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  Investigating Detroit Water Shutoffs and Hepatitis A

  Tammy Hsia and Marcus J. Zervos

  Introduction: Hepatitis A (HAV) is a self-limiting viral liver disease that can manifest as abdominal pain, anorexia, nausea, fatigue, and jaundice with elevated serum aminotransferase levels. Despite an efficacious vaccine, there has been an outbreak across the country, including metropolitan Detroit. Recent cases in Michigan have presented with severe life-threatening manifestations. Already, 905 cases of hepatitis A have been reported in Michigan in the months of September and October... Read More

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  Patients with Diabetes: Perspectives on Obesity Management and Barriers to Care

  Sabrina Huq, Supriya Todkar, and Sharon Lahiri

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  Long-term risk of recurrence in surgically treated intermediate-high risk renal cell carcinoma: a post-hoc analysis of the Eastern Cooperative Oncology Group - American College of Radiology Imaging Network E2805 Trial cohort

  Marcus Jamil, Jacob Keeley, Akshay Sood, Deepansh Dalela, Sohrab Arora, James O Peabody, Quoc-Dien Trinh, Mani Menon, Craig G. Rogers, and Firas Abdollah

  Background: Surgical resection remains the gold standard treatment modality for clinically localized renal cell carcinoma (RCC). However, the optimal follow-up period in these individuals is controversial, and the current recommendations are based on retrospective data, which inevitably contain attrition bias. Our objective was to re-visit the recurrence rate of surgically treated intermediate-high risk RCC patients using randomized clinical trial data. MethodsWe performed a post-hoc analysis of all the patients... Read More

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  Outcomes after a Colectomy Among Elderly with Inflammatory Bowel Disease

  Pridvi Kandagatla, Amy Tang, Craig Reickert, and Amalia Stefanou

  Purpose/Background: The average age of surgical patients with inflammatory bowel disease (IBD) is rising, and understanding morbidity and mortality unique to these patients is important. Optimizing perioperative risk is significant to quality of care and outcomes. We sought to utilize a national database to evaluate surgical outcomes after colectomy in elderly patients with IBD.

  Methods: We queried the 2016 NSQIP Targeted Colectomy Database to identify colectomies with an associated... Read More

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  Does the use of peri-articular anesthetic cocktail provide adequate pain control following shoulder arthroplasty?

  Elizabeth Klag, Gabriel J Sheena, Kelechi R Okoroha, and Stephanie J. Muh

  Purpose: Interscalene nerve block (INB) and liposomal bupivacaine (LB) have been previously found to provide adequate pain control following shoulder arthroplasty. We hypothesized that local infiltration of a peri-articular cocktail (LIC) would provide equivalent pain control compared to INB and LB at a decreased cost. Methods: Eighty-six patients undergoing primary shoulder arthroplasty were consented for participation. Patients were treated with either LIC (200 mg of 0.5% ropivacaine/1 mg epinephrine/30... Read More

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  The Safety of Per Os Naloxone and its Efficacy in Resolving Postoperative Ileus in Patients Undergoing Spine Surgery

  Eric Klomparens, Karam Asmaro, Jacob Pawloski, Hesham Mostafa Zakaria, Mathew Jones, Beverly C Walters, and Jason Schwalb

  Background and hypothesis: Postoperative ileus (POI) is a common complication after spine surgery which often leads to increased length of stay and associated co-morbidities. While the use of laxatives and supportive therapy can be effective in resolving the symptoms, the use of oral µ-opioid receptor antagonists has not been evaluated in this field. Per os (PO) naloxone is a µ-opioid receptor antagonist with limited systemic absorption with effects mainly... Read More

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  Predictors of Functional Disability in Patients Undergoing Anterior Cruciate Ligament Reconstruction

  Michael Korn, Caleb Gulledge, Chaoyang Chen, Vasilios Moutzouros, and Eric C Makhni

  Purpose: The primary purpose of this study was to identify the patient-centric factors that contribute to functional disability in patients undergoing ACL reconstruction, in an effort to help guide patient selection, counseling, and optimal timing of surgery. Methods: All patients undergoing ACL reconstruction by two fellowship-trained sports medicine surgeons from July 2017 to September 2018 were included.Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test (CAT) scores for... Read More

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  CT Guided Cryoablation of Primary and Metastatic Lung Tumors: Low Recurrence and Complication Rates

