2011 Surgical Summer Research Students

The Department of Surgery faculty host summer students annually, providing funded research opportunities to enrich their education.  The goal of the program is for students to have an opportunity to learn more about research, complete a project and have an opportunity to potentially publish their work or present their findings at local and national meetings.  At the end of the summer, all students participate in a poster session at the medical school.  This year, ten students are participating in research in the department.

Clark DuMontierStudent:  Clark DuMontier
Preceptor:  Dr. Karen Brasel
Title:  The Association Between Frailty and Outcome in an Elderly Trauma Population

Frailty is a state of increased vulnerability to health-related stressors that is measured by evaluating certain, quantifiable traits that are present in an individual.  Our project seeks to assess associations between frailty traits, discharge destination and outcomes in elderly trauma victims.  One of the difficulties in the trauma population is the inability to perform some of the tests incorporated in measures of frailty may be due to injury rather than frailty.  We hope to determine which measures will perform well in the injured elderly, and whether these are the same or different than measures that perform well in the uninjured elderly.  We will research these associations via a literature review followed by both a retrospective and prospective cohort study.  Our aim is to derive a measure of frailty that can be used to inform patients and their families about their recovery and future status.

Berry FairchildStudent:  Berry Fairchild
Preceptor:  Dr. Travis Webb
Title:  Sarcopenia and Frailty in Elderly Trauma Patients

The terms frailty and sarcopenia are used widely throughout the geriatric literature to describe the condition of elderly patients and identify those at risk of adverse health outcomes.  Measures of frailty and sarcopenia have not been studied as predictors of outcome in elderly trauma patients.  We will be conducting a retrospective chart review aimed at identifying risk in elderly blunt trauma victims that can effect discharge disposition. This study will include a review of CT scans obtaining anthropomorphic measurements directly from the imaging. Conducting this study will facilitate our ability to determine whether or not certain frailty characteristics predict outcome in elderly trauma patients and help facilitate appropriate discharge planning, anticipate prognosis and direct individualized treatment in future patients.

Michelle HofmeisterStudent:  Michelle Hofmeister
Preceptors:  Dr. Karen Brasel, Dr. Terri deRoon-Cassini
Title:  Partnership to Improve Care for Adolescent and Young Adult Violence Survivors

Patients who experience traumatic injury as a result of violent assault, as opposed to non-violent means, are at an increased risk for trauma-related psychopathology, such as development of Post-Traumatic Stress Disorder (PTSD). Our project will be looking at young adults who have been exposed to interpersonal violence, and how health care disparities affect the long-term mental health consequences of such an experience.  We are focusing on the uninsured adolescent population, as the rate of violence-related traumatic injury is higher in adolescents from ethnic minority backgrounds and low socioeconomic status (SES) groups than in Caucasian and high SES youth. We will be surveying trauma patients at the Saturday Free Clinic to determine if they have a lower rate of follow-up medical care after a traumatic event, what factors prevent them from seeking follow-up medical care, and how this correlates to their mental health status and PTSD-related symptoms. We hope these data can be used for a future project creating an intervention to improve follow-up medical care after a traumatic event, and that this intervention may reduce the rate of PTSD in this population.

Bart ImielskiStudent:  Bart Imielski
Preceptor:  Dr. James Tweddell
Title:  Outcomes following the Fontan procedure in subjects with single ventricle congenital heart disease

Single ventricle congenital heart disease, for example hypoplastic left heart syndrome, may require palliative surgical treatment to restore adequate blood flow to either the systemic or pulmonary circulation. Depending on the congenital anomaly, multiple surgeries are usually performed; however, most patients will typically require Glenn and Fontan procedures at some point during early childhood. The aim of these two surgeries is to redirect venous return, bypassing the right side of the heart, so that it passively drains into the right pulmonary artery. This allows for the remaining single ventricle to solely pump blood into the systemic circuit.   Our aim is to investigate the post operative outcomes in patients who underwent fenestrated Fontan procedures for univentricular congenital cardiac anomalies. Fenestration refers to a shunt created between an external conduit, connecting the inferior vena cava and the pulmonary artery, and the right atrium.  We aim to compare patients whose fenestrations were closed either surgically, with a subcutaneous stitch, with a catheter device, or spontaneously to those whose fenestrations were kept patent. In addition to quantifying these outcomes, we will identify clinical indications for fenestration closure and correlate these with survival outcomes. The overarching goal is to gain greater appreciation for when fenestrations should be closed to maximize long term patient health.

Torsten JoergerStudent:  Torsten Joerger
Preceptors:  Dr. Raymond Fedderly and Dr. Michael Mitchell
Title:  Use of monocusp reconstruction of the right ventricle outflow tract (RVOT) in patients with congenital heart disease

Several surgical strategies have evolved for re-creation of the RVOT in patients with severe RVOT obstruction.  A transannular patch is currently the most widely used strategy.  This allows for relief of the RVOT obstruction, however it does allow free pulmonary insufficiency.  Homografts and heterografts placed in this position during the initial primary repair allow for valve function and have the potential to limit pulmonary insufficiency, however these grafts are prone to develop insufficiency as well as stenosis as the patient grows.   The use of  monocusp reconstruction allows for relief of the RVOT obstruction and gives the theoretical advantage of limiting the degree of pulmonary insufficiency without the use of a heterograft or a homograft.  Few studies have compared the transannular patch vs. the monocusp at a single institution.  Specifically lacking is data from the post-operative PICU period.  We will be studying patients who have undergone RVOT reconstruction either with a transannular patch or with a transannular patch and monocusp reconstruction, or with a heterograft or with a homograft.  Our hypothesis is that the use of monocusp reconstruction is of both short and intermediate term benefit for patients with congenital heart disease who required RVOT reconstruction and who would have otherwise received a transannular patch across the RVOT, a homograft, or a heterograft.

Deborah KarmStudent:  Deborah Karm
Preceptor:  Dr. Amanda Kong
Title:  Vascular calcifications on mammography: A marker for coronary artery disease?

Coronary artery disease (CAD) is the number one cause of death for women in the United States. Although many risk factors for this disease are known, it is currently difficult for physicians to diagnose CAD due to the lack of screening tools.  Studies have shown that several risk factors for CAD, such as diabetes and hypertension, are also associated with vascular breast calcifications seen on screening mammograms.  We will be analyzing the records of women who have had a cardiac catheterization and mammogram within the past two years of the cardiac catheterization for the past ten years. These women will be categorized into two groups, those who were diagnosed with CAD and those who were not diagnosed with CAD by receiving cardiac catheterization reports.    The most recent mammogram taken within the past two years will then be examined by a single breast radiologist to assess for benign vascular breast calcifications.  We will also identify other significant clinical variables such as smoking and diabetes.  Our goal is to identify a correlation between CAD and an increase in benign vascular breast calcifications on mammograms.  If a correlation is identified, screening mammograms could potentially be used as a screening tool for CAD.

Bilikisu Ashley LawalStudent:  Bilikisu Ashley Lawal
Preceptors:  Dr. Andrea Winthrop and Dr. Timothy Corden
Title:  Epidemiology of Motor Vehicle Crashes Involving Teen Drivers and occupants in Southeastern Wisconsin: Compliance with the Graduated Drivers License Regulations

The overall hypothesis of our research study is that teenage drivers and occupants that were involved in a MVC (motor vehicle crash) have inconsistent compliance with Graduated Drivers License (GDL) guidelines. The aim of the research project is to evaluate the epidemiology of MVC’s involving teenage drivers and occupants in the 7 Southeastern Wisconsin counties. This study will be a retrospective review specifically evaluating current driving behaviors, compliance with the components of the GDL, MVC patterns, and resulting injuries.  Our findings will also provide a baseline analysis that can be used in the future to evaluate the impact of the new Text Message Ban implemented on December 1, 2010. This research study will provide important information to inform our community partners and assist in the design of prevention programs targeting teen drivers in Southeastern Wisconsin.

Andrew LeikerStudent:  Andrew Leiker
Preceptor:  Dr. Tracy Wang
Title:  An Analysis of Intraoperative Parathyroid Hormone Kinetics in Elderly Patients with Primary Hyperparathyroidism

To date, parathyroidectomy is the only cure for primary hyperparathyroidism.  With the advent of intraoperative parathyroid hormone (IOPTH) monitoring and improved preoperative gland localization, surgical practice calls for the implementation of minimally invasive parathyroidectomy (MIP) in the absence of multigland disease, in contrast to a full neck exploration.  Intraoperative PTH monitoring allows the surgeon to monitor PTH levels in the operating room and determine whether or not additional hypersecretory glands need resection.  Current criterion for intraoperative biochemical cure utilizing IOPTH monitoring does not take into account age-related differences in PTH kinetics.  Our research aims to identify age-related differences in intraoperative PTH kinetics through the implementation of one phase exponential decay modeling.  Assuming age related PTH kinetic differences exist, a new intraoperative PTH algorithm for elderly patients based on multivariate analysis will be developed, which will include real time kinetic modeling of intraoperative PTH levels during parathyroidectomy.  This work is supported by the National Institute on Aging T35 Training Grant.

David PelozaStudent:  David Peloza
Preceptor:  Dr. Alonzo Walker
Title:  Assessing the Use of Stress Management Techniques and Biological Readings in the Breast Cancer Patient Population

We will be investigating the use of Dialectical Behavior Therapy in the breast cancer patient population.  Specifically, we will be exploring the use of Biofeedback tools, including bio-thermal measurements and pulse rate, in order to allow patients to both monitor and help manage stress.  We will also be teaching patients a breathing technique that can be used to reduce stress and impact Biofeedback levels.  Additionally, we will assist in analyzing quality of life data from several tools, which will be reported by the patients throughout the study.  The goal of the project is to gather preliminary data on the effects of stress management techniques and Biofeedback tools in the breast cancer patient population to better understand these strategies for future use in therapy.

Kai YangStudent:  Kai Yang
Preceptor:  Dr. Cheryl Brosig
Title:  Behavioral Functioning and Quality of Life in Children with Congenital Heart Disease

Research suggests that children with congenital heart disease are at higher risk for neurodevelopmental and psychosocial problems.  The purpose of our study is to describe the behavioral functioning and quality of life of children referred for psychological services within the Herma Heart Center at Children’s Hospital of Wisconsin. The specific goals of this project are describing the patient population based on demographic data, reasons for referral, cardiac diagnoses, and psychological diagnoses.  We will also compare this population to a normative population based on measures of behavioral functioning, specifically the Child Behavior Checklist and Pediatric Quality of Life Inventory. This study is part of a larger, IRB-approved study that was initiated in 2008.