Medicine and Health Sciences Commons^™

When Plasticity Becomes Pathological: Sequential Decreases In Basolateral Amygdala Response To Threat Cues Predict Failure To Recover From Ptsd, Alyssa Roeckner, Esther Lin, Rebecca Hinrichs, Nathaniel G. Harnett, Lauren A M. Lebois, Sanne J H Van Rooij, Timothy D. Ely, Tanja Jovanovic, Vishnu P. Murty, Robert A. Swor

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No abstract provided.

Disentangling Sex Differences In Ptsd Risk Factors: A Systematic Overview And Multiple Mediation Analysis The The Aurora Study, Stephanie Haering, Antonia V. Seligowski, Sarah Linnstaedt, Vasiliki Michopoulos, Stacey L. House, Francesca Beaudoin, Xinming An, Thomas C. Neylan, Gari Clifford, Robert A. Swor

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No abstract provided.

Rethinking Resilience Using The R-Factor: Neurobiological Mechanisms Of Static And Dynamic Components Of Resilience Following Trauma, Sanne Van Rooij, Justin Santos, Cecilia A. Hinojosa, Timothy Ely, Nathaniel Harnett, Vishnu P. Murty, Lauren Lebois, Tanja Jovanovic, Stacey House, Robert A. Swor

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Resilience is a dynamic process of recovery after trauma, but in most studies it is conceptualized as the absence of specific psychopathology following trauma. Using the large emergency department AURORA study (n=1,865, 63% women), we took a longitudinal, dynamic and transdiagnostic approach to define a static resilience (r) factor, that could explain >50% of variance in mental wellbeing 6-months following trauma, and a dynamic r-factor, which represented recovery from initial symptoms. We assessed its neurobiological profile across threat, inhibition, and reward processes using fMRI collected 2-weeks post-trauma. Our neuroimaging results suggest that resilience is promoted by activation of higher-level cognitive …

Pilot Study Of The Association Between Microbiome And The Development Of Adverse Posttraumatic Neuropsychiatric Sequelae After Traumatic Stress Exposure, Abigail L. Zeamer, Marie-Claire Salive, Xinming An, Stacey L. House, Francesca L. Beaudoin, Jennifer S. Stevens, Donglin Zeng, Thomas C. Neylan, Gari D. Clifford, Robert A. Swor

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Background Patients exposed to trauma often experience high rates of adverse post-traumatic neuropsychiatric sequelae (APNS). The biologic mechanisms promoting APNS are currently unknown, but the microbiota-gut-brain axis offers an avenue to understanding mechanisms as well as possibilities for intervention. Microbiome composition at the time of trauma exposure has been poorly examined regarding neuropsychiatric outcomes. We aimed to determine whether baseline the gut microbiomes of trauma-exposed emergency department patients who later develop APNS have dysfunctional gut microbiome profiles and discover potential associated mechanisms.

Methods We performed metagenomic analysis on stool samples (n=51) from a subset of adults enrolled in the Advancing …

Correction Of Velopharyngeal Insufficiency Secondary To Palatal Gunshot Wound: Case Presentation And Review Of The Literature, Rogelio Martinez-Wagner, Cristopher Cardenas-Cruz, Ivan Ortiz-Monasterio, Edgar Vargas, Maria M. Cabrera, Pablo A. Ysunza, M. Del Carmen Pamplona, Diane E. Campos-Lopez

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Reconstruction of midfacial traumatic defects secondary to a gunshot wound (GSW) is one of the most challenging head surgeries. The high impact on the functional and aesthetic quality of life, and the small margin of error to achieve a successful outcome are significant hurdles in the surgical treatment of these cases. Here we report a 33-years old patient who suffered a GSW with an entrance wound penetrating between the soft and hard palate and an exit wound on the right malar region. A description of the case and a systematic review of the literature were conducted. The treatment depends on …

Roundtable Discussion: 68-Year-Old Man With Mhspc, Jason M. Hafron

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No abstract provided.

Case Discussion: 66-Year-Old Man With Low-Volume Prostate Cancer, Jason M. Hafron

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An interview with Michigan Institute of Urology's Doctor Jason M. Hafron is presented. He presents a case of a 66-year-old male with low-volume prostate cancer to discuss his possible prognosis and the risk group he should be categorized. He explains his preferred approach to treat the patient like ordering a bone scan, computed tomography (CT) of the chest, abdomen and pelvis, and germline testing. He recommends some treatments for metastatic castration-sensitive prostate cancer (CSPC).

