General Medicine

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    (2013-04-12) McFarlin, Jared
    Purpose: Investigation of the correlation between obesity, as defined by BMI, and risk of infection following TKA has been met with mixed results. Several studies show an increased risk of infection in the obese, while others show an acceptable success rate. It is our belief that a specific study of the fat distribution surrounding the knee itself versus the general BMI measurement will yield a more precise corollary to the risk of infection. We plan to assess the fat distribution over the knee quantitatively by creating a "prepatellar fat thickness ratio", which would compare the soft tissue thickness anterior to the patella with the actual thickness of the patella. Methods: An alpha level of 0.05 was used to determine statistical significance. Descriptive statistics including means, standard deviations, frequencies and confidence intervals were computed for the variables of interest in the study. Chi-square tests were used to determine if a patient's development of an infection was associated with their gender, smoking or diabetes status. Linear regression were used to determine if the prepatellar ratio was significantly affected by a patient's BMI or age. Logistic regression and odds-ratios were computed to examine the effect that BMI, smoking, diabetes, gender or the prepatellar ratio had on developing an infection post total knee arthroplasty. Results: There were no significant associations detected between developing an infection and the patient's gender, age, BMI, smoking or diabetes status. Using logistic regression, it was determined that for every 0.925mm increase in the ratio between the thickness of the patella and the thickness of the prepatellar soft tissue, a patient's risk of developing an infection post-surgery increased approximately 2.523 times. Conclusions: Many authors believe obesity plays a significant part in increasing infection risks, and used BMI to verify this risk; however, the prepatellar fat thickness ratio proved to be the most accurate predictor of infection in our study. BMI is a not a composition specific measurement, and has met mixed results when used to predict infection risks in some studies. In contrast, the prepatellar ratio is both composition and site specific for TKA. Further investigation is warranted, but it is our belief that this measurement holds promise as a pre-operative indicator of infection risk
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    (2013-04-12) Kazenske, Faustino
    Purpose: Acetabular fractures are among the most complex of all orthopedic injuries. Surgeons who treat these injuries are aware of the associated morbidity and mortality related to acetabular fractures. There is much literature involving these injuries, but there is little research outside of case reports on unusual injury patterns involving the acetabulum. The bilateral acetabular fracture is one of these rare entities. The purpose of this study is to evaluate the demographics, fracture patterns, survival, and related injuries in patients with this unusual fracture pattern. Methods: Prospectively collected data from February 2004 to May 2010 on bilateral acetabular fractures will be retrospectively evaluated. This data was collected from two trauma hospitals: John Peter Smith Hospital and Atlanta Regional Medical Center. Data from each medical center regarding morbidity including ISS scores, spine injuries, visceral injuries, pelvic vascular injuries, extremity fractures/injuries, shock, pneumonia, sepsis and mortality was gathered for analysis Results: There was a total of thirty patients that met inclusion criteria for this retrospective study. The average age of the patient was 39 years of age. The average ISS score was 21.12 with a mortality rate of 11 %. Patients were found to have visceral injuries involving the chest 15.7%, abdominal visceral 39.2%, and genitourinary 9.8%. Associated spine injuries were found in 45.1% of the patients. Upper and lower extremity injuries occurred in 35.3% and 43.1% of patients, respectively. Conclusions: - Bilateral Acetabular fractures are rare injuries that were found in this study to present with many associated injuries. To our knowledge, this is the largest series of its kind. The findings from this study could be used by orthopedists and traumatologists to better appreciate and evaluate patients with this unusual fracture pattern
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    (2013-04-12) Leber, Julie
    Purpose: Cyclic vomiting syndrome (CVS) is a perplexing disease, and is often a delayed diagnosis. As such, it leads to considerable distress in individual patients, and mounts a significant burden on the medical financial system. This report illustrates a case of its presentation, diagnosis, and management. Methods: A 29 year old female with a past medical history of migraines, borderline personality disorder, and depression presented with a 5 day history of intractable abdominal pain, nausea and vomiting. She admitted to experiencing these episodes, usually lasting from 5-7 days, about once a month for the past 8 years. Labs, imaging studies, and a gastric emptying study revealed no abnormalities. A toxicology screen was positive for marijuana, which the patient stated abstinence from for the past 2 months. Results: She was treated symptomatically, and counseled on the identification of possible triggers for vomiting episodes. She was discharged on a daily regimen of aripiprazole, topiramate, ranitidine, and flexeril. At a follow up visit 2 months later, she reported no recurrence of vomiting episodes or migraines. Conclusions: Cyclic vomiting syndrome represents a perplexing entity of the mind-gut continuum, and must be distinguished from cannabis hyperemesis in applicable patients. Associated with migraine headaches, it is a condition characterized by intractable vomiting episodes lasting from 1 hour to 10 days, with a return to normal health between episodes. Although cannabis hyperemesis differs in presentation with a noncyclic pattern, marijuana cessation is required for diagnosis. As CVS is a disease process proposed to have both physical and emotional contributions, successful treatment may require pharmacologic measures in conjunction with an awareness and avoidance of triggers.
