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  Trends in Thoracic Endovascular Aortic Repair in Patients 45 Years Old and Younger

  Brandon Diaz, Alexander Chen, Graham W. Long, Rose Callahan, Diane Studzinski, and Otto W. Brown

  Publication Date: 3-2024

  Objective:Thoracic endovascular aortic repair (TEVAR) is now the preferred method of repair for most aortic pathology. This report explores the indications, morbidity, and long-term implications of TEVAR in patients under 45 years old.
  Methods:This is a retrospective, single-institution study of electronic medical records for all patients under age 45 years treated with TEVAR from July 2006 to December 2022. Data collected included demographics, comorbidities, and 30-day and long term outcomes, including medical and aortic-related complications.
  Results:The study cohort consisted of 30 patients, mean age 32 years, 22 males (73.3%), 10 (33.3%) with hypertension, and 15 (50%) were smokers. There were 16 (53.3%) traumatic disruptions, 1 (3.3%) aneurysm, 1 (3.3%) penetrating atherosclerotic ulcer, and 12 (40%) dissections (7 Type A and 5 Type B). Three patients died within 30 days of their procedure for a perioperative mortality rate of 10%; the interval from procedure to death was a mean 4.3 days (SD ± 3.8). Twenty-one had at least 1 follow-up visit post-TEVAR and 22 underwent at least one follow-up imaging study. Thirty-day morbidity overall was 50% and included endoleak in 6 (20%), cardiac complications in 5 (16.7%), renal failure in 7 (23.3%), spinal cord ischemia in 1 (3.3%), graft failure in 1 (3.3%), limb ischemia in 3 (10%), and multi-system organ failure in 3 (10%). Of the 22 patients with follow-up imaging, endovascular reinterventions were required in 4 (18.2%), while open surgical reintervention was necessary in 1 (4.5%). Reinterventions occurred at a median of 3.7 months postoperatively (0.7-60.8) and were indicated for 1 expanding aneurysm, 3 endoleaks, and 1 for combined endoleak and expanding aneurysm. There was one late death at 1.1 months (aortic-related) and another deceased patient whose cause and date of death are unknown.
  Conclusion: Historically, patients that undergo TEVAR for underlying aortic pathologies, especially young patients, are followed long-term to monitor for further aortic degeneration and possible reintervention. In our study, majority of all reinterventions (80%) occurred within 1 year. However, all patients with traumatic aortic disruption who underwent TEVAR did not require any reintervention upon follow-up imaging. These patients may not require surveillance past one year

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  Utility of Great Saphenous Vein Mapping in the Detection of Superficial Vein Thrombosis Prior to Infrainguinal Arterial Bypass

  Melissa C. Hetrick, Ashley E. Beale, Graham W. Long, Sarvar Oreizi-Esfahani, Rose E. Callahan, Diane M. Studzinski, and Otto W. Brown

  Publication Date: 3-2024

  OBJECTIVE: The great saphenous vein (GSV) is widely used as a bypass conduit for the treatment of infrainguinal peripheral arterial disease. Preoperative vein mapping assesses both the quality and diameter of the GSV. Ultrasound findings regarded as unfavorable are the presence of superficial vein thrombosis (SVT), ipsilateral deep vein thrombosis (DVT), and small vessel diameter. Identifying a suitable conduit is of utmost importance as GSV bypasses have improved patency compared to alternative conduits. The primary objective of this study was to identify the percentage of patients with ipsilateral SVT as well as patient characteristics associated with SVT and unsuitable GSV.
  METHODS: Retrospective, single-institution study from March 2013-December 2021. All patients with peripheral arterial disease who underwent outpatient vein mapping were included. Unsuitable GSV was defined by the presence of SVT, DVT, or size < 2.5 mm in any segment (from proximal thigh to distal calf).
  RESULTS: A total of 191 patients met inclusion criteria. Most patients were male (71.7%), Caucasian (69.8%), and the mean(SD) age was 68.6(10.8) years. Ipsilateral SVT was identified in 10.5% of patients. No significant differences in demographics or comorbidities were identified in patients with and without ipsilateral SVT. Less than half (45.8%) of patients had GSV that was greater than 2.5 mm throughout, and only one third (37.4%) had a GSV conduit of adequate size without SVT or ipsilateral DVT. GSV conduits of adequate size and without SVT or ipsilateral DVT were associated with male gender, 86.6% male vs 13.4% female (p=0.001, OR 3.6 (95% CI 1.6-8.2)). After completion of vein mapping, 90 (62.1%) patients underwent infrainguinal bypass and the ipsilateral GSV was used as a conduit in 58.9% of cases.
  CONCLUSIONS: Our study revealed that 10.5% of patients have SVT identified on preoperative vein mapping. Given these findings, routine preoperative venous duplex should be performed to assess for the presence of SVT, as this finding is difficult to identify intraoperatively and may predict lower patency rates. Veins identified as unsuitable, based on size criteria alone, should still be investigated intraoperatively with ultrasound or direct surgical exploration as vessel diameter, unlike SVT, is a dynamic finding.

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  A Penetrating Neck Injury Resulting in Complete Transection of the Ipsilateral Common Carotid Artery, Delayed Contralateral Pneumothorax and Occult Esophageal Injury: A Case Report with a Multidisciplinary Approach to Management

  Michaela Knaggs, Christian Przeslawski, Peter Habib, Ahmed Ghamraoui, Caitlin Wahl, and Jeffrey Gerken

  Publication Date: 5-4-2023

  A 29-year-old male presented a zone one penetrating neck injury. He had a proximal common carotid artery and internal jugular vein injuries which were successfully managed with vessel ligation. Patient also had an occult esophageal injury at the junction of the cervical and thoracic esophagus which was successfully managed with wide drainage of the neck and right chest.

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  Effectiveness of a Modified Difficult Colonoscopy Score A Retrospective Review of General Surgeon Performed Colonoscopies at a Community Hospital

  Killian Llewellyn, Lianne Caceres, Karen Childers, and John Parmely

  Publication Date: 5-4-2023

  Colonoscopy remains the mainstay of screening for colon cancer in the US and an essential operating room skill for general surgeons.

  ▪ A quality review was performed of general surgeons at a community hospital.

  ▪ Difficult Colonoscopy Score (DCS) was a score created to predict difficulty of colonoscopy which was defined as prolonged intubation time, need for external compression, or increased pain score [1]. We tested the utility in our community and resident-involved endoscopy department.

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  Traumatic Thoracostomy Tube Management at a Community Hospital A Retrospective Review

  Christian Przeslawski, Peter Habib, Kita Mack, Vimal Love, Julie George, and Amelia Pasley

  Publication Date: 5-4-2023

  Thoracostomy tubes or chest tubes (CT) have been a mainstay in thoracic trauma treatment since the Vietnam war with their roots dating back to the 5th century [1]. Trauma is the number one cause of death in the world, with chest trauma being the second highest cause of trauma related death [2]. 18% of patients with a blunt thoracic injury require chest tube. Management varies widely and there is no general consensus on management [3].

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  Aberrant Diagnostic Imaging Resulting in Misdiagnosed Acute Perforated Appendicitis A Case Report

  Christian Przeslawski, Leanne Iorio, and Jeffrey Gerken

  Publication Date: 5-4-2023

  300,000 appendectomies are performed every year in the United States with lifetime risk of acute appendicitis in the United States is approximately 9% [1,2].

  We present a case where initial diagnostic imaging was consistent with perforated sigmoid diverticulitis with definitive diagnosis at the time of surgery being acute perforated appendicitis.

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  Invasive Lobular Carcinoma of the Breast Presenting as Pneumoperitoneum with Omental and Retroperitoneal Metastasis A Case Report

  Logan Smith, Christian Przeslawski, Katie Sarraf, Steven Jones, and Raimundo Pastor

  Publication Date: 5-5-2023

  A 65 year old female presenting with abdominal pain and imaging findings of pneumoperitoneum was brought to the operating room and found to have a retroperitoneal mass and omental caking secondary to metastatic breast lobular carcinoma. Intra abdominal metastasis is rare however lobular carcinoma is more likely to spread here than other types of breast cancer [1]. This is the first case of pneumoperitoneum from metastatic lobular carcinoma in the literature.

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  Relationship Between Obesity and Triple-Negative Breast Cancer: A Retrospective Study

  Mariam Aoun, Anna Jahshan, Nayana Dekhne, and Varna Taranikanti

  Publication Date: 5-2-2022

  INTRODUCTION
  Several research studies have identified a positive correlation between obesity and specific receptor statuses in breast cancer, including ER-positive, PR-positive, and HER2-positive breast cancers. However, triple-negative breast cancer (TNBC) in particular has not been studied in relation to body mass index (BMI), which suggests that an analysis of triple-negative breast cancer and its relation to obesity is warranted. This study aims to analyze the association between triple-negative breast cancer and BMI through a retrospective analysis in order to further guide patient counseling about TNBC risk factors.

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  Multiple Endocrine Neoplasia Type 1 in a Young Man With Seizures

  Nitya Batra, Nishant Aggarwal, Shailesh Niroula, Daniel Misra, Peter Czako, and Daniel Shelden

  Publication Date: 10-2022

  Introduction

  Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder involving mutation of the MEN1 gene. Clinically it is defined by tumors of the pituitary, parathyroid, and the entero-pancreatic endocrine cells. Other tumors have been associated with MEN1. We present a case of a previously healthy young man presenting with seizures.

