Medicine and Health Sciences Commons^™

Percutaneous Distal Metatarsal Mini-Invasive Osteotomy: Comparison Between Standard Vs. Modified Intraosseous Approach - A Cadaveric Study, Elijah C. Auch, Fernando S. Martins, Victoria Vivtcharenko, Eli Schmidt, Shuyuan Li, Alexandre L. Godoy-Santos, John Femino, Cesar De Cesar Netto

Conference Presentation Abstracts

BACKGROUND | The objective of this cadaveric study was to identify and compare the structures at risk of damage in standard versus modified intraosseous distal mini-invasive metatarsal osteotomy (DMMO). Our hypothesis was that the modified DMMO technique may be a safer, less complex procedure that could decrease the risk of iatrogenic injuries. METHODS | 11 thawed fresh-frozen under the knee cadaveric specimens underwent DMMO of the forefoot. The modified technique proposed by this study enters the dorsal cortex (at 45 degrees) straight through to the plantar cortex followed by cutting the lateral cortices (panels D, E, F). The standard technique …

The Altis Mid-Urethral Sling: One Surgeon's Experience With Immediate Post-Operative Adjustment, Jennifer Nguyen, Brett Friedman, Annah Vollstedt, Mireya Diaz, Ly Hoang Roberts, Larry Sirls

Conference Presentation Abstracts

Introduction: The Altis® transobturator sling uses a dynamic anchor on a pulley suture for intraoperative tension adjustment. Given the potential for over-tensioning seen with any sling, we have adopted a technique using the pulley suture that allows for sling tightening should stress urinary incontinence (SUI) persist in the immediate post-operative period or sling loosening if there is bladder outlet obstruction. Our objective is to describe our technique and rate of post-operative adjustment. Methods: In this single-surgeon experience, retrospective chart review, demographic and clinical data were collected on patients who had received the Altis® sling between 2014 and 2020. Descriptive statistics …

Concordance Between Antibiotic Resistance Genes By Multiplex Polymerase Chain Reaction And Antibiotic Susceptibility By Pooled Antibiotic Sensitivity Testing In Symptomatic Patients With Urinary Tract Infection, Annah Vollstedt, Dakun Wang, Natalie Luke, David Baunoch, Kirk J. Wojno, Howard Korman, Natalie Gaines, Shuguang Huang, S Mohammad Jafri, David Wenzler, Patrick Cacdac, Frank Burks, Larry Sirls

Conference Presentation Abstracts

Introduction: Studies have shown many genes influence antibiotic resistance, and the relationship between genotypic and phenotypic antibiotic resistance is unclear. We sought to analyze the concordance between the presence of antibiotic resistance (ABR) genes and antibiotic susceptibility results. Methods: Urine samples were collected from patients presenting with possible UTI to 37 Urology clinics from July 2018 to February 2019. Multiplex polymerase chain reaction (M-PCR) was used to test for 33 ABR genes. Pooled Antibiotic Susceptibility Testing (P-AST) was performed against 14 different antibiotics. The concordance rate between the ABR genes and P-AST results was generated. The concordance rates for each …

Metastatic Crohn's Disease: A Case Of Genital Cutaneous Crohn's Disease Involving The Penis And Scrotum, Zubin Shetty, Megen Schober

Conference Presentation Abstracts

Introduction: Crohn’s disease is an autoimmune inflammatory disorder affecting the gastrointestinal tract. Rarely, Crohn’s disease can cause cutaneous manifestations that are non-contiguous with the GI tract or “metastatic.” Genital Cutaneous Crohn’s Disease (CCD) is the most frequent presentation of CCD in the pediatric population and has shown to be difficult to manage. Case: A 13-year-old boy with a history of fistulizing Crohn’s disease presented with severe penile and scrotal edema for the previous 4 years. While his gastrointestinal symptoms were responsive to Adalimumab, his genital swelling only minimally and temporarily improved between treatments. He was referred to pediatric urology for …

