury Statistical Center (NSCISC) defines traumatic spinal cord injury (TSCI) as a lesion within the spinal cord and cauda equina with any sensory or motor deficit following traumatic injury. Management of TSCI involves early spinal stabilization and immobilization, pharmacologic cord protection, and surgical cord decompression if needed. Adequate spinal cord perfusion is necessary for appropriate healing and repair of injury, as well as to prevent further ischemia. The current …

Interhospital Transfers Do Not Affect Outcomes Of Necrotizing Soft Tissue Infections, Casey Landreneau, Rachel Saravia, Sarah Stobbs, Jonathan Schoen, Alison Smith

Medical Student Research Poster Symposium

BACKGROUND: Necrotizing soft tissue infection (NSTI) is a rapidly progressive disease with high morbidity and mortality that requires extensive care and multifaceted rehabilitation typically found at a tertiary facility. However, many patients initially present to smaller outside hospitals with less resources and require inter-hospital transfer during their treatment. OBJECTIVE: The aim of in this study was to further characterize the overall prognosis of subjects with NSTI transferred to a higher echelon of care and to determine if there is a clinical difference in outcomes based on transfer status. METHODS: We conducted a retrospective, multi-institutional review of subjects admitted for NSTI …

Impact Of Mean Arterial Blood Pressure Compliance On Neurologic Outcomein Patients With Traumatic Spinal Cord Injuries, Brock D. Lingle, Zohaib Lakhani, Emily Noel, Ina Du, Alison Smith

Medical Student Research Poster Symposium

No abstract provided.

Prehospital Tension Pneumothorax: A Retrospective Review Of Indications, Wil Plants, Elizabeth Lacy, Alison Smith

Medical Student Research Poster Symposium

Introduction: Thoracic trauma can result in the development of a pneumothorax, which is defined as a collapsed lung. Tension pneumothorax is a life-threatening condition caused by the build up of pressure around the lungs leading to obstructive shock. Needle thoracostomies, which involves the insertion of a needle into the pleural cavity to release pressure, can be used to promptly relieve a tension pneumothorax. Objective: The objective of this study was to evaluate the use of needle thoracostomies in the trauma population by prehospital medical providers. Methods: A retrospective chart review of adult trauma patients with prehospital needle thoracostomies presenting to …

Incidence Of Fat Necrosis Associated With Compromised Subdermal Plexus Of Diep Flaps For Breast Reconstruction, Aran Yoo, Jonathan Richard, Hannah Doran, Daniel J. Womac, Hugo St. Hilaire, Mark Stalder

Medical Student Research Poster Symposium

Introduction The deep inferior epigastric perforator flap (DIEP) is a major workhorse in autologous breast reconstruction. However, despite advancements in flap optimization, fat necrosis (FN) remains a problematic complication for both the patient and the surgeon, and rates are estimated to range from 6-17.4%.1 The pathophysiology of FN implicates compromised vascular supply and drainage of the flap. Anatomic studies of the blood supply to abdominal fat revealed two sources: perforating blood vessels from a deep subcutaneous plexus and the subdermal plexus.2 In certain types of reconstruction flaps may be almost completely deepithelialized, and thus the subdermal plexus incidentally compromised. The …

Management Of Anticoagulation Therapy After Craniotomy, Kierany B. Shelvin, John M. Wilson, Sarah E. Lawhon, George A. Crabill, Ellery Hayden, Olivia Gilbert, James A. Velander

Medical Student Research Poster Symposium

Introduction: In the in-patient setting, physicians routinely administer anticoagulation (AC) therapy to treat venous thromboembolism (VTE). However, AC therapy is often held in neurosurgical patients undergoing craniotomies due to the risk of intracranial hemorrhage (ICH) associated with this operation. In addition to ICH, these patients are at an increased risk for post-operative VTE. It is estimated that 50% of patients experience VTE post-craniotomy. Currently, there is no standard protocol for VTE therapy following craniotomy. This continues to challenge neurosurgeons when determining the most appropriate management of anticoagulation therapy after craniotomy to simultaneously mitigate the risks of ICH and VTE. Purpose: …

Enzymatic Disaggregation Is Superior To Mechanical De-Epithelialization In Preparation Of Cutis Grafts For Hernia Repair: Results Of The Cutis Ex-Vivo Graft I Study (Cute Graft I), Jeanette A. Zavala, Ian Hodgdon, John Paige, Jeff Carter, Herb A. Phelan, Michael W. Cook

Medical Student Research Poster Symposium

Introduction Biologic or synthetic mesh reinforcement is the current standard of care for abdominal hernia repairs but remains prohibitively expensive and can increase healthcare costs by over 100,000 USD per complication. The use of autologous cutis grafts (full thickness skin grafts with the epidermis removed) are a cost-effective solution. However, the process of mechanical de-epithelialization can be physically demanding, time consuming, and result in discrepancies between patients due to differences in skin pigment, with darker pigments being easier to de-epithelialize. To facilitate this process, we proposed the use of enzymatic disaggregation. In this study, we compare the effectiveness of mechanical …

Use Of Viscoelastic Testing In Trauma Patients, Nicolas Chanes, Shyam Murali, Eric Winter, Madhu Subramanian, Allyson Hynes, Mark Seamon, Jeremy Cannon, Alison Smith

Medical Student Research Poster Symposium

Background: Coagulopathic trauma patients are at a three-fold higher risk of death compared to noncoagulopathic patients. However, identification and targeted treatment of coagulopathy is still being researched. Thromboelastography (TEG) may allow us to not only identify these patients, but also provide optimal transfusion to reverse coagulopathy. Methods: This was a secondary analysis of a multicenter retrospective review, which included adult patients receiving massive transfusion protocol. A numerical “TEG score” was calculated for each patient based on abnormalities in TEG alpha angle (<65 >degrees), clot time (>8.9 min), and clot strength (<55 >mm). Each abnormal value was assigned a point …

Severity Of Chronic Venous Insufficiency On Primary Total Knee Arthroplasty Outcomes, Tanner Reed, Eden Gallegos, Berje Shammassian, Alan Marr, Lance Stuke, Patrick Greiffenstein, Jonathan Schoen, John P. Hunt, Alison Smith

Medical Student Research Poster Symposium

Current screening guidelines for intoxicated trauma patients favor the routine use of cervicalspine (c-spine) CT scans. The objective of this study was to identify parameters that predispose intoxicated trauma patients to c-spine injuries in order to refine diagnostic imaging utilization. A retrospective chart review of intoxicated adult trauma patients involved in motor vehicle collisions presenting to a Level I trauma center from March 2020-September 2021 was performed. Baseline demographics, protective devices, and Injury Severity Score (ISS) were assessed in patients with c-spine fractures or nerve root damage, diagnosed by clinical examination and imaging, compared to patients without injuries. Univariate and …

Small Bowel, Appendix, And Conduit Fistula Formation After Ileal Conduit Urinary Diversion., Shivangi Bhatt, Gina Rooker, Kyle Schuyler

Tower Health Research Day

No abstract provided.

Podium Presentation: Opioid Use Among Total Knee Arthroplasty Patients, Kelsie Welle, Karen Colorafi, Kenn Daratha

2022 Providence Nurse Research Conference

No abstract provided.

Will Apfel Score Awareness Among Caregivers Improve Postoperative Nausea And Vomiting (Ponv) Incidence And Management In Day Surgery?, Leni Alejo, Cherry De Guia, Cassandra Luck-Bird, Cynthia Rodriguez, Lilibeth Paloso, Gillian Ramirez, Deborah Graham

2022 Providence Nurse Research Conference

Background: Evidence supports Apfel Simplified Risk Score (SRS) as being effective in predicting postoperative nausea and vomiting (PONV) in patients following general anesthesia. Raising awareness of a person’s risk for PONV allows for prescription of antiemetics based on the Apfel SRS. Clinical Practice Guidelines (CPGs) for the management of PONV highlight first identifying patients’ risk to better manage anesthesia side effects. A team of nurses working in a tertiary hospital in Texas led a project using the Apfel SRS to improve PONV management.

