Browsing by Author "Patterson, Tyler"
Now showing 1 - 4 of 4
- Results Per Page
- Sort Options
Item Appendiceal Mucinous Neoplasm Case Study(2024-03-21) Tamayo, Jesús; Patterson, TylerAppendiceal Mucinous Neoplasm Case Study Jesse Tamayo, Tyler Patterson, Michael Smith, Jay Patel Appendiceal Mucinous Neoplasms account for less than 1% of all malignancies in the United States. Patients with low grade neoplasms often present with symptoms of an acute appendicitis with right lower quadrant pain due to the distention of the appendix caused by the increasing levels of mucin. These patients may also have perforation of the appendix or appendicitis if the tumor growth is obstructing the orifice of the appendix. An patient with advanced disease may present with similar symptoms as well as distention of the abdomen due to mucinous ascites growing in the peritoneum. Patients may also present with weight loss, abdominal pain, and even intestinal obstruction. A majority of these primary neoplasms have mucin involved in more than 50% of the lesion, arising from low-grade appendiceal neoplasms (LAMN) seen as adenomatous changes in appendiceal mucosa. They can also arise from a polyp forming adenoma similar to those seen in patients who develop colon cancer. Histologically they can be seen with signet ring cells. The patient involved in this case report had presented to the Emergency Department on numerous occasions for right lower quadrant pain. This pain had persisted for years, CT imaging was performed and the tumor was recognized. A procedure for removal was scheduled, however prior to the day of surgery, the patient again presented to the emergency department with excruciating RLQ pain. Surgery was performed the following day. The tumor size was so great that the patient also had a right hemicolectomy performed to remove the tumor in entirety. It was 5.5 cm in greatest dimension. Surgical margins were negative for invasion and twenty six lymph nodes were biopsied and all came negative for cancer. The surgical case was successful for a appendectomy along with a right hemicolectomy to remove a 5.5 by 1.5 low grade appendiceal mucinous tumor confined to the muscularis propria of this patient.Item Hyperemesis Cannabinoid Syndrome Chart Review(2023) Patterson, Tyler; Porter, Cardon; Birky, Jaxton; Judd, Dallin; Zhang, Fan; Espinoza, Anna; Galke, Curtis; Petersen, JamesPurpose: The purpose of this research study is to determine if the combination of Compazine and Benadryl is a superior method of treatment for patients who present with nausea and vomiting symptoms due to a diagnosis of Hyperemesis Cannabinoid Syndrome. Based on patient charts from a regional hospital emergency department in Oklahoma, an analysis was performed to determine if this combination of medications is more effective in quickly reducing the nausea, vomiting, and other symptoms associated with cannabis use.Methods: An agreement was created between a regional hospital in Duncan Oklahoma and The University of North Texas Health Science Center which allowed students at the Texas College of Osteopathic Medicine to review and analyze a total of 75 patients’ charts from the regional hospital. IRB approval was obtained for this project. The chart review process consisted of evaluating the patient's age, chief complaint, abnormal lab values, history of present illness (HPI), and medications administered in the emergency department. The important variables that assisted in this study were drug screening values, and the medications administered. The main outcome for which statistical efficacy of drug treatment was measured by duration of stay in the emergency department and whether or not an additional dose of medication was given. Results: This chart review showed that the 12 patients that used the Benadryl and Compazine combination had a decreased time spent in the emergency department by an average of 56 minutes when compared to 38 patients who received alternative medications. The average time spent in the emergency department for those who received Benadryl and Compazine was 127 minutes vs the average time spent for those using an alternative medication was 183 minutes. The typical dose was 50 mg of Benadryl and 10 mg of Compazine. While using an ANOVA statistical analysis these doses showed a significantly statistical relationship by decreasing provider-to-discharge time with a p value of 0.012. It was also found while using a logistic regression analysis that those patients who received this combination as their initial dose were less likely to receive a second dose. This relationship also was statistically significant with a p value of 0.005. It was also noted in the logistic analysis that females were more likely to receive a second dose when compared to men. This relationship also showed a relationship with significance and a p value of 0.037. Conclusions:The findings from this study recommend and encourage providers who are in a setting where Hyperemesis Cannabinoid Syndrome is prevalent to consider the medication combination of 50 mg of Benadryl and 10 mg of Compazine when providing treatment. There may be multiple ways to alleviate the discomfort and symptoms that patients may present with, however the combination stated above appears most effective to reduce provider-to-discharge time 56 minutes and eliminate second doses of medication based off of the data reviewed from the charts provided.Item Hyposplenia(2022) Patterson, Tyler; Ramirez, Cynthia; Park, Chanyang; Sabbaghi, Tiffany; Patel, Kavita; Fisher, Cara L.Background: The spleen is the largest secondary lymphoid organ in the human body. It is an intraperitoneal organ, located in the left upper quadrant, posterior to the stomach and inferior to the diaphragm from the