Fractional Carbon Dioxide Vaginal Laser For The Treatment Of Urinary Symptoms: Preliminary Short-Term Results, Annah Vollstedt, Lauren Tennyson, Michael Rezaee, Ly Hoang Roberts, Larry Sirls, Priya Padmanabhan, Kenneth M. Peters

Conference Presentation Abstracts

Introduction: It has been proposed that fractional carbon dioxide (fCO2) vaginal laser can also treat stress urinary incontinence (SUI) by increasing collagen production. The aim of our study was to evaluate the effect of vaginal fCO2 laser therapy in patients complaining of SUI. Methods: This is a prospective, open-label study of women over 18 years old with complaints of urogenital symptoms. Women with a history of vaginal estrogen use within the last 3 months were excluded. Participants received 3 laser treatments 6 weeks apart. Cough stress test (CST) was performed at each visit. Incontinence-Quality of Life (I-QOL), Questionnaire for Urinary …

A Rare Case Of Pure N4-Acetyl-Sulfaethoxazole Nephrolithiasis Associated With Trimethoprim-Sulfamethoxazole Treatment Of Pulmonary Nocardiosis, Alexander Geisenhoff, Sugandh Shetty

Conference Presentation Abstracts

Introduction: Trimethoprim-sulfamethoxazole is a commonly used antibiotic for treatment of urinary tract infections (UTIs). It is also commonly used to treat nocardia infections. Less common are reports of nephrolithiasis consisting purely of N4-acetyl-sulfamethoxazole, the primary metabolite of trimethoprim-sulfamethoxazole. Case: A 70-year-old male with history of mantle cell lymphoma and T-cell leukemia treated with bone marrow transplant now with nocardia lung infection receiving trimethoprimsulfamethoxazole for the past 6 months who presented to the emergency room with confusion and a fall. He had no prior history of nephrolithiasis, but during hospitalization developed renal colic and was found to have obstructing right proximal …

Stimwave For Pudendal Neuralgia, Ly Hoang Roberts, Joshua Volin, Teresa Mccartney, Annah Vollstedt, Kenneth M. Peters

Conference Presentation Abstracts

Introduction: In patients with pudendal neuralgia refractory to traditional therapies, prior studies have shown efficacy in chronic stimulation with Interstim® (Medtronic, Inc., Minneapolis, MN). This study reports on a wireless system to power an implanted lead at the pudendal nerve, StimWave®, to treat pudendal neuralgia. Methods: Retrospective chart review identified patients with a lead placed at the pudendal nerve for neuralgia and powered wirelessly. Clinical outcomes were assessed at postoperative visits and phone calls. Administered non-validated follow-up questionnaire evaluated the GRA, percentage of pain improvement, satisfaction with device, and initial and current settings of the device (hours/day of stimulation). Results: …

Patient Reported Outcomes Of Urinary Incontinence Rates Using Viable Cryopreserved Umbilical Tissue Over Neurovascular Bundles During Robotic Assisted Radical Prostatectomy, Samantha Kraemer, Mit Shah, Chirag Dave, Ji Qi, Fionna Sun, Sugandh Shetty, Brian Seifman, Jason Hafron

Conference Presentation Abstracts

Introduction: Incontinence remains a side effect from robotic assisted radical prostatectomy (RAP) for prostate cancer despite nerve sparing (NS) techniques. Use of growth factors and anti-inflammatory substances over neurovascular bundles is an emerging technique to enhance recovery of continence and potency. Viable cryopreserved umbilical tissue (vCUT) is FDA approved for homologous use in surgery. The objective is to determine if vCUT use in NS-RAP accelerates return to continence. Methods: Retrospective review of 176 patients who underwent NS-RAPs from October 2015 through July 2020 were identified through the Michigan Urological Surgery Improvement Collaborative (MUSIC). Return to social urinary continence (0-1 pads …

Acute Segmental Testicular Infarction Resulting From Illicit Anabolic Steroid Use, Jacob Stephens, Frank Burks

