Surgery Commons^™

Integrating Positive Psychology And Spirituality To Foster Meaning And Well-Being In Older Adults, Crystal Morris

Adultspan Journal

This perspective article explores the integration of positive psychology interventions (PPIs) and spirituality in therapy to foster meaning and well-being in older adults. It highlights exercises such as the positive introduction, positive legacy, character strengths, mindfulness, mindful-based yoga, and a manifestation prayer journaling. The interventions presented are tools to support older adults that may experience depression, difficult life transitions, and the search for renewed meaning. Therapists who integrate PPIs and spirituality into therapy can promote a holistic, non-pathological approach to treatment.

Atypical Presentation Of Non-Small Cell Lung Carcinoma With Metastasis To Breast Tissue, Tylar P. Seckman, Diane Krutzler-Berry, Mohamed Ashal, Waqas Mahmud, Krista L. Denning, Logan M. Lawrence

Marshall Journal of Medicine

Malignant neoplasms of the lung commonly metastasize to lymph nodes, bone, brain, and liver via hematogenous and lymphatic routes. Much less commonly, metastasis occurs in the breast. Secondary metastatic disease of the breast is very rare, with a reported incidence ranging from 0.4-1.3%­­—with primary lung cancer being one of the most anomalous sources. This case details non-small cell lung cancer metastasis to the breast with proven primary contralateral lung origination. This atypical finding prompts medical professionals to consider these malignant cells' immunologic, histologic, and pathologic makeup to understand further and treat the neoplasm.

Factors Affecting The Joy Of Life In Old Age: A Scale Development Study, Yalçın Karagöz, Yusuf Karaşi̇n, Mustafa Filiz, Mehmet Ateş

Adultspan Journal

This study aims to introduce a measurement tool into the literature that can reveal the factors affecting the joy of life in older adulthood. Participants included 266 individuals aged 55 and over living in Izmir, Turkey. The process of developing the scale includes the following stages: problem identification, item pool creation, expert opinion, form shaping, pilot application, and finalizing the scale. The exploratory factor analysis revealed that the scale consists of 6 different dimensions, and the variance explained by these dimensions was found to be 65.184%. The acceptable values for the scale's fit indicators are as follows: χ²/df0.90, IFI > 0.90, …

Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West

Adultspan Journal

This qualitative study aimed to address the gap in the research related to end-of-life counseling by exploring the experiences of counselors working with clients at end of life. While counseling literature and education are lacking regarding end of life, many counselors will work alongside clients approaching death. The purpose of this study was twofold: (a) to better understand the nuanced experiences of counselors providing end-of-life counseling and (b) to explore the supports and preparations helpful for counselors to provide end-of-life counseling. A narrative approach, using the Listening Guide (Gilligan, 2015), was employed to analyze and present the stories of three …

Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego

Adultspan Journal

The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …

The Effect Of Blood Flow Restriction Training On Quadriceps Activity After Anterior Cruciate Ligament Reconstruction: A Preliminary Randomized Controlled Trial, Florian Forelli, Camille Nguyen, Jean Mazeas, Georgios Kakavas, Timothy E. Hewett, Andreas Bjerregaard, Vasileios Korakakis, Alexandre Jm Rambaud

Marshall Journal of Medicine

Background

After anterior cruciate ligament reconstruction, a crucial priority is restoring knee muscle strength, especially the quadriceps, to reach the pre-injury strength levels as fast as possible. A feasible alternative to heavy loading might be blood flow restriction training that may elicit quadriceps muscle strength adaptations using low external loads. This study assessed whether quadriceps strengthening using low load blood flow restriction (LL-BFR) would enhance electromyographic (EMG) activity of the vastus medialis (VMO), vastus lateralis (VLO), and rectus femoris (RF) similar to quadriceps strengthening using heavy loads resistance training (HLRT). The secondary objective was to assess intra-quadriceps regional EMG differences …

Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …

The Case For Using Composition Tomography To Evaluate Perirectal Necrotizing Fasciitis: Is It Really Necessary?, Tyler Bayliss, David Denning

Marshall Journal of Medicine

Clinical reviews of Fournier’s Gangrene state that diagnostic protocol includes interpreting CT, MRI, or Ultrasound imaging along with clinical symptoms and lab findings. We think that the use of imaging techniques as a diagnostic tool is no longer needed as Fournier’s Gangrene is specific enough of a disease that clinicians can diagnose using labs and physical examination alone.

