Baylor University Medical Center Proceedings最新文献

A 13-year-old boy was referred to orthopedic surgery for chronic intermittent pain and swelling of the left knee. Initial imaging was consistent with osteochondritis dissecans of the femoral condyle. Follow-up imaging demonstrated unexpected progression, with a mass extending into the notch, replacing the anterior cruciate ligament, and eroding the femoral and tibial condyles. Subsequent surgical biopsy and resection revealed tumoral calcinosis, with an ultimate diagnosis of autosomal recessive familial tumoral calcinosis. This case report highlights the radiographic appearance and progression of a rare disease in this unusual location and the differential diagnosis.

In this narrative account, we describe our experiences as medical students coordinating a health fair in collaboration with a student-led free clinic. We gain insights into the challenges of delivering healthcare beyond the walls of a clinic or hospital. This article explores the importance of integrating community-based initiatives into medical student education.

Physicians, and specifically surgeons, have unique expectations and responsibilities regarding professionalism. Further, surgeons interact with multiple different groups of people including surgical peers, trainees, other physicians, ancillary care partners, and patients. Communication between all of these groups must be respectful, appropriate, and effective, even in the high-stress environment of surgery. Norms of professional behavior are evolving to reflect the practices of the current era as well as the increasingly diverse surgical workforce. Thus, multiple surgical societies as well as the Accreditation Council for Graduate Medical Education have incorporated professionalism as a core pillar of surgeon evaluation. While professionalism has typically been modeled, the trait is now being more formally taught in medical education pathways. Future directions for professionalism in surgery include validated modules, more formalized surgeon review, linkage to credentialing, and reimbursement.

Background: With the increased use of robotic surgery, robotic transabdominal preperitoneal repair (R-TAPP) has become a commonly used approach for inguinal hernia repair. The laparoscopic totally extraperitoneal repair (L-TEP) has the advantage of not entering the peritoneal cavity; however, it has greater technical difficulty. Robotic surgery has demonstrated superiority over laparoscopy in many surgical settings, but there is limited evidence comparing L-TEP and R-TAPP.

Methods: This was a retrospective review of patients who underwent L-TEP and R-TAPP at Baylor University Medical Center between December 2011 and January 2022. Information on patient demographic characteristics, comorbidities, postoperative complications, hospital length of stay, and postoperative complications requiring a procedure was collected.

Results: A total of 298 patients were analyzed; 245 underwent R-TAPP and 53 underwent L-TEP. Hernia recurrence was significantly decreased in those who underwent R-TAPP (1.2%) compared to L-TEP (9.4%) (P = 0.01). Postoperative pain was also significantly decreased in the R-TAPP group (5.3%) as compared to the L-TEP group (13.2%) (P = 0.01).

Conclusions: With the transition from L-TEP to R-TAPP over recent years, there is limited evidence supporting this change in practice. Our single-center retrospective review demonstrates that R-TAPP is noninferior to L-TEP and has significantly decreased hernia recurrence.

Background: Persistent genital arousal disorder (PGAD) is a rare condition characterized by unwanted and distressing symptoms of arousal and dysesthesia. The aim of this scoping review was to map the current state of PGAD management, identify gaps in the literature, and understand patient perspectives.

Methods: We completed a scoping review following guidelines from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta Analyses Scoping Reviews extension. A systematic literature search for articles pertaining to PGAD/genito-pelvic dysesthesia (GPD) was conducted in August 2023 via Medline, Embase, Scopus, and Web of Science. The search returns were deduplicated and the remaining titles and abstracts were screened for inclusion. General publication characteristics and treatment data were extracted from the included publications via a pilot-tested Google form. All screening and extraction were completed in a masked, duplicate fashion.

Results: Findings from our scoping review revealed a scarcity of systematic research, limited evidence-based data, and the importance of addressing both physical and psychiatric concerns. Our sample included 46 publications from an initial pool of 636 returns. Case studies were the most common study design. Thirty-three studies examined medication, either alone or as part of a treatment regimen. Selective serotonin reuptake inhibitors were the most used medication, followed by pramipexole and carbamazepine. Seven studies used a surgical or procedural intervention. Treatment with pelvic floor Botox was the most common procedure. Patient perspectives in the included case studies highlighted themes of shame, suicidal ideation, social isolation, decreased sleep, and overall decline in quality of life.