  Mark Krycia and Hussein D. Aoun

  Purpose: To assess technical feasibility, efficacy and complication rates of CT guided cryoablation of lung tumors in multiple locations. Materials and Methods: CT fluoroscopic-guided percutaneous cryoablation was performed in 277 procedures on 378 tumors (116 primary, 262 metastatic tumors) in 158 patients. Tumor and ablation volumes, location, abutting vessels >3mm, recurrences, and PFT’s were reviewed for all patients. Complications were graded by the National Institutes of Health, Common Terminology... Read More

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  Perioperative Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Type 2 Diabetics: A MBSAQIP Analysis

  Shravan Leonard-Murali, Hassan Nasser, Tommy Ivanics, Dania Shakaroun, and Jeffrey A. Genaw

  Introduction: The safety and efficacy of laparoscopic sleeve gastrectomy (LSG) and roux-en-Y gastric bypass (RYGB) for the treatment of obesity and associated comorbidities, including type 2 diabetes mellitus (T2DM), is well established. However, these comorbidities may add risk to the perioperative period. We sought to characterize perioperative outcomes of these surgical procedures in type 2 diabetics using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database,... Read More

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  Importance of Radar Gun Inclusion During Return-to-Throwing Rehabilitation Following Ulnar Collateral Ligament Reconstruction in Baseball Pitchers: A Simulation Study

  Vincent A Lizzio, Grace Smith, Toufic R Jildeh, Caleb Gulledge, Alexander Swantek, Jeffrey P Stephens, Brian Schulz, and Eric C Makhni

  Background: Rehabilitation following elbow ulnar collateral ligament reconstruction (UCLR) in baseball pitchers relies on a progression of pitching activities to ensure protection and gradual strengthening of the reconstructed ligament. Typically, players rely on subjective, perceived effort during pitches instead of an objective assessment to guide pitch velocity progression. This reliance on subjective effort levels leaves the elbow vulnerable to early over-load.

  Purpose: To determine the correlation between pitch velocity... Read More

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  Predictive accuracy of the low erythropoietin level for the diagnosis of Polycythemia Vera

  Oleksandra Lupak, Xiaoxia Han, Peter Xie, Sharmeen Mahmood, Hadi Mohammed, and Vijayalakshmi Donthireddy

  Background: A low erythropoietin (EPO) level is a minor diagnostic criterion for Polycythemia Vera (PV) based on the updated 2016 World Health Organization (WHO) diagnostic criteria for myeloproliferative neoplasms. The diagnostic value of EPO has been debated due to the increasing availability of advanced molecular testing. We hypothesized that EPO level below the normal range may not provide additional diagnostic information if JAK2 mutation status is positive. Methods: In... Read More

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  Comparison of Single-Balloon with Double-Ballon Transcervical Catheters Used for Cervical Ripening and the Incidence of Altered Fetal Presentation

  Joshua Lupton, Robert Jarski, and Gregory Goyert

  Obstetrics: Original ResearchComparison of single-balloon with double-ballon transcervical catheters and the incidence of altered fetal presentationJoshua Lupton, DO, Henry Ford Wyandotte Hospital, Wyandotte MIOBJECTIVE: To determine whether double-balloon transcervical catheters used for cervical ripening are associated with an increased incidence of altered fetal presentation in comparison with single-balloon transcervical catheters. STUDY DESIGN: We performed a retrospective study of women who had received either a single-balloon transcervical catheter (foley catheter)... Read More

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  The Efficacy of Topical Hydrolyzed Psoralea corylifolia Extract in Treating Postinflammatory Hyperpigmentation

  Alexis B Lyons, Indermeet Kohli, Amanda F. Nahhas, Taylor L. Braunberger, Tasneem F Mohammad, Cynthia L. Nicholson, Nathan T. Nartker, Krishna Modi, Mary S. Matsui, Henry W. Lim, and Iltefat H. Hamzavi

  Background: Post-inflammatory hyperpigmentation (PIH) is common following resolution of acne. Purpose: The purpose of this study is to determine the treatment efficacy of Topical Hydrolyzed Psoralea Corylifolia extract (HPCE) on acne-induced PIH and TCA-induced PIH using a previously validated model.1Methods: A prospective, single-blinded, non-randomized study was conducted on 20 subjects with acne-induced PIH. Three acne-induced PIH areas on the face and three 35% TCA-induced PIH areas on the buttocks... Read More

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  Outcomes of irrigation and debridement in periprosthetic joint infections using antibiotic-

  Lindsay Maier, Allen Kadado, Robert Matar, Jason J. Davis, and Michael A. Charters

  Title: Outcomes of Irrigation and Debridement in Periprosthetic Joint Infections Using Antibiotic-Impregnated Calcium Sulfate Beads. Purpose: The use of dissolvable antibiotic-impregnated calcium sulfate beads as an adjunct to systemic antibiotics has been proposed as a potential strategy to increase success of treatment of periprosthetic joint infection (PJI). Currently, there is limited information regarding the efficacy of this strategy and prior studies have suggested poor utility. The purpose of this... Read More

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  Clinical Outcomes of Acute Myocardial Infarction Cardiogenic Shock: A Contemporary Single Center Experience

  Sagger Mawri, Mir B. Basir, Paul Nona, Malav Parikh, Mohammad Alqarqaz, Mohammed Zaidan, Tiberio M. Frisoli, Gerald C. Koenig, Henry Kim, Marvin H. Eng, Akshay K. Khandelwal, Michele Voeltz, Adam Greenbaum, Khaldoon Alaswad, and William W. O'Neill

  BACKGROUND: Acute myocardial infarction cardiogenic shock (AMICS) continues to carry high morbidity and mortality, despite advances in revascularization strategies. Recent data shows several trends in the field of AMICS, including increased patient complexity, overall low utilization of percutaneous mechanical circulatory support (MCS), and increased mortality rates. We sought to study the clinical characteristics and outcomes of AMICS patients at our institution. METHODS: From January 2014 to June, 2017, consecutive... Read More

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  Who Skips the Ambulance? A Study Examining Which Patients Choose Private Vehicle Transport Over EMS in Trauma

  Samia Mazumder, Ursula Barghouth, Jeffrey Johnson, David A Moore, and Dhir Patwa

  Introduction: Current data suggest trauma patients arriving via private vehicle transport (PVT) have improved outcomes forpenetrating trauma compared to patients arriving via EMS. These studies suggest patients that utilize EMS overprivate vehicle transport (PVT) have worse outcomes and are described as older, hypotensive, higher injury severityscore (ISS) and lower GCS. While previous studies focus on national data, regional behaviors likely play a role in selection of PVT. This study... Read More

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  Randomized Prospective Trial of Stereotactic Radiosurgery versus Chemotherapy for Recurrent Malignant Glioma after Second-line Chemotherapy

  Ankit Modh, David Bergman, Lonni Schultz, Renee Hanna, James Snyder, Tom Mikkelsen, Samuel Ryu, Tobias Walbert, and M Salim Siddiqui

  Purpose: Outcomes for patients with recurrent malignant glioma are dismal. Fractionated radiosurgery (FSRS) has been shown to be feasible and safe when delivered in this setting, but prospective evidence is lacking. We conducted a single-institutional randomized trial on the use of FSRS versus chemotherapy for recurrent malignant glioma after second-line chemotherapy.

  Methods: High-grade glioma patients with tumor progression after two previous treatment regimens were enrolled. They were randomized to... Read More

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  Recurrent Thrombectomy in Patients with Prior Mechanical Endovascular Revascularization: A Single Center Experience

  Ghada A. Mohamed, Khadija Arshad, Muhammad Affan, Mohammed Ismail, Owais Alsrouji, Daniel J Miller, Maximillian K Kole, and Horia Marin

  Background: Mechanical endovascular reperfusion therapy (MER) has become the standard of care for treatment of large vessel occlusion (LVO) acute ischemic strokes (AIS) with expansion of treatment window to 24 hours from LNW. Nearly 25% of all stroke patients have a recurrent event within 5 years. Intravenous alteplase use in AIS patients with recent ischemic stroke history is often restricted due to the risk of intracranial hemorrhage, however this... Read More

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  Comparison of clinical outcomes in traditional gastrointestinal hemorrhage work up versus direct utilization by push enteroscopy in patients with a left ventricular assist device

  Sandra Naffouj, Mouhanna Abu Ghanimeh, Areej Mazhar, Mahmoud Isseh, Anas Kutait, and Mark Blumenkehl

  BACKGROUND: Patients with left ventricular assisted devices (LVADs) are at considerable risk of gastrointestinal bleeding (GIB) of about 23%. A significant portion of GIB occur in the stomach, duodenum or small intestine as compared with lower intestinal tract. A traditional work up for such patients differs between institutions but generally includes an esophagogastroduodenoscopy (EGD) and colonoscopy +/- RBC tagged scan. If the cause of GIB is not found, a... Read More

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  Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy in the Super-Obese and Super-Super-Obese: An Analysis of the Metabloic and Bariatric Surgery Accreditation and Quality Improvement Program Database

  Hassan Nasser, Tommy Ivanics, Shravan Leonard-Murali, Dania Shakaroun, and Jeffrey A. Genaw

  Background: With the increase in the prevalence of obesity and the need for bariatric surgery, there continues to be contradictory evidence for the perioperative outcomes of super-obese (SO) and super-super-obese (SSO) patients. The purpose of this is study is to investigate 30-day morbidity and mortality following laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in SO and SSO patients using the Metabolic and Bariatric Surgery Accreditation and... Read More

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  Pacemaker Following TAVR Associated With Increased Tricuspid Reguritation

  Paul Nona and Dee Dee Wang

  Background: Transcatheter Aortic Valve Replacement (TAVR) therapies have increased in the treatment of aortic disease. As TAVR procedures increase, more data is available on complications, such as the development of conduction abnormalities, often requiring pacemaker placement (PMP). A common complication of pacemaker lead placement is the development of tricuspid regurgitation which develops due to pacemaker wire impingement of leaflet function and coaptation.

  Methods: Retrospective data was obtained from a... Read More

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  Predictors of Response and Outcome of Patients with Acquired Hemophilia A

  Ifeoma Onwubiko, Gary Kaperek, Philip Kuriakose, and Zaher K. Otrock

  Context: Acquired hemophilia A (AHA), which is caused by autoantibodies against coagulation Factor VIII, is a rare and life-threatening bleeding disorder with a mortality rate of up to 25%. The clinical characteristics and outcomes of AHA remain difficult to establish due to disease rarity. We evaluated the clinical characteristics, predictors of response and outcome of patients with AHA.Design: We retrospectively evaluated 25 consecutive patients with AHA managed at our... Read More

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  Outcome of Germinal Center B-Cell Type Compared to Non Germinal Center/Activated B-Cell Type Diffuse Large B-Cell Lymphoma as Determined by Immunohistochemistry Using The Hans Algorithm

  Neha Patil

  Outcome of Germinal Center B-Cell Type Vs Non Germinal Center/Activated B-Cell Type Diffuse Large B-Cell Lymphoma as Determined by Immunohistochemistry at Henry Ford Hospital Over 7 Years. Background: The classification of diffuse large B cell lymphoma (DLBCL) takes into consideration the cell of origin (COO), germinal center B-cell (GCB) vs non germinal center/activated B-cell type (non-GCB/ABC), since its determination by gene expression profiling predicts prognosis when treated with standard... Read More

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  Hemodynamic changes with placement of wrung-out topical 1: 1000 epinephrine nasal pledgets before and during endoscopic sinonasal surgery

  John Peleman, John R Craig, Tarwade Pritee, and Donald Penning

  Topical epinephrine is proven to be safe and effective during endoscopic endonasal surgery when used appropriately. Our aim is to evaluate the hemodynamic effects of topical 1:1000 epinephrine under general anesthesia both preoperatively and intraoperatively using wrung out pledgets. 22 patients undergoing endoscopic endonasal surgery with various pathologies were evaluated for the study. Heart rate, blood pressure, and ECG measures were recorded for 7 minutes after epinephrine pledget placement... Read More

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  Does Time of Day Matter for Acute Cholecystectomy in an Acute Care Surgery Model?

  Ilya Rakitin, Nathan Schmoekel, Jerry Stassinopoulos, Nadia Obeid, Cletus Stanton, Michael Dix, Nathan Ziegler, and Jeffrey Johnson

  INTRODUCTION: Prompt cholecystectomy for acute cholecystitis is well accepted; however, whether this warrants urgent nocturnal surgery remains a matter of debate. Differences in available resources, multitasking, and sleep hygiene may affect performance. This could impact conversion rates to open surgery, operation time, bile duct injury, blood loss, complications, and hospital length of stay. Some evidence supports improved outcomes in patients who can avoid after-hour cholecystectomy. We aimed to determine... Read More