The Influence of Medication Assistance Programs on Glucose Control for Uninsured Type 2 Diabetic Patients

Amanda Herd

The purpose of this study was to assess the efficacy of medication assistance program enrollment and formal patient educational level on diabetic patient glucose control through HbA1c levels. The results of this study provide information of the effectiveness of an assistance program and if increased availability of testing supplies has a positive effect on diabetic patients. The results of this study also provide information indicating if a significant relationship is found between the patients...

Effect of Average Blood Glucose on Nosocomial Infections

Paul Swiecicki

This project examines the relationship between the degree of control of blood glucose and nosocomial infections. Data pending for MERC Research Day 2010.

Acute Kidney Injury Associated with the 2009 H1N1 Influenza in Pediatric Patients

Jin Chung

This is a case series of children with the 2009 H1N1 influenza infection seen by HDVCH pediatric nephrology, looking at renal involvement. Children with and without chronic kidney disease with a confirmed RT-PCR H1N1 infection were included in the study, and it suggests that there was an increased incidence of acute kidney injury in children with the H1N1 infection.

The correlation of foot angle measurements with functional outcomes of operatively treated Lisfranc injuries

Cameron Patthanacharoenphon

This is a retrospective review of patients with injuries to the tarsometatarsal (Lisfranc) joint treated operatively with Open Reduction Internal Fixation (ORIF) or Primary Arthrodesis (PA). Radiographs were digitally blinded and common foot angle measurements were correlated with prospective gathered functional outcome measures. Some foot angle measurements may predict return to work status.

Laparoscopic Jejunoileal Bypass Reversal with Concomitant Vertical Sleeve Gastrectomy: two case reports

Amy Banks

Jejunoileal Bypass (JIB) for morbid obesity created significant malabsorption by bypassing most of the small intestine. This resulted in weight loss but also numerous complications, including severe malnutrition, vitamin deficiencies, uncontrollable diarrhea, liver failure, and death. This surgery was ultimately abandoned and patients have needed reversal procedures. There is, however, limited literature in regards to the operative technique, outcomes and post-operative complications. We present...

Cryptococcal meningitis in Immunocompetent patient

Purnachander Vangala

Suspecting cryptococcal meningitis in patients with lymphocytic meningitis, would help in initiating treatment at an early stage and help in reducing mortality and morbidity

"Consumption": An Ancient Disease in Modern America

Matthew Gale

Our project is a case report of a young man with severe tuberculosis which presented interesting challenges. His therapeutic regimen eventually included six medications.

Outcome of Operatively Treated High Energy Multiligament Knee Injuries

Jeffrey Bradley

The treatment of patients with multiligament knee injuries is variable and complex. This retrospective clinical study looks at objective outcomes of surgical treatment in patients with acute and chronic multiligament knee injuries. Further studies including those with subjective results and outcomes will aid in the development of a more ideal treatment algorithm for this difficult patient population.

A Surgical Approach for Type 2 Compensated Equinus: Retrospective Review Of Outcomes And Review Of The Literature

Scott Holthusen

Gastrocnemius contracture may result in arch collapse and forefoot deformities. This study involving 374 patients demonstrated excellent results and functional outcomes following the use of a structured treatment algorithm for management of these deformities.

Implementation Of Colonoscopic Process Measures: Does It Improve Quality?

Theodor Asgeirsson

Although screening colonoscopy has significantly reduced the incidence of colorectal cancer due to removal of clinically significant adenomatous polyps, the clinical benefit of removing micro adenomas is of unclear benefit. As a result basing the value of increasing withdrawal time on adenoma detection rate may not be a good surrogate quality indicator for colonoscopic cancer screening. The aim of this study was to compare colonoscopic screening prior to and after full implementation of 6 minute...

Incomplete Correction versus True Clubfoot Recurrences

Matthew Halanski

We retrospectively reviewed two prospective cohorts treated for clubfeet either by surgical or the Ponseti method. We analyzed those patients that required further treatment for recurrent deformities in an attempt to discern between an incomplete correction or a true recurrent deformity.

Ankyloglossia: Diagnosis, Treatment and Complications

Brian  Queen

This is a descriptive study utilizing a survey to obtain data on the frequency, diagnostic criteria, and opinions of various medical providers regarding frenulectomy as a treatment for ankyloglossia (tongue-tie) and its potential complications. Data concerning frenulectomies was also collected from Spectrum Health and Helen DeVos Children's hospital databases and analyzed.

The Effectiveness of High Fidelity Simulation in Health Professions Education

Leslie Crowley

This study investigated the use of high fidelity simulation in health professions education to determine if it leads to increased learning. Surveys of nine high fidelity simulation scenarios completed at Grand Valley State University were assessed for major strengths and weaknesses participants felt contributed most, or least, to the learning environment. The results may lead to modifications of these experiences to further benefit and prepare future health care providers.

Bridging Hand Assisted Laparoscopic colectomy to Laparoscopic colectomy improves outcome without a significant learning curve

Sree Suryadevara

Retrospective review of outcomes for colectomies performed during two separate time periods. A trend away from hand assist laparoscopic surgery to straight laparoscopy was demonstrated with clear benefits in results.

Humeral Head Autograft: A Solution for Glenoid Bone Deficiency in Reverse Total Shoulder Arthroplasty

Kendall Hamilton

The rotator cuff deficient shoulder is a challenging surgical problem leading to instability, arthritis, and glenoid bone deficiency. Reverse total shoulder arthroplasty is the preferred treatment for providing pain relief, stability, and functional improvement for patients with rotator cuff arthropathy; however insufficient glenoid bone can adversely affect component positioning, presenting an opportunity for both prosthetic dislocation and for scapular notching. Our goal is to introduce a surgical...

Persistent Fever in a 3 month old: a Case of Unsuspected Congenital Diaphragmatic Herniation

Amber Loyson

A persistent fever can be a relatively unspecific presenting sign in children and can be caused by both benign and life-threatening conditions. Congenital diaphragmatic herniation (CDH) is uncommon and most cases are diagnosed prenatally by ultrasound or present in the first few hours of life with respiratory distress. In this case, the late presentation of a right-sided congenital diaphragmatic hernia as a persistent fever in a 3 month old was interesting and unusual.

Radiation-Induced Valvular Disease

John Michael Chua Chiaco

This presentation describes two cases of valvular disease caused by radiotherapy for Hodgkin disease. Damage was severe enough in one patient to require surgery. The heart was previously thought to be radioresistant, and this type of injury is probably an under-recognized form of valvular dysfunction and heart failure.

Microscopic Analysis of Silicone Breast Implant Shells Damaged by Surgical Instruments

Derek Rapp

Microscopy can serve as a useful tool in determining mechanism of shell failure when used to analyze ruptured implants. Despite what has been previously published, full thickness striations are seen only in the setting of scissor induced surgical damage and not when damage is the result of a cut from a scalpel. Breast implants are susceptible to surgical instrument damage, which may propagate shell failure.

Improving Patient Satisfaction Through Physician Communication Education

Charlotte Lofgren

Patient satisfaction was assessed before and after pediatric residents were given a series of lectures based on the publication, "Plain Language Pediatrics." The goal was to improve the level of patient satisfaction with pediatrics residents' communication skills.

Early TKR revision for tibial component debonding

John Stirton

We retrospectively reviewed a series of 17 early TKR failures of a single design which required revision for aseptic loosening due to tibial debonding. We believe that specific design flaws of this particular implant may lead to debonding of the interface between the tibial baseplate and the cement mantle. This mode of early failure has not previously been explored in the TKR literature.

Knowledge Regarding Human Papillomavirus (HPV), its Transmission, and its Complications in College Freshman (Men and Women) at One Public University in the Midwest

Kelly  Anthony

The intent of this research is to explore college freshmens comprehension of the Human Papillomavirus (HPV) in order to identify gaps in current knowledge. An online survey tool was created through SurveyMonkey and distributed to 1000 Grand Valley State University freshman, age 18 and older. The data will be analyzed and the results utilized to gain a better understanding of where the gaps in knowledge are and recommendations on how to fill those gaps in this population.

Mechanical Bowel Preparation with Oral Antibiotics: Is it Superior?

Khaled El-Badawi

Bowel preparation prior to colon resections has been a matter of much debate. Recent data suggests mechanical bowel prep with oral antibiotics may be superior in preventing surgical site infections. We looked at this by retrospectively assessing our data.

The Role of the 3D Camera in Breast Measurement Analysis and Augmentation

Marissa Baca

During consultation for breast augmentation, the standard of practice for obtaining breast measurements are simple measuring tapes and calipers, tools that lack the precision of modern medical technology. The technology is available in the form of 3D cameras, but the current literature lacks studies that show the efficacy of such a tool. The present aims to validate 3D camera imaging as an efficacious and accurate method of breast measurement in augmentation consultation.

Food-induced Lowering of Blood-Ethanol Profiles in Intoxicated Patients Presenting to the Emergency Department

Rachel Hagert

Drinking alcoholic beverages together with or after a meal is widely known to diminish the intensity and duration of ethanol intoxication compared with drinking the same dose on an empty stomach. A specific food-induced effect on the activity of alcohol metabolizing enzymes has been suggested by some workers. This was a prospective, clinical study using a convenience sample of patients admitted to the ED with acute alcohol intoxication to determine the effect of eating a meal on the rate of ethanol...