Surgical Treatment Of Multiple Deforming Xanthomas Of The Foot And Ankle With Complete Excision And Rotational Skin Flaps: A Case Report, Qanita Ali, Rachelle Randall, Lawrence M. Fallat

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Xanthomas are cholesterol rich nodular dermal lesions characterized by lipid-laden macrophages that accumulate in skin and tendons.1 These lesions are frequently associated with hyperlipidemia disorders characterized by impaired cholesterol metabolism and accelerated atherosclerotic plaque development.2 Until recently, xanthomas were considered mere cosmetic lesions, however extensive evidence has shown that the presence of xanthomas signify increased cardiovascular risk and reduced average lifespan.3 Treatment centers around lipid lowering agents and rarely are these masses large enough to require surgical resection, thus there is very little literature discussing proper surgical excision.4, 5 We present a rare case of a 65 year old female …

A Case Series Of Three Patients With Rare Pantalar Dislocation, Marissa Mogavero, Andrew Robitaille, Lawrence M. Fallat

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Total talar dislocations are rare, significant surgical challenges for foot and ankle surgeons. These dislocations can be very difficult to manually close-reduce, requiring immediate surgical intervention secondary to arterial impingement, pain and risk of skin necrosis attributable to skin tenting. In this case series, we report on three patients who presented to the emergency room following a traumatic ankle injury. Ankle radiographs and computed tomography (CT) scans were obtained, revealing pantalar dislocations. Closed reduction utilizing Charnley’s principles was attempted in the emergency room through manual accentuation of the deformity, traction and reduction. Closed reduction was unsuccessful in all three patients …

What Is Meaningful Participation For Physical Therapists In Multidisciplinary Cancer Conferences And Tumor Boards?, Stacy Weber, Athena A. Manzino, Christopher M. Wilson, Nicole D. Booms

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Tumor boards are multidisciplinary team meetings composed of providers from different specialties who collaborate to provide comprehensive cancer care. Although the term “tumor board” may be used commonly in practice, these meetings are often referred to as multidisciplinary cancer conferences (MCCs) within the literature and are referred to as such in this article. At this time, there is no current literature describing the role of physical therapists (PTs) and rehabilitation professionals as part of the MCC or multidisciplinary tumor boards. Yet, PTs are often included as part of this multidisciplinary team in cancer care. This inclusion has not completely shifted …

Tibiotalocalcaneal Fusion With Bulk Femoral Head Allograft In A Patient With A Rare, Trauma Induced, Rigid, Cavovarus Foot Deformity, Josh Carroll, Joseph Wolf, Lawrence M. Fallat

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Tibiotalocalcaneal (TTC) arthrodesis with bulk femoral head allograft is a commonly performed limb salvage procedure when dealing with complex deformity. However, little has been reported in patients who receive tibiotalocalcaneal arthrodesis with femoral head allografts for a rigid cavovarus foot type. The purpose of this case report was to examine the outcomes of a tibiotalocalcaneal arthrodesis with a femoral head allograft in a diabetic patient with a trauma induced rigid cavovarus deformity who had complete lateral dislocation of the talar body. The secondary purpose was to highlight the preservation of limb length in the surgical extremity when utilizing a tibiotalocalcaneal …

A Rare Benign Soft-Tissue Chondroma In The Plantar Foot: A Case Report, Ashley Mariano, Lawrence M. Fallat

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Extraskeletal chondromas are rare, benign cartilaginous neoplasms that are usually found in adults and often present as a slow growing solitary mass. We present a case of a 78-year-old male who initially presented with a painful hyperkeratotic lesion to the plantar aspect of his right foot resembling a porokeratosis. He noted increased pain when bearing weight. Initial radiographs revealed no osseous pathology, bone spurs or foreign bodies that correlated with the area of pain. Due to failed conservative treatment that consisted of regular debridement, surgical excision of the lesion was performed which revealed a large underlying hard nodule. The nodular …

What You Need To Know About Em Administration Fellowships, Michael Muradian

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No abstract provided.

Vitamin B12 Deficiency In Nitrous Oxide Abuse, Colby Jones, Jordan Verlare, Reehan Ali

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33yo F presents to ED with numbness & tingling in hands, feet for 10 days. History of recreational drug use, including nitrous oxide 'whippets.' Unremarkable Head CT was obtained.

Impact Of Urgent Care Centers And Telehealth In The Ed, Javed Osmani, Michael Muradian, Christina Brown, Nicholas Stark

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No abstract provided.