  Discussion

  We present a classic case of MEN1 in a patient with significant family history with the presence of primary hyperparathyroidism, pituitary microadenoma, and duodenopancreatic NETs. • Interestingly, rare presentation of MEN1 as refractory seizures have been reported secondary to hyperinsulinemic hypoglycemia, but our patient was euglycemic with appropriate levels of insulin and C-peptide. This suggests an alternative etiology that is not well documented in available literature. • Given the complex and highly specialized skills needed to diagnose and treat MEN1, involvement of a multidisciplinary team is vital.

  Conclusion When the clinical suspicion for MEN1 is high, endocrinology evaluation with appropriate laboratory workup and targeted imaging of the typical endocrine organs as described for this patient are advised with careful multidisciplinary management and follow-up.

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  Incidental Pathogenic Fibrin-Associated Diffuse Large B-Cell Lymphoma Found During Aorto-Biiliac Bypass

  Peter Habib, Thomas Serena, Caitlin Flynn, Aaron Hartkop, Elizabeth Wey, David Lang, and Eugene Laveroni Jr

  Publication Date: 5-2022

  Introduction • Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) is an extremely rare form of Epstein-Barr virus positive (EBV+) non-Hodgkin’s lymphoma. • This case presents a rare and unique presentation of a pathological non-Hodgkin’s lymphoma

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  Relationship Between Smoking and Triple-Negative Breast Cancer: A Retrospective Analysis

  Anna Jahshan, Mariam Aoun, Nayana Dekhne, and Varna Taranikanti

  Publication Date: 5-2-2022

  INTRODUCTION
  Breast cancer is currently the most common cancer by incidence among women in the United States with high mortality. Compared to other specific types, triple-negative breast cancer (TNBC) is considered to be an aggressive cancer with poor prognosis. Hence, it is important to study the risk factors associated with it. Smoking has been implicated in many cancers, including breast cancer. However, there is no evidence in literature that has shown a relationship between smoking and a specific type of breast cancer. The goal of this study is to analyze the relationship between smoking and TNBC so that we may improve the understanding of the risk factors related to this type of breast cancer.

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  Clearance of the Cervical Spine in Obtunded Pediatric Blunt Trauma Patients: Quality Assessment of an Existing Clearance Pathway

  Rachel Kalthoff, Elizabeth Boudiab, Diane Studzinski, Nathan Novotny, Pavan Brahmamdam, and Begum Akay

  Publication Date: 5-2-2022

  INTRODUCTION
  Obtunded patients following blunt trauma need clearance of the cervical spine (c-spine) that cannot depend on a clinical exam. Our center’s current pediatric c-spine evaluation pathway includes both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). The objective of this study was to review our use of both CT and MRI for obtunded pediatric trauma patients to assess the quality of our pathway and utility of MRI.

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  Factors Influencing Reintubation in Self Extubated Pediatric Intensive Care Unit Patients

  Ahmed Naseem, Ameer Al-Hadidi, Morta Lapkus, Patrick Karabon, Begum Akay, and Paras Khandar

  Publication Date: 5-2-2022

  NTRODUCTION
  Intubated pediatric patients that self-extubate may be particularly susceptible to reintubation. Identifying factors that increase risk of reintubation allows for better monitoring and response in cases of self-extubation and can potentially identify patients needing reintubation.

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  Radioactive iodine therapy (RAIT) in N1 papillary thyroid cancer: Are we overtreating?

  Elizabeth Odil, Jordan Reilly, Fionna Sun, Diane Studzinski, Rose E. Callahan, and Sapna Nagar

  Publication Date: 4-28-2022

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  A Rare Case of Subcutaneous Panniculitis-Like T-cell Lymphoma

  Blake Seelbinder, Angela Kim, Marcos Rosado, Mohamed Musheinesh, Amanda Cimino, John Pui, Armen Korkigian, and Craig Gordon

  Publication Date: 5-2022

  Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare and typically slow growing variant of T-cell lymphoma. The clinical course usually mimics infectious panniculitis. It characteristically affects the subcutaneous adipose tissue of the trunk or extremities without resultant lymph node involvement. It comprises

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  Association of Gut Metabolomic Biomarkers with Sleeve Gastrectomy Weight-Loss Outcomes

  Pamela Spicer, Wendy Miller, Kathryn Ziegler, and Stewart Graham

  Publication Date: 5-2-2022

  INTRODUCTION
  Obesity is a prevalent health challenge with high morbidity and many associated chronic diseases. Sleeve gastrectomy is currently the predominant intervention for obesity. However, weight loss results are variable. The mechanisms and factors influencing this variability are not well understood. We evaluated the correlation of metabolomic biomarkers with weight-loss.