Reversal of Posterior Tibial Slope after Patellar Tendon Advancement

Cameron Patthanacharoenphon

This is a retrospective review of the radiographs and clinical charts of ambulatory pediatric patients who underwent multi-level surgery including soft tissue patellar tendon advancement. The posterior tibial slope and physes of sixteen patients with 31 patellar tendon advancements were reviewed. This study shows a possible reversal in tibial slope associated with tibial tubercle advancement.

Long-Term Functional Outcome of Cuboid Fractures

Gary  Olson

Cuboid fractures (CF) are rare and functional outcome remains under-reported. Cuboid fractures are debilitating injuries that require restoration of lateral column length and articular surface congruity. Increased injury severity and increased BMI determined inferior functional status.

Neurolysis versus Neurectomy for the treatment of Mortons Neuroma (IDN)

Julie Sara

My project involves the surgical treatment of Morton's Neuroma. I retrospectively compared 2 authors surgical technique and looked at pain as the outcome for the procedures.

STAGE IV NON-SMALL CELL LUNG CARCINOMA IN A 14-YEAR-OLD GIRL

Wen Chung

Respiratory papillomatosis is a benign neoplasm of the respiratory tract caused by human papilloma viruses (HPV), mostly subtypes 6 and 11. Pediatric patients are at risk of vertical transmission after vaginal delivery by an infected mother. Just as HPV infection can lead to cervical cancer, there is a risk of malignant transformation from pulmonary lesions into lung carcinoma.

A Decision Aid for Rheumatoid Arthritis Patients Considering Methotrexate Therapy

Rich Martin

Patient decision aids (PtDA) are tools that medical providers use as a supplement to clinical discussion. PtDAs contain information with choices and outcome probabilities, help patients clarify their values, and provide structured guidance about deliberation. This study sought to develop and pilot test an inexpensive PtDA that could be used during and following a clinical encounter by rheumatoid arthritis (RA) patients considering methotrexate (MTX) therapy.

Recurrent Stenosis After Carotid Stenting

Seth DeCamp

Carotid angioplasty and stenting (CAS) is performed in patients who are deemed too high-risk for carotid endarterectomy. The incidence of recurrent carotid stenosis (RCS) after stenting is low, however, the precise incidence and management has not been clearly defined. The purpose of this study is to review the incidence and management of recurrent carotid stenosis after stenting.

Gastric Outlet Obstruction Caused by an Impacted Gallstone (Bouverets Syndrome)

Bilal Ali

Case report of rare cause of gastic outlet obstruction by gallstone which had migrated into duodenum through cholecystoduodenal fistula.

Eyes do not see what mind does not know

Bilal Ali

Methimazole is rare but a known agent to cause cholestatic jaundice. Diagnosis is clinical and lack of awareness of this association can cause delay in diagnosis, with significant morbidity for the patient. All of which can be avoided by discontinuation of drug

Comparison of Perimortem Blood Alcohol Level with Postmortem Alcohol Levels: A Retrospective Cohort Study

Raymond Scurek

The measurement of postmortem alcohol levels is often used as evidence in criminal cases and plays a role in filing claims in automobile accidents. This is a retrospective cohort study based on chart review which includes subjects who died in the emergency department at Spectrum Health between 2002 and 2009, had a blood alcohol level drawn within 24 hours of death, and then had an autopsy performed where blood and vitreous humour alcohol levels were obtained. Although detailed analysis is still...

Nocardia Intracerebral Abscess

Eric Payne

This is a case report of an immunocompetent patient presenting with focal neurologic signs without evidence of an overt infectious process. It underscores the importance of maintaining a high index of suspicion for this infectious process as early detection and treatment are critical for reducing morbidity and mortality.

Counterterrorism Planning Using the Michigan Hazardous Substances Events Surveillance System (HSEES)

Randi Brown

Over a 4-year period (2005-2008), we analyzed HSEES data collected by the Michigan Department of Community Health to determine the frequency and locations of hazardous substance events occurring in Michigan; which major industry categories and sub-categories had the most frequent events; which substances were most commonly released; and to identify human exposures and injuries. The MI-HSEES project is part of a larger program in the MDCH that addresses chemical terrorism and chemical emergency events...

The Effects of Skin Pigmentation on the Detection of Genital Injury From Sexual Assault

Crosby Rechtin

This retrospective cohort trial evaluated consecutive female patients presenting to a community-based Nurse Examiner Program (NEP) during a 10-year study period to investigate the role of skin pigmentation in the visual identification of genital injury following rape in women 13 years and older. Despite the use of colposcopy with nuclear staining and digital imaging, forensic examiners in this community-based study consistently documented fewer anogenital injuries in black women. These findings suggest...

Mediastinal Paraganglioma

Indu Rekha Meesa

Case report of a rare mediastinal paraganglioma, describing imaging findings, histology, and management.

MR Imaging of Pregnant Women with Abdominal Pain: Diagnostic Accuracy and Outcomes

Indu Rekha Meesa

This study will determine the application/usefulness of using MRI in pregnant women presenting with right lower quadrant pain.

Clinical application of MR Spectroscopy in Tumor Diagnosis and Management

Indu Rekha Meesa

Retrospective review of the radiology literature from 2000 through 2009 was performed to evaluate the current clinical application of MR Spectroscopy towards diagnosing and managing tumors in various organ systems.

Transformation of Chronic Lymphocytic Leukemia to Mantle Cell Leukemia

Ghazia Pervaiz

This case describes a patient who developed Mantle Cell Lymphoma in the setting of pre-existing Chronic Lymphocytic Leukemia.

Extremely Late Recurrence of T-ALL in a Patient with t(11;14)

Ghazia Pervaiz

This case describes a 40 year old man, initially diagnosed with T-All with t(11;14)at the age of 13.

Increasing Tdap Immunization through Patient Education and Opportunity

Michelle Davis

Pertussis (whooping cough) is a bacterial illness which is typically very mild in adults but can cause serious illness in infants. Reimmunizing adolescents and adults for pertussis potentially reduces the reservoir for the disease, thus reducing the incidence and complications from the illness. The purpose of this study was to determine if providing patients education regarding pertussis and the Tdap vaccination, and offering vaccination at all patient visits, would increase vaccination.

Persistent Pain Following Spinal Immobilization in Trauma Patients: Results of a Multicenter, Prospective Study

Jeffrey Jones

To assess whether spinal immobilization is associated with persistent pain in MVC patients transported by EMS, we performed a secondary analysis of a cohort of patients enrolled in project CRASH, an ongoing multi-center trial whose purpose is to identify predictors of chronic pain post MVC. Ninety-four MVA patients were transported by EMS and included in this study. In this preliminary analysis, backboarded patients had a higher degree of pain persistence at one month. Further work is needed to...

Catechol O-Methyltransferase Haplotype Predicts Immediate Musculoskeletal Neck Pain and Psychological Symptoms after Motor Vehicle Collision

Jeffrey Jones

Genetic variations in the catechol-o-methyltransferase (COMT) gene have been associated with experimental pain and risk of chronic pain development, but no studies have examined genetic predictors of neck pain intensity and other patient characteristics after motor vehicle collision (MVC). We hypothesized that individuals with a COMT pain vulnerable genotype, who have relatively high catecholamine levels, would experience more intense post-MVC neck pain and somatic symptoms. Our findings suggest...

Unintentional Victims: Children at Clandestine Methamphetamine Labs

Margo Martin

A growing concern for child protective agencies is children of methamphetamine users. It is estimated that children are present at 20% of clandestine drug laboratories and are sometimes forced to assist in meth production. In addition to exposure to toxic and explosive chemicals from home methamphetamine cooking, children may be neglected by their parents or guardians. HazMat events data from the Agency for Toxic Substances and Disease Registry (ATSDR) Hazardous Substances Emergency Events Surveillance...

eBay Shopping: A Vast Resource for Dangerous Poisons

Emily Seif

While the sale and distribution of most toxic substances is tightly regulated within the Unites States, many highly dangerous chemicals and drugs can still be purchased with relative ease online. Over a 12-month period from April 2009 through March 2010, weekly listings on the online auction Web site eBay were searched using only the term poison. Product name, toxic ingredient(s), product formulation, the amount of the product in the container (full or partially full), and relative toxicity rating...

The Impact of Suture Removal Kits and Wound Instructions on Emergency Department Patients

Katherine Kruse

For each laceration that requires sutures in the emergency department (ED), there is currently a protocol in place for that patient to return to a medical care provider to have those sutures removed. For patients who are uninsured, unable to access an urgent care facility or lacking a primary care provider, the medical care to remove sutures often occurs in the same ED where the laceration repair originally occurred. These visits are costly and could possibly be avoided, saving the health care...

