West Suburban Medical Center

Endoscopic sleeve gastroplasty (ESG) has emerged as a minimally invasive intervention for obesity, bridging the gap between conservative medical therapy and surgical bariatric procedures. ESG reduces gastric volume through endoscopic suturing, creating a tubular gastric sleevewithout gastric resection and with the preservation of native anatomy. This approach offers clinically meaningful weight loss, metabolic improvement, and a favorable safety profile while minimizing procedural risk and recovery time. This qualitative narrative review provides a comprehensive evaluation of ESG, including its historical development, procedural technique, patient selection criteria, mechanisms of action, clinical outcomes, and safety considerations. The comparative efficacy of ESG relative to established bariatric surgeries, including laparoscopicsleeve gastrectomy (LSG) and open sleeve gastrectomy (OSG), is discussed, highlighting ESG's unique balance between effectiveness and minimally invasive design. Evolving applications are also explored, including combination with pharmacologic therapy, use as a bridge to surgery for high-risk patients, and revisional strategies for weight regain after prior non-resective procedures, where preserved gastric anatomy allows safe and effective volume modification. Future directions focus on procedural refinement, optimizing patient selection, combining with adjunct therapies, and integrating into multidisciplinary obesity management. ESG represents a versatile, patient-centered tool that complements existing treatment paradigms, expands therapeutic options, and offers a practical, low-risk alternative for patients seeking minimally invasive treatment for obesity. Its growing adoption underscores its potential to play a central role in contemporary obesity management strategies.

Solid organ transplant (SOT) recipients are vulnerable to infections with multidrug-resistant organisms, and they often do not receive adequate empiricantimicrobialsfor serious Gram-negative infections. Knowledge of differences in antimicrobial resistance rates in this specific population can help guide empiric antimicrobial choices. We performed a retrospective cohort study comparing antimicrobial susceptibility patterns of Gram-negative organisms isolated from the adult SOT recipients with documented sepsis with the hospital-wide inpatient antibiogram. To evaluate empiric antimicrobial coverage, we constructed a Weighted-Incidence Syndromic Combination Antibiogram (WISCA) by calculating the proportion of susceptible isolates per antimicrobial agent. We then compared the coverage rates against our institution's sepsis treatment guidelines. A total of 90 Gram-negative isolates comprised the SOT cohort, while the inpatient antibiogram cohort had 1328 isolates. Pseudomonas aeruginosa (27%) and Escherichia coli (31%) were the most common isolates in the SOT and inpatient antibiogram cohorts, respectively. Overall, antimicrobial resistance rates were higher in the SOT population compared to the hospital-wide inpatient antibiogram population. WISCA analysis showed imipenem was activefor 59% of isolates as opposed to the institutional recommendation of piperacillin-tazobactam, which covered 39% of SOTisolates. Current empiric antimicrobial recommendations for SOT patients are based on data from the general patient population, which may not accurately reflect the resistance patterns in this unique population. Utilizing patient population-specific antibiograms may improve empiric antimicrobial therapy and warrants further research.

Candy cane syndrome (CCS) is a rare complication of Roux-en-Y gastric bypass, caused by a redundant blind afferent limb at the gastrojejunostomy anastomosis. It typically presents with persistent postprandial abdominal pain, nausea, and vomiting, significantly impacting quality of life. We report the case of a 39-year-old woman who developed chronic upper abdominal discomfort two years after Roux-en-Y gastric bypass. Symptoms persisted despite conservative management, and CCS was ultimately identified as the underlying cause. Surgical resection of the redundant limb was performed, resulting in marked symptomatic relief. This case highlights the critical role of clinical suspicion and timely surgical intervention in the recognition and management of CCS while underscoring its significant impact on function and quality of life in post-bariatric surgery patients.

The inpatient addiction medicine consult team at West Suburban Medical Center started administering long-acting injectable buprenorphine (LAIB) to hospitalized patients in response to low rates of patients continuing treatment with sublingual buprenorphine after discharge. The aims of this study are to understand patients' motivations to receive LAIB during hospitalization and their experiences with the medication after discharge. We conducted semi-structured interviews with patients who received LAIB while hospitalized between August 2022 and April 2023. Inductive analysis was used to identify themes and develop the codebook. Two researchers independently coded each interview and refined the codebook with oversight from 2 senior members of the research team. After the coding team reviewed each interview together to arrive at a joint consensus, a third coder found concordance in a random sample of interviews. Finally, the entire research team met to discuss key themes. Eighteen participants were interviewed between March and May 2023. The following key themes emerged: (1) limited knowledge and access to LAIB before hospitalization, (2) the role of peer support specialists in deciding to start LAIB while hospitalized, (3) fears around an increasingly unpredictable drug supply and personal experience with overdose as motivations to receive LAIB, (4) benefits of LAIB in multiple areas of participants' lives, and (5) negative aspects of LAIB. Our participants' overall positive experiences with hospital-administered LAIB should inform policymakers and payors to support the expansion of this model and the exploration of additional strategies to lower barriers to LAIB access.