Conference Presentation Abstracts

Introduction: Segmental testicular infarction (STI) is a rare cause of acute scrotum of unknown etiology. The diagnosis is often made by color Doppler ultrasonography (CDUS) demonstrating absent perfusion in a well-defined testicular region. Previously patients underwent surgical exploration, but currently conservative therapy is recommended. Methods: We report a case of STI related to anabolic steroid use. Results: A 44-year-old male with a history of hypertension presented to the emergency room with acute, severe right testicular pain which was unprovoked and constant. Physical exam was notable only for tenderness at the inferior right testicle. CDUS showed small bilateral hydroceles but preserved …

Multi-Institutional Outcomes Of A One-Sided Dorsal Onlay Buccal Mucosal Urethroplasty For Penile Urethral Strictures Accessed Via A Penoscrotal Incision, David Abramowitz, Felicia Balzano, Jay Simhan, Frank Burks, Dmitriy Nikolavsky, Stephen Blakely

Conference Presentation Abstracts

Introduction: Optimal surgical management of penile urethral strictures remains unclear. Herein, we report our multi-institutional series of patients undergoing a one-sided dorsal onlay buccal mucosal urethropalsty for penile urethral strictures accessed via a penoscrotal invagination technique. Methods: We retrospectively reviewed consecutively treated penile urethral stricture patients who underwent a one-sided dorsal onlay buccal mucosal urethroplasty accessed via a penoscrotal incision and penile invagination across 7 institutions. This technique is a modification of the Kulkarni invagination technique to include penoscrotal rather than perineal incision for penile strictures. Thus, allowing for supine positioning, and less dissection to reach the stricture location. Minimum …

A Unique Case Of Renal Pelvic Urothelial Carcinoma With Extensive Small Round Cell Sarcoma Differentiation Showing Swsr1 Gene Rearrangement, Zubin Shetty, Mitual Amin, Savitha Balaraman, Sugandh Shetty

Conference Presentation Abstracts

Introduction: Ewings-like sarcoma is a rare subgroup of small round cell sarcoma with immunohistochemistry and morphological similarities to Ewing Sarcoma. We report a rare case of renal pelvis invasive urothelial carcinoma with small round cell sarcoma differentiation showing EWSR1 gene rearrangement. Case: An 84-year-old male presented with 6 months of intermittent painless gross hematuria. Workup revealed a 5.4cm left renal pelvicalyceal mass suspicious for transitional cell carcinoma and a 2.5cm enhancing left renal cortical lesion. The patient underwent an uncomplicated robotic left nephroureterectomy. Pathology revealed small round cell sarcoma composing greater than 80% of the renal pelvis tumor with the …

A Comparative Analysis Of Pelvic Fracture Urethral Injury Repairs In U.S. And Third World Country Patients, Jacob Stephens, Daniel Rosenstein, Frank Burks

Conference Presentation Abstracts

Introduction: Pelvic fracture urethral injury (PFUI) often results from significant, high energy trauma such as motor vehicle accidents or crush injuries. PFUI doesn’t spare those in third-world countries who may not have access to reliable healthcare. We aim to compare outcomes of PFUI repair in the US and third-world countries. Methods: A retrospective chart review and comparative analysis were performed on patients who had a PFUI repair during international trips to Haiti and Rwanda and a cohort of US patients from 2014-2020. FNB performed all US repairs while FB and DR collaborated internationally with local urologists. Results: A total of …

A Novel Approach To Short Bulbar Urethral Strictures: Ventral Urethrotomy For A Non-Transection Excision And Primary Anastomosis, Alexander Geisenhoff, Samantha Kraemer, Frank Burks

Conference Presentation Abstracts

Introduction: Excision and primary anastomosis (EPA) has been the gold standard procedure for definitively managing short bulbar urethral strictures. A non-transecting approach was developed to help preserve proximal blood supply of the urethra. The previously described technique involves a dorsal urethrotomy and excision of the stricture without disrupting the anterior spongiosum. We describe a novel approach by performing a ventral urethrotomy leaving the posterior spongiosum intact. By not requiring urethral rotation, we believe this technique is simpler and does not compromise outcomes. Methods: Retrospective chart review was performed on 8 consecutive patients from April 2019 to February 2021 who underwent …

Pulmonary Artery Sling-An Extremely Rare Etiology Of Dysphagia, Khola Qamar, Abhinav Tiwari

Conference Presentation Abstracts

No abstract provided.