Cases of perirectal necrotizing soft tissue infection recorded at St. Marys Medical Center were reviewed. Results of physical exams and imaging were compared along with measurements of severity upon admittance and length of stay. Due to the COVID-19 pandemic, we investigated if …

Ogilvie's Syndrome: Acute Colonic Pseudoobstruction. A Review For Residents., Tyler Bayliss, Caleb Clark, Errington C. Thompson

Marshall Journal of Medicine

Ogilvie's syndrome (acute colonic pseudoobstruction) was first described in 1948. Acute colonic pseudoobstruction can occur in a variety of clinical settings, including postsurgical, obstetrics, pelvic surgery, critical care and sepsis. Clinicians need to recognize the syndrome early. Colonic distention without evidence of obstruction can be seen on plain films of the abdomen or CT scan. Successful therapies, including bowel rest, neostigmine and colonoscopic decompression, have been used. Avoiding respiratory compromise from abdominal distention and colonic perforation of the primary goals of treatment. Surgical intervention should be reserved for patients who are refractory to medical treatment or develops signs and symptoms …

Burnout For General Surgeons, Luke Edwards, Lindsay Mckelvey

Theses, Dissertations and Capstones

Introduction: In the healthcare sector, burnout among surgeons has emerged as a critical issue, impacting both the well-being of medical professionals and the quality outcomes of patient care. Research has consistently shown that long hours, high workloads, demanding results, and mental fatigue make physicians more vulnerable to experiencing burnout than others. Studies have revealed alarming statistical rates, with a significant percentage of surgeons reporting physical exhaustion and mental health repercussions. This trend is further enhanced by the demanding nature of the medical environment, where work-related stress and burnout have become common concerns.

Purpose of the Study: The negative effects of …

The Unequal Distribution Of Social Risk For Black Men Across The Life-Span. A Novel Framework., Waleed Y. Sami

Adultspan Journal

This conceptual overview offers a comprehensive overview of systemic pathways that negatively impact the mental health of Black Men throughout their lives. Our argument highlights the importance for counselors and mental health professionals to utilize a thorough social risk assessment that considers these pathways in order to effectively address the mental health needs of Black Men while fostering positive working relationships. This overview strongly advocates for the use of context and structural determinants when evaluating mental health symptoms. Without an appropriate understanding of social risk and determinants, counselors may inadvertently perpetuate disparities by decontextualizing symptomology, and reproducing racist discourse.

Spontaneous Pneumothorax: A Rare Complication Of Neurofibromatosis Type 1 Associated Diffuse Lung Disease, Emma I. Sherfinski, Mark H. Cooper Md, Phd

Marshall Journal of Medicine

The visually striking neurocutaneous findings of neurofibromatosis type 1 (NF1) are well recognized and have been well documented throughout scientific literature. While not uncommon, the pulmonary manifestations of NF1 are unknown to many physicians. Complications of NF1 associated diffuse lung disease (NF-DLD) include pulmonary hypertension, pulmonary artery stenosis, subpleural cysts, and spontaneous pneumothorax. We present a case of a 34-year-old male with NF-DLD found incidentally in adolescence with previous apical bleb repair, presenting nearly twenty years later with spontaneous pneumothorax. In NF1 patients with pulmonary complaints, NF-DLD should be assessed with computed tomography (CT) and physicians should be familiar with …

Chronic Cavitary Pulmonary Aspergillosis: An Unusual Cause Of Chronic Cough, Pleuritic Chest Pain, And Hemoptysis In A 24-Year-Old Coal Mine Worker, Emma I. Sherfinski, Emily J. Vore, Mark H. Cooper Md, Phd, Peimei He Md