Re: Safety, Tolerability, And Efficacy Of Liris 400 Mg In Women With Interstitial Cystitis/Bladder Pain Syndrome With Or Without Hunner Lesions, R Evans, A Kohan, R Moldwin, D Radecki, T Geib, K M. Peters

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Editorial Comment: The lidocaine-releasing intravesical system (LiRIS) is a passive, nonresorbable intravesical system inserted cystoscopically and designed to provide continuous, controlled release of lidocaine into the bladder over a 2-week period, after which it is removed. There was a positive anticipation that this treatment system might provide symptomatic relief for at least a segment of patients with interstitial cystitis/bladder pain syndrome (IC/BPS), based on the logic of the rationale and from results in 2 small studies, 1 of which was presented at the American Urological Association annual meeting in 2016,1 showing positive results in patients with Hunner lesions (HL). This …

Direct Oral Anticoagulants For Stroke Prevention In Patients With Atrial Fibrillation And Bioprosthetic Heart Valves, Vardhmaan Jain, Kirtipa Bhatia, Devika Aggarwal, Agam Bansal, Bharat Narasimhan, Michael J. Hendrickson, Sameer Arora, Michael J. Ricciardi, Arman Qamar

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No abstract provided.

A New Pediatric Monteggia Fracture Type 4 Variant, Ehab S. Saleh

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Introduction: Monteggia fracture-dislocations are rare and complex injuries that usually involve a fracture of the proximal ulna associated with a proximal radioulnar and radiocapitellar joint dislocations. These injuries comprise

Going Off The Deep End - The Life And Controversies Of Henry Heimlich, Md, Bradford L. Walters, Matthew Drogowski

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No abstract provided.

Allogenic Fibular Bone Graft Reconstruction With Complete Regeneration Of The Lateral Malleolus After En Bloc Resection Of A Distal Fibular Aneurysmal Bone Cyst: A Case Report, Kalli E. Mortenson, Lawrence M. Fallat

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Aneurysmal bone cysts are expansile lytic lesions that most commonly affect the metaphysis of long tubular bones. These lesions are locally aggressive and predominately occur within the first two decades of life. Currently the most widely used surgical treatment involves intralesional curettage of the affected bone. However, there have been several reports of high recurrence rates with this technique. We present a case of a 12 year old female who presented with an aneurysmal bone cyst of the lateral malleolus of the right ankle. The patient underwent multiple surgeries and ultimately had complete surgical resection of the cystic lesion and …

When We Know Better, We Do Better: Maintaining And Retrieving Advance Directive Documents In The Electronic Health Record, Linda Caurdy-Bess, Sara Damiano, Amy Fresch, Marilyn Begle, Srikala Yedavally-Yellayi, Hany A. Eraqi, Ali H. Mahmood

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LEARNING OBJECTIVES: 1. Define and understand the value of an advance care planning system approach at a large health system. 2. Learn how to evaluate the rate and quality of advance directive documents uploaded in the EHR. 3. Gain practical skills to leverage stakeholder engagement and resource development to enhance an advanced care planning system approach.

A Rare Case Of Jejunal Perforation Due To Post-Transplant Lymphoproliferative Disease 27 Years After Liver Transplant, Marcos Rosado, Thomas Serena, Zophia Martinez, Erich Schwartz, Harris Mainster

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Post-transplant lymphoproliferative disease (PTLD) is a well-known post-transplant malignancy common in both solid organ and stem cell transplants. The incidence of PTLD in adult liver transplant recipients is approximately 2.8%. While most often presenting in the first year after transplant, PTLD can occur at any time. This case report narrates a 61-year-old female with a history of liver transplant in 1992 for autoimmune hepatitis that was found to have a jejunal perforation due to PTLD 27 years later. The patient presented to the hospital with a fifteen hour history of left sided abdominal pain that was progressively worsening. The patient …

Identifying Predictors Of Peripheral Intravenous Catheter Failure Using A Novel Combination Of Clinical And Ultrasonographic Assessments, Amit Bahl, Steven Johnson, Nicholas Mielke, Patrick Karabon

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No abstract provided.

Improved Walk Test Performance And Blood Pressure Responses In Men And Women Completing Cardiac Rehabilitation: Implications Regarding Exercise Trainability, Felipe Araya-Ramirez, Jose Moncada-Jimenez, Peter W. Grandjean, Barry A. Franklin

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Purpose. To evaluate changes in walk test performance and blood pressure (BP) responses following a 12-week exercise-based outpatient cardiac rehabilitation (CR) program. Methods. Six-Minute Walk Test (6MWT) and resting systolic BP (SBP), diastolic BP (DBP), post-6MWT heart rate (HR), and post-6MWT BPs were measured before and after CR in 311 (237 men,74 women) patients. Using age as a covariate, 2 by 2 (Gender × Measurement) ANCOVAs were used to determine differences in 6MWT performance and hemodynamic variables. Results. After adjusting for age, men covered a greater 6MWT distance than women; pre-CR versus post-CR program values are as follows: men, 429.3 …

Self-Expanding Metal Stent (Sems) Placement To Treat Bleeding From Late Radiation Esophagitis, Inayat Gill, Bana Antonios, Zaid Imam, Gahad Ghaith

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Radiation esophagitis is a serious complication occurring in patients receiving radiotherapy for head and neck cancers. Current treatment with proton pump inhibitors and mucosal protectants provides symptomatic relief with few studies showing improvement in erosive esophagitis or ulceration. Use of self-expandable metal stents (SEMS) in cases of erosive radiation esophagitis refractory to medical therapy has not been studied. We report a case of a patient presenting with recurrent hematemesis from late (chronic) radiation esophagitis with bleeding esophageal ulceration successfully treated with SEMS placement after failure of conservative medical management, proposing a possible utility for SEMS in this setting.

