Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Is The Thomas Ring An Effective Approach To Prevent Recurrence Of Persistent Atrial Fibrillation With Advanced Atrial Fibrosis?, Ruifang Yang Md, Jose Luis Henao Md, David Goldgrab Do, Sokol Kalaveshi Md, Stephen Mester Md, Christian Perzanowski Md

Cardiology

Introduction | Objectives: Pulmonary vein isolation (PVI) with the Thomas ring (TR, single ring posterior wall isolation) has been shown to reduce recurrence of primarily paroxysmal atrial fibrillation (AF). Atrial fibrosis, as an important pathophysiological contributor, is directly linked to AF recurrence and resistance to therapy. The effect of TR ablation on outcomes of persistent AF (peAF) with advanced atrial fibrosis has not been adequately studied.

Methods: Observational series of three peAF patients (Tab.) who underwent TR. The degree of atrial fibrosis was determined by electroanatomic bipolar voltage mapping (CARTO, Diamond Bar, CA, USA). The reduced voltage areas (Fig.) reflected …

Flexor Tenotomy For The Treatment Of Hallux Ulcers, Nathalia Esmeral, Val E. Haddon, Chase G. Dahl, Erin Lewis, David Khakshoor

Podiatry

Aims: To assess and evaluate the relationship between flexor tenotomies in a clinical setting and the time course for healing neuropathic, diabetic and structural deformity hallux ulcers.

Methods: This retrospective study analyzes the medical files of 1,471 patients treated for digital foot ulcers by flexor tenotomies between September 2011 and January 2019. For the intent of this particular research, focus was preserved towards the effect of flexor tenotomy on healing time to address hallux ulcers. A total of 97 patients between the ages of 41 and 86 years old underwent flexor tenotomy for the treatment of hallux ulcers with a …

What Is Scannable? An Mri Safety Guide, Michael Burcescu, Ravi Patel, Robert Hessemer, Peter Lore, Sriharsha Kota, Guarav Kumar

West Florida Division GME Research Day 2020

Supernumerary MRI protocols and recommendations exist to guide physicians at the forefront of patient care. While urgent imaging may be necessary for critical patients, inadvertent imaging of implantable devices can incur serious morbidity and mortality[11]. The American College of Radiology published a 30-page manual in 2013[1] on MRI safe practices and releases yearly updates with critical information separately[2]. There is increased utilization of advanced imaging modalities, especially among academic institutions[3]. Physicians are hard pressed to maximize efficiency; uncertainty delays imaging. Moreover, inappropriate orders delay appropriate management. We present pertinent and often questioned considerations in a comprehensible format along with devices …

Impact Of Methicillin-Resistant Staphylococcus Aureus (Mrsa) Nasal Swab On Total Duration Of Mrsa Therapy For Pneumonia Patients, Darren D. Yum, Kayihura Manigaba, Danielle Gagne, Heather Ellis

Infectious Disease

Purpose: Recent literature has highlighted MRSA nasal screening as a possible antimicrobial stewardship program tool for avoiding unnecessary empiric anti-MRSA therapy for pneumonia. MRSA is an important cause of pneumonia and clinicians must determine when empiric antimicrobial therapy directed toward this pathogen is needed. Negative MRSA nasal swab has been shown to have a high negative predictive value ( >95%) across different types of pneumonia. The objective of this study is to assess the impact of negative MRSA nasal swabs on the duration of anti-MRSA therapy in a community hospital setting.

Methods: This study will be submitted to the institutional …

Using Simple Ct Perfusion To Help Identify Ictal Vs. Interictal Lateralized Periodic Discharges (Lpds): A Case Report, Michelle Nunes, Aqsa Ullah, Amna Imran, Enrique Serrano

Neurology

No abstract provided.

Evolution Of Acute Ischemic Stroke Treatment As Supported By Clinical Trials, Savya S. Shukla, Brian F. Baigorri Md, Roberto I. Fourzali Md, Yafell Serulle Md

Radiology

No abstract provided.

Standardized Reporting In Pancreatic Protocol Ct: Implementation Across 3 Community Hospitals, Jacob L. Miller, Kevin Carr, James Banks, Nisha Mani

Radiology

No abstract provided.