Due to the high rates of overweight and obesity in Mexican and Puerto Rican women, interventions that target these groups are in great need. The purpose of this cross-sectional study is to explore the role of four cultural variables (acculturation, acculturative stress, ethnic identity, and cultural values) that may help to explain ethnic disparities in correlates of obesity (diet, physical activity, and body image) among Mexican and Puerto Rican women. This paper describes the study design, measures, and initial analyses of participant characteristics, as well as implications for the development of an obesity intervention. A total of 552 participants contacted the study staff, with 368 completing the oral script and initial eligibility interview. From these, 227 completed the written consent, 199 completed the "Health and Culture" interview, and 186 completed all study components; 42 women completed the qualitative interview. Data for the current study is from the 199 participants who completed the "Health and Culture" interview. Mexican women were younger, more likely to have completed less than a 9th grade education, and more likely to prefer to complete the interview in Spanish (vs. English) compared to Puerto Rican women. In addition, Mexican women were more likely to be in the normal-weight group, be a non-smoker, and not have health insurance compared to Puerto Rican women. Results revealed key initial differences between Puerto Rican and Mexican women which should be considered when developing interventions that address overweight and obesity.

Preeclampsia is a known complication of pregnancy. Patients meet diagnostic criteria when they have hypertension along with proteinuria and/or end-organ dysfunction. Preeclampsia can pose a serious threat to the lives of pregnant patients and their fetuses. A 35-year-old G4P0030 female was diagnosed with preeclampsia at 35 weeks gestation. She was scheduled for an induction of labor at 37 weeks. With further elevation in blood pressure during labor, she met the criteria for preeclampsia with severe features. Additionally, the presence of clinical signs concerning a placental abruption led to a cesarean delivery. Following her delivery, her respiratory distress prompted a computed tomography angiography, which showed evidence of pulmonary edema. The occurrence of both placental abruption and pulmonary edema can be related to the patient's preeclampsia. We urge that healthcare providers have a low threshold for diagnosing placental abruption and pulmonary edema in patients with preeclampsia.

Hematomas are a common occurrence in clinical practice, often resulting from trauma or underlying bleeding disorders. They can manifest with various symptoms depending on their location and size. While hematomas are typically straightforward to diagnose and manage, specific presentations can pose diagnostic challenges. We present the case of a growing post-traumatic right upper extremity mass in a 67-year-old male on anticoagulant medication, Xarelto (rivaroxaban) 20mg, with no history of bleeding disorders. Differential diagnoses include a benign lipoma or possible soft-tissue malignancy. The mass was surgically excised and sent to pathology, which confirmed it was a hematoma and led to a diagnosis of a chronic expanding hematoma. Ultrasonography, computed tomography,and magnetic resonance imaging are diagnostic modalities that can help distinguish different presentations. Despite the commonality of hematomas in clinical practice, atypical hematomas may also present unique challenges in diagnosis and management due to their varied clinical presentations and locations. This report underlinesthe importance of understanding hematomas' diverse etiologies, presentations, and imaging characteristics for appropriate treatment and diagnosis.

Acute appendicitis, a typical abdominal emergency, presents in nonperforated and perforated forms. While nonperforated cases often respond well to antibiotics or appendectomy, perforated cases pose more significant challenges. We report a unique case of appendicitis in a 34-year-old female with an unusual anatomical adherence to the left ovary. The patient successfully underwent laparoscopic surgery, during which precise incisions were made to accommodate the unique location of the appendix. This tailored approach contributed to a positive surgical outcome.This case underscores the importance of tailored surgical approaches in managing complex appendiceal variations.

To report on the visual outcomes of the second-generation (ActivShieldTM) Light Adjustable Lens (LAL) used in cataract surgery for patients with a history of laser refractive surgery (LASIK and/or photorefractive keratectomy [PRK]) using a co-managed, open-access methodology. This retrospective case series of consecutive patients with history of laser refractive surgery implanted with the second-generation LAL with an emmetropic target were included in the study. Following surgery, all patients received their ultraviolet (UV) light treatments at a separate open-access facility through a co-managed arrangement. Uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and residual cylinder for eyes with an emmetropic refractive target were the primary outcome measures as documented at the patient's final, stable, refractive postoperative exam. Thirty-three patients (34 eyes) with a history of laser refractive surgery were included in the study and implanted with the second-generation LAL with a postoperative emmetropic refractive target. Twenty-eight (82.4%) saw 20/20 or better and 9 (26.5%) saw 20/15 or better. The mean SE was 0.01 ± 0.31 D and 33 (97.1%) were within ±0.50 D SE of plano. The mean residual cylinder was -0.28 ± 0.32 D and 30 (88.2%) were within ±0.50 D. Use of the second-generation LAL was efficacious in cataract surgical patients with a history of LASIK and/or PRK using a co-managed, open-access methodology.

A cutaneous horn is a yellow or white-colored conical projection made up of complex keratin that arises from the surface of the skin. It is usually diagnosed clinically but requires histologic examination to rule out malignancy or determine the underlying lesion. Verruca vulgaris, a human papillomavirus-associated lesion, is a very common benign underlying lesion. We present a case of an 80-year-old female who presented with a cutaneous horn on a unique location, the proximal interphalangeal joint (PIP) of her left fourth digit. Post-excision biopsy revealed a diagnosis of a verruca vulgaris-associated cutaneous horn.