Hereditary Hemochromatosis As An Independent Risk Factor For Liver Cancer: A Matched Case-Control Study Of The National Inpatient Sample Database, Maryam Haider, Ali F. Alsbihi, Zaid Imam, Adnan Malik, Sana Iqbal, Mahum Nadeem, Ahmed J. Chaudhary

Conference Presentation Abstracts

No abstract provided.

Refractory Non-Tumor Lambert Eaton Syndrome Treated With Rituximab, Bipin Ghimire, Samiksha Pandey, Ashbina Pokharel, Emma Herrmann, Mohammad Muhsin Chisti

Conference Presentation Abstracts

With a worldwide prevalence of 3-4 per million, Lambert-Eaton syndrome is a rare entity. It often occurs as a paraneoplastic syndrome, most commonly associated with small cell lung cancer. Less frequently, it occurs as an autoimmune disease in the absence of cancer. Both entities demonstrate circulating immunoglobulins against presynaptic voltage-gated calcium channels and Electromyogram (EMG) with an increase in compound muscle action potential on repetitive stimulation. A 35-year-old female with past medical history of hypothyroidism presented with bilateral lower extremity weakness, generalized fatigue, blurry vision, and slurred speech in 2010. Upon further workup, Lambert-Eaton syndrome was diagnosed after she tested …

Diabetic Preventative Care In A Resident Clinic: A Quality Improvement Study, Karishma Chopra, Charity Owusu-Asare, Aimee Espinosa, Alexandra Halalau

Conference Presentation Abstracts

Introduction: Studies have shown significant gaps in diabetic preventative care in resident clinics compared to private clinics of practicing physicians. In our medicine-pediatrics resident clinic at Beaumont Hospital, diabetic point of care resources are largely underutilized. We aim to improve the care of patients with diabetes by increasing resident awareness of point of care A1c and retina scan resources. Methods: A team of residents, attendings, and nurses was created. Baseline data looking at use of point of care resources, specifically the number of orders placed in electronic medical record for A1c and retina scan tests, was obtained. A root cause …

Social Determinants Of Health Correlating With Mechanical Ventilation Of Covid-19 Patients; A Multi-Center Observational Study, Alexa Giovanatti, Heba Elassar, Patrick Karabon, Tracy Wunderlich-Barillas, Alexandra Halalau

Conference Presentation Abstracts

Importance: Several studies have relayed the disproportionate impact of COVID-19 on marginalized communities, however few have specifically examined the association between social determinants of health and mechanical ventilation (MV). Objective: To determine which demographics impact MV rates among COVID-19 patients. Design: This observational study included COVID-19 patient data from eight hospitals’ EMR between February 25, 2020 to December 31, 2020. Associations between demographic data and MV rates were evaluated using uni- and multivariate analyses. Setting: Multicenter (8 hospitals), largest health system in Southeast Michigan Participants: Inpatients with a positive RT-PCR for SARS-CoV-2 on nasopharyngeal swab. Exclusion criteria were missing demographic …

Massive Pulmonary Embolism After Pfizer Vaccine, Samiksha Pandey, Bipin Ghimire, Emma Herrmann, Dilip Khanal

Conference Presentation Abstracts

Introduction Vaccines against COVID -19 have been reported to cause venous thromboembolism (VTE). To our knowledge, this is the first case to report the massive, near-fatal Pulmonary Embolism (PE) associated with BNT162b2 Covid-19 (Pfizer/BioNTech) vaccine and discuss the associated risk factors for PE. Case 41-year-old, non-smoker, female on OCP, presented for syncope and seizure-like activity. Upon presentation, she was obtunded and tachypneic. Initial labs showed leukocytosis, mild anemia, and thrombocytopenia, respiratory and metabolic acidosis. She deteriorated quickly to cardiac arrest requiring Cardiopulmonary Resuscitation and intubation. Tissue Plasminogen Activator administered for possible PE. Computed Tomography Angiography (CTA) pulmonary confirmed sagittal pulmonary …

