Publications by authors named "Megan Swonke"

4 Publications

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Medical Malpractice Trends in Thyroidectomies among General Surgeons and Otolaryngologists.

OTO Open 2020 Apr-Jun;4(2):2473974X20921141. Epub 2020 May 13.

Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Objectives: This study aims to examine litigation trends with thyroidectomies in the United States from 1984 to 2018.

Methods: We used the Westlaw legal database to collect data on the defendant, plaintiff, case demographics, alleged reasons for malpractice, additional complications, and case outcomes.

Results: The most common reason for litigation was vocal cord paralysis (51%, n = 28), with the majority ruling in favor of the defendant (64%, = .042). Of those, 43% of cases (n = 12) were due to unilateral recurrent laryngeal nerve (RLN) injury, and 39% (n = 11) were due to bilateral RLN injury. Of the claims due to vocal cord paralysis that resulted in indemnity payment (36%), the majority included additional damages, such as lack of informed consent (30%) or subsequent damages from permanent tracheostomy (40%), which is usually a result of bilateral nerve paralysis.

Conclusion: RLN injury was the most common complication leading to trial, with most cases ruling in favor of the defense. However, most verdicts that favored the plaintiff or those that settled were due to subsequent damages from bilateral nerve paralysis, such as permanent tracheostomy. We encourage surgeons to consider a staged procedure in high-risk cases or cases with signal loss. There needs to be a bigger emphasis on informed consent in the training of surgeons. Surgeons should educate patients at high risk on potential surgical complications that may drastically affect their quality of life.
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http://dx.doi.org/10.1177/2473974X20921141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223205PMC
May 2020

Unexplained destructive nasal lesions in half-brothers: A possible case of Munchausen syndrome by proxy.

Int J Pediatr Otorhinolaryngol 2019 Aug 25;123:75-78. Epub 2019 Apr 25.

Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA.

Munchausen syndrome by proxy (MSBP) is a condition diagnosed when a caregiver knowingly fabricates or inflicts illness on another for his/her own gain. Typical cases of MSBP detected by otolaryngologists involve facial trauma or otologic injury, while descriptions involving the nose are rare. Destructive nasal lesions have a broad differential diagnosis and may require visits to numerous specialists, placing strain on both the patient and the healthcare system. Early recognition of MSBP in patients with chronic nasal destruction may prevent such unnecessary strain. We present a case of MSBP involving two half-brothers with unexplainable nasal destruction and discuss the literature and current recommendations for managing the diagnosis.
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http://dx.doi.org/10.1016/j.ijporl.2019.04.029DOI Listing
August 2019

Early Stone Manipulation in Urinary Tract Infection Associated with Obstructing Nephrolithiasis.

Case Rep Urol 2018 25;2018:2303492. Epub 2018 Nov 25.

Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA.

A urinary tract infection (UTI) and sepsis secondary to an obstructing stone are one of the few true urological emergencies. The accepted management of infected ureteral stones includes emergent decompression of the collecting system as well as antibiotic therapy. Despite this, no consensus guidelines clarify the optimal time to undergo definitive stone management following decompression. Historically, our institution has performed ureteroscopy with laser lithotripsy (URS-LL) treatment at least 1 to 2 weeks after decompression to allow for clinical improvement and completion of an antibiotic course. In this case series, we retrospectively review four cases in which patients had a documented UTI secondary to an obstructive ureteral stone. The patients underwent urgent decompression and, based on labs and clinical improvement, were subsequently treated with URS-LL. The presented patients received URS-LL within 5 days of decompression and antibiotics. The patients had no sepsis related postoperative complications from the accelerated course of treatment, resulting in discharge within 2 days following URS-LL. We provide a detailed examination of each patient presentation to describe our institution's experience with treating infected kidney stones within days of urgent decompression in order to question the previous standard of treating an infected kidney stone with a more delayed intervention.
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http://dx.doi.org/10.1155/2018/2303492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286750PMC
November 2018

Neurostereology protocol for unbiased quantification of neuronal injury and neurodegeneration.

Front Aging Neurosci 2015 31;7:196. Epub 2015 Oct 31.

Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, College of Medicine Bryan, TX, USA.

Neuronal injury and neurodegeneration are the hallmark pathologies in a variety of neurological conditions such as epilepsy, stroke, traumatic brain injury, Parkinson's disease and Alzheimer's disease. Quantification of absolute neuron and interneuron counts in various brain regions is essential to understand the impact of neurological insults or neurodegenerative disease progression in animal models. However, conventional qualitative scoring-based protocols are superficial and less reliable for use in studies of neuroprotection evaluations. Here, we describe an optimized stereology protocol for quantification of neuronal injury and neurodegeneration by unbiased counting of neurons and interneurons. Every 20th section in each series of 20 sections was processed for NeuN(+) total neuron and parvalbumin(+) interneuron immunostaining. The sections that contain the hippocampus were then delineated into five reliably predefined subregions. Each region was separately analyzed with a microