Medical Specialties Commons^™

Consistent Technique Limits Suspension Laryngoscopy Complications, Sean P. Larner, Rick A. Fornelli, Shane D. Griffith

Faculty & Staff Scholarship

ntroduction Suspension laryngoscopy (SL) is a commonly performed procedure among otolaryngologists. Several studies have shown that adverse effects occur regularly with SL.

Objective To evaluate the postoperative complications of SL, and to determine if protecting the dentition and the oral mucosa and limiting suspension times decrease the overall incidence of oral cavity and pharyngeal complications of SL.

Methods All of the cases of SL performed by 1 surgeon from November 2008 through September 2014 were retrospectively reviewed. A consistent technique for dental and mucosal protection was utilized, and suspension times were strictly limited to 30 consecutive minutes. The incidence of …

Cardiac Prostheses‐Related Hemolytic Anemia, Mohamad Alkhouli, Ali Farooq, Ronald S. Go, Sudarshan Balla, Chalak Berzingi

Faculty & Staff Scholarship

Hemolysis is an unintended sequel of temporary or permanent intracardiac devices. However, limited data exist on the characteristics and treatment of hemolysis in patients with cardiac prostheses. This entity, albeit uncommon, often poses significant diagnostic and management challenges to the clinical cardiologist. In this article, we aim to provide a contemporary overview of the incidence, mechanisms, diagnosis, and management of cardiac prosthesis-related hemolysis.

A Pedunculated Skin Lesion In A Case Of Clear Cell Renal Carcinoma, Meghana Kesireddy, Amit Correa, Raoul Correa, Rohit Venkatesan

Faculty & Staff Scholarship

Clear cell type renal carcinoma accounts for about 80% of all renal cell carcinomas. We present a 39-year-old male with clear cell renal carcinoma of the right kidney, stage I: T1 b (5 cm) N0 M0, who developed cutaneous metastases in the right submandibular region 28 months after nephrectomy. Our case is unique as i) the patient with stage I cancer (at the time of nephrectomy) presented with an isolated cutaneous nodule in a location distant from the primary site; ii) cutaneous nodule developed while being treated with pazopanib for metastatic lesions in the lung and adrenal; and iii) nivolumab …

Trial Sequential Analysis Comparing Bleeding And Major Adverse Cardiovascular Events In Patients With Atrial Fibrillation And Acute Coronary Syndrome On Dual Versus Triple Therapy, Muhamad B. Munir, Khansa Osman, Maryam Saleem, Kinjan Patel, Sudarshan Balla

Faculty & Staff Scholarship

Objective To assess efficacy and safety of dual therapy (DT) and triple therapy (TT) in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) with or without percutaneous coronary intervention (PCI) and evaluate the quality of evidence with respect to said outcomes based on contemporary randomized trials (RCTs). The efficacy outcome taken was major adverse cardiovascular events (MACE) while safety outcome was major bleeding events. Introduction Appropriate anti-thrombotic therapy is still controversial in patients with AF and concomitant ACS or PCI. We conducted a conventional meta-analysis pooling data from major RCTs to assess the efficacy and safety of DT …

Venous Manometry As An Adjunct For Diagnosis And Multimodal Management Of Intracranial Hypertension Due To Meningioma Compressing Sigmoid Sinus, Cletus Cheyuo, Charles L. Rosen, Ansaar Rai, Christopher P. Cifarelli, Rabia Qaiser

Faculty & Staff Scholarship

Intracranial venous hypertension is a rare presentation of meningiomas in the transversesigmoid sinus region. We describe a case of a young patient presenting with intracranial hypertension due to a meningioma causing compression of the dominant sigmoid sinus. We were able to document the cerebral venous pressure gradient across the lesion confirming our hypothesis that compression of the sigmoid sinus from the meningioma was the cause of intracranial hypertension. The patient is a 17-year-old male who presented with intracranial hypertension due to meningioma at the right dominant sigmoid sinus, which was treated by a Simpson grade IV surgical resection followed by …

Can Symptoms Differentiate Between Chronic Adenoiditis And Chronic Rhinosinusitis In Pediatric Patients, Phillip R. Purnell, Jad H. Ramadan, Hassan H. Ramadan

Faculty & Staff Scholarship

The purpose of this article is to differentiate pediatric patients with chronic adenoiditis from those with chronic rhinosinusitis (CRS) based on presenting symptoms. A chart review from a tertiary care facility with pediatric patients who presented with suspected CRS from 2006 to 2014 was identified. We compared patient characteristics, clinical symptoms, duration of symptoms, and past medial history using univariate and multivariate logistic regression models. Based on recent literature, utilizing the computed tomography (CT) score, we identified those children with CRS versus those with chronic adenoiditis. Of the 99 pediatric patients included, 22 patients had diagnosis of adenoiditis and 77 …

Molecular Mechanisms Of Cancer-Induced Sleep Disruption, William H. Walker, Jeremy C. Borniger

Faculty & Staff Scholarship

Sleep is essential for health. Indeed, poor sleep is consistently linked to the development of systemic disease, including depression, metabolic syndrome, and cognitive impairments. Further evidence has accumulated suggesting the role of sleep in cancer initiation and progression (primarily breast cancer). Indeed, patients with cancer and cancer survivors frequently experience poor sleep, manifesting as insomnia, circadian misalignment, hypersomnia, somnolence syndrome, hot flushes, and nightmares. These problems are associated with a reduction in the patients’ quality of life and increased mortality. Due to the heterogeneity among cancers, treatment regimens, patient populations and lifestyle factors, the etiology of cancer-induced sleep disruption is …

Story Of An Unfortunate Fall: Cardiac Contusion Presenting With An Atrioventricular Block, Maryam Saleem, Fatima Ahmed, Kinjan Patel, Muhamad B. Munir, Mary Warden

Faculty & Staff Scholarship

Blunt cardiac injury (BCI), also referred to in the literature as a cardiac contusion, is a known cause of myocardial injury. It is often challenging to diagnose this condition in the absence of clear diagnostic criteria. Furthermore, its clinical presentation is highly variable depending on the severity, type, and duration of the trauma, as well as the timing from the initial insult. The clinical manifestation of BCI ranges from none to fatal arrhythmias to cardiac wall rupture seen on post-mortem examination. Cardiac biomarkers and electrocardiograms (EKG) are usually helpful in identifying cardiac trauma but are not necessarily abnormal in all …

Meniscal Repair In Pediatric Populations: A Systematic Review Of Outcomes, Daniel J. Liechti, David S. Constantinescu, Taylor J. Ridley, Jorge Chahla, Justin J. Mitchell, Alexander R. Vap

Faculty & Staff Scholarship

Background: Loss of meniscal tissue in the pediatric population can have long-term consequences on joint health, highlighting the importance of meniscal preservation in this group. Purpose: To systematically review reported knee outcome measures and complication rates after repair of meniscal tears in children and adolescents. Study Design: Systematic review; Level of evidence, 4. Methods: A review of the literature regarding the existing evidence for pediatric meniscal tear outcomes was performed through use of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-present), and MEDLINE (1980-present). Included were articles in English that reported the outcomes …

Closed-Loop Cardiovascular Interactions And The Baroreflex Cardiac Arm: Modulations Over The 24 H And The Effect Of Hypertension, Gianfranco Parati, Paolo Castiglioni, Andrea Faini, Marco Di Rienzo, Giuseppe Mancia, Riccardo Barbieri, J. Philip Saul

Faculty & Staff Scholarship

Closed-loop models of the interactions between blood pressure (BP) and heart rate variations allow for estimation of baroreflex sensitivity (feedback effects of BP changes on heart rate) while also considering the feedforward effects of heart rate on BP. Our study is aimed at comparing modulations of feedback and feedforward couplings over 24 h in normotensive and hypertensive subjects, by assessing closed-loop baroreflex models in ambulatory conditions. Continuous intra-arterial BP recordings were performed for 24 h in eight normotensive and eight hypertensive subjects. Systolic BP (SBP) and pulse interval (PI) beat-by-beat series were analyzed by an autoregressive moving average model over …