Late Onset Burkitt Post Transplant Lymphoproliferative Disorder (Ptld) Following Solid Organ Transplant, Melinda Sager, Devika Aggarwal

Conference Presentation Abstracts

Post Transplant Lymphoproliferative Disorder (PTLD) is an uncommon complication after solid organ transplant, with several different monomorphic subtypes; Burkitt Lymphoma PTLD (B-PTLD) is particularly rare and aggressive.

A 30 year old female with a history of IgA nephropathy and two renal transplants presented to the emergency room with nausea, vomiting, and diffuse abdominal distention and pain that started one week prior to presentation. CT imaging showed significant mesenteric and pelvic lymphadenopathy with moderate ascites, paracentesis was performed. Her immunosuppressive therapy was adjusted: azathioprine was held, tacrolimus was decreased for lower target level, and steroid was continued. A lymph node biopsy …

Improving Telemetry Utilization In An Inpatient Hospital Setting, Kamil Sardarli, Lauren Reinhold, Ankit Arora, Sumesh Khanal, Pradeep Kaminoulu, Alexandra Halalau

Conference Presentation Abstracts

Background: Telemetry is a cardiac monitor that continuously records heart activity and monitors abnormal rhythms. Most current clinical indications are limited to 48 hours maximum, but telemetry monitoring service (TMS) is commonly used for a greater duration. This leads to resource exploitation that may create limitations of the resource and also comes with economic burden. Limiting usage to appropriate indications and durations can reduce overall costs and improve profit margin for the hospital and also cut down on unnecessary burden for patients. Through our study, we aim to decrease TMS overuse. Methods: The study was done at Beaumont Hospital Royal …

Metronidazole Neurotoxicity--Not Your Usual Suspect, Markie Zimmer, Bana Antonios, Emma Herrmann, Ramona Berghea

Conference Presentation Abstracts

An 85-year-old female with past medical history notable for chronic lymphocytic leukemia and Stage III Merckel cell carcinoma presented to our hospital for evaluation of generalized weakness of a few weeks duration. Notably, she had a recent hospital admission for E. coli bacteremia in the setting of hepatic abscesses that underwent ultrasound guided drainage. She was discharged to inpatient rehabilitation, and ultimately home, with a planned six-week course of ceftriaxone and metronidazole, in addition to oral vancomycin for C. difficile infection. Upon readmission, she was fatigued and had progressive lower extremity weakness. She denied any bowel or bladder incontinence or …

Cost-Effectiveness Analysis Of Recombinant Zoster Vaccine For The Prevention Of Herpes Zoster In Immunocompromised Adults Diagnosed With Select Cancers In The United States, Desmond Curran, Brandon Patterson, Justin Carrico, Ahmed Salem, Elizabeth La, Stephane Lorenc, Katherine Hicks, Sara Poston, Christopher Carpenter

Conference Presentation Abstracts

Introduction / Background / Significance: Immunocompromised (IC) populations diagnosed with cancer are at increased risk for herpes zoster (HZ) due to their underlying disease and/or therapy. This risk is highest among individuals receiving hematopoietic stem cell transplant (HSCT) to treat multiple myeloma, lymphomas, or other diseases. HZ is characterized by a painful vesicular rash. IC populations with HZ are also at increased risk of developing HZ-related complications such as postherpetic neuralgia, a persistent pain that can last for months or years. This study evaluates the cost-effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in …

Stability Of The Sacral Table Angle In Pediatric Patients With Spinal Pathology, David G. Wallington, Patrick D. Albright, Alexandria I. Chrumka, Rebecca D. Funk, Dale E. Rowe, Joseph K. Weistroffer, Karen M. Bovid