Marshall Journal of Medicine

Pulmonary Aspergillus infections are caused by the ubiquitous fungus mold when spores found in compost, dust, and plant material are inhaled. Manifestation of the disease is represented by a delicate balance between host and pathogen interactions, making Aspergillus infection more commonly observed in immunocompromised individuals. Chronic cavitary pulmonary aspergillosis (CCPA) is a subtype of pulmonary Aspergillosis associated with history of chronic or prior lung disease. Here we present the case of a non-immunocompromised 24-year-old male with a history of intermittent asthma with chronic pulmonary symptoms and finding of a lung mass on imaging. We describe the diagnostic challenge and surgical …

Use Of Mandibular Distraction Osteogenesis To Correct Micrognathia And Airway Obstruction In Newborn Female With Pierre Robin Sequence And Neonatal Abstinence Syndrome In Rural Appalachia, Seneca Williams, Adam Van Horn Md

Marshall Journal of Medicine

We present a case of Pierre Robin sequence and Neonatal Abstinence Syndrome (NAS) in a newborn female patient to highlight the surgical technique of mandibular distraction osteogenesis to correct airway obstruction due to micrognathia. The patient presented as a transport after delivery due to respiratory distress. She was noted to have a cleft palate and micrognathia. The absence of other dysmorphic features diagnosed her with non-syndromic Pierre Robin sequence. To solve her upper airway obstruction, mandibular distraction osteogenesis was performed. This procedure allowed the patient to be weaned from all respiratory support and nasogastric tube feeds by the end of …

Current And Novel Neuroregenerative Therapies, Arrin Brooks

Theses, Dissertations and Capstones

Underlying the physical and cognitive deficits consequent of many neuropathologies is one common factor, the loss of neurons. While neurodegenerative diseases, stroke, and traumatic brain injury arise from a variety of etiologies, they all ultimately result in injury and/or death of neuronal cells and concomitant functional deficits. In the present work we primarily focus on current and potential treatments for localized lesions, particularly those in the striatum of Parkinson’s disease (PD) or the cortex as in stroke. First, we discuss a new surgical technique for deep brain stimulator (DBS) placement, as DBS is a mainstay treatment for movement disorders including …

A Case Of Recurrent Breast Cancer Diagnosed From Symptomatic Metastasis To Bladder, Reagan M. Stafford, Andrew J. Weaver, Mary Legenza, Douglas Henson

Marshall Journal of Medicine

Abstract:

Women in the United States have an approximate 1 in 8 chance of developing breast cancer in their lifetime. The main cause of death from breast cancer is from metastatic spread of the disease; with the most frequent sites of spread being to the bone, brain, and lungs. The urinary bladder is a rare site of metastasis that has been rarely reported on in the literature. Here we present a case of recurrent metastatic breast cancer found in the urinary bladder without findings of any other sites of metastasis.

Pyloric Stenosis Leading To Sinus Venous Thrombosis; A Case Report, Amber Wright, Andrew J. Weaver, Daniel Beals

Marshall Journal of Medicine

Pyloric stenosis is typically diagnosed early and repaired after resuscitation and electrolyte correction in a timely manner. Delay in diagnosis or presentation of patient can lead to significant morbidity and even mortality. Here we present a case of pyloric stenosis leading to dehydration severe enough to lead to venous sinus thrombosis. This case highlights the importance of early detection of pyloric stenosis with timely correction of fluid status and electrolytes. Venous sinus thrombosis is a serious complication associated with our patient’s pyloric stenosis that has not yet been reported in literature.

Hyperkalemia Secondary To Prophylactic Heparin Use In A Trauma Patient: Case Report, Marco Custodio, Errington C. Thompson

Marshall Journal of Medicine

This case report describes a complex trauma patient who develops hyperkalemia secondary to heparin. Heparin is a commonly used drug in trauma patients. Physicians need to be aware of this potentially harmful adverse reaction in these high-risk patients.

Eradication Of Stage Iv Gastric Cancer: Case Report, Ibrahim Mohammed, Cherishma Nagisetty, Arslan Iqbal, Michael Abdelmasseh, Doreen Griswold, Muhammad Omer Jamil, Juan R. Sanabria

Marshall Journal of Medicine

Background. Gastric cancer has a low overall survival rate worldwide, and surgery still remains the intent to cure option on early stages of disease. HER-2 positive cancers may have a survival advantage. We present a patient with stage IV gastric cancer HER-2 positive responsive to Herceptin, free of detectable disease two years after surgery.

