Willis-Knighton Cancer Center

Introduction: Increased intracranial pressure (ICP) ≥ 20 mmHg is associated with poor neurologic outcomes in children with traumatic brain injury (TBI). Pupillometry measures pupil size, symmetry, and reactivity by stimulating pupillary constriction via light reflex. Neurologic pupillary index (nPI) is a derived measure of pupil constriction, latency, and velocity. Values range from 0 to 4.9, with abnormal being < 3. Adult studies demonstrate a correlation between refractory increased ICP and low nPI. Our aim was to examine the relationship between ICP and nPI in children. Methods: This prospective observational study was performed in the pediatric intensive care unit (PICU) in a tertiary care children’s hospital that is the region’s Level 1 Trauma Center. Data was collected Dec 2024 to Jun 2025. Inclusion criteria were patients 0-18 years old with TBI and an invasive ICP monitor. Pupil size and nPI measurements were obtained by trained PICU nurses utilizing a pupillometer. The primary outcome was the association the between ICP and nPI, assessed via repeated measures correlation. Results: In our sample of 6 patients, 5 (83%) were male, mean age was 13.0 years (SD 2.8), and mean length of stay was 26.0d (SD 20.8). All patients survived, but one had significant morbidity. 220 ICP measurements and 440 corresponding nPI measurements (one per eye) were obtained. There were 7 (3.2%) ICP measurements ≥ 20 mmHg and 2 (0.5%) nPI values < 3. ICP demonstrated a weak correlation with the right nPI (r=-0.18, p=0.01), but not the left (r=-0.01, p=0.92). No change in nPI was seen following 3% hypertonic saline infusion in either the right pupil (mean change 0.32 SD 0.35, p=0.11) nor the left (mean change -.08 SD 0.50, p=0.74). No correlation was found between ICP and right pupil size (r=0.00, p=0.99) nor the left pupil size (r=0.06, p=0.37). Conclusions: Pupillometry is feasible in children with TBI. In our sample there was no strong correlation between ICP and nPI. However, most ICP measurements were < 20 and most nPI values were >3. Future research should examine a sample with higher prevalence of increase ICP to better elucidate its relationship with nPI.

Introduction:Intussusception occurs when one segment of bowel invaginates into an adjacent segment of bowel from a lead point. Literature suggests a nonpathological lead point attributed to adult intussusception: marijuana. This report describes a unique presentation of intussusception in a patient with a history of previous surgical intervention and marijuana use.Case Presentation:We report a 33-year-old male with a history of surgically treated intussusception and 12 years of marijuana use, who presented to the emergency department (ED) twice with nausea, vomiting, and abdominal pain. After imaging revealed intussusception, the patient underwent multiport-robot-assisted small bowel resection. The patient had no complications and was discharged after 6 days.Conclusion:Intussusception can be deadly if not caught early. The use of marijuana can mislead clinicians due to similar appearing presentations. This case highlights the importance of a comprehensive patient history for abdominal pain. Additionally, it suggests placing intussusception higher in the differential for marijuana users.

Introduction: Several studies have demonstrated the advantage of Kidney-pancreas transplant; however, their effect on BMI in patients receiving simultaneous kidney-pancreas transplantation (SKPT) with type-1 diabetes Mellitus (T1DM) as compared to type-2 diabetes mellitus (T2DM) patients is unclear. This study aimed to compare the change in BMI after SKPT between T1DM and T2DM recipients. Methods: This is a retrospective cohort study conducted from 2013 to 2024, focusing on recipients of kidney-pancreas transplantation. The parameters evaluated included body mass index (BMI), C-peptide levels, hemoglobin A1c (HbA1c), and estimated glomerular filtration rate (eGFR). These measurements were assessed before and after the transplant over five years. Results: One hundred twenty patients had SKPT. Overall, portal systemic management was used for 118(98%.5) patients. Among these, 68 (56.6%) patients had T1DM, and 52(43.3%) had T2DM. The result showed an increase in BMI in T1DM and T2DM in 6 months, one, three, and five years of T1DM (25.1,26.6, 27.7, and 29.6, respectively) and in T2DM (28.4,30.3,30.4 and 32.6, respectively). The result was higher BMI among the T2DM group as compared to T1DM, and this difference was statistically significant. Conclusions: Based on our small sample size we can suggest that KP transplant for type II diabetic patients are as effective as for type I diabetic patients in long term patient & graft survival, as well as providing an excellent control of HbA1c for both type I &II diabetic patients. Weight gain after transplant is still a big problem and needs more scrutiny in developing protocols to control the weight gain.