Assessment Of Volume Status During Prone Spine Surgery Via A Novel Point-Of-Care Ultrasound Technique, Jeremy Hensley, Hong Wang

Faculty & Staff Scholarship

Background Operations performed with the patient in the prone position can pose a significant challenge to the anesthesiologist. Hypotension is a commonly encountered complication. Intravascular volume depletion and decreased cardiac output secondary to decreased preload are thought to be the most likely cause of hypotension in the prone position. Measurement of inferior vena cava (IVC) diameter via point-of-care ultrasound examination (POC_US) has been used to provide an estimate of intravascular volume status. However, this measurement is most often obtained with the patient in the supine position. Materials and methods In this study, we describe a technique for evaluating IVC diameter …

Long-Term Effectiveness Of Balloon Catheter Sinuplasty In Pediatric Chronic Maxillary Sinusitis, Habib G. Zalxal, Chadi A. Makary, Hassan Ramadan

Faculty & Staff Scholarship

The objective of our study was to assess the long-term effectiveness of balloon catheter sinuplasty in the treatment of pediatric chronic maxillary sinusitis following failed first-line medical and surgical management with adenoidectomy. Pediatric patients younger than 12 years were reviewed for having failed previous adenoidectomy and undergone a balloon catheter sinuplasty between August 2006 and March 2011 for chronic rhinosinusitis. Demographic data and clinical characteristics were recorded in patients who met inclusion criteria. Outcomes were assessed by need for functional endoscopic sinus surgery and persistence of chronic infection within at least 5 years of follow-up. Failure was defined by any …

Global Climate Change And Invariable Photoperiods: A Mismatch That Jeopardizes Animal Fitness, William H. Walker Ii, Olga Hecmarie Meléndez‐Fernández, Randy J. Nelson, Russel J. Reiter

Faculty & Staff Scholarship

The Earth's surface temperature is rising, and precipitation patterns throughout the Earth are changing; the source of these shifts is likely anthropogenic in nature. Alterations in temperature and precipitation have obvious direct and indirect ef‐ fects on both plants and animals. Notably, changes in temperature and precipita‐ tion alone can have both advantageous and detrimental consequences depending on the species. Typically, production of offspring is timed to coincide with optimal food availability; thus, individuals of many species display annual rhythms of reproductive function. Because it requires substantial time to establish or re‐establish reproduc‐ tive function, individuals cannot depend on the …

Racial Disparities In The Utilization And Outcomes Of Structural Heart Disease Interventions In The United States, Mohamad Alkhouli, Fahad Alqahtani, David R. Holmes, Chalak Berzingi

Faculty & Staff Scholarship

Background-—Data on race- and ethnicity-based disparities in the utilization and outcomes of structural heart disease interventions in the United States are scarce. Methods and Results-—We used the National Inpatient Sample (2011-2016) to examine racial and ethnic differences in the utilization, in-hospital outcomes, and cost of structural heart disease interventions among patients ≥65 years of age. A total of 106 119 weighted hospitalizations for transcatheter aortic valve replacement, transcatheter mitral valve repair, and left atrial appendage occlusion were included. The utilization rates (defined as the number of procedures performed per 100 000 US people >65 years of age) were higher in …

Modeling Human Cancer-Induced Cachexia, Erin E. Talbert, Maria C. Cuitin˜ O, Katherine J. Ladner, Priyani V. Rajasekerea, Melissa Siebert, Reena Shakya, Gustavo W. Leone, Michael C. Ostrowski, Brain Paleo, Noah Weisleder, Peter J. Reiser, Amy Webb, Cynthia D. Timmers, Daniel S. Eiferman, David C. Evans, Mary E. Dilhoff, Carl R. Schmidt

Faculty & Staff Scholarship

Talbert et al. developed an inducible mouse model of cachexia caused by pancreatic cancer. This model exhibits features of the human condition, including the progressive depletion of muscle and adipose tissue associated with tumor progression.

Emerging Risk Profile Of Lung Cancer Therapy: Diffuse Alveolar Hemorrhage From Osimertinib, Michael J. Forte, Rahul G. Sangani

Faculty & Staff Scholarship

Osimertinib is an oral epithelial growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) used primarily in the treatment of metastatic non-small cell lung cancer. It is usually well tolerated with less than 5% of patients developing significant pulmonary toxicity from the medication, typically within the first few months after initiation. Previously reported pulmonary adverse reactions include pneumonitis (nonspecific interstitial pneumonia or other forms of acute interstitial process), fleeting asymptomatic infiltrates on imaging, and eosinophilic pneumonia. We present an interesting case of a 65-year-old female with recurrent metastatic adenocarcinoma of the lung, treated with Osimertinib for 4 months, who developed a previously …

Metabolic Deregulation Of The Blood-Outer Retinal Barrier In Retinitis Pigmentosa, Wei Wang, Ashwini Kini, Yekai Wang, Tingting Liu, Yao Chen, Eric Vukmanic, Douglas Emery, Yongqing Liu, Xiaoqin Lu, Lei Jin, San Joon Lee, Patrick Scott, Xiao Liu, Kevin Dean, Qingxian Lu, Enzo Fortuny, Robert James, Henry J. Kaplan, Jianhai Du, Douglas C. Dean

Faculty & Staff Scholarship

Retinitis pigmentosa (RP) initiates with diminished rod photoreceptor function, causing peripheral and nighttime vision loss. However, subsequent loss of cone function and high-resolution daylight and color vision is most debilitating. Visual pigment-rich photoreceptor outer segments (OS) undergo phagocytosis by the retinal pigment epithelium (RPE), and the RPE also acts as a blood-outer retinal barrier transporting nutrients, including glucose, to photoreceptors. We provide evidence that contact between externalized phosphatidylserine (PS) on OS tips and apical RPE receptors activates Akt, linking phagocytosis with glucose transport to photoreceptors for new OS synthesis. As abundant mutant rod OS tips shorten in RP, Akt activation …

Target® Intracranial Aneurysm Coiling Prospective Multicenter Registry: Final Analysis Of Peri-Procedural And Long-Term Safety And Efficacy Results, Osama O. Zaidat, Alicia C. Castonguay, Ansaar T. Rai, Aamir Badruddin, William J. Mack, Amer K. Alshekhlee, Qaisar A. Shah, Syed I. Hussain, Mouhammed R. Kabbani, Ketan R. Bulsara, Asif M. Taqi, Vallabh Janardhan, Mary S. Patterson, Britany L. Nordhaus, Lucas Elijovich, Ajit S. Puri

Faculty & Staff Scholarship

Background and Purpose: To describe the final results of the TARGET Registry, a multicenter, real-world study of patients with intracranial aneurysms treated with new generation TARGET Coils.

Methods: The TARGET Registry is a prospective, single-arm study with independent medical event monitoring and core-lab adjudication. Patients with de novo intracranial aneurysms were embolized with either TARGET-360° or helical coils in 12 US centers. The primary outcome was aneurysm packing density (PD), which was assessed immediately post-procedure. The secondary outcomes were immediate and long-term aneurysm occlusion rate using the Raymond Scale, and independent functional outcome using the modified Rankin Scale (mRS). A …

Master Of Science In Anesthesia Fort Lauderdale, Nova Southeastern University

Health Professions Divisions Course Catalogs and Course Descriptions

No abstract provided.

12-Month Outcomes Of The Us Patient Cohort In The Sonata Pivotal Ide Trial Of Transcervical Ablation Of Uterine Fibroids., Joseph Hudgens, D. Alan Johns, Andrea S. Lukes, David A. Forstein, Dipak Delvadia

Touro College of Osteopathic Medicine (New York) Publications and Research

Objective: The prospective SONATA pivotal Investigational Device Exemption (IDE) trial was performed in the United States (US) and Mexico to examine the safety and effectiveness of transcervical fibroid ablation (TFA) in the treatment of symptomatic uterine fibroids. This is an analysis of 12-month clinical outcomes in the US cohort.

Methods: TFA with the Sonata System was performed on women with symptomatic uterine fibroids. The 12-month co-primary endpoints were reduction in menstrual blood loss and freedom from surgical reintervention. Symptom severity, quality of life, patient satisfaction, safety, and reductions in uterine and fibroid volumes were also evaluated.