Patient Presentation. 70 years old Caucasian male complained of left-sided chest pain. Upon evaluation, he was diagnosed with HER-2 positive adenocarcinoma of the stomach at the pylorus with two liver metastases. Near complete response was observed with Herceptin and Cis-platinum based chemotherapy followed by 80% distal …

Complete Response To Stage Iv Colorectal Adenocarcinoma With Disease-Free Survival At 24 Months: Case Report And Overview Of The Literature, Madison N. Crank 6746693, Arslan Iqbal, Michael Abdelmasseh, Mohamed Alsharedi, Doreen Griswold, Alysia Browne, Juan R. Sanabria

Marshall Journal of Medicine

Over 150,000 new cases of colon cancer were diagnosed in the US in 2019. Stage and age at diagnosis are important prognostic factors for overall survival (OS). For the age group 70-79, the OS for females with poorly differentiated stage IV colon cancer at 1, 2 and 5 years after surgery is 39%, 15%, and 2%, respectively. We present a case of a 77-year-old female with significant cardiac history. She was diagnosed with stage IV colorectal cancer complicated with enteric fistula. Due to her initial performance status and comorbidities, she was not a candidate for surgery or systemic chemotherapy. Nonetheless, …

Modern Ventilator Management In Surgical/Trauma Patients, Errington C. Thompson

Marshall Journal of Medicine

Physicians have a lot to consider when they place a patient on the ventilator. This article reviews the literature and provides the physician with a clear guide to managing the ventilator in the ICU. This manuscript is meant to be a practical guide to managing the ventilator at the patient's bedside.

Geriatric Hepatology: The Hepatic Diseases Of The Elderly And Liver Transplant, Shima Ghavimi, Hamed Azimi, Neel Patel, Oleg Shulik

Internal Medicine

Introduction: With the aging US population, chronic liver diseases are becoming more commonly diagnosed in the geriatric population. Advanced age leads to changes in liver blood flow, volume, morphology and normal physiology. This predisposes elderly patients to develop certain chronic liver diseases. Also, the clinical course and management differ in an older patient when compared to a younger patient. Some causes of chronic liver disease in the geriatric population include Hepatitis A, B, C, Non-Alcoholic Fatty liver disease, prolonged alcohol use and inflammation. Many chronic liver diseases are characterized by a slow, indolent course of progression with non-specific symptoms and …

A Case Review Of A Morel Lavellee Lesion With Delayed Presentation, Ammar Qureshi, Pradeep Monoot

Marshall Journal of Medicine

A Morel Lavellee lesion is a relatively rare post traumatic condition which is missed at the time of early presentation. It involves a closed internal degloving injury where the subcutaneous tissue is torn away from the underlying fascia and thus creating a cavity containing hematoma and necrotic fat. It occurs most commonly over the greater trochanter. The lesion can be treated conservatively and surgically. Here we report an unusually delayed presentation of a Morel Lavellee lesion that was treated by incisions, drainage and primary closure.

The Effects Of Obesity On Outcomes In Trauma Injury: Overview Of The Current Literature, Milad Modarresi, Brad Gillon, Javad Najjar Mojarrab, Rodrigo Aguilar, Zackary Dylan Hunter, Matthew Steven Schade, Jackie Sanabria, Rebecca Klug, Seth Adkins, Juan R. Sanabria

Marshall Journal of Medicine

Obesity has reached epidemic proportions and is now considered a chronic disease by the National Institute of Health (NIH) in the West. Its impact on trauma outcomes is of particular interest with several studies presenting conflicting information. The present overview suggests a strong association between obesity and injury severity, hospital length of stay (LOS), intensive care unit (ICU) admission, pattern of injury, rate of complications and mortality. The nature of the observations may relate to an underlying physiological state of the obese patient and its associated comorbidities with a constant heightened inflammatory state aggravated by the second hit on an …

Re-Excision Rates Following Breast Conserving Therapy: A Single Institutions Experience Over Ten Years, Kathryne J. Blair, Mary Legenza

