Medicine and Health Sciences Commons^™

Relaxation Thyroplasty – A Classical Surgical Approach For Puberphonia, Balasubramanian Thiagarajan, Karthikeyan Arjunan

Balasubramanian Thiagarajan

Abstract: The persistence of adolescent voice even after puberty in the absence of organic cause is known as puberphonia. 1,2,3 The condition is commonly seen in males.1-7 . This case report illustrates a novel surgical method “Retrusion thyroplasty” in the management of puberphonia. Introduction: The persistence of adolescent voice even after puberty in the absence of organic cause is known as puberphonia. 1,2,3 The condition is commonly seen in males.1-7 Normally adolescent males undergo voice changes due to sudden increase in length of vocal cords due to enlargement of thyroid prominence (Adam’s apple). This is uncommon in females because their …

Successful Management Of Severe Liver Failure On Venoarterial Extracorporeal Membrane Oxygenation Using Molecular Adsorbent Recirculating Systeme., Shigeki Tabata, Nicholas Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

A 49-year-old female with Adriamycin induced cardiomyopathy presented with decompensated biventricular congestive heart failure. Despite multiple Inotropes, the patient’s hemodynamics deteriorated and she underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) placement as a bridge to decision. Pre-ECMO workup showed liver dysfunction with elevated total bilirubin of 5.9 mg/dl, normal liver enzymes and liver ultrasound image. Tentative diagnosis of “end-stage liver failure” was made without a biopsy.

Shortly after initiation of ECMO, the patient developed massive hemoptysis which was successfully managed with continuation of ECMO and ventilator management. [i] The patient’s total bilirubin continued to increase to peak of 56 mg/dl on …

A 'Snip' In Time: What Is The Best Age To Circumcise?, Brian J. Morris, Jake H. Waskett, Joya Banerjee, Richard G. Wamai, Aaron A. R. Tobian, Ronald H. Gray, Stefan A. Bailis, Robert C. Bailey, Jeffrey D. Klausner, Robin J. Willcourt, Daniel T. Halperin, Thomas E. Wiswell, Adrian Mindel

Richard G. Wamai

Background Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves. Discussion We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant …

Quantitative, Spectrally-Resolved Intraoperative Fluorescence Imaging, Pablo A. Valdés, Frederic Leblond, Valerie L. Jacobs, Brian C. Wilson, Keith D. Paulsen, David W. Roberts

Dartmouth Scholarship

Intraoperative visual fluorescence imaging (vFI) has emerged as a promising aid to surgical guidance, but does not fully exploit the potential of the fluorescent agents that are currently available. Here, we introduce a quantitative fluorescence imaging (qFI) approach that converts spectrally-resolved data into images of absolute fluorophore concentration pixel-by-pixel across the surgical field of view (FOV). The resulting estimates are linear, accurate, and precise relative to true values, and spectral decomposition of multiple fluorophores is also achieved. Experiments with protoporphyrin IX in a glioma rodent model demonstrate in vivo quantitative and spectrally-resolved fluorescence imaging of infiltrating tumor margins for the …

Prevention Of Infection In Pin Sites, Sarah Pelletier, Audrey Stearns, Victoria Smith

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

External fixation is a term describing skeletal apparatuses that attach to wire or pins that penetrate the bone, used for complex fractures and limb deformity. 11-100% of patients with external fixation develop some sort of infection. The purpose of this study is to determine whether the measures taken to prevent infection are effective.

Successful Management Of Bleeding Complications In Patients Supported With Extracorporeal Membrane Oxygenation With Primary Respiratory Failure., K Lamb, Sw Cowan, N Evans, H Pitcher, T Moritz, M Lazar, H Hirose, Nc Cavarocchi

Department of Cancer Biology Faculty Papers

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure in patients with severe respiratory insufficiency failing conventional support. Bleeding complications are common due to the necessity for anticoagulation and circuit-related factors. METHODS: A retrospective review was conducted in patients requiring ECMO for respiratory failure from 7/2010 to 6/2011 to identify episodes of major bleeding, bleeding management and outcomes. RESULTS: Twenty-one patients were supported with ECMO during the study although five experienced massive bleeding related to chest tube insertion, jejunal arterio-venous malformations, distal perfusion cannula dislodgement and ventricular rupture. Patients required aggressive resuscitation or endoscopic or operative intervention, totaling 28 procedures. …

Parenthood With Exposure To Mycophenolic Acid Products, Sophia M. Termimi, Megan Clary, Lisa Coscia, Carolyn Mcgrory, Vincent T. Armenti

Department of Surgery Faculty Papers

Successful pregnancy outcomes have been reported in all solid-organ transplant recipients on a variety of immunosuppressive medication regimes. In October 2007, the FDA pregnancy category of mycophenolic acid products (MPA) was changed from category C to D, based on registry and post-marketing data which revealed a higher incidence of spontaneous abortions and structural birth defects. The purpose of this abstract is to describe pregnancy outcomes with exposure to MPA and pregnancies fathered by male transplant recipients conceived while taking MPA. Data were collected by the National Transportation Pregnancy Registry (NTPR) via questionnaires, telephone interview and medical records. There were 152 …

Early Adoption Of Transoral Robotic Surgical Program: Preliminary Outcomes., David Cognetti, Adam Luginbuhl, Anthony L. Nguyen, Joseph Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: The objective of this study is to demonstrate the feasibility and safety of establishing a transoral robotic surgical (TORS) program in the post-Food and Drug Administration (FDA) approval setting. Early outcomes are compared with the previously reported results of pioneering centers.