Purpose: To raise awareness of patients' PONV risk perioperatively to improve patient outcomes of PONV events, prophylactic …

Identifying Skin Integrity Issues In The Post Anesthesia Care Unit: A Qualitative Improvement Project, Lori Patten

2022 Providence Nurse Research Conference

No abstract provided.

Rate Of Intraoperative Proximal Femoral Fractures With Automated Broaching, Tyler Radack, Hope Skibicki, Julian Zangrilli, Ruchir Nanavati, Cole Kleinman, Michael Harrer

Rowan-Virtua Research Day

Intraoperative proximal femur fractures (PFF) occur in 3.7% of total hip arthroplasties (THA) using the standard mallet broaching technique and increase a patient’s risk of revision surgery from 3.4% to 10%. The Depuy KINCISE automatic broaching system is designed to attenuate the risk of these fractures by applying consistent co-linear force to the broach. The aim of this study is to determine if the KINCISE system decreases the rate of intraoperative PFF fracture during THA compared to the standard mallet technique.

The Utilization Of Osteoarticular Transfer System In The Treatment Of Distal Femur Osteoid Osteoma: A Case Report, Nikki A. Doerr, Efstratios A. Papadelis, Alec S. Kellish, Matthew T. Kleiner, Christina Gutowski

Rowan-Virtua Research Day

We describe a technique for excision of subchondral epiphyseal bone lesions in the distal femur in skeletally immature patients that mitigates risk of complications associated with physeal injury, incomplete tumor resection, and iatrogenic injury to the overlying cartilage.

The Impact Of Racial Disparities And Outcomes On Urinary Anastomotic Leak In Radical Prostatectomy, Young Son, Benjamin A. Fink, Lance Earnshaw, Brian Thomas, Fred Okoye, Ryan Moriarty, Kathryn Goettle, Thomas Mueller

Rowan-Virtua Research Day

Prostate cancer is the leading malignancy and third most common cause of cancer death among men. In the United States, racial disparities exist in prostate cancer incidence and mortality rates. According to the National Cancer Institute, African American (AA) men have a significantly increased incidence of prostate cancer compared to Caucasians or Asians. Urinary leak at the urethrovesical anastomosis has been cited as a complication of radical prostatectomy (RP), with incidence rates as high as 23%. Urinary anastomotic leak is associated with increased rates of ileus, prolonged hospitalization rates, and longer time to achieve continence. The etiology of risk factors …

Appendiceal Diverticulum Masquerading As Acute Appendicitis, Aesha Patel, Asad Abbas, Ratul Bhattacharyya, Dana Galaktionova

Rowan-Virtua Research Day

Appendiceal diverticula present as rare clinical findings and are most often confused with acute appendicitis due to similar presentation. The incidence in such cases is reported at a rate no greater than 1%.

We present a rare case of a 65-year-old female treated for acute appendicitis who was instead found to have acute sequelae of appendiceal diverticulosis.

Latarjet Surgery Leads To Decreased Rates Of Subjective Instability Compared To Bankart Repair With Concomitant Remplissage, Joshua Spada, Ryan W. Paul, Manoj Reddy, Gabriel Onor, John Hayden Sonnier, Ari Clements, Meghan E. Bishop, Brandon J. Erickson

Rowan-Virtua Research Day

Background: Predictive factors for performing remplissage concomitantly with arthroscopic Bankart repair include the presence of humeral or glenoid defects >11% and/or revision surgery. International and societal consensus statements support these findings, as surgeons recommend the Latarjet procedure for patients with significant glenoid bone loss (>15-20%) while remplissage is recommended for patients with off-track or engaging Hill-Sachs lesions without significant glenoid bone loss. While several studies have compared outcomes between Latarjet surgery and remplissage, these studies have only evaluated patients with engaging Hill-Sachs lesions, not consecutive patient cohorts indicated for each surgery.

