Browsing by Author "Wattsman, Terri-Ann"

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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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    Preventing Severe Hypoglycemia with a Continuous Glucose Monitor Device in an Infant with Glycogen Storage Disease 1a undergoing a Gastrostomy Tube Placement: Case Report
    Ward, Chad; Washofsky, Anne; Nguyen, Emily; Fortune, Laura; Wattsman, Terri-Ann (2022-11-12)
    We describe a case in which a continuous glucose monitor (CGM) was used during hospitalization to safely prevent severe hypoglycemia in a 10-month-old male with glycogen storage disease 1a undergoing placement of a gastrostomy tube. The child was admitted to the hospital for placement of a gastrostomy tube given increased severe hypoglycemic episodes at home secondary to worsening feeding aversion. During hospitalization, the CGM was monitored before, during and after surgery. Severe hypoglycemic episodes were avoided while hospitalized. The CGM device assisted with the management and titration of continuous dextrose infusion while the child was fasting. The CGM device improved patient and family centered outcomes by reducing the need for frequent finger stick point-of-care glucose checks and allowed the family and anesthesiologist to carefully monitor the child’s blood glucose continuously during the procedure.
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    Understanding family-level decision-making when seeking access to acute surgical care for children: Protocol for a cross-sectional mixed methods study
    Hall, Bria; Tegge, Allison; Condor, Cesia Cotache; Rhoads, Marie; Wattsman, Terri-Ann; Witcher, Angelica; Creamer, Elizabeth; Tupetz, Anna; Smith, Emily R.; Tokala, Mamata Reddy; Meier, Brian; Rice, Henry E. (PLoS, 2024-06-24)
    Background There is limited understanding of how social determinants of health (SDOH) impact family decision-making when seeking surgical care for children. Our objectives of this study are to identify key family experiences that contribute to decision-making when accessing surgical care for children, to confirm if family experiences impact delays in care, and to describe differences in family experiences across populations (race, ethnicity, socioeconomic status, rurality). Methods We will use a prospective, cross-sectional, mixed methods design to examine family experiences during access to care for children with appendicitis. Participants will include 242 parents of consecutive children (0–17 years) with acute appendicitis over a 15-month period at two academic health systems in North Carolina and Virginia. We will collect demographic and clinical data. Parents will be administered the Adult Responses to Children’s Symptoms survey (ARCS), the child and parental forms of the Adverse Childhood Experiences (ACE) survey, the Accountable Health Communities Health-Related Social Needs Screening Tool, and Single Item Literacy Screener. Parallel ARCS data will be collected from child participants (8–17 years). We will use nested concurrent, purposive sampling to select a subset of families for semi-structured interviews. Qualitative data will be analyzed using thematic analysis and integrated with quantitative data to identify emerging themes that inform a conceptual model of family-level decision-making during access to surgical care. Multivariate linear regression will be used to determine association between the appendicitis perforation rate and ARCS responses (primary outcome). Secondary outcomes include comparison of health literacy, ACEs, and SDOH, clinical outcomes, and family experiences across populations. Discussion We expect to identify key family experiences when accessing care for appendicitis which may impact outcomes and differ across populations. Increased understanding of how SDOH and family experiences influence family decision-making may inform novel strategies to mitigate surgical disparities in children.