Rapidly Recurrent Basilar Artery Thrombosis Treated With Emergent Mechanical Thrombectomies And Stenting, Mark Cohen, Amna Imran, Ankur Garg

Neurology

Acute basilar artery thrombosis (BAT) is a life-threatening condition that can be treated by emergent mechanical thrombectomy (EMT). Recurrent acute BAT is a rare phenomenon. Here we describe a case of rapid recurrent acute BAT that was treated each time by EMT and finally by emergent basilar artery stenting with good outcome

Creutzfeldt Jakob Disease: Progressive Neurological Decline, Christine Fayad Md, Scott J. Anderson, H. Alex Akhondi Md

Internal Medicine

No abstract provided.

Availability Of Pain Medications For Npo Patients, Anna Augustin Do, Kyle Borodunovich Do, Sean Quinonez Do, Furqan Haq, My Myers Md

Family Medicine

In recent years, the opioid epidemic has been a key catalyst in changing the medical standards for treating both acute and chronic pain. Instead of relying heavily on narcotics for pain management, practitioners are not encouraged to adapt a non-pharmacologic, non-opioid approach to analgesia. While many guidelines have been set to standardize outpatient pain management, the rules surrounding inpatient analgesia are limited or lacking.

Safe And Effective Use Of A Hands-Free Intracorporeal Retractor For Suture-Based Liver Retraction During Minimally Invasive Bariatric Procedures: Results Of A Large Case Series, Roger De La Torre, Matthew Sappington, Tom Smith, Jeremy Bryner, David Mantilla, J Stephen Scott

General Surgery

Background

Laparoscopic bariatric surgery requires retraction of the left lobe of the liver to provide adequate operative view and working space. Conventional approaches utilize a mechanical retractor that requires a dedicated incision, may cause liver damage, and often requires an assistant. This study evaluated the safety and efficacy of hands-free intracorporeal retractors in a large series of subjects undergoing laparoscopic bariatric surgery. This method eliminates the need for a subxiphoid incision, enables full surgeon autonomy, and allows for adjustments throughout the procedure.

Methods

Retrospective chart review identified all subjects at a single hospital undergoing bariatric surgery between September 2017-March 2019 …

Double Pylorus: Case Report Of Atypical Presentation, Christopher Lozano Orpiano Do, Gurjeet Kang Do, Michael Quinn Do, Lakshminarasimhan Venu Md, Joseph Staffetti Md

Gastroenterology

Introduction: Double pylorus is a rare endoscopic finding that has been reported in 0.001% to 0.4% of upper gastrointestinal endoscopies, consisting of a gastroduodenal fistula extending from the prepyloric gastric antrum to the duodenal bulb through an accessory channel. In the majority of cases, it is a complication when peptic ulcers erode and create a fistula between the duodenal bulb and the distal stomach. It usually presents on the lessor curvature of the gastric antrum and on a superior wall of the duodenal bulb. It is commonly an endoscopic finding, since clinical presentation is similar to other peptic diseases.

Case …

A Novel Polyelectrolyte Multilayer Nanofilm-Based Synthetic Bioresorbable Antimicrobial Matrix Accelerated Healing Of Chronic Wounds In A Prospective Clinical Evaluation, Sarah Waterman Manning Md, David A. Humphrey, Michael J. Schurr, Eric C. Crawford, Gaurav Pranami, William Shillinglaw, Lorinda K. Baker, Michael J. Schurr

General Surgery

No abstract provided.

Size Matters: A Case Of Recurrent Proximal Esophageal Stenoses Treated With A Biliary Self Expanding Metal Stent (Sems), Sahityan Viswanathan, Timothy Dobin, Long T. Hoang

Gastroenterology

Esophageal stenosis after radiotherapy occurs in up to 15% of patients within three months of treatment. Endoscopic dilation remains the standard of care for cervical esophageal stenosis with refractory cases requiring stenting. Proximal stenosis poses a challenge as standard esophageal stents can cause cervicalgia and globus sensation due to their size and expansive force. We report on the usage of a biliary SEMS for a severe-recurrent stricture at the level of the proximal esophageal sphincter.