Treatment-Resistant Hypercalcemia From Ectopic Pth Hypersecretion Suspected Secondary To Disseminated Ovarian Cancer, Alexander M. Balinski, Neil J. Khatter, Jeffrey M. Gold, Krishna S. Pothugunta, Vamshi K. Garlapaty, Steven M. Rankin, Christopher A. Thornburn, Jamal Abu-Khaled

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Hypercalcemia of malignancy (HCM) can present secondary to hypersecretion of parathyroid hormone (PTH)-related protein (PTHrP) from malignant tumors, but rare cases of HCM have also been documented due to inappropriate PTH secretion from ectopic neoplasms. Here, we report an unusual case of HCM due to hypersecretion of PTH suspected secondary to a disseminated mucinous ovarian adenocarcinoma. A 45-year-old female presented with severe hypercalcemia and significant elevations in both PTH and PTHrP two weeks after total abdominal hysterectomy with bilateral salpingo-oophorectomy and suboptimal debulking of a newly discovered left ovarian mucinous adenocarcinoma with numerous metastases. Ectopic PTH secretion was highly suspected …

Fluoroscopic Demonstration Of Thoracic Tumor Immobilization With High Frequency Percussive Ventilation, Ina M Sala, Beverly Maurer, Cristian Solano, Ronald Levitin, Thomas M Guerrero

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Purpose: The purpose of this first-in-man study is to directly measure thoracic tumor immobilization by high frequency percussive ventilation (HFPV).

Methods: In an IRB approved protocol (IRB # 2017-046) we screened patients with conspicuous lung tumors that exhibited motion >10 mm to undergo kV fluoroscopy with HFPV. Two sets of consecutive AP (anterior posterior) fluoroscopy frames were acquired during multiple breathing cycles for free- and HFPV- breathing. All images were acquired using our kV source/panel of the therapeutic linear accelerator. Percussions were delivered via the intrapulmonary percussive ventilation device (IPV-2C) and phasitron (Percussionaire Corp., Sagle, Idaho). The baseline settings for …

Recording Of Endoscopy And Fluoroscopy Of The Vocal Tract With Sound (Or Its Absence): A Disappointment, Robert J Shprintzen, Pablo Antonio Ysunza

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There is an old say: “The devil knows more for being old than for being the devil”. One of the advantages of being old and observing clinical practice and clinical research advance is that successful procedures and methods can be selected and put into practice. Indeed, it is possible to define when practices we thought could be used by our peers simply by being reported in the literature have proven to be doubtful hopes that leave us trying to find out what went wrong. Such is the case with imaging procedures of the vocal tract during speech tasks.

Association Of Metabolomic Biomarkers With Sleeve Gastrectomy Weight Loss Outcomes, Wendy Miller, Kathryn Ziegler, Stewart Graham, Michael Maddens, Matthew Sims

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Background: Factors influencing weight loss variability following sleeve gastrectomy (SG) are not well understood. We evaluated the correlation of metabolomic biomarkers with weight loss outcomes. Methods: This prospective study evaluated the metabolomic profile of feces and serum prior to SG and three months post-SG, along with weight loss outcomes at three months post-SG (N=45). Serum and fecal samples were quantitatively profiled using a combination of 1H NMR and DI-LC-MS/MS (AbsoluteIDQ P180 kit (Biocrates, Innsbruck)). Results: Percent total weight loss (%TWL) for the lowest versus the highest weight loss tertiles (T1 vs T3) was 11.1 + 0.8% and 17.0 + 1.3%, …

A Reference Data Set For Image Registration Of The Pelvis Using Combinatorial Rigid Registration Optimization (Corro)., Afua A Yorke, David Solis Jr, Thoas Guerrero

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Purpose Clinical image pairs provide the most realistic test data for image registration evaluation. However, the optimal registration is unknown. Using combinatorial rigid registration optimization (CORRO) we demonstrate a method to estimate the optimal alignment for rigid-registration of clinical image pairs.

Methods Expert selected landmark pairs were selected for each CT/CBCT image pair for six cases representing head and neck, thoracic, and pelvic anatomic regions. Combination subsets of a k number of landmark pairs (k-combination set) were generated without repeat to form a large set of k-combination sets (k-set) for k = 4,8,12. The rigid transformation between the image pairs …