Vaginal Injuries After Consensual Versus Nonconsensual Sexual Intercourse In a Community-Based Population

Omar Kolonda

The spectrum of vaginal injuries from coitus can range from minor superficial trauma to life-threatening laceration or perforation. There is limited data involving the evaluation of patients with nonobstetric vaginal lacerations—almost all previous reports are case studies.To describe the predisposing factors, injury patterns and treatment in women presenting with vaginal laceration due to consensual versus nonconsensual sexual intercourse we performed a retrospective analysis of adult females...

The Cost Effectiveness of Crisis Intervention: Can a Public Shelter for Inebriates Offset the High Cost of Service

Amanda Williams

Over 4% of all emergency department visits are secondary to acute or chronic alcohol intoxication. Clinicians observe these patients for prolonged periods of time in the emergency department (ED) and order excessive testing to avoid missing hidden or serious illness in these patients. Often these patients are admitted for observation because they have no caretaker available and they cannot be thoroughly observed. This repeating cycle incurs significant medical costs to the health care system that...

Ingestion of a Newly Described North American Mushroom Species from Michigan Resulting in Chronic Renal Failure: Cortinarius orellanosus

Muhammad Kashif Adnan

We describe a woman who developed chronic renal failure after ingesting an unknown mushroom. The mushroom was preliminarily identified as one from the genus Cortinarius. Phylogenetic analysis confirmed the mushroom to be a new North American Cortinarius species, Cortinarius orellanosus. This is the first confirmed case in North America of renal failure developing after the ingestion of a Cortinarius mushroom.

Vitamin A Toxicity Resulting from Chronic Ingestion of Buttercup Squash, Spinach, and a Multivitamin

Amery Robinson

Vitamin A toxicity is extremely rare from plant sources. We describe a woman who developed vitamin A toxicity after chronically ingesting a large quantity of buttercup squash, spinach, and a multivitamin containing 3500 IU of vitamin A on a daily basis. A lumbar puncture and free retinol level confirmed the diagnosis.

"Esophageal Perforation following Transoral Incisionless Fundoplication (TIF)"

Amanda McClure

This is a case presentation documenting the only known esophageal perforation following a Transoral Incisionless Fundoplication Procedure.

Ultrasound Fusion: A Real-time Complement to CT and MRI Imaging

Linda Woolpert

Volume-fusion is an innovative ultrasound technology which fuses real-time ultrasound imaging with a previously acquired CT or MRI volume data set.This advanced ultrasound imaging offers physicians an alternative to conventional CT and MRI in follow-up of lesions,increases diagnostic confidence,and provides interventional guidance. This presentation is designed to introduce the medical community to this technology and illustrate its utility in the clinical setting by means of a pictorial essay....

Intractable Hiccups in the Elderly and Palliative Care Population: A Review of Literature of the Diagnosis and Management

Jay Sanvictores

This is a review of literature of articles regarding treatment of intractable hiccups from 1950-2009. The authors plan to make a strength of recommendation for the reviwed articles.

46 year old male presenting with multiple firm, yellowish papule on an erythematous base

Rajani Lohani

A 46 year old male presented to the office with numerous skin lesions that were firm, yellowish papules on an erythematous base. The lesions were present for two months. Diagnosis of Eruptive Xanthomas was made clinically and confirmed retrospectively.

Post-operative benign calcifications secondary to Floseal(TM) in breast surgery: A case report.

Jessica L. Keto

Floseal(TM) is a gelatin-thrombin matrix used intraoperatively to assist in achieving hemostasis. We present a case in which Floseal was used to decrease bleeding during a breast lumpectomy. Followup MRI at 2 weeks showed extensive new microcalcifications at the previous lumpectomy site. As these new microcalcifications hinder surveillance efforts for local recurrence of breast cancer post lumpectomy, we do not encourage the use of Floseal as a hemostatic agent in breast surgery.

A Case of Ectopic Pregnancy in Fallopian Tube Remnant after Ipsilateral Salpingectomy

Stephanie Vitale

We present a case of recurrent ectopic pregnancy after ipsilateral total salpingectomy and oophorectomy. Repeat ectopic in the remnant stump of a previous salpingectomy is a rare occurrence. This case demonstrates the necessity for a high index of suspicion and a thorough examination.

COMPLICATION RATES ARE HIGHER WITH ANTEGRADE APPROACH FOR PERIPHERAL VASCULAR INTERVENTIONS

Brian Wheatley

The management of peripheral arterial occlusive disease is shifting to a more widespread use of percutaneous techniques, including balloon angioplasty, stenting and atherectomy. The most common approach is retrograde arterial access (RA), however, in order to reach distal tibial vessels, the antegrade approach (AA) is frequently used. We tested the hypothesis that the AA is associated with more complications.

Magnetic Resonance Imaging (MRI) Findings in Breast Adenoid Cystic Carcinoma

Jessica Keto

Adenoid cystic carcinoma of the breast is a rare tumor with overall favorable prognosis. Due to the microinvasive nature of the ACC tumors, preoperative imaging including breast MR should be considered especially in when considering breast conserving surgery. Recent data suggests the role of adjunctive radation therapy due to increased risk of local recurrence in the setting of wide excision only.

Impact of Statin Transition on LDL-C Goal Attainment in Patients with Diabetes

Karin Proos

This project was a retrospective review of pharmacy and laboratory claims adjudicated in a primary care patient population with diabetes. Statin utilization was evaluated to determine LDL-C goal attainment rates and the impact of statin generic transition on this clinical outcome.

Goal-Directed Brain Tissue Oxygen Monitoring in Traumatic Brain Injury

Joel Green

A retrospective cohort study analyzing patient outcomes with respect to the use of brain tissue oxygen monitoring in the setting of severe traumatic brain injury.

Developing A Resident Driven Pediatric Leadership Curriculum

Heather L. Helton

Recognizing the importance of leadership training during residency as a part of physician career development, the pediatric residency at Helen DeVos Children's Hospital has developed a resident driven, three year longitudinal leadership curriculum. We describe how this curriculum was developed, the types of materials utilized and the plans for evaluating the success of participation in the curriculum.

The Malignant Manifestations of Histoplasmosis in the Pediatric Population

Ajay A. Khilanani

We describe three cases of histoplasmosis in the pediatric population where the presenting signs and symptoms and initial test results were suspicious for malignancy. These cases serve as a reminder to physicians that there is significant overlap in the clinical presentation of malignancy and infection. Therefore, it is important to consider histoplasmosis when the presentation of malignancy is unusual or when laboratory data does not conclusively demonstrate malignancy.

School Evacuations in the United States Due to Hazardous Chemical Incidents

Sadie Bush

Chemicals that can cause adverse health effects are used in many elementary and secondary schools (e.g., in chemistry laboratories, art classrooms, automotive repair areas, printing and other vocational shops, and facility maintenance areas). Every year, unintentional and intentional releases of these chemicals, or related fires or explosions, occur in schools, causing injuries, costly cleanups, and lost school days. The federal Agency for Toxic Substances and Disease Registry (ATSDR) conducts national...

Clinical Teaching in a Busy Emergency Department: Interruptions During Case Presentations

Matthew Dull

In the emergency department (ED) of a teaching hospital, attending physicians are challenged to instruct medical students and residents while simultaneously caring for critically ill patients. Thus, they must balance the need to quickly devise patient assessments and plans with their responsibility to devote time toward teaching students. This was a prospective observational study which took place from June 2009 through August 2009 at Spectrum Health (Butterworth Campus) Emergency Department to determine...

Prophylactic Intra-Aortic Balloon Pump Counterpulsation During Mastectomy: A Case Report

Jessica Keto

Intra-aortic balloon pump counterpulsation (IABP) has been used to reduce cardiac morbidity and mortality in emergent and elective non-cardiac surgical procedures. We describe the first reported mastectomy utilizing an IABP.

Residents and Medical Students Noting the Chief Complaint during Verbal Presentations

Ken Kuper

The importance of the medical history cannot be underestimated even in this day of high-technology medicine. The chief complaint, the framework around which a clinician builds a focused patient history, is an important component of the verbal case presentation and should be mentioned at the beginning of the presentation. This was a prospective observational study which took place from June 2009 through August 2009 at Spectrum Health (Butterworth Campus) Emergency Department to determine how often...

Radiographic Correction After Hindfoot Arthrodesis

Chad Carlson

Hindfoot deformity is associated with numerous debilitating and disabling conditions. Arthrodesis and correction of underlying deformity is the gold standard of care in the treatment of hindfoot pain and deformity. We report the radiographic correction and AOFAS data at short term follow up after hindfoot arthrodesis.

Don't Poke Me!

Ronald Ray Guzman

Foreign body ingestion could happen without a clear history of the event occurring. This is a case of how foreign body ingestion may present with abdominal pain with a peculiar quality.

Assessing the Impact of Pharmacy Involvement in a Veterans Affairs Palliative Care Ward

Lindsey Dyke

A five-month comparison of specific quality measures was conducted to determine if clinical pharmacy involvement in a palliative care ward improves quality outcomes. Pharmacy reviewed patient charts, attended weekly treatment team meetings, and rounded on patients. Changes in quality measures were analyzed retrospectively after five months of intervention.

46 years old healthy woman developing spontaneous upper extremity DVT

Muhammad Kashif Adnan

This is very interesting case of upper extremity DVT in a young lady with no risk factors and negative thrombophillia workup.....Paget Shroetter Syndrome, a diagnosis which can easily missed.