Not Just A Cyst: A Rare Presentation Of Luq Pain, Richard Henriquez, Isin Y. Comba Md, Sundeep Kumar Md, Khawaja Arsalan Bashir, Maria Wallis-Crespo Md, Lakhinder Bhatia Md

Gastroenterology

Lymphangioma is a benign congenital malformation of the lymphatic system that is relatively common in juvenile population. Rarely, it can be seen in adults and majority of the cases are reported in the head and neck region (70-75%). Typically, these malformations are asymptomatic. In this report, we present a rare case of splenic lymphangioma presenting with severe, intractable abdominal pain.

Iron Pill-Induced Gastropathy In Elderly Patients: A Case Series Report, Isin Y. Comba Md, Richard Henriquez, Sundeep Kumar, Ruthvik Srinvasa-Murthy, Maria Wallis-Crespo, Lakhinder Bhatia Md, Joshua Shultz

Gastroenterology

Introduction: Iron deficiency anemia is a global health problem with an estimated two billion cases worldwide. Oral iron supplementation is considered the first line treatment. However, recent studies favor the use of short-term IV iron especially in patients with drug tolerance and efficacy concerns. In this report, we present three cases of iron pill gastropathy in patient's whose clinical courses were complicated by gastric erosion, ulcer or gastrointestinal (GI) bleeding. All of our patients had a history of iron deficiency anemia and were being treated with oral ferrous sulfate.

Case Description/Methods: The first case involved a 72-year-old male with multiple …

A Unique Presentation Of Scurvy In The Modern Era, Anita Bhagavathula Do, Joanna Linsteadt Md, Sonam Jaggi Md

Internal Medicine

No abstract provided.

Point-Of-Care Ultrasound For The Pediatric Limp, Lucas Friedman Md

Pediatrics

Objectives

• Describe the technique and use of POCUS in the Limping Child
• Describe the use of POCUS in the diagnosis and treatment of Septic arthritis

Endoscopic Management Of A Surgical Clip Found Within The Common Bile Duct Following Remotely Performed Laparoscopic Cholecystectomy, Sheila Rastegari Do, Curtis Brewer Do, Long T. Hoang

Gastroenterology

Minimally invasive surgery with surgical clip placement has become the gold standard for management of cholecystitis and biliary colic due to its favorable safety profile and low rate of complications. Though generally safe, surgical clips may cause complications days to years after the cholecystectomy by migrating into the common bile duct and serving as a nidus for stone formation. To date, very few cases of this have been reported. While uncommon, this possibility should be considered in the differential diagnosis for choledocholithiasis with or without cholangitis post laparoscopic cholecystectomy.

Spontaneous Fungal Peritonitis: A Rare Complication Of Ascites Secondary To Right Heart Failure: A Case Report, Saaah Siddiqui Md, Dharti R. Patel Md, Arshad M. Iqbal Md, Ateeq Mubarik Md, Salman Muddassir Md, Fahad Zafar Md

Internal Medicine

•Spontaneous fungal peritonitis (SFP) is an infection defined as a neutrophil count (> 250 cells/mL) in the ascitic fluid with the evidence of positive fungal culture (1) while excluding other intra-abdominal infections. SFP is not as common as spontaneous bacterial peritonitis and has higher mortality rates due to late recognition and difficulty in differentiation between SFP and SBP. (1,2). The common risk factors that have shown to increase the mortality for SFP include hepatorenal syndrome, patient on SBP prophylaxis, elevated APACHE II scores on admission, and elevated lactate levels (2,3). Candida albicans and Candida glabrata are the two …

An Unusual Case Of Broken Heart, Ammar Hasan, Enrique Rincon

Cardiology

No abstract provided.