Marshall Journal of Medicine

As breast conserving therapy has become the standard of care for patients with early stage breast cancer an area of debate within the surgical literature has been the rate of positive surgical margins requiring re-excision. Nationally re-excision rates are highly variable and have been reported as high as 40%. Any cancer diagnosis and treatment is stressful for patients and having to return to the operating room for a second surgery can greatly affect both patient satisfaction and cosmetic outcomes. Within our institution we wanted to examined our population over ten years undergoing breast conserving therapy to determine our re-excision rates …

Trauma Team Activation For Geriatric Trauma At A Level Ii Trauma Center: Are The Elderly Under-Triaged?, Grant S. Buchanan, Daniel Scott Kahn, Harry Burke, Brian Czarkowski, Richard Boe, Milad Modarresi, Franklin D. Shuler

Marshall Journal of Medicine

Abstract

Geriatric patients often sustain life-threatening injuries from minor trauma. A growing body of research suggests that these patients are often under-triaged in the emergency setting.The purpose of this research was to evaluate whether or not geriatric trauma patients are under-triaged at a community based level II trauma center.

1434 trauma patients over the age of 65 presenting from 2010-2015 were retrospectively reviewed from the Cabell Huntington Hospital trauma registry and analyzed for age, gender, arrival type, ED response, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), injury cause, ICD-9 diagnosis codes, and mortality. Under-triage and over-triage rates were determined …

Angiosarcoma Of The Lower Extremity Presenting As Bilateral Pneumothoraces, Mark H. Cooper

Marshall Journal of Medicine

Abstract

Spontaneous pneumothorax usually presents as unilateral disease. Bilateral spontaneous pneumothoraces are less common and are more likely to be secondary than primary. We describe a case of bilateral spontaneous pneumothoraces that were resistant to conventional treatment, and found ultimately to be secondary to angiosarcoma of the lower extremity. A previously well 49 year old white female was referred to our institution in London with bilateral pneumothoraces. A left video assisted thoracoscopic procedure was undertaken, and the wedge resection of the lung specimen contained an area of metastatic tumor. Talc was placed into the left pleural cavity; talc was also …

Inferior Stemi Complicated By Retroperitoneal Hemorrhage Due To Ruptured Aaa, Farley B. Neasman Iii, Melissa D. Lester, Nepal C. Chowdhury

Marshall Journal of Medicine

When patients present with life threatening conditions, a rapid cost-benefit analysis prioritizes care and commits treatment to a certain course that, in the case of ST Elevation Myocardial Infarction (STEMI) treated with drug-eluting stents (DES), could be fatal if there is any deviation. Antiplatelet therapy is vital and secondary concerns (i.e. bleeding diatheses) may accept suboptimal outcomes – in rare cases, another life-threatening condition may be unmasked, the treatment for which runs directly counter to the first. We present a case of STEMI with high clot burden treated with multiple DES, complicated by retroperitoneal hemorrhage due to a ruptured abdominal …

Traumatic Posterior Tibial Pseudoaneursym: A Rare Late Complication Repaired Conventionally, Farzad Amiri, Md, Zachary Sanford, Constantinous Constantinou, Md

Marshall Journal of Medicine

Posterior tibial artery pseudoaneurysms are extremely rare. They commonly present as a late complication of trauma or iatrogenic injury. Diagnosis can be elusive. Treatment has been described in the context of open primary repair, endovascular stenting, and coil embolization. There has been increasing interest in the use of endovascular treatment options for this type of injury. If left untreated, pseudoaneurysms can rupture, partially thrombose, expand and cause adjacent local compression and compartment syndrome. The following case presented is of a young gentleman with a posterior tibial pseudoaneurysm incidentally discovered after stepping on glass and the management of his posterior tibial …

Management Of Co-Existing Lung Cancer And Endobronchal Hamartomas, Mark H. Cooper, Md

Marshall Journal of Medicine

Abstract:

The coexistence of lung cancer with an endobronchial hamartoma is infrequent, and requires accurate oncologic evaluation of the endobronchial lesion prior to potential surgical treatment of the lung cancer. We describe a patient who presented with an undiagnosed endobronchial mass and and a biopsy-proven lung cancer which were successfully managed by a staged approach using initial bronchoscopic resection of the endobronchial lesion and subsequent lobectomy for squamous cell lung cancer.