What is a Handful?

Katie Buch

It is common place for patients to present with ingestions which is quantified as a handful of pills. Vague descriptions regarding the quantity ingested lead to errors in assessing the amount of toxic substance ingested, anticipating the effects of the ingestion, and ultimately the appropriate treatment. This prospective study utilized volunteers to determine if there is a standard pill count that represents a handful of pills. Secondly, we determined the ability of subjects to estimate fluid medicinal...

Just a Click Away: Hallucinogenic Botanicals Marketed on the Internet

Joshua Fedewa

This was a prospective, internet survey to document the wide variety of dangerous hallucinogenic botanicals available for sale to the general public using a popular Internet search engine. Internet sites offer thousands of pages of information—albeit of questionable accuracy—on how to obtain, synthesize, extract, identify, and ingest hallucinogens. Much of this information has yet to appear in textbooks. By contrast, the authors found few U.S. government agency sites offering cautionary material...

Pain Management Following Total Knee Arthroplasty: Scheduled versus as-needed Pharmacotherapy

Joshua DeMott

Studies indicate that more than half of all patients undergoing total knee arthroplasty (TKA) receive suboptimal pain control and may have severe pain postoperatively. A gold standard regimen or intervention to optimize pain management has yet to be recognized. The purpose of this retrospective study is to examine different pain regimens after TKA to determine if a scheduled pain regimen that does not include epidurals, patient controlled analgesia, and other intravenous opiates differs from one...

Missing teeth? Check the Lung!

Tony Oliver

Foreign bodies in the airways can cause post obstructive pneumonia with lung abscess.The occult nature of the culprit foreign body makes the diagnosis a challenge. We present a case of lung abscess suspected due to a dislodged tooth.

Positron emission tomography with FDG-avid siliconosis mimicking recurrent tumor: A case report.

Jessica Keto

Positron emission tomography (PET) is a useful modality in evaluating non-specific lesions for malignant potential. We describe a patient with a history of locally recurrent invasive ductal carcinoma with combined latissimus flap- implant reconstruction presenting with locally re-recurrent disease and evidence of FDG-avid siliconosis.

Analysis of pharmacodynamic target attainment and utilization of piperacillin-tazobactam in large community teaching hospital

Carly Samyn

A retrospective, non-interventional chart review of piperacillin-tazobactam use in a large community teaching hospital. Pip-tazo use was frequently inappropriate either because of inappropriate breakpoint MIC standard or because of failure to de-escalate to narrower spectrum antimicrobial. Implementation of antimicrobial stewardship and prolonged Pip-tazo infusion time may lead to more appropriate antimicrobial use.

Adherence to acetaminophen dosage guidelines and associated outcomes in hospitalized patients with concomitant alcohol abuse in a computerized physician order entry (CPOE) setting.

Andrew Kline

This study is a retrospective chart review exploring the use of acetaminophen and adherence to dosing recommendations in a high-risk patient population. Patients with a diagnosis code of continuous alcohol abuse will be reviewed to see if these patients received greater than the recommended amount of acetaminophen in a 24-hour period. These patients will be studied to identify any adverse hepatic damage or dysfunction secondary to acetaminophen usage during their hospitalization.

Development and Implementation of a Tracking System for Warfarin Therapy Atrial Fibrillation Patients

Jiji Valiaveettil

Evaluating electronic warfarin tracking programs for use in an outpatient setting. Implementing an electronic warfarin tracking program to a targeted patient population. Utilizing an electronic tracking program to increase patient adherence to INR draws.

Does Your Dog Bite?

Matthew Gormley

Rare presentation of Pasturella multocida Endocarditis of 28 year old man with congenital heart disease and subsequent prosthetic valve involvement. Only second case reported in the literature. A negative echocardiogram should not rule out endocarditis in patients with other risk factors for the diagnosis.

Trigeminal Cephalagia

Tina Luo

Trigeminal autonomic celphalgia (TAC) is a rare type of chronic short-lasting primary headaches with CN-V autonomic dysfunction involved. It is poorly recognized by clinicians. This is a case report of a patient suffered TAC for 3 years before he was diagnosed and treated.

A Case of Aseptic Cavernous Sinus Thrombosis

Shahid Mohammed

Since 1976, only 166 cases of cavernous sinus thrombosis have been reported in medical literature, most of which were acute and associated with infection. We present the case of a 70 year old woman with aseptic chronic cavernous sinus thrombosis following radiation for invasive squamous cell carcinoma of her ear. This unique case also invokes discussion of when to anticoagulant for cavernous sinus thrombosis, as well as Tolosa Hunt syndrome

Blood Is Thicker Than Water

Kristy Pahl

Hyperviscosity syndrome is a manifestation of increased circulating immunoglobulins in patients diagnosed with a myeloproliferative disorder. We present the case of a previously healthy 74 year old man who was sequentially diagnosed with CHF, Parkinsons, and dementia before a unifying diagnosis of hyperviscosity secondary to Waldenstrom Macroglobulinemia (WM) was made. WM is a rare disease, with an incidence of 3 per million people each year; at the same time, this patient also had cyroglobulinemia,...

Prevotella Bivia- the unsuspected culprit

ASIF ANSARI

Fever of unknown origin commonly poses a clinical challenge. Anaerobic organisms causing infections are often slow to grow in culture media and often missed. We present a case with bacteremia with an anaerobic organism, prevotella bivia.

VOMITING - Somebody stop me

Shameen Salam

An elderly fit man was admitted with a 5 day history of persistent vomiting. His vomiting persisted for several days after admission. Further diagnostic testing revealed the presence of superior mesenteric artery syndrome (SMAS).

Autoimmune Pericarditis with Cardiac tamponade - an unusual presentation

Fatima Kidwai

To present a case of cardiac tamponade secondary to autoimmune pericarditis as the presenting feature of Adrenal crisis.

Massive APAP Ingestion Presenting with Altered Mental Status and Lactic Acidosis

Aaron Ziegler

Acetaminophen is the leading analgesic used in the United States; however in overdose its metabolites are hepatotoxic. N-acetylcysteine (NAC) was developed as an antidote for APAP toxicity, it can prevent hepatic injury if given within 12 hours of a single ingestion. We present a case of a patient that presented with severe acidosis and altered mental status from a massive APAP ingestion. She went on to develop acute liver failure despite receiving NAC within 12 hours of her presumed ingestion. Although...

Ultrasonographic Diagnosis of Tenosynovitis

James Enderle

We describe the case of a patient that presented to the ED with progressive discomfort in his right middle finger after sustaining a puncture wound at work. Early diagnosis of infective tenosynovitis was made at the bedside by detection of an echogenic effusion using a high-resolution ultrasound probe and the hand submerged in a water-filled emesis basin.

Hold the Anchovies? A Case Report of Clupeotoxism

Drue Orwig

We describe the case of a patient that presented to the ED with progressive nausea, fatigue, and a metallic taste in his mouth hours after eating a pizza with anchovies. Symptoms and history were consistent with Clupeotoxism, a rare seafood poisoning that can be fatal in severe cases. The toxin is concentrated in fish organs and is tasteless and odorless. The identity of the toxin is unknown. Toxicity does not depend on fish freshness or size. The poison does not break down when the fish is cooked.

Diagnosis of Macula-off Retinal Detachment by Bedside Ultrasound

Todd Struckman

We present the case of a patient that presented to the ED with intermittent loss of vision. She subsequently underwent bedside US in the ER to quickly determine the etiology of macula-off retinal detachment. Bedside ultrasound is particularly useful in children and uncooperative patients, and when the view to the retina is obscured by peri-orbital edema, blood, cataract, or other opacities. The efficiency of US allows ED physicians extra time that may prove necessary for effective treatment.

The Utility of Foley Catheters with Temperature Sensors During Scheduled Cesarean Section

Casey Sager

Prospective, descriptive control trial using a sample of patients undergoing scheduled cesarean sections, to determine if Foley catheters with temperature sensors are necessary for monitoring the core body temperature during c-sections. Discontinuation of the Foley catheter with temperature sensor may provide an annual savings of over $27,000.

Acute Non-traumatic Paraplegia: Transverse Myelitis and anti-TNF Therapy

Charisse Siapno

This is a case report of a 54-year old woman who presented with acute non-traumatic paraplegia. A link between transverse myelitis and anti-TNF therapy is considered.

Using Radiofrequency ablation as a treatment option in a young woman with history of congenital acquired HPV of the respiratory tract presenting with recurrent, squamous cell carcinoma of the lungs.

Indu Rekha Meesa

Description of refractory SCC secondary to HPV papillomatosis and treatment options. Description of used of Radiofrequency Ablation and complications

Vascular malformations of the foot in pediatric population: presentation and treatment

Indu Rekha Meesa

Description of vascular malformations of the foot. Description of treatment with sclerotherapy and complications.

Novel Influenza A (H1N1) Virus Infection Causing Encephalitis

Aaron Hampton

33-year-old previously healthy man presented with a four day history of fevers, myalgias, arthralgias, confusion, tachycardia, tachypnea. He was found to be H1N1 positive by RT-PCR of nasopharyngeal specimens. Despite aggressive treatment this patient died from encephalitis and multisystem organ failure on hospital day five.