Conclusion: The findings from our study emphasize patients' distressing and psychiatric symptoms, indicating a need to improve treatment regimens, using both evidence-based research outcomes and patient-reported outcomes. Management for PGAD/GPD lacks a standardized framework, indicating a need for further research and the development of clinical practice guidelines to improve patient care.

Introduction: Colon cancer is the second most common cause of death in the United States. With an increasing number of patients diagnosed at younger ages, the disease remains a significant burden. However, recent data on early onset patients admitted with colon cancer are still limited.

Methods: We utilized the 2016 to 2021 National Inpatient Sample to investigate trends and characteristics of colon cancer hospitalizations. Nonelective participants were divided into early onset and normal-age groups, with a cut point of 50 years old. In addition, we also investigated factors associated with the risk of inpatient mortality in the study population.

Results: There were 26,903 early onset nonelective colon cancer hospitalizations in the population group, amounting to 11.91% of total colon cancer hospitalizations. No significant changes or trends were seen from 2016 to 2021. Compared to the normal-age population group, there was a disproportionate number of Blacks, Hispanics, and Asian Americans, as well as those with obesity and tobacco usage.

Conclusion: Some demographic factors and comorbidities disproportionately affect early onset colon cancer patients when compared to the normal-age population group. Further investigations are necessary to combat the growing incidence of early onset colon cancer.

Background: For most patients with hypertrophic cardiomyopathy (HCM), the clinical course is considered relatively benign, similar to hypertensive heart disease (HHD). We compared the long-term outcomes in patients with HCM versus HHD from a large healthcare system database.

Methods: Data from SSM Virtual Data Warehouse were used to identify patients with a new diagnosis of either HCM or HHD who followed up in our system for at least 6 months. HCM patients were matched 1:1 to HHD patients based on age, sex, and race. Outcomes examined included heart failure (HF) admission, ventricular tachyarrhythmia (ventricular fibrillation or sustained ventricular tachycardia), and need for pacemaker or defibrillator implantation. We identified 1904 HCM patients along with HHD controls.

Results: After adjusting for demographic characteristics and relevant comorbidities, HCM had higher odds of HF admission (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.43-2.10), ventricular tachyarrhythmias (OR: 2.31, CI: 1.60-3.33), pacemaker implantation (OR: 2.14, CI: 1.29-3.57), and defibrillator implantation (OR: 3.77, CI: 1.82-7.83). Survival analysis confirmed the difference in outcomes early on from the time of diagnosis.

Conclusion: In this retrospective study from a large healthcare system database, HCM patients had significantly higher incidences of HF admission, ventricular tachyarrhythmias, and pacemaker or defibrillator implantation compared to HHD patients.

Background: Screening for Barrett's esophagus (BE) remains controversial, even for high-risk populations. Our study aimed to evaluate the proportion of patients diagnosed with esophageal adenocarcinoma (EAC) who were not screened for BE or did not receive recommended BE surveillance screening. We then evaluated the relationship between cancer staging and screening/surveillance opportunities.

Methods: This single-center retrospective study included 187 patients from January 2016 to January 2022 with newly diagnosed EAC. Data extracted from patient charts included BE risk factors, and BE, endoscopic, and histologic history.

Results: A total of 187 patients had a new diagnosis of EAC. Among this group, 44% had appropriate BE surveillance adherence, and 47% of patients met the criteria for BE screening but had not been screened prior to EAC diagnosis. Adherence to BE surveillance was associated with earlier stages of cancer on biopsy. No significant difference in cancer staging was found in those with missed BE screening opportunities.

Discussion: Patients with a diagnosis of BE who adhered to surveillance guidelines had earlier stage EAC at diagnosis, which emphasizes the importance of surveillance. Most of those with an initial diagnosis of EAC had not received any BE screening.