STUDY DESIGN: Clinical data from a prospective TORS study.

SETTING: Academic university institution.

SUBJECTS AND METHODS: Sixty-one patients treated with 63 TORS procedures. Main outcome measures: intraoperative times, margin status, complications, time to diet, and percutaneous endoscopic gastrostomy (PEG) tube retention rate. The authors also report oncologic outcomes on their first 30 patients.

RESULTS: The spectrum of subsites …

Obstructive Sleep Apnea And The Effects Of Co-Existing Factors On Pacu Stay Time, Shari F. Jones Phd, Crna

Dissertations

Significance/Background: Obstructive Sleep Apnea (OSA) is the most common disturbance during sleep affecting 30% of the population. The occurrence of moderate/severe OSA is 11.4% in men and 4.7% in women. OSA is caused by repetitive partial or complete obstruction of the upper airway with apnea episodes. OSA is prevalent in western society, yet is frequently undiagnosed due to lack of knowledge of the disorder. This population presents a challenge during the peri-operative period due to increased risk for several complications. Of particular interest to Nurse Anesthetists, are respiratory complications that result in delayed emergence from anesthesia, delayed post-operative recovery, increased …

Volume 1 (2012), Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Periodontal Resident Self-Assessment Of Ergonomics Before And After Videotaped Surgeries, Corin Marantz

Theses and Dissertations

Objective: To examine whether self-assessment of videotaped surgeries helps improve periodontal residents’ ergonomics. Methods: Residents (n=8) provided self-assessments of their own ergonomics while performing periodontal surgery using a questionnaire with open and closed items. Results were analyzed using quantitative and qualitative means. Results: Comparison of responses resulted in a change between Pre-video Surgery 1 and PSV1 (p<0.05) and between the three occasions for flat foot and horizontal shoulder positions (p<0.05). Resident goals were most numerous for improving positions of shoulder, back and neck and most notable responses for failure to achieve goals were the need for surgical access and being too focused the procedure. Conclusions: Videotape review is a valid means of self-assessment. Intervention solely in the form of a questionnaire and videotape review was insufficient in its ability to change the residents’ ergonomics. Barriers to implementation of proper ergonomics were identified.

Exploring The Unique Characteristics Of Cancer In Adolescents And Young Adults In Tennessee, Megan Quinn

Electronic Theses and Dissertations

Adolescents and Young Adults (AYAs) ages 15-39 years with cancer have received little attention in the medical and health fields, resulting in a lack of progress for this age group. Little is known about the unique biologic, epidemiologic, and psychosocial issues that play an integral role in the AYA cancer journey. The purposes of this study were to use the Tennessee Cancer Registry for all new cancer cases from 2004-2008 to determine 1) the main types of cancer that affect AYAs in TN, 2) the predictors of late-stage diagnosis of melanoma, and 3) the factors that predict a total thyroidectomy …

Spatial Frequency Domain Tomography Of Protoporphyrin Ix Fluorescence In Preclinical Glioma Models, Soren D. Konecky, Chris M. Owen, Tyler Rice, Pablo A. ValdéS, Chris M. Owen, Pablo A. Valdes, David W. Roberts, Kolbein Kolste, Frederic Leblond, Keith D. Paulsen, Brian C. Wilson

Dartmouth Scholarship

Multifrequency (0 to 0.3  mm−1), multiwavelength (633, 680, 720, 800, and 820 nm) spatial frequency domain imaging (SFDI) of 5-aminolevulinic acid-induced protoporphyrin IX (PpIX) was used to recover absorption, scattering, and fluorescence properties of glioblastoma multiforme spheroids in tissue-simulating phantoms and in vivo in a mouse model. Three-dimensional tomographic reconstructions of the frequency-dependent remitted light localized the depths of the spheroids within 500 μm, and the total amount of PpIX in the reconstructed images was constant to within 30% when spheroid depth was varied. In vivo tumor-to-normal contrast was greater than ∼ 1.5 in reduced scattering coefficient for all wavelengths …

Mitogen Activated Protein Kinase Phosphatase-1 Prevents The Development Of Tactile Sensitivity In A Rodent Model Of Neuropathic Pain, Christian Ndong, Russell P. Landry, Joyce A. Deleo, Edgar A. Romero-Sandoval