Results: One hundred twenty-five …

Pediatric Testicular Torsion: Does Patient Transfer Affect Time To Intervention Or Surgical Outcomes At A Rural Tertiary Care Center?, Tyler Overhoolt, Morris Jessop, Osama Al-Omar, John Barnard

Faculty & Staff Scholarship

Background: Testicular torsion (TT) is a urologic emergency that requires prompt surgical intervention. In rural Appalachia, patients are often transferred from surrounding communities due to lack of urologic care. We hypothesized that those transferred would have delayed intervention and higher rates of orchiectomy when compared to those who presented directly to our hospital. Methods: We performed a retrospective review of patient charts with an ICD-9 diagnosis of TT from 2008 to 2016. Patients met inclusion criteria if diagnosis was confirmed by operative exploration. We compared rate of testicular loss and time until surgical intervention between groups. Results: Twenty-three patients met …

Middle Ear Choristoma Presenting As Cholesteatoma With Conductive Hearing Loss, Phillip R. Purnell, Erik Interval, H James Williams, Adam M. Cassis

Faculty & Staff Scholarship

A 6-year-old male was seen for evaluation of middle ear polyp with associated hearing loss and otorrhea. CT scan revealed canal polyp with a stalk extending to the middle ear with malformation of the malleus and incus. The patient underwent exploratory tympanotomy which revealed a fistula from the bony-cartilaginous junction connecting to a middle ear mass which had eroded the incus. Intraoperative pathology suggested columnar epithelium without cholesteatoma or muscle. Final pathologic diagnosis reported dense fibrous tissue as well as ectopic salivary gland tissue, consistent with salivary gland choristoma. After removal of the mass, a partial prosthesis was successfully placed. …

Cardiovascular Risk Factor Control And Lifestyle Factors In Young To Middle-Aged Adults With Newly Diagnosed Obstructive Coronary Artery Disease, M. S. Garshick, G. D. Vaidean, A. Vani, J. A. Underberg, J. D. Newman, J. S. Berger, E. A. Fisher, E. Gianos

Journal Articles

No abstract provided.

First Series Of Minimally Invasive, Robot-Assisted Tracheobronchoplasty With Mesh For Severe Tracheobronchomalacia, R. Lazzaro, B. Patton, P. Lee, J. Karp, E. Mihelis, S. Vatsia, S. J. Scheinerman

Journal Articles

No abstract provided.

Single-Direction Thoracoscopic Lobectomy: A Step In The Right Direction, J. S. Young, P. C. Lee

Journal Articles

No abstract provided.

Predictors And Impact Of Right Heart Failure Severity Following Left Ventricular Assist Device Implantation, R. D. Baxter, K. M. Tecson, S. Still, J. D. G. Collier, J. Felius, S. M. Joseph, S. A. Hall, B. Lima

Journal Articles

No abstract provided.

Incidence Of Acute Kidney Injury In Patients With Chronic Renal Insufficiency: Transcatheter Versus Surgical Aortic Valve Replacement, M. Catalano, D. Lin, H. Cassiere, N. Kohn, B. Rutkin, G. Maurer, J. A. Berg, R. Esposito, A. Hartman, P. Yu, +1 Additional Author

Journal Articles

No abstract provided.

Robotic Sleeve Resections: New Territory But Not The Final Frontier, B. D. Patton

Journal Articles

No abstract provided.

Touch Preparation Of Skin Biopsy Specimen For Rapid Diagnosis Of Cutaneous Nocardia Nova In The Immunocompromised Host, E. C. Traver, S. Husain, M. E. Grossman

Journal Articles

No abstract provided.

Enhanced Macrophage Pannexin 1 Expression And Hemichannel Activation Exacerbates Lethal Experimental Sepsis, W. Chen, S. Zhu, Y. Wang, J. Li, X. Qiang, X. Zhao, L. Becker, P. Wang, K. J. Tracey, H. Wang, +2 Additional Authors

Journal Articles

No abstract provided.