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    (2013-04-12) Marshall, Hayley
    Purpose: The purpose was to assess the association between aggression, including the subcategories of physical, verbal, anger, and hostility aggression, with serum DHEA-S levels in non-Hispanic Caucasian (NHC), non-Hispanic African American (AA), and Hispanic (H) women, aged 20-40 years. Methods: Data were obtained from the Racial/Ethnic Differences in Stress Age Among Women Study. This study included women 20 - 40 years of age who were not pregnant and not taking glucocorticoids. Participants also did not have cancer; endocrine disorders (e.g. Diabetes Mellitus); thyroid, parathyroid, or adrenal gland disorders; or immunologic disease (e.g. HIV, AIDS, Lupus). Participants completed self-reported questionnaires including the Aggression Questionnaire. DHEA-S levels were measured via a blood draw. Five simple linear regression models were analyzed with each category of aggression as the independent variable and DHEA-S as the dependent variable. Multiple linear regressions included the aggression category, age, and race/ethnicity. Log-transformed DHEA-S was utilized to achieve normality. Statistical significance was assessed at alphad0.05. Results: A total of 70 women with mean age of 29.4(sd=5.4) were included. There were 23 NHC, 21 AA, and 27 H participants. In crude analysis, an increase in total(p=0.019) and verbal aggression (p=0.008) was associated with a decrease in logDHEA-S. The association for physical aggression approached significance (p=0.059). After controlling for age and race/ethnicity, an increase in verbal aggression (p=0.021) was associated with a decrease in logDHEA-S. A borderline association was observed for total aggression (p=0.054). Compared to NHC, being AA was associated with a decrease in logDHEA-S in models with total, physical, and anger aggression. The association approached significance in the models for verbal and hostility aggression. An increase in age was associated with a decrease in logDHEA-S in all models. Conclusions: Results indicate there is interplay between the psychosocial factors of physical, verbal, and total aggression (the first two being physical manifestations of aggression) with DHEA-S levels. Since DHEA-S is associated with many (non)physiological processes, it is important that future clinicians understand how these biopsychosocial aspects of life can influence each patient individually. If clinicians can understand these relationships, then they can work with their patients towards a goal of both physical and psychosocial well-being.
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    (2013-04-12) Ly, Thu
    Purpose: Compared to benign adrenocortical tumors, adrenal cortical carcinomas (ACC) are rare occurrences affecting 1 out of 1,000,000 persons in the general population with a 3% prevalence rate in those older than 50 years old. Of interest is this unusual case of a nonfunctional adrenal cortical carcinoma in the left adrenal cortex in a 58-year old male. Methods: Laboratory evaluation was obtained while patient was in the hospital. This included plasma metanephrine, normetanephrine labs and a dexamethasone suppression test that ruled out pheochromocytoma and Cushing's syndrome. In addition, computerized tomography (CT) scan of the abdomen and pelvis was obtained. Results: The computerized tomography (CT) scan revealed a large, lobulated, heterogeneous density obliterating the left adrenal gland. Pathology reported adrenal cortical carcinoma from the biopsy. Conclusions: After surgical resection, further imaging was obtained that revealed metastasis into the lumbar spine. Oncology follow-up included mitotane chemotherapy.
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    (2013-04-12) Peebles, Rebecca
    Purpose: Metabolic syndrome (MetS) is a cluster of medical conditions that synergistically increase the risk for development of cardiovascular disease and type two diabetes mellitus. The rapid and persistent rise in the prevalence of MetS has sparked much interest and debate among researchers regarding activity and inactivity physiology. Exercise as a prescription for prevention and management of this disease process has been suggested and explored. The purpose of this study was to address the relationship between physical activity levels and the presence of MetS risk factors within a rural community. Methods: Patients from a family medicine clinic in San Saba County, Texas were recruited, consented, and given a survey to complete. The survey assessed the amount of physical activity levels, presence of MetS risk factors and demographic information of each participant. Results: Frequencies of the five MetS risk factors were calculated revealing 7.7% of participants had none, 33.3% had one, and 20.5% had two. 38.5 % self-reported three or more risk factors which qualified them to have MetS. There was a medium, negative correlation, r = -0.33, n=31, between increase in moderate-to-vigorous intensity physical activity at work and a decrease in the presence of MetS risk factors. However, the relationship was not statistically significant (p=0.067). No correlation was observed between exercise and the presence of MetS risk factors (r = 0.084, n = 17, p = 0.75) or time sitting and the presence of MetS risk factors (r = 0.094, n =28, p =0.063). A one-way, between group analysis of variance showed statistical significance between high school graduates and higher levels of education, but no statistically significant differences between other levels of education or any income groups. Conclusions: Based on the data collected for this project, there is no significant association between exercise and the presence of MetS risk factors. However, over the past two decades, exercise has been well documented to decrease the development of risk factors and slow or even prevent the progression to fulminant disease. The deviation of the results of this investigation from prior research is likely due to the limitations and confounding factors of this study. Further research is needed to make definitive remarks regarding the role of exercise in prevention and management of MetS.