Medical Specialties Commons^™

A Rare Complication Of Dilation And Evacuation: Unrecognized Extrauterine Retained Products Of Conception, Aviana Terschueren, Lauren Siewertsz Van Reesema, Joseph Hudgens

Department of Obstetrics & Gynecology Faculty Publications

Introduction: Surgical abortions, including dilation and evacuation, are among the safest gynecological procedures, with complication rates ranging from 0.5–4.0%. Uterine perforation, though rare (0.2–0.8%), can result in serious sequela, including translocation of retained products of conception into the abdominal cavity. We present a rare case of abdominal retained products of conception following a second-trimester dilation and evacuation.

Case Report: A 29-year-old G3P1112 underwent an elective surgical abortion at 17 weeks’ gestation, complicated by hemorrhage necessitating transfer to an outside hospital. She was treated with uterotonics and a blood transfusion and was discharged after a 6-day hospitalization. Initial transvaginal ultrasound showed …

A Qualitative Study Of End-Stage Liver Disease And Liver Transplant Referral Practices Among Primary Care Providers In Nonurban America, Vashisht Madabhushi, Matthew Wright, Gabriel Orozco, Allison Murphy, Antonio R. Garcia, Natalie D. Pope, Xiaonan Mei, Alexandra Cocca, Roberto Gedaly, Meera Gupta

Surgery Faculty Publications

Purpose: In rural America, the road to obtaining a liver transplant (LTX) often starts at the primary care provider’s (PCP’s) office. Patients with end-stage liver disease (ESLD) in rural communities experience lower rates of wait-listing and higher mortality. This study identifies issues related to the knowledge and perceptions of ESLD and LTX referral among PCPs in rural Kentucky (KY).

Methods: The study protocol involved relying upon a semistructured outline to explore the knowledge, attitude, and perceptions of PCPs toward ESLD and LTX referral among PCPs in rural KY. Inductive thematic analysis was utilized to identify, analyze, and report themes.

Findings: …

Upper Airway Soot And Facial Burns Do Not Necessitate Intubation, Jessica Burgess, John Dubensky

Department Surgery Faculty Publications

Introduction

Identifying which patients are at risk for respiratory decompensation, whether from airway compromise or inhalation injury, is an important component of initial burn resuscitation. Findings that traditionally suggest the need for intubation include cutaneous burns to the face and neck, soot seen in the upper airway, and carbonaceous sputum. However, evidence suggests that a significant number of pre-burn center intubations are ultimately unnecessary. The purpose of this investigation was to determine if head and neck burns or sputum seen in the upper airways were correlated with the need for intubation.

Methods

This was a retrospective review of adults admitted …

Surgical Management Of Gastroenteropancreatic Neuroendocrine Tumors, Lisa M. Kenney, Marybeth Hughes

Department Surgery Faculty Publications

Background/Objectives: Neuroendocrine tumors (NETs) are heterogeneous malignancies arising from enterochromaffin cells that can arise from the gastrointestinal (GI) tract and pancreas. Surgical management is the cornerstone of treatment, with the optimal approach tailored by tumor grade, size, location, and presence of metastasis. This review discusses the current strategies for the surgical management of NETs of the gastroenteropancreatic tract. Methods: A review of the available literature was conducted to evaluate surgical approaches to NETs. Consensus guidelines were incorporated to synthesize evidence-based recommendations. Results: For gastric NETs, surgical approach depends on Rindi Classification, WHO grade, and tumor size, with endoscopic approaches favored …

Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis In The Management Of Intermediate-Risk Pulmonary Embolism: Primary Results Of The Peerless Randomized Controlled Trial, Wissam A. Jaber, Carin F. Gonsalves Md, Stefan Stortecky, Samuel Horr, Ripal T. Gandhi, Keith Pereira, Jay Giri, Sameer J. Khandhar, Khawaja Afzal Ammar, David M. Lasorda, Brian Stegman, Lucas Busch, David J. Dexter, Ezana M. Azene, Nikhil Daga, Fakhir Elmasri, Chandra R. Kunavarapu, Mark E. Rea, Joseph S. Rossi, Joseph Campbell, Jonathan Lindquist, Adam Raskin, Jason C. Smith, Thomas M. Tamlyn, Gabriel A. Hernandez, Parth Rali, Torrey R. Schmidt, Jeffrey T. Bruckel, Juan C. Camacho, Jun Li, Samy Selim, Catalin Toma, Sukhdeep Singh Basra, Brian A. Bergmark, Bhavraj Khalsa, David M. Zlotnick, Jordan Castle, David J. O'Connor, C. Michael Gibson, For The Peerless Committees And Investigators

Department Surgery Faculty Publications

BACKGROUND: There are a lack of randomized controlled trial data comparing outcomes of different catheter-based interventions for intermediate-risk pulmonary embolism.

METHODS: PEERLESS is a prospective, multicenter, randomized controlled trial that enrolled 550 patients with intermediate-risk pulmonary embolism with right ventricular dilatation and additional clinical risk factors randomized 1:1 to treatment with large-bore mechanical thrombectomy (LBMT) or catheter-directed thrombolysis (CDT). The primary end point was a hierarchal win ratio composite of the following (assessed at the sooner of hospital discharge or 7 days after the procedure): (1) all-cause mortality, (2) intracranial hemorrhage, (3) major bleeding, (4) clinical deterioration and/or escalation …

Contact Pathway Factors As Potential Modifiers Of Bleeding Related To Factor Xi Deficiency, Ivy R. Han, Leah Rosenfeldt, Courtney Young, Bal Krishan Phd, Rachel Cantrell Phd, Cassie Sprague, Mousa Kharnaf, William Abplanalp, Joseph Palumbo Md

Williams Honors College, Honors Research Projects

Factor XI (FXI) deficiency, also known as Hemophilia C, is characterized by mild to moderate bleeding symptoms. However, the factors that modify bleeding severity in FXI deficiency are not fully understood. In this study, we investigated whether components of the contact activation pathway can act as modifiers of bleeding in the context of FXI deficiency. Using a tail vein transection (TVT) model in rats, we assessed bleeding in four experimental groups: wild-type Sprague-Dawley rats, Prekallikrein knockout (PKK^-/-) rats, rats treated with a FXI-inhibiting antibody, and PKK-/- rats treated with the FXI antibody.

Under anesthesia, each rat underwent a …

Multi-Modal Neo-Adjuvant Anti-Obesity Medications May Be More Effective Than Medically Supervised Weight Loss Or Glp-1 Therapy Alone In Preparing Bmi ≥ 70 Patients For Metabolic Surgery, Michael Kachmar, Florina Corpodean, Iryna Popiv, Kyle B. Lapenna, Denise M. Danos, Michael W. Cook, Brian A. Saunders, Jean J. Domercant, Vance L. Albaugh, Philip R. Schauer

School of Medicine Faculty Publications

Background/objectives: Optimizing patients with a body mass index (BMI) ≥ 70 kg/m² for metabolic surgery (MS) is challenging. However, pre-operative weight loss may be important for improving the safety of MS for these high-risk patients. Multi-modal anti-obesity medications (mmAOM) may enhance preoperative weight loss compared to non-pharmacologic medically supervised weight loss (NP-MSWL) or glucagon-like peptide-1 receptor agonist monotherapy (Mono-GLP-1) alone. Subjects/methods: This retrospective study analyzed 113 patients with BMI ≥ 70 kg/m² at a single metabolic disease treatment institute. Interventions/methods: Patients were categorized into NP-MSWL (n = 13), Mono-GLP-1 (n = 54), and mmAOM (n = 46) groups. The primary …

Opioid Usage And Non-Opioid Alternatives In Septorhinoplasty: A Narrative Review, Robert M. Frederick, Eric Dobratz

Department of Otolaryngology (ENT) Faculty Publications

Background and Objective: Opioids are routinely prescribed following septorhinoplasty and oftentimes surgeons prescribe a larger number of tablets than patients require. Considering the high risk of developing opioid dependence and risk of diversion, it is imperative that surgeons practice safer, evidence-based prescribing habits. This review is intended to detail the current state of opioid usage after septorhinoplasty, focusing on articles that show pertinent and practice-altering findings. This will allow surgeons to reflect on their prescribing patterns and make evidence-based decisions to improve them.

Methods: A literature search was performed in November 20, 2024 via PubMed using keywords such as ‘opioid …

Categorizing Clinical Response To Mepolizumab For Patients With Chronic Rhinosinusitis With Nasal Polyps: Synapse Trial, Claire Hopkins, Larry Borish, Jared Silver, Peter Howarth, Robert Chan, Priya Dsilva, Joseph K. Han

Department of Otolaryngology (ENT) Faculty Publications

[Introduction] Chronic rhinosinusitis with nasal polyps (CRSwNP) can substantially affect quality of life (QoL), and is often challenging to manage.¹ First-line treatment for the management of CRSwNP involves intranasal corticosteroids, with short courses of systemic corticosteroids (SCS) for exacerbations, and sinus surgery for uncontrolled disease.² Biologics targeting type 2 inflammation (eg, dupilumab, omalizumab, and mepolizumab) have become a treatment option for refractory CRSwNP. With the advent of disease-modifying treatments such as biologics, control, defined as patients reporting no/low-symptom levels, has increasingly become the treatment goal for CRSwNP.³ However, the optimal use of biologics for symptom control in individual patients remains …

Independent Component Analysis Of Resting-State Fmri Identifies Regions Associated With Seizure Freedom After Laser Interstitial Thermal Therapy For Temporal Lobe Epilepsy, Mahdi Alizadeh, J. Miao, Caio Matias, Kevin J. Hines, Christopher T T. Skidmore, Michael R. Sperling, Joseph I Tracy, Ashwini Sharan, Chengyuan Wu

Department of Neurosurgery Faculty Papers

OBJECTIVE: Temporal lobe epilepsy (TLE) is a common form of drug-resistant epilepsy often treated with surgical interventions, including laser interstitial thermal therapy (LITT). However, patient-specific factors influencing LITT outcomes remain unclear. This retrospective study aimed to identify pre-operative resting-state functional MRI (rs-fMRI) patterns associated with seizure freedom following LITT in mesial TLE.

METHODS: We analyzed rs-fMRI data from 28 patients with mesial TLE who underwent LITT, classifying them into seizure-free (SF) and not seizure-free (NSF) groups based on 12-month post-operative outcomes. Independent component analysis (ICA) was used to identify subject-specific brain networks, and generalized linear models (GLM) were employed to …

Comparison Of Baumgaertner Reduction Quality Criteria , Chang Criteria And Ap3×Ml3 Classification And Their Ability To Predict Mechanical Complications Of Trochanteric Fractures Fixed With Proximal Femoral Nail, Amr Elhadidy Elhadidy, Ahmed Abdelbadie Ibrahim, Sallam Ibrahim Fawzy, Ehab Youssef Hassanin

Mansoura Medical Journal

Background Trochanteric fractures are common injuries among the elderly. Despite advances in fixation with proximal femoral nails (PFN), Mechanical complication remain significant. Several reduction quality systems have been proposed, but their predictive value and reproducibility remain debated. Aim To evaluate and compare the predictive value and reproducibility of Baumgaertner Reduction Quality Criteria (BRQC), Chang Reduction Quality Criteria (CRQC), and AP3×ML3 classification in patients with AO Foundation/Orthopaedic Trauma Association (AO/OTA) 31-A1 and 31-A2 trochanteric fractures fixed with PFN. Methods A prospective observational study was conducted on 146 patients with 31-A1 and A2 trochanteric fractures treated by PFN. Postoperative radiographs were assessed …

Comparison Of Isoflurane To Sevoflurane In A Pediatric Patient With Refractory Status Asthmaticus: A Case Report, Janella Rianna N. Benitez Mba, Pharmd, Norm Fenn Bcps, Bcpps, Fashp

Parkview Pharmacy Department

Presented at Midyear Clinical Meeting.

Objective: To describe the use of inhaled anesthetics in a pediatric patient with severe, refractory status asthmaticus unresponsive to conventional therapies.

The Impact Of State-Mandated Certification Of Surgical Technologists On Surgical Site Infection Rates: Evaluating Policy, Practice, And Patient Outcomes, Katherine E. Geiger

Graduate Student Theses, Dissertations, & Professional Papers

Abstract

Chairperson: Matthew Schertz, Ph.D.

Committee Member: Morgen J Alwell, Ph.D.

Committee Member: Jill Davis, M.Ed.

As a surgical technology instructor, I have witnessed firsthand the impact that certified surgical technologists (CSTs) have on patient safety, particularly in the prevention of surgical site infections (SSIs). This professional paper investigates the relationship between state-mandated certification of surgical technologists and SSI rates, with a focus on how standardized education and credentialing influence clinical outcomes. SSIs remain a significant concern in surgical environments, contributing to increased morbidity, longer hospital stays, and greater healthcare costs. The research presented here examines certification requirements across various …

Old Habits Die Hard: Why Surgeons Continue To Conduct Robotic Surgery Despite A Lack Of Statistical Support, Ansley Connelly, Francheska Razalan-Krause, Taylor Johnson

South Atlantic Division GME Research Day 2025

No abstract provided.

Surgical Treatment For Severe Penile Calciphylaxis: Case Report And Systematic Review, Kenley Tyler, Peter L. Miller, Kenneth Carney

South Atlantic Division GME Research Day 2025

No abstract provided.

Wandering Spleen With Intermittent Splenic Torsion, Brandon M. Epps, Margaret Carey, Nicholas Hrdlicka, William Boswell, Miller Hamrick

South Atlantic Division GME Research Day 2025

No abstract provided.

Rare Case Report: Scapholunate Ligament Tear With Isolated Scaphoid Dislocation, Nicholas Distefano, Jason Clark

South Atlantic Division GME Research Day 2025

No abstract provided.

Case Report: Delayed Presentation Of Midline Diaphragmatic Hernia After Blunt Trauma: A Case Repor, Aziza Win, Jason Clark, Kellie Amodeo, James Benner

South Atlantic Division GME Research Day 2025

No abstract provided.

Rare Intercostal Herniation Of Abdominal Organs In Copd Patient Managed Non-Operatively, Dalya Abdelmaged, Thomas Litton

South Atlantic Division GME Research Day 2025

No abstract provided.

Challenges And Lessons In Re-Operative Pelvic Surgery, S. Caleb Jerris, Selim Gebran, Kendall Post, Hao Tang, Richard Fortunato, James T. Mccormick

South Atlantic Division GME Research Day 2025

No abstract provided.

Congenital Posterior Urethroperineal Fistula Presenting As A Cystic Mass, Muhammad Siddiqui, Sang Woo Pak, Preeya Mistry, Sarah Starnes, Stacy White, Anthony Zarka, Lori Gurien

South Atlantic Division GME Research Day 2025

No abstract provided.

Management Of Upper Extremity Hemihyperplasia In Beckwidth-Wiedman Syndrome: A Pediatric Case Over The Course Of 9 Years, Savannah Yeh, Nancy Jimenez, Vidhur Sohini, Jonathan R. Sorelle

South Atlantic Division GME Research Day 2025

No abstract provided.

Surgical Outcomes Of Median Arcuate Ligament Release, Savannah Yeh, Alina Chen, Yasmeen Dhindsa, Peter Lawrence, Karen Woo

South Atlantic Division GME Research Day 2025

No abstract provided.

Wound Dehiscence, Risk Factors Presenting A Costly Complication, James Montgomery, Alyssa Mcmandon, Eleah Porter, Heather O'Field, Wesley Vosburg

South Atlantic Division GME Research Day 2025

No abstract provided.

Quality Outcomes For Older Adults Undergoing Elective Cholecystectomy And Colectomy In The United States: A Scoping Review From The Sages Qos Committee, Jeannie Kontos, Wesley Vosburg, H Lin, J Blancaflor, K Fay, K Park, J Stulberg

South Atlantic Division GME Research Day 2025

No abstract provided.

Factors Associated With Length Of Stay After Metabolic And Bariatric Surgery, James Montgomery, Rachel Daley, Margaret Rose, R Wesley Vosburg

South Atlantic Division GME Research Day 2025

No abstract provided.

Acute Diverticulitis Found With An Incarcerated Inguinal Hernia: A Case Report, Robert Larsen, Brandon Epps, Syl Lord

South Atlantic Division GME Research Day 2025

No abstract provided.

Emergent Transcatheter Tricuspid Edge-To-Edge Repair For Right Ventricular Shock From Tricuspid Regurgitation In Hypertrophic Cardiomyopathy, Nicholas J. Valle, Amin Yehya, Animesh Rathore, Erich L. Kiehl, Matthew R. Summers

Department of Medicine Faculty Publications

Background

Transcatheter tricuspid edge-to-edge repair (T-TEER) is an emerging technology used to treat severe tricuspid regurgitation (TR). The pivotal trials demonstrating the safety and efficacy of T-TEER exclude patients with severely reduced left ventricular function (≤20%).

Case Summary

We demonstrate the use of T-TEER in a patient with end-stage hypertrophic cardiomyopathy who suffered acute, torrential TR and subsequently developed cardiogenic shock as a complication of high-risk transvenous lead extraction. Why Beyond the Guidelines Currently, there are no guidelines addressing the nonsurgical emergent management of acute TR.

Discussion

The TriClip system (Abbott) may have certain advantages when used in managing acute …

Arthroscopic Inlay Biceps Tenodesis Using A Tendon-Docking Anchor, Mark G. Soliman, Katherine S. Worcester M.S., Thomas E. Herron, Kevin F. Bonner

Department of Medicine Faculty Publications

Pathology of the long head of the biceps tendon can be treated surgically with a multitude of tenodesis techniques; however, there is a lack of consensus on which technique provides the most optimal outcomes. Commonly used methods include inlay tenodesis with a bone tunnel and interference screw construct and onlay tenodesis with anchors or unicortical buttons. Although current methods typically provide satisfactory outcomes, many surgeons believe complications and failure rates remain suboptimal across techniques. In this article, we present an arthroscopic suprapectoral biceps tenodesis technique using an anchor device that was developed to address the shortcomings of current techniques, optimize …

Percutaneous Closure Of A Left Ventricular Pseudoaneurysm Using A Post-Infarct Vsd Device Guided By Intracardiac Echocardiography, Omar Jafar, Nicholas Valle, Rupinder Bahniwal, Matthew Summers

Department of Medicine Faculty Publications

Left ventricular pseudoaneurysm (LVPA) is a rare, life-threatening complication that may arise after cardiac surgery, myocardial infarctions, or infective endocarditis. We present a case of a 55-year-old woman with complex surgical history and prior infective endocarditis who developed an incidental LVPA. Due to lack of surgical repair options, a percutaneous approach was pursued using a post-infarct ventricular septal defect device (PIVSD) under guidance of fluoroscopy and intracardiac echocardiography (ICE) guidance with successful exclusion of LVPA. This case highlights the utility of multimodal imaging in the percutaneous management of complex left ventricular lesions.