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Browsing by Author "Saway, Brian F."

Now showing 1 - 6 of 6
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    Attempted Suicide in a Parkinsonian Patient Treated with DBS of the VIM and High Dose Carbidopa-Levodopa
    Ayobello, Ayotunde; Saway, Brian F.; Greenage, Michael (Hindawi Publishing Corp, 2019-03-26)
    Introduction. Parkinson’s disease (PD) is a complex disease that is often treated with dopaminergic medications such as carbidopa-levodopa and now with innovative interventions such as deep brain stimulation (DBS). While PD frequently presents with depression and apathy, research must elucidate whether its treatment modalities have an additive or synergistic effect that can lead to an increased suicide risk. DBS has been associated with depression, behavioral changes, and suicidality while dopaminergic treatment has also been shown to cause behavioral changes such as hypersexuality and impulsivity. Considering the now frequent practice of utilizing both DBS and carbidopa-levodopa to treat PD, it is crucial to understand how to properly manage PD patients who are displaying this overlap in symptomology. Case Report. A 56-year-old Caucasian male with a 6-year diagnosis of PD who was being treated with high dose carbidopa-levodopa and left DBS of the ventral intermediate nucleus (VIM) presented after a suicide attempt. The patient was found to be severely depressed and had exhibited behavioral changes in the weeks leading up to the attempt. Imaging was performed to assess positional changes of DBS and carbidopa-levodopa dosage adjusted while under close observation in the inpatient unit. The patient was started on fluoxetine to treat the depressive symptoms and was eventually discharged with close monitoring. Discussion. With PD and DBS being associated with behavioral changes and depressive symptoms and carbidopa-levodopa therapy being linked to behavioral changes such as impulsivity, it is important that these patients be closely monitored and research analyzes how these factors may interact and lead to an increased risk of suicide. Furthermore, when symptoms appear, a clear protocol must be established on managing these patients. We therefore recommend an approach that utilizes imaging to assess any changes in DBS placement, dose management of carbidopa-levodopa, and behavior monitoring in an inpatient setting.
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    Burkitt-type lymphoma incidentally found as the cause of acute appendicitis: a case report and review of literature
    Shahmanyan, Davit; Saway, Brian F.; Palmerton, Hannah; Rudderow, John S.; Reed, Christopher M.; Wattsman, Terri-Ann; Faulks, Emily R.; Collier, Bryan R.; Budin, Robert E.; Hamill, Mark E. (2021-09-24)
    Background Appendectomy remains one of the most common emergency operations. Recent research supports the treatment of uncomplicated appendicitis with antibiotics alone. While nonoperative management of appendicitis may be safe in some patients, it may result in missed neoplasms. We present a case of acute appendicitis where the final pathology resulted in a diagnosis of a Burkitt-type lymphoma. Case presentation An 18-year-old male presented to the emergency department with 24 h of right lower quadrant pain with associated urinary retention, anorexia, and malaise. Past medical history was significant for intermittent diarrhea and anal fissure. He exhibited focal right lower quadrant tenderness. Workup revealed leukocytosis and CT uncovered acute appendicitis with periappendiceal abscess and no appendicolith. Laparoscopic appendectomy was performed and found acute appendicitis with associated abscess abutting the rectum and bladder. Pathology of the resected appendix reported acute appendicitis with evidence of Burkitt-type lymphoma. A PET scan did not reveal any residual disease. Hematology/oncology was consulted and chemotherapy was initiated with an excellent response. Conclusions Appendiceal lymphomas constitute less than 0.1% of gastrointestinal lymphomas. Primary appendix neoplasms are found in 0.5–1.0% of appendectomy specimens following acute appendicitis. In this case, appendectomy allowed for prompt identification and treatment of an aggressive, rapidly fatal lymphoma resulting in complete remission.
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    Effect of Various OR Noise on Fine Motor Skills, Cognition, and Mood
    Rogers, Cara M.; Palmerton, Hannah; Saway, Brian F.; Tomlinson, Devin C.; Simonds, Gary S. (Hindawi, 2019-07-04)
    Background. The amalgam of noises inherent to the modern-day operating room has the potential of diluting surgeon concentration, which could affect surgeon performance and mood and have implications on quality of care and surgeon resilience. Objective. Evaluate the impact of operating room environmental noises on surgeon performance including fine motor dexterity, cognition, and mood. Methods. 37 subjects were tested under three different environmental noise conditions including silence, a prerecorded soundtrack of a loud bustling operating room, and with background music of their choosing. We used the Motor Performance Series to test motor dexterity, neuropsychological tests to evaluate cognitive thinking, and Profile of Mood States to test mental well-being. Results. Our results showed that typical operating room noise had no impact on motor dexterity but music improved the speed and precision of movements and information processing skills. Neurocognitive testing showed a significant decrement from operating room noise on verbal learning and delayed memory, whereas music improved complex attention and mental flexibility. The Profile of Mood States found that music resulted in a significant decrease in feelings of anger, confusion, fatigue, and tension along with decreased total mood disturbance, which is a measure of psychological distress. Loud operating room noise had a negative impact on feelings of vigor but no increase in total mood disturbance. Conclusion. Our results suggest that loud and unnecessary environmental noises can be distracting to a surgeon, so every effort should be taken to minimize these. Music of the surgeons’ choosing does not negatively affect fine motor dexterity or cognition and has an overall positive impact on mood and can therefore be safely practiced if desired.