Conference Presentation Abstracts

INTRODUCTION | Pelvic incidence, lumbar lordosis, and pelvisacral angle are common radiographic measures used to evaluate sagittal alignment of the spine and pelvis to assist in clinical decision making. However, the natural history of the sacral table angle (STA) is not well characterized, and there remains uncertainty regarding STA progression over time. Previous studies have established that the STA is stable over time in adult patients, however this question has not been answered for younger patients who have not reached skeletal maturity. In this study, we aim to determine sacral table angle stability over time in a younger patient population. …

Anti-Nmda-Receptor Encephalitis In A Patient With Ovarian Teratoma, Harboring Brain Histology Of Varying Developmental Stages And Regions With Chronic Inflammation, S Fatemi, E Qu, J Fullmer

Conference Presentation Abstracts

Introduction/Objective Anti-NMDA-receptor encephalitis is a subacute, autoimmune disorder thought to be caused by autoantibodies directed against the N-methyl-D-aspartate (NMDA) receptor. Clinical symptoms of anti-NMDAR encephalitis may mimic schizophrenia and psychotic spectrum disorders or substance-induced psychosis. Although initially described in association with ovarian teratomas in women, anti-NMDAR encephalitis has been reported in individuals without paraneoplastic association, as well as in males. Herein, we report a case of a 29-year-old woman with suicidal ideation and other neuropsychiatric manifestations who was found to have a right ovarian cystic mass by imaging study. Microscopically, the resected ovarian mass is composed of mature skin, fat, …

Crossfire: Controversies In Urology Debate: Prophylactic Suburethral Sling At Time Of Prolapse Sling In Era Of Mesh Controversy, Eric Scott Rovner, Alexander Gomelsky, Ariana L. Smith, Leslie Minor Rickey, Jason P. Gilleran

Conference Presentation Abstracts

No abstract provided.

How Much Time Do General Surgical Pathologists Spend On Diagnostic Data Entry?, Zhenhong Qu, Lanjin Zhang, Xianzhong Ding, Kausar Jabbar

Conference Presentation Abstracts

Context: As many pathology institutions have eliminated transcription service by office assistants, pathologists assume the task of diagnostic data entry (DDE) into pathology reports in the laboratory information system. This is not a trivial undertaking, yet tangible data are lacking on how much DDE adds to the workload of pathologists. Without such data, it is very difficult to assess the financial benefit of such a task shift and establish benchmarks. Design: Four practicing pathologists covering a general surgical pathology service in 3 institutions with different laboratory information systems were selected for their dominant DDE method (speech recognition, pre-text, or manual …

The Surgical Treatment Of Cervical Myelopathy In Patients Who Ambulate Independently, Ambulate With Assistive Devices, Or Are Wheelchair Bound: A Michigan Spine Surgery Improvement Collaborative Study, Rafid Kasir, Lonni Schultz, Richard W. Easton, Victor Chang, Jad Khalil

Conference Presentation Abstracts

We examine whether wheelchair bound patients undergoing cervical spine surgery for cervical myelopathy have improvement in patient-reported outcome measures.

Indications For A "Surgery First" Approach For The Treatment Of Lower Extremity Arterial Disease, Mohineesh Kumar, Steven D. Rimar, Graham W. Long, Diane M. Studzinski, O W. Brown

Conference Presentation Abstracts

No abstract provided.

Modulation Of The Acute Post-Anterior Cruciate Ligament Rupture Intra-Articular Environment Via Recruitment Of Marrow-Derived Stem Cells To Promote Bone Tunnel Healing In Acl Reconstruction, Kevin C. Baker, Samantha Hartner, Mackenzie M. Fleischer, Michael D. Newton, William B. Acker, Perry Altman, Christopher Bush, Tristan Maerz, Asheesh Bedi

Conference Presentation Abstracts

Acute, post-injury peripheral blood mobilization therapy with a CXCR4 antagonist improved bone tunnel healing and graft integration following ACL reconstruction surgery in a rat model.