Purpose: To compare rates of recurrent instability, re-operation, …

Celiac Artery Aneurysm: A Rare Cause Of Abdominal Pain, Duwayne Campbell, Wayne Tamaska, Kevin Dwyer

Rowan-Virtua Research Day

Celiac artery aneurysm is a very rare vascular lesion accounting for only 5.1% of all splanchnic artery aneurysms. Etiology for celiac artery aneurysm includes, but not limited to, infectious diseases, atherosclerosis, trauma, congenital conditions such as median arcuate ligament syndrome and iatrogenic causes.

Etiology for abdominal pain is extensive. Patients should be evaluated for both intra-abdominal and extra-abdominal causes for pain, as presentations of a different pathophysiology vary widely. CT scan has become a mainstay part of the work for abdominal pain in the Emergency department, and often elicit pathologies that would otherwise be missed on blood work and other …

Extragonadal Perirectal Mature Cystic Teratoma In The Adult Male, Pranamaya Mahankali, Liam Trimble, Diana Panciera, Hui Li, Thaer Obaid

Rowan-Virtua Research Day

A teratoma is a mass that originates from the germ cells of the three primitive embryonic layers and commonly arises from the ovaries or testicles, thereby characterized as gonadal in origin. These masses comprise different types of tissues such as fat, hair, muscle, and bone. Extragonadal teratomas are uncommon and arise from anatomical locations other than the gonads, such as the pineal gland, anterior mediastinum, retroperitoneum, and sacrococcygeal regions. The most common is the presacral region, as it contains tissue derived from all germ layers. Tumors in this specific location are far more common in neonates, infants, and children rather …

Perforating Gastric/Duodenal Ulcer Development Following Roux-En-Y Gastric Bypass Surgery: A Case Series, Sugosh Anur, Michael A. Coscia Iii, Louis Balsama

Rowan-Virtua Research Day

Roux-en-Y gastric bypass is a well-studied procedure resulting in long term weight loss. Due to countless years of study, the morbidity and mortality associated with a Roux en Y gastric bypass has been greatly decreased. However, there are still several rare, yet serious, complications that may arise in the post-operative period. Anastomotic leaks and ulcers are just two of those complications. We describe a case of a 41 year old female developing postoperative perforated duodenal ulcer. A laparoscopic repair was performed using a Graham patch technique. This review aims to identify factors contributing to the ulcer development as well as …

Complications Of Fitz-Hugh-Curtis Syndrome In A Teenage Female: A Case Presentation, Marina Cugliari, Trupti Pandit

Rowan-Virtua Research Day

Fitz-Hugh-Curtis Syndrome is a manifestation of Pelvic Inflammatory Disease (PID) associated with Chlamydia trachomatis infections and less frequently with Neisseria gonorrhea.

PID affects sexually active women (15-30 years old) and accounts for 750,000 cases each year.

The case presented illustrates a female who presented with a small bowel obstruction and appendicitis, who was incidentally found to have Fitz-Hugh-Curtis Syndrome on laparoscopic exam.

Lung Hernia: An Uncommon Cause Of Pleuritic Chest Pain, Brittany Fera

Rowan-Virtua Research Day

Lung hernia is a rare but important consideration in the differential diagnosis of chest pain in patients with recent thoracic trauma or a history of thoracic surgery. Patients who undergo an anterior approach to thoracotomy, as was the case with our patient, are at a higher risk for developing lung herniation as a result of inherent anatomical weakness and wider intercostal spaces anteriorly and inferiorly.

A Rare Case Of Acute Appendicitis In A 21-Year-Old Male With Midsternal Chest Pain, Muhammad Noman, James Espinosa, Alan Lucerna, Andrew Caravello

Rowan-Virtua Research Day

Acute appendicitis is inflammation of the vestigial vermiform appendix. It is one of the leading causes of emergency department visits due to abdominal pain. The vermiform appendix is located at the base of cecum. The attachment does not change; however the tip may migrate to the retrocecal, subcecal, preileal, postileal and pelvic positions. Considering these normal anatomical positions, the pain presentation may vary in patients.

Even though this patient presented with midsternal chest pain, which was suspicious for GERD, it was crucial to perform a thorough head-to-toe exam to discover incidental findings that the patient did not report. In this …