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    Medical Students' Knowledge and Perception of Deep Brain Stimulation
    Saway, Brian F.; Monjazeb, Sanaz; Godbe, Kerilyn; Anwyll, Tessa; Kablinger, Anita S.; Witcher, Mark R. (2021-03)
    BACKGROUND: Deep brain stimulation (DBS) is a well-established neurosurgical procedure commonly used in movement and psychiatric disorders. Its widespread clinical implementation, however, may not be commensurate with medical education. No current assessment of medical student's understanding of DBS as a treatment option for indicated conditions is available, potentially threatening the availability of DBS to future patients. The aim of the present study is to explore the current knowledge and attitudes of medical students toward DBS as a treatment modality. METHODS: A total of 65 medical students at Virginia Tech Carilion School of Medicine were surveyed regarding their knowledge of DBS. The survey consisted of a 25-item questionnaire including a demographic section and 3 separate inventories designed to assess bias, knowledge, and self-assessment of knowledge specific to DBS therapy. Students in pre-clinical and clinical years were analyzed separately to describe changes in knowledge or attitude associated with clinical exposure to DBS. Comparisons were analyzed using t tests, ANOVA, and Pearson correlations. RESULTS: Of surveyed students, 36% were unsure of the FDA approval status of DBS treatment; 65% of students believed they had not been adequately educated about DBS and its utility; and 10.6% of students believed that DBS is likely associated with severe adverse effects and/or brain damage. The overall baseline attitudes of students toward DBS were positive. There was no observed difference between surveyed pre-clinical and clinical students, highlighting a lack of exposure throughout the clinical years of medical school education. CONCLUSION: Although DBS is an effective treatment modality for various conditions, current education is non-commensurate with its application, which can negatively impact awareness and understanding for its implications by medical professionals. In order to better serve patients who may benefit from DBS, medical curricula must change to educate future physicians on the benefit of this intervention.
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    Spontaneous necrotizing granuloma of the cerebellum: a case report
    Godbe, Kerilyn; Saway, Brian F.; Guilliams, Evin L.; Entwistle, John J.; Jarrett, Robert W. (2020-06-05)
    Background Intracranial necrotizing granulomatous space-occupying lesions are sparsely reported in literature. Variability in presenting symptomatology and radiographic features makes diagnostic work-up difficult Case presentation This report presents the case of a 77-year-old female with sinusitis and fatigue who underwent an MRI revealing a posterior fossa lesion compressing the fourth ventricle. Subsequent contrast CT of the chest, abdomen, and pelvis was negative for primary malignancy. Histopathologic examination of the lesion following biopsy showed it to be a necrotizing granuloma in an antineutrophil cytoplasmic antibody (ANCA) negative patient. The most likely diagnosis was determined to be spontaneous necrotizing granuloma, a rare entity with only one previous report noted. Conclusions Spontaneous necrotizing granuloma of the CNS is a rare entity that represents an important differential consideration in the work-up of space occupying lesions of the CNS.
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    Systematic content analysis of patient evaluations of START NOW psychotherapy reveals practical strategies for improving the treatment of opioid use disorder
    Truong, Albert Y.; Saway, Brian F.; Bouzaher, Malek H.; Rasheed, Mustafa N.; Monjazeb, Sanaz; Everest, Soleille D.; Giampalmo, Susan L.; Hartman, David; Hartman, Cheryl; Kablinger, Anita S.; Trestman, Robert L. (2021-01-10)
    Background Clinical trials provide consistent evidence for buprenorphine’s efficacy in treating opioid use disorder (OUD). While the Drug Addiction Treatment Act of 2000 requires physicians to combine medication-assisted treatment (MAT) with behavioral intervention, there is no clear evidence for what form or elements of psychotherapy are most effective when coupled with MAT to treat OUD. This investigation involves focus groups designed to collect patient opinions about a specific psychotherapy, called START NOW, as well as general beliefs about various elements of psychotherapy for treating OUD. Our analysis reveals trends about patient preferences and strategies for improving OUD treatment. Methods Subjects included patients enrolled in buprenorphine/naloxone MAT at our institution’s office-based opioid treatment program. All subjects participated in a single START NOW group session, which was led by a provider (physician or nurse practitioner trained and standardized in delivering START NOW). Consented subjects participated in satisfaction surveys and audio-recorded focus groups assessing individual beliefs about various elements of psychotherapy for treating OUD. Results Overall, 38 different focus groups, 92 participation events, and 44 unique subjects participated in 1-to-6 different START NOW session/audio-recorded focus group sessions led by a certified moderator. Demographic data from 36/44 subjects was collected. Seventy-five percent (33/44) completed the START NOW Assessment Protocol, which revealed self-reported behavioral trends. Analysis of all 92 START NOW Satisfaction Questionnaire results suggests that subjects’ opinions about START NOW improved with increased participation. Our analysis of audio-recorded focus groups is divided into three subsections: content strategies for new psychotherapies, implementation strategies, and other observations. For example, participants request psychotherapies to target impulsivity and to teach future planning and build positive relationships. Conclusions The results of this study may guide implementation of psychotherapy and improve the treatment of OUD, especially as it relates to improving the modified START NOW program for treating OUD. Our study also reveals a favorable outlook of START NOW with increased participation, suggesting that any initial reticence to this program can be overcome to allow for effective implementation.