Dartmouth Scholarship

Neuropathic pain due to nerve injury is one of the most difficult types of pain to treat. Following peripheral nerve injury, neuronal and glial plastic changes contribute to central sensitization and perpetuation of mechanical hypersensitivity in rodents. The mitogen activated protein kinase (MAPK) family is pivotal in this spinal cord plasticity. MAPK phosphatases (MKPs) limit inflammatory processes by dephosphorylating MAPKs. For example, MKP-1 preferentially dephosphorylates p-p38. Since spinal p-p38 is pivotal for the development of chronic hypersensitivity in rodent models of pain, and p-p38 inhibitors have shown clinical potential in acute and chronic pain patients, we hypothesize that induction of …

Heterotopic Ossification: Cellular Basis, Symptoms, And Treatment, Brian Wolfe

Senior Honors Theses

Heterotopic ossification (HO) is the process by which calcified bone develops in soft tissues. Because of the abnormal calcification, complications such as bone deformation, loss of range of motion, and joint immobility adversely affect patients. There are many genetic types of heterotopic ossification, namely fibrodysplasia ossificans progressiva, progressive osseous heteroplasia, and Albright hereditary osteodystrophy. However, this condition can also arise from surgery, burns, or traumatic injuries, so it is seen as an important area for research in the future. There are various treatments available such as non-steroidal anti-inflammatory drugs and radiation therapy, as well as combinations of the two. The …

Surgical Delay For Hip Fracture Clients And The Use Of Clopidogrel: An Integrative Review, Phoebe Genevieve Waller

Senior Honors Theses

Abstract

Hip fractures in elderly patients have very high postoperative mortality rates and the number of hip fractures in the United States is expected to increase exponentially before 2030. Early surgery is essential to improve outcomes, but patients on clopidogrel (Plavix) have a high risk for increased bleeding if surgery is performed within the usual 72 hour window. This paper presents literature and research addressing the dangers of delaying surgery versus undergoing surgery before the effects of the clopidogrel are gone. Based on articles published after 2006, most researchers advocated earlier surgical intervention than previously recommended and emphasized an individualized …

She’S A Survivor: Post-Operative Counseling And Its Importance To The Recovery Of A Woman Victimized By Female Genital Mutilation, Jacent Wamala

McNair Poster Presentations

The prevalence of Female Genital Mutilation and the difficulty in preventing its practice call for a fresh way of resolving the problem. As the availability of medical professionals equipped with the ability to correct clitoral mutilation grows, there is also an increasing need for professionals that can help the victims after the reconstructive surgery. Post-operative therapy for victims that have opted to receive reconstructive surgery is necessary in order to fully recover. Furthermore, more research in this area is needed to support the findings of this review and will fill the physical and emotional gap exhibited in prior studies related …

Trends In Total Laryngectomy In The Era Of Organ Preservation: A Population- Based Study, Patrick Tate Maddox, Louise Davies

Public Health Resources

Objective. To describe time trends in total laryngectomy health services utilization across the United States, such as rates of surgery, cost, length of stay, and insurance payer, and to compare this to important milestones in recommendations for laryngeal cancer treatment.

Study Design. Population-based cohort study

Setting. Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) 1997-2008: stratified sample of all US hospital discharges.

Subjects and Methods. All patients with the principal procedure of complete laryngectomy. The unit of analysis was the discharge.

Results. Between 1997 and 2008, the number of laryngectomies done in the United States …

Right Diaphragmatic Lipoma: Report Of Five Cases And Review Of The Literature, Yener Aydin, Mustafa Esat Yamaç, Ali̇ Bi̇lal Ulaş, Habi̇b Bi̇len, Ati̇la Eroğlu

Turkish Journal of Medical Sciences

Approximately 40 diaphragmatic lipoma cases have been reported in the literature to date. Diaphragmatic lipoma is 2 times more likely to appear on the left rather than the right side. In the present study, diaphragmatic lipoma was evaluated in patients who underwent surgical management in light of the literature data. Materials and methods: This study retrospectively evaluated 5 consecutive diaphragmatic lipoma patients who underwent surgical treatment at the Thoracic Surgery Clinic between January 2003 and April 2012. Results: Of the patients, 3 were female and 2 were male. The average age of the patients was 62.2 years (range: 54-77). All …

Understanding Stress In The Operating Room: A Step Toward Improving The Work Environment, Robert V. Topp, Jill Berger, Anthony Vowels

College of Nursing Faculty Research and Publications

Job-related stress is an important factor predicting staff satisfaction and position turnover among nursing staff, particularly in the operating room. The purpose of this study was to examine the perceived amount of stress elicited by events in the perioperative environment, the frequency of those events, and the impact of those events on the perceived stress of operating room nurses (ORNs) and operating room technologists (ORTs). The Survey on Stress in the OR instrument, which was used to query the subjects, exhibited high internal consistency of all items. The findings indicated that the ORNs and the ORTs exhibited remarkable similarities between …