T8-T11 vertebral levels. The typical size of the spleen is 6 cm in width and 10 cm in length, with a depth length of 3 cm. Embryonically, it is derived from mesenchyme in the dorsal mesogastrium, and during fetal development in utero, the spleen transiently functions in the production of blood cells during fetal development. During adulthood, the spleen acts as a major repository for phagocytic cells, lymphocytes, and platelets, with a primary function of blood filtration. Hyposplenia is reduced size and function of the spleen. It is a condition that can complicate many diseases, such as sickle cell anemia, alcoholic liver disease, and many autoimmune disorders. Functional hyposplenia is characterized mostly by defective immune responses against pathogens. This cadaver case report presents the clinical condition of hyposplenia. Case Information: First-year medical students engage in anatomy courses in which routine cadaver dissections are performed. An abnormally small spleen was found in the upper abdominal cavity of a 66-year-old female. The donor presenting with the hyposplenia outlined in this case report passed from acute liver failure of uncertain etiology, chronic kidney disease, and peripheral artery disease. A typical spleen as compared to the cadaver's spleen indicated the cadaver's spleen was drastically reduced in size. The donor's spleen measured 2.72 cm in width and 4.38 cm in length, with a depth of 1.39 cm. Conclusions: In contrast to splenomegaly, the clinical determinant of a small spleen, hyposplenia, is unclear. However, there are potential causes for the spleen's size to decrease. Exposure to radiation, sickle cell disease, diabetes and chronic alcoholism are all hypotheses for this change in size. Patients with a defect in Kupffer cell function in relation to alcoholism have a predisposition to hyposplenism. In this case, the donor had the pathologies of diabetes and liver disease. The cause of death of acute liver failure of uncertain etiology could have been linked to the consumption of alcoholic beverages and their effects on the liver, as well as the effect on the Kupffer cells in the spleen.Item Perioperative Complications in Swan Neck Deformity Repair Case Report(2024-03-21) Patterson, Tyler; Carpenter, Brayden; Boody, Taylor; Heidenrich, Taylor; Tamayo, Jesse; Hyatt, BrookeBackground Excessive vagal stimulation in the intraoperative and perioperative periods can lead to bradycardia, asystole, and death. Painful stimulus or excessive pressure on the vagus nerve can lead to bradycardia. Increased stretch from a mechanical standpoint can also lead to more vagal nerve firing and input. Case Summary This case investigates the disease process of a 69-year-old female who presented to the surgical team following multiple failed conservative treatments for cervical chin on chest spinal deformity, requiring three months of hospitalization. Given the expected airway edema and swallowing dysfunction, surgical risks were high, and the patient was informed of potential complications. She consented for surgery and was educated on risks and benefits, including the possibility of requiring a tracheostomy and a Percutaneous Endoscopic Gastrostomy placement. The patient underwent a closed reduction of cervicothoracic spinal deformity, anterior cervical C4-5 osteotomy, C4-C7 corpectomies, C3-T1 anterior cervical fusion, posterior cervical C5-6 osteotomy, C2-T6 laminectomies, posterior cervical instrumented fusion C2-T8, and left L4 hemilaminectomy for placement of drains. On post op day 6, the patient requested PEG and tracheotomy placement. On post op day 10, the patient compounded a necrotizing soft tissue infection of the anterior neck that required emergent washout. The wound displayed profuse black fluid upon incision which along with imaging and crepitus on physical exam led to the diagnosis of acute necrotizing fasciitis. The patient also acquired persistent cervical esophageal perforation with a non-healed fistula and was taken to the OR two days later for tracheotomy revision and esophageal perforation repair. On post op day 20, the patient developed a neck hematoma requiring OR incision and drainage. On post op day 30, the patient was being turned by nursing to clean cervical wounds and became unresponsive. The patients became bradycardic, then developed asystole with no palpable pulses. After a few seconds, telemetry showed sinus rhythm and vitals became stable. Cardiology was consulted and attributed the patient’s episodes of asystole to pressure on the carotid sinus causing stimulation of the vagus nerve. The care team was instructed to minimize turning the patient to avoid further asystole. Local anesthesia was advised for future procedures. With an arrhythmia lasting longer than 90 seconds, pacemaker placement was indicated and performed. Discussion The interprofessional team effort allowed us to quickly identify the cause and treatment, which were vagal nerve compression and pacemaker placement, respectively. There are several explanations as to what contributed to the vagal stimulation. These include anatomical reconstruction, postoperative infection, neck hematoma, esophageal perforation, or mechanical ventilation stimulation. These may have caused vagal nerve stretching, causing increased vagal sensitivity. Above all, the increased vagal stimulation mostly occurred due to the drastic change in the patient’s anatomy, going from an extreme hyper flexed cervical position to hyperextension. This causes stretching and pulling on the structures in that region, which includes the vagus nerve. As anesthesia providers, it is crucial to recognize these possible complications and be able to adapt to care for these patients inside and outside of the operating room.