Non-Incarcerated Inguinal Hernia With Sigmoidal Diverticulitis, Umair J. Khan, Ali Hassan, Kingsley Dah, M Lambing, P Mathew

Internal Medicine

Introduction: Abdominal wall hernia is defined as a protrusion of a part or whole organ through the wall of a cavity. Inguinal hernias account for 75% of abdominal wall hernias, with a lifetime risk of 27% in men and 3% in women. Indirect inguinal hernia account for 80% of total inguinal hernias. A wide variety of pathological processes can present as inguinal hernias however, large reducible inguinal hernias are quite rare. Recent studies have associated abdominal wall hernia with colonic diverticulosis, a term referred to as herniosis. This association suggests that an underlying connective tissue disorder could be a common …

Sarcoidosis Presenting With Massive Splenomegaly And Severe Epistaxis, Austen Stoelting Md, Shawn B. Esperti Do, Andrew Mangano Do, Nino Balanchivadze Md

Internal Medicine

No abstract provided.

Rare Infective Endocarditis Caused By Dental Source Due To Streptococcus Bovis Masquerading As Cardiac Failure, Ravish Patel, Pratikkumar Vekaria, Devin Vaishnani, Johnnie Mao, Asif Shah

Internal Medicine

No abstract provided.

The Palpitations That Thumped Us All:, Carolyn Falk Tran Do, Gurmanpal Sandhu Md, Daniel Robitshek Md, Tejas Raiyani Md

Internal Medicine

No abstract provided.

Peripheral Nerve Stimulator For Treating Nummular Headaches And Occipital Neuralgia, Bruce Dixon Do, Stephen Pyles Md, Ettore Crimi Md

Anesthesiology

No abstract provided.

A Case Of Cannot Intubate, Cannot Ventilate, Evan Davidson Md, Su Min Oon

Anesthesiology

69M with a PMH of parotid gland carcinoma status post resection and radiation therapy with extensive reconstruction, G-tube placement, COPD, multiple tracheostomies with takedowns (with refusal permanent tracheostomy over objections of family members) presented for CTR and ulnar tunnel exploration. With plans of MAC, an axillary block was placed and maintained on minimal propofol infusion. After administration of 50 mcg fentanyl due to pain, he was noted to be apnic. Ventilation via mask and #3 LMA failed, as well as placement of an 6 mm ET tube. Eventually, patient was ventilated via emergency surgical cricothyroidotomy. He was discharged on POD4.

Intraabdominal Fire During Emergency Laparotomy, Heather Christopherson Md, Alan Kroll Md

Anesthesiology

72 yo obese male presented to ED for 2 day history abdominal pain: sharp, radiating bilateral upper quadrants, n/v/constipation. Patient took entire bottle magnesium citrate, pain became unbearable. On arrival SaO2 88% RA, other vitals stable, Lactic Acid 1.85 mg/dl, CT abdomen massive free air. Taken to OR, intubated, general anesthesia, peritoneal cavity entered with cautery device. Upon entering peritoneum abdomen, flames erupted from the cavity. Flames spontaneously extinguished. No thermal injury sustained by patient. Surgeon’s eyebrows where singed, no other injuries sustained by OR staff. Patient remained hemodynamically stable, surgery proceeded without incident.

Severe Bradycardia During A Spinal Cord Stimulator Procedure, Marc Blanchard Md, Ettore Crimi Md, Stephen Pyles Md

Anesthesiology

We report a case of severe bradycardia during spinal cord implantation. A 43 year old female with a history of chronic refractory lumbar back pain presented for revision of spinal cord stimulator. Preoperative assessment was positive only for bilateral lower extremity radiculopathy. During the procedure, surgeon’s attempt to advance the lead through scar tissue elicited severe bradycardia (HR 28) resolved with glycopyrrolate. Compression of spinal cord secondary to difficult lead placement could be the cause of this cardiovascular event. Anesthesiologists need to be aware that severe bradycardia can occur during spinal cord implantation.

Using Education To Increase Compliance With Heart Failure Medications, Kara Stout Do, Isaac Navarro Dmd

Internal Medicine

• Approximately 5.7 million adults in the United States have heart failure.
• 25% of individuals die within one year of diagnosis and more than 80% die within 8 years.
• Full adherence to medications may be as low as 30% in heart failure patients.
• Non-compliant patients are two times more likely to be readmitted to the hospital and have a three times higher mortality rate.