Obesity and Complicated Diverticular Disease: Is There an Association?

Amber Loyson

Obesity is increasingly recognized as a risk factor for disease. A number of digestive diseases have been associated with obesity, including cirrhosis, gallstone disease, gastroesophageal reflux disease, and cancers of the colon, esophagus, and pancreas. To determine if body mass index (BMI) is associated with a higher incidence of complicated diverticulitis, we performed a retrospective analysis of patients hospitalized with complicated diverticulitis between 2000 and 2009 at two urban academic...

Inter-rater Variability in the Documentation of Anogenital Injuries Following Sexual Assault

Aaron Ziegler

To determine baseline variability in the documentation of anogenital injuries (location, frequency and type of injury) among nurse examiners with the same level of experience and training, we performed a retrospective cohort trial evaluating consecutive patients (> 13 years old) presenting to a community-based Nurse Examiner Program (NEP) during a 10-year study period. The primary outcome of interest was the baseline variability in the forensic documentation of anogenital injuries (frequency, location...

Implementation of A Risk Assessment Algorithm in the Prevention of Early Onset Group B Strep Disease

Cristina Ignacio

In 2002, CDC issued updated guidelines for the prevention of perinatal Group B streptococcal(GBS)disease leading to universal GBS screening. In institutions where high adherence to the guidelines were implemented, a significant decrease in EOSGBS was observed.We expect that the implementation of standardized neonatal evaluation and management algorithm in our community-based teaching hospital will show improved clinical efficiency, improved utilization of resources and decreased clinical errors.

Atypical Chest Pain s/p Porcine Aortic Valve Replacement

Jeremiah McNamara

Porcine heart valves are the most common biological prostheses utilized in the treatment of valvular heart disease. Once a common problem, early rejection of transplanted tissue is now an extremely rare occurrence due to pre-treatment of xenografts with glutaraldehyde which denatures antigenic surface proteins. We report an unusual case of acute rejection of a porcine valve with extensive inflammatory pannus formation which occluded the ostia of the re-implanted native coronary arteries.

Atypical presentation of Myasthenia gravis

Erik Howell

Unsually late-onset myasthenia gravis presented by an unrelated chief concern

A community hospital experience using computer-assisted total knee arthroplasty

Erik Howell

A Retrospective case-controlled study evaluating computer-assisted total knee arthroplasty v. total knee arthoplasty based on perioperative outcomes

Pretransplant Laparoscopic Nephrectomies in Pediatric Patients

Brent Goslin

Pretransplant unilateral or bilateral nephrectomies are often recommended for pediatric patients with end stage renal disease. This study is a retrospective review of our institution's experience using a laparoscopic, four port, transperitoneal approach to remove the native kidneys. What have our outcomes been using this approach in pediatric patients?

Gastropericardial Fistula: A Rare and Life-Threatening Complication of Roux-en-Y Gastric Bypass

Nick Aloisio

The Roux-en-Y gastric bypass procedure is becoming increasingly common as a therapeutic option to treat morbid obesity. For many patients, this procedure can be both safe and effective. Still, intraoperative and postoperative complications can cause considerable morbidity. We present the case of one such life-threatening and exceedingly rare complication.

An elusive Epstein-Barr virus positive large B-cell lymphoma in a non-immunocompromised host

Randell Ganchua

The diagnostic classification of Epstein-Barr virus (EBV)-associated lymphoproliferative diseases in non-immunocompromised hosts is quite heterogenous in terms of morphology, genetics, and biologic behavior. I present a case of a distinct clinicopathologic subtype that eluded diagnosis from initial work-up and biopsies.

The Internal Medicine Resident Clinics compliance with the 2002 Updated Beers Criteria and an evaluation of quality improvement strategies: One-year follow-up

Jennifer Gerardin

Last year, the 30 to 35% of geriatric patients in the Internal Medicine Residency Clinic had at least one Beers Criteria medication on their medication profile, which was above the national average of patients on Beers Criteria medications. The interventions last year did not make an impact the type of medications that the patients were prescribed. This year the quality improvement efforts included the nursing staff and education on alternatives to Beer's Criteria medications.

Impact of RotaTeq on Pediatric Acute Gastroenteritis Admissions

Alan Young

The Rotavirus vaccine has been proven effective in protecting individual pediatric patients from becoming ill when exposed to the virus. In this study, we seek to determine the overall effect that the rotavirus vaccine has had on all cause pediatric admissions for acute gastroenteritis in a community hospital setting.

Perceptions of Quality of Care in a Pediatric Resident Continuity Clinic

Stephanie  Berry

The perceptions of quality of care provided within a pediatric residency training outpatient clinic was assessed through survey of office staff, attending physicians and residents. Comparisons were made between responses of the three groups. Signficant barriers to the providing the highest quality of care were identified and strategies to overcome these barriers need to be designed.

Use of Patient Historical Clues to Predict Weekly Raynauds Condition Score Measured by Electronic Digital Diary

Rich Martin

Validation of a structured physician interview to predict raynaud's phenomenon clinical activity in real word conditions.

Incidence of Serious Infectious Events with Methotrexate Treatment: Meta-analysis of Randomized Controlled Trials

Jennifer Powers

Meta-analysis of the placebo groups of rigorously conducted clinical trials of new biologic therapies can give insight into the comparitive risks of serious infections for patients taking standard of care methotrexate therapy. This information is essential for presenting accurate risk - benefit comparison in patient decision aids.

A comparison of the prevalence of depression between African Americans and Whites with type II diabetes mellitus.

Kirra Sheremet

This cross-sectional study investigated the prevalence of depression among African American and White diabetic patients in Grand Rapids. Patients were mailed a depression screening tool, the Patient Health Questionnaire, in order to collect the data. An additional chart review was also preformed to further investigate the effect of depression on diabetic care issues.

OCD and ADHD: Is There a Connection?

Susan Laham

To investigate any correlation between Osteochondritis Dessicans (OCD) and Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD).

Kinetics of Cysteamine Bitartrate in an Anephric Patient on Hemodialysis

Jin Chung

This is a case study of cysteamine bitartrate kinetics of an anephric patient with nephropathic cystinosis on hemodialysis. Since the introduction of the medication for treatment of cystinosis, renal outcome and life expectancy has improved significantly. There is no data reported in literature on cysteamine bitartrate clearance on hemodialysis patient.

Emergency Department Patients with Sexually Transmitted Infections: Who Gets Lost to Follow-up?

Whitney Kiebel

Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) are common causes of bacterial genitourinary infection in women. Because of the individual and public health risks associated with GC and CT pelvic infections, the CDC advocates routine testing and liberal antibiotic treatment for women with suspected PID. This was a retrospective, cohort analysis of consecutive female seen at the Spectrum Health ED with positive results for GC/CT, and their subsequent follow-up and treatment. Our objectives...

Decision Aid Formats to Communicate the Effect of DMARDs on Structural Joint Damage in Rheumatoid Arthritis

Alexander Geralds

Many patients have difficulty accurately interpreting numeric statements of risk. This can diminish the ability of patients to make well-informed decisions regarding their care. This study explored how using different presentation formats in a decision aid effected a patients comprehension of risk.

Long-Term Functional Outcome of Navicular Fractures

Gary  Olson

The purpose of this study was to evaluate functional outcome in patients treated for navicular fractures. Navicular fractures are debilitating injuries and in the long term functional outcome remained poorer than normative controls. Associated cuboid fractures, increased injury severity of the foot (associated foot injuries >3), and BMI determined inferior functional status. Inability to return to previous level of activity or work was reflected with inferior functional outcome status.

The Utility of MRI for Diagnosis of Implant Rupture with the McGhan Style 153 Double-Lumen Implant

Katherine Hamilton

MRI has been established as the most effective way of diagnosing implant ruptures. An increased rupture rate is reported with the McGhan Style 153 double-lumen implant, thus requiring more frequent surveillance. After MRI assessment of 38 implants, they were surgically excised in order to determine usefulness and accuracy (specificity and sensitivity) of the use of MRI to diagnose implant ruptures when the Style 153 implant is used.

IN SITU CHOLANGIO CARCINOMA - AN EMERGING ENTITY

KATHERINE  SHAFER

Cholangiocarcinoma is a malignancy of the bile ducts which often does not present until the disease has advanced to a point where it is unresectable. The classification schemes for staging are dependent on the location of the tumor (intrahepatic, perihilar, and distal), and are undergoing recent modifications. The following case report describes a unique case that involves an asymptomatic patient who was found on pathology to have an early form of cholangiocarcinoma not usually detected at this...

MS-DRG Grouping Poorly Defines Risk and Reason for Unplanned Visits After Colectomy: Implications for Bundled Payment Policy

Theodor Asgeirsson

Hospital reimbursement for colectomy was significantly impacted by the adoption of Medicare Severity- Disease Related Groups (MS-DRGs). Further change is contemplated as CMS (Centers for Medicare and Medicaid Services) has evaluated pilot programs in bundled fees for an entire episode of surgical care and begins to define readmission as a component of the index admission. The aim of this study was to define the economic and clinical impact of readmission after colectomies (MS-DRG 329-331)

Does Liposuctioning of the Abdomen Affect Cosmetic Abdominoplasty Outcome?

Shannon Armstrong

Retrospective chart review of 1008 patients over 10-year period. Six different surgeons at one plastic surgery practice.

Comparison of Primary Care and Sleep Physician Responses to Clinical Scenarios involving Sleep Apnea

Alan  Young

In this study, we are investigating primary care physician and sleep specialist responses to clinical scenarios involving patients who are at risk for obstructive sleep apnea. Physicians will be asked to indicate the likelihood that the patient warrants a polysomnogram. The study is in the form of a 10 question survey that will be sent out to primary care physicians and sleep specialists in the Grand Rapids area.

Effect of Pregnancy on the Arches of the Foot

John  Dunn

The aim of the study was to determine whether pregnancy had a role in affecting the foot arches at long term. Nulliparous women were compared with women who had been pregnant at least once and having been pregnant over 10 years ago. The primary outcome variable of the study was a change in foot size of the subjects over time.

H1N1 Influenza Complicated by Cryptococcemia and Fatal Aspergillus pneumonia and Brain Abscess

Amarendhar Gopireddy

A case report about a patient who acquired fatal Aspergillus brain abscess and Cryptococcal fungemia after H1N1 infection.

Determining the Predictive Value of Iron Deficiency Anemia Screening in Children Aged Nine Months to One Year

Kristy Pahl

The purpose of this study is to determine the predictive value of iron deficiency anemia (IDA) screening for children aged nine months to one year as recommended by the American Academy of Pediatrics.

A Dissection Based Parascapular Bursa Investigation and Discussion of Snapping Scapula Syndrome

Abby Ryan

Cadaveric dissection based research was conducted to describe and quantify the various bursae in the parascapular region. These structures have been linked to the a potentially debilitating and difficult to treat condition called snapping scapula. A discussion of snapping scapula syndrome is presented as well.

Goodpasture Syndrome Associated with Polymyalgia Rheumatica

Abdur Rehman

The reason of submission of this case is to highlight the unusual presentation of a rare disease and also a rare association of this case with a common disease.

SQUASH HEADACHES

Sanjeet Rangarajan

Idiopathic intracranial hypertension (IIH), (pseudotumor cerebri), affects 1 in 100,000. Hypervitaminosis A is one of the known associations with IIH. We present a patient whose quest for a healthier diet resulted in complications.

Sutures vs. Staples: A Survey of Patient Satisfaction Following Primary Cesarean Section

Kristina Mixer

A survey of patient satisfaction with their skin closure at the time of primary cesarean section. Secondary analysis of pain, wound breakdown, scar formation and cost differentiation. Ongoing data collection and analysis.

Dimensional Considerations for Operative Repair of the Fractured Pediatric Orbit

Matthew Martin

The present study analyzes a series of computerized tomographic (CT) images of the pediatric orbit to determine measurements to critical anatomic landmarks that figure prominently in the operative repair of the fractured pediatric orbit. Using maxillofacial and sinus CT scans of patients aged 1 month to 18 years at Helen DeVos Children's Hospital, we identified these key dimensions that will allow safer orbital exploration and fracture reduction in this patient population.

First Clostridium sordellii infection associated with breast mass excision wound infection

Brent Goslin

We present the first case of a Clostridium sordelli wound infection after a surgical procedure of the breast in a healthy, young female. C. sordelli infections are extremely rare and lethal with a mortality rate of 69% in the literature.

Endovascular Repair is Safer for Ruptured Aortic Aneurysms

Timothy Liao

A retrospective review of clinical outcomes of 100 consecutive patients with ruptured abdominal aortic aneurysms (rAAA) treated either by open repair or endovascular repair (EVAR) at a single University-affiliated community hospital. Our data concludes that EVAR is feasible and safe in the emergent setting, and compares favorably to published mortality rates for endovascular repair of rAAA.

Severe hypocalcemia and Vitamin D deficiency presenting within first seven weeks of life in babies born in Michigan

Belen Amat

Vitamin D deficiency is a more commonly recognized problem in recent years in United States especially in cold climates. The babies of mothers in cold climates are more prone to develop vitamin D deficiency in the newborn period. This retrospective chart review study included newborns diagnosed with hypocalcemia due to vitamin D deficiency. We presented 8 infants with severe hypocalcemia, with or without seizures, with very low levels of vitamin D. Our conclusions suggest that pregnant women should...

Vitamin D Supplementation and Fall Prevention in the Elderly Population: A Retrospective Study

Jay Sanvictores

This study is a chart review of residents in a local nursing home comparing frequency of fall with or without vitamin d supplementation. Results are pending since IRB approval is needed.

Recombinant factor VIIa utilized in successful treatment of disseminated intravascular coagulation secondary to amniotic fluid embolism

Casey Sager

Amniotic fluid embolism (AFE) is a rare, but potentially fatal complication of pregnancy. Immediate and aggressive treatment of AFE is imperative. This report focuses on two patients with suspected AFE and their successful treatment with the controversial procoagulant, recombinant factor VIIa.

Results and Complications of Operatively Treated Tibial Pilon Fractures

Matthew Dubiel

The objective of this study was to analyze the results and complications of operatively treated tibial pilon fractures. A retrospective cohort analysis was completed for 432 patients with 425 tibial pilon injuries who had been operatively treated at a level I teaching trauma center. Tibial pilon fractures continue to present significant surgical repair challenges and can have a detrimental long-term effect on pain, ankle function, arthrosis, and return to employment.

Opinions on Male Fertility Control: A Survey of Post-Partum Couples

Zachary King

This study is a survey of post partum women and their male partners. The focus of the survey is testosterone based male fertility control. The goal is to determine couple's opinions of male fertility control and to determine demand for male fertility control.

Comparison of hip reduction utilizing MRI or CT in patients with developmental dysplasia of the hip

Matthew S. Chin

Given the need for image confirmation of femoral head reduction, limited visualization of non-ossified femoral heads, and radiation exposure with CT, this study assesses the post-operative sensitivity and specificity of CT versus MRI in infants (13 months or younger) with developmental dysplasia of the hip. Comparisons were also made in the areas of anesthesia requirements, scanner time, and age between these two groups.

Splenic Infarcts in a Female Patient with Infectious Mononucleosis, Serologically Positive for CMV and EBV

Cristina Therese De Castro-Dela Cruz

Case report of a female who presents with splenic infarction and is doubly seropositive to both CMV and EBV.

External Cephalic Version

Heather Bedell

A review of outcomes of external cephalic version compared to matched controls from 2002-2008. Increased intrapartum complications have been demonstrated in patients that have undergone successful external cephalic version.

Cosmetic Rhinoplasty: A Review of 384 Consecutive Cases

Keith Neaman

This is a project reviewing outpatient cosmetic rhinoplasties performed over the past 8 years. It represents the largest general retrospective review performed in to date. It reviews the revision, satisfaction rate and associated risk factors.

Male pattern baldness and prostate cancer risk: Testing for a significant relationship

David Boss

Male pattern baldness and prostate cancer have been known to be caused by similar biological occurances. We used information from a previous study to examine them and test for a significant relationship between the two events. The goal was to determine if early onset male pattern baldness was a biomarker for prostate cancer.

Eosinophilic Esophagitis in a Child

John vanSchagen

We present the case of an 18 month-old boy with chronic vomiting and poor weight gain. Endoscopic evaluation of the upper gastrointestinal tract including biopsies showed inflammatory changes and intraepithelial eosinophilia, consistent with eosinophilic esophagitis (EE). Often misdiagnosed as gastroesophageal reflux disease resistant to medical management, this diagnosis is only recently becoming more recognized as a cause for chronic upper gastrointestinal dysfunction in pediatric populations.

Effect of basigin on heparin-binding EGF-like growth factor and matrix metalloproteinase expression in human cytotrophoblast cells

David Hobbs

Basigin (CD147, EMMPRIN), a cell surface glycoprotein of the Ig superfamily, has multiple functions including the induction of matrix metalloproteinases (MMPs) and shedding of heparin-binding EGF-like growth factor (HB-EGF). This work describes the effect of Basigin on the expression of HB-EGF and MMPs in human cytotrophoblast cells.

A Comparison of Standard Facetectomies versus Smith-Petersen Osteotomies in Idiopathic Scoliosis Deformity Surgery

Matthew Halanski

In this study we compare the coronal and sagital plane correction of scoliotic deformities using facetectomies or posterior based osteotomies. The routine use of osteotomies showed small improvements in coronal and sagital correction but with significant increases in operative time and blood loss.

Ossification patterns of the anterior arch of atlas vertebra

Matthew S. Chin

This study assesses the anterior arch in the atlas vertebra of children (96 months or younger) in a non-trauma setting, through retrospective reviews of all sinus and temporal CT examinations from 2002 - 2009 at Helen DeVos Children's Hospital, in order to identify patterns of ossification and their frequency, with the goal of improving recognition and differentiation of normal endochondral variants from fractures in trauma settings.

Relevance of Estimation of Gestational Age by Day in Predicting Outcomes in Extremely Low Gestational Age Infants

Timothy Bedell

The study is a retrospective chart review of all non-anomalous neonates delivered at estimated gestational ages of 23 0/7 - 25 6/7 weeks within the spectrum health care system. We wish to illustrate a statistically significant difference between the survivability of the neonates on a sub-weekly or daily basis. To date, morbidity and mortality at a given estimated gestational age have been based on weekly estimates of gestational age rather than a sub-weekly description.

Role of Serum Lipase in Diagnosing Acute Pancreatitis in a Patient with Recurrent Pancreatitis

Mohsin Khan

The serum lipase level is the primary diagnostic marker for acute pancreatitis due to its high sensitivity and specificity. Serum lipase levels are more then 90% sensitive for acute pancreatitis.We present a case of acute pancreatitis without elevated serum lipase in a patient with a history of multiple episodes of pancreatitis.

THE PREVALENCE OF XEROSTOMIA AFTER INTENSITY MODULATED RADIOTHERAPY (IMRT) FOR HEAD AND NECK CANCER IN A COMMUNITY SETTING

Andrew Wyman

A retrospective review of the prevalence of xerostomia after IMRT in head and neck cancer patients. The study looked at one institutions rate of xerostomia as compared to historical rates of xerostomia from both 3D-conformal radiotherapy and IMRT. The data was also analyzed for any independent predictors of xerostomia.

Seroma Rates in Cosmetic Abdominoplasties: Does technique really matter?

Keith Neaman

This is a detailed study examining seroma rates in cosmetic abdominoplasties. It shows that certain surgical techniques are associated with increased complication rates.

Diagnosis of A Giant Atrial Myxoma in the Left Atrium: Case Report

Tammy Provatas

We report a case of an unusually large prolapsing left atrial myxoma in a 63-year-old woman that was diagnosed with transesophageal echocardiography (TEE). As seen in this case, atrial myxomas may develop into giant masses without producing any symptoms. Symptoms may develop late in the course of tumor development and may be vague or nonspecific. In elderly patients presenting with dyspnea but no pulmonary disease, cardiac problems must be considered as the cause of pulmonary symptoms and complaints....

GIST - A Unique Gastrointestinal Neoplasm

Vetriselvi Moorthy

Gastrointestinal Stromal Tumors(GIST) are rare neoplasms of the intestinal tract. Since the identification of KIT kinase role in these tumors, significant advances have been made in the treatment. We report a patient with Gastric GIST who presented with upper gastrointestinal bleeding.

Patient preferences regarding partner treatment options for sexually transmitted infections

Anna Pierzchala

EPT was developed to treat the sexual contacts of patients treated for gonorrhea and/or Chlamydia by allowing providers to write prescriptions for patients' sexual partners without clinical evaluation, a practice which is not currently permitted under Michigan state law. This is a cross sectional study in which we will attempt to elucidate patient interest in Expedited Partner Therapy (EPT). We will survey patients in community clinics at the time of gonorrhea and Chlamydia testing.

Spontaneous Dissection of the Carotid Artery in a 39 Year Old Man with Carotid Artery Stenosis

Abdur Rehman

Carotid artery dissection is one of the important and treatable causes of stroke, especially in young patients. Early treatment of dissection may improve the outcome of stroke.

Apical Ballooning Syndrome (or Stress Induced Cardiomyopathy) Presenting as Acute Coronary Syndrome

Ginger Wiersma

Stress induced cardiomyopathy is described as an acute cardiomyopathy characterized by acute, but rapidly reversible, left ventricle systolic dysfunction in the absence of atherosclerotic coronary artery disease which appears to be triggered by intense psychological and physical stress. To assess the incidence, the clinical characteristics and the outcome of Apical Ballooning Syndrome (ABS), we performed a retrospective, cohort study using a database of all visits to the Spectrum Health Chest...

Antegrade Drilling of Osteochondritis Dessicans using Simultaneous Bi-planar Fluoroscopy

Susan Laham

Arthroscopic and fluoroscopic assisted antegrade drilling of Osteochondritis Dessicans (OCD) lesions have been found to be an effective treatment of stable lesions which have failed non-operative treatment. Using a single fluoroscopic unit can be tedious when confirming the placement of multiple pins used in the drilling process. The purpose of this study is to present a clinically useful and novel technique in treating these lesions.

Vitamin D and Parathyroid Hormone Levels in Vertebral Compression Fractures

Rob Keller

Vertebral compression fractures (VCFs) are the most common type of osteoporotic fracture. There have been few studies correlating serum 25-hydroxy vitamin D levels and parathyroid hormone levels with VCFs. We will perform a retrospective chart review of paper and electronic medical records for patients who have VCFs that have undergone 25-hyroxy vitamin D and parathyroid hormone measurements.

Diverse presentations of Systemic Lupus Erthematosus

Sherley Aramath

Systemic Lupus Erythematosus (SLE) is an unusual systemic illness in children, and the absence of typical findings in its initial presentation often leads to a delayed diagnosis. We report the case of a 13 year old female with initial non specific symptoms of upper respiratory infection, found to have blood dyscrasias, and later confirmed to have SLE with more characteristic multi-organ involvement. A high index of suspicion can result in earlier diagnosis and decrease in morbidity in the pediatric...

Relationship between Clinical Charateristics of Osteomyelitis and the Extra-Osseous Fat Fluid Levels on MRI

Tod Mattis

This is a retrospective case review of MRI studies used to diagnose osteomyelitis. This study will attempt determine a relationship between extra-osseous fat fluid levels on MRI and clinical charateristics of osteomyelitis.

Capsular Contracture Rate in Low-Risk Population after Primary Augmentation Mammaplasty: A Retrospective Review

Kyle Lineberry

The safety of augmentation mammaplasty has increased dramatically in the last 20 years. Specific advancements in the standard of care include the inframammary, submuscular approach and the use of antibiotic irrigation of the breast pocket. We report the incidence of capsular contracture in a very low-risk patient population after primary augmentation with scientifically-validated protocols.

A prospective study to evaluate the effectiveness of the Renessa treatment for female stress urinary incontinence in women with suboptimal response to surgical treatment: an analysis of local data

Kathryn Hayes

The Renessa radiofrequency device, which denatures collagen in the proximal suburethra to lessen urethral hypermobility, has been shown in previous studies to improve stress urinary incontinence. This project examines the local data of a larger national prospective trial on the effectiveness of the Renessa device in patients who have previously failed surgical management of their stress urinary incontinence.

Reducing Hospital Re-admission: Optimizing Transitions of Care from the Hospital to the Community

Nicolas Kettaneh

Our project is a retrospective study with the primary objective of determining the impact of a comprehensive discharge tool, optimized through a multidisciplinary Lean Process, on the readmission rate in our community.

INNOCENT KILLER

ALBERT NAVEED

Complications from untreated streptococcal pharyngitis can include glomerulonephritis, scarlet fever, or rheumatic fever. Streptococcal toxic shock syndrome (GAS TSS) is almost always associated with skin and soft tissue infections, but is rarely caused by streptococcal pharyngitis in adults. GAS TSS can have high morbidity and mortality rates, with risk of amputation, organ failure, or death. A previously healthy 46 years old man presented with 3 day history of fatigue, high fever, and suspected...

complex recurrent ventral hernia repair in a morbidly obese patient following gastric bypass

Ali  Fouladi

Case report about a morbidly obese patient who had wound complication and recurrent complex ventral hernia. Ventral hernia was repaired successfully follwing gastric bypass surgery and significant weight loss

Does a preoperatively placed percutaneous endoscopic gastrostomy tube impact negatively on eventual esophagectomy?

Sarah Foster

Esophagectomy remains the curative therapy for early esophageal carcinoma. In this retrospective chart review, we examined the impact of pre-operative percutaneous endoscopic gastrostomy (PEG) placement in patients undergoing esophagectomy. We reviewed each patient's pre-operative therapy, stage of tumor, type of esophagectomy, pre-operative PEG placement, gastric conduit suitability, anastomotic leak, morbidity and mortality (in-hospital or 30 day).

Rasburicase improves hyperuricemia in infants with acute kidney injury

David Hobbs

Recent data suggest that elevated levels of uric acid (UA) contribute to the progression of renal disease. Rasburicase, recombinant urate oxidase, is a highly safe and efficacious hypo-uricosuric agent for treatment of elevated UA levels from tumor lysis. We adopted the use of rasburicase for management of hyperuricemia in infants with acute kidney injury (AKI) and, herein, report our experience.

Cervical Cerclage at Butterworth and Blodgett Hospitals from 1997 to 2007

Natalia Korneeva

A retrospective cohort study of cervical cerclage in Butterworth and Blodgett hospitals - the rate, indications and provider participation examined. Majority of the procedures were done for not classical indications. We observed a very skewed distribution of few providers who put in most cerclages, which raises a question concerning significant personal bias with this procedure.

Use of 1.5 Tesla and 3 Tesla MRI to evaluate femoral head reduction in developmental dysplasia of the hip

Matthew S. Chin

The study examines the differences between 1.5 Tesla and 3 Tesla MRI scanners in evaluating post surgical hip reduction in children (15 months or younger) with developmental dysplasia of the hip. Comparisons were made in the areas of anesthesia requirements, scanner time, image quality, and reduction assessment between these two groups.

Vertebral Artery Dissection: A Diagnosis Not to Be Missed

Mohsin Khan

Vertebral artery dissection is increasingly being recognized as an important cause of vertebrobasilar stroke in young patients. The majority of cases are spontaneous, but it can occasionally follow a trauma or rapid neck movement.

Analyzing Diabetes Care at Wege Clinic: QI Project

Shahid Mohammed

This is a QI project auditing the accountability of the diabetic care of physicians at the Wege internal medicine clinic.

The 5-Year Real World Outcomes of Geoform Ring Implantation in Patients with Ischemic Mitral Regurgitation

Robin Collingwood

Analysis retrospective of clinical outcomes following Geoform Ring implantation at a single center.

Pictoral Essay of Branchial Cleft Cysts

Andrew Olsen

Branchial Cleft Cysts are of multiple types which demonstrate distinctive differentiating imaging findings. This poster will demonstrate multiple images from various patients presenting to our institution which demonstrate the multiple types. The embryology and anatomy of branchial cleft cysts will also be discussed.

Doppler Derived Systole to Diastole Ratio Correlates to MRI Measured RV End Diastolic Volume and RV Ejection Fraction at Long Term Follow Up of Repaired TOF

Erik Howell

Our goal was to evaluate the Doppler derived systole to diastole(S:D) ratio as an index of global RV function in children with repaired TOF and to compare this measurement with Cardiac MRI measured RV ejection fraction and RV end diastolic volume. A retrospective, case-controlled review of patient chart, ECG, MRI and echo data was completed.

The Efficacy of Group Visits for Chronic Pain Patients as a Modality to Improve Overall Quality of Life

Jason Littleton

Group medical visits are emerging tools that have the potential to improve patient satisfaction, quality of care and quality of life. In this study, group visits are used to assess how quality of life and patient satisfaction is affected by the teaching of coping skills and meditation to improve patient perceptions of their chronic pain. We hope to show that the group visit concept can be applied successfully to care for patients with chronic non-malignant pain in a residency training setting.

West Michigan Camp Fires Injuries

Viet Do

A retrospective clinical study of a regional burn center's experience taking care of camp fire burn victims. Examining mechanism of injury, treatment modalities, and associated morbidities.

HAART Treatment Benefits for Development and Emotional Wellbeing in Young Ugandan Children with HIV

Elizabeth Schut

Young Ugandan children with HIV were evaluated for neurocognitive development. Some of these children had previously been put on HAART therapy due to low CD4 counts or serious opportunistic infections. HAART therapy correlated with better fine motor skills and emotional wellbeing which supports the initiation of HAART therapy earlier for these children.

Splenic Artery Aneurysm Rupture in a Young Athlete with Successful Outcome by Coil Embolization

Saira Khan

Isolated splenic artery aneurysm (SAA) rupture is a rare cause of abdominal pain and hypovolemic shock, especially in young, healthy males. Ruptured aneurysms are associated with a high mortality rate in the absence of timely intervention, making accurate and rapid diagnosis critical. We present a case of spontaneous SAA rupture in a young male athlete which was successfully diagnosed and treated with coil embolization.

COLLATERAL DAMAGE: THE EFFECT OF PATIENT COMPLICATIONS ON THE SURGEONS PSYCHE

Amit Patel

The effect of patient complications on physicians is not well understood. Our objectives were to determine when the first significant complication occurs in a surgeon’s career and investigate its effect on his/her emotional state, job performance, and to define surgeons’ coping mechanisms.

Results and Functional Outcome of Femoral Neck Fractures in Young Adults

Gary  Olson

The purpose of this study was to evaluate long-term functional outcome, results and complications after operative treatment of femoral neck fracture in young adults. If free of complications long-term functional status returned comparatively to normative controls. However, complications led to significant impairment represented by decreased functional status scores and increased BMI was also related to an inferior functional outcome.

A Case of Calciphylaxis

Amal Ashraf

Calciphylaxis is a very rare condition seen in patients with end stage renal disease. There is limited data available on the various management options for calciphylaxis. We treated our patient with hyperbaric oxygen with success.

Shoulder Dystocia Simulation: Improving Neonatal and Maternal outcomes.

Sharrell Gibson

The shoulder dystocia simulation training has been linked to improved management and improved neonatal outcomes in previous studies. A retrospective chart review of cases done here, at Spectrum Health did not reflect these findings.

A Case of Delayed Hemolytic Transfusion Reaction Caused by Jra Alloantibody

Zachary King

This is a case report of a woman who suffered a hemolytic reaction following a blood transfusion. After a thorough work-up it was determined that the cause of the patient's hemolysis was an antibody known as Jra. Because Jra antigen-negative blood is extremely rare, the patient can not have matched blood for transfusion.

Title: Towards validation of predictive genomic algorithms to demonstrate improved chemotherapeutic response in murine xenograft models of human malignancy

Sanjeet Rangarajan

Patient outcomes to cancer treatments are heterogeneous due to the molecular complexity of the disease and the diversity of treatment options available. We hypothesize that predictive genomic algorithms can be used to produce superior disease remissions when compared to current standards of care. We seek to develop a xenograft model of human malignancy which demonstrates predictable and reproducible take/growth rates, and to analyze the progression and treatment of refractory/late stage malignancies...

Incidental Noncardiac Findings on Cardiac MR

Zagum Bhatti

Retrospective review to determine the prevalence of both significant and nonsignificant incidental noncardiac findings on cardiac magnetic resonance imaging.

The Harmonic Scalpel: An effective method of preventing recurrent capsular contracture?

Rocco Piazza

The best surgical treatment for established capsular contracture remains somewhat uncertain with divergent opinions being commonplace with regards to the effectiveness of capsulotomy versus capsulectomy. The purpose of this study was to evaluate 10 patients prospectively after undergoing complete capsulectomy using the Harmonic Scalpel.

MRI of Congenital Heart Disease: A Pictorial Review

Indu Rekha Meesa

Describle the MR imaging findings in frequently encountered congenital heart disease and the surgical treatment and post operative anatomy.

paradoxical embolism in Osler-Weber_rendu Syndrome

faiza niaz

Paradoxical Emboli Due to Shunting Through Pulmonary AVMs in Osler-Weber-Rendu Syndrome with Venous thromboembolism an uncommon association. CT angiography can be used to diagnose pulmonary AVMs. Embolization of the pulmonary AVMs can be used to decrease the risk of further episodes of stroke.

Bedside Ultrasound For the Rapid Detection of Pericardial Effusion in the Emergency Department

Ginger Wiersma

We present three diverse ED patients who were evaluated for dyspnea. The diagnosis of pericardial effusion was quickly made with bedside US, and subsequently confirmed by formal echocardiography. These cases demonstrate that bedside focused echocardiography performed by emergency department clinicians enables rapid and reliable detection of pericardial effusion. It holds the advantage of portability, simplicity, rapidity, and higher sensitivity and accuracy when compared to CXR.

Using a Diagnostic Score to Determine the Likelihood of Monogenic Fever Disorder Amongst Pediatric Patients with Periodic Fevers

Tabitha Oosterhouse

This study involves the application of the Italian Gaslini Diagnostic score to pediatric patients with recurrent fevers referred to the Helen Devos Childrens Health pediatric infectious disease clinic.

Sudden Ventricular Fibrillation as the Initial Presentation of Apical Ballooning Syndrome

Joseph Postma

An oral presentation consisting of: a case report featuring the unique presentation of two patients with apical ballooning syndrome, and the implications to outcome and treatment of patients with this syndrome.

Laparoscopic Adjustable Gastric Banding in a Patient with Type I Diabetes Mellitus: A Novel Case Report.

Lisa Marie Chargualaf

Bariatric surgery has now been proven to ameliorate certain co-morbidities associated with obesity, most markedly is its benefits for patients who suffer from type 2 diabetes mellitus. This case report presents novel success of achieving weight loss and improving hyperglycemia in a type 1 diabetic patient utilizing an adjustable gastric band.

Advanced Endometrial Cancer Sandwich Therapy

Emily Dietrich

Retrospective review of patients with advanced stage endometrial cancer treated with sandwich therapy. The objective is to determine progression free survival and toxicity profile for this treatment regimen to work toward identifying an optimal adjuvant treatment protocol for patients with advanced stage endometrial cancer.

Battle for Buttressing in Bariatric Surgery: Seamguard versus Peristrips

Jasmina Hadziosmanovic

This study is a retrospective chart review which compared two types of buttressing material used to reduce the incidence of surgical complications related to the use of stapling devices. Two brands of buttressing materials, Seamguard and Peristrips, were reviewed for the incidence of staple line leaks and bleeding. Additional outcomes of interest include operative time, length of stay, and 30-day mortality.

Outpatient Circumferential Abdominoplasty in Non-Bariatric Patients

robert bajnrauh

Looking at performing circumferential abdominoplasties for cosmetic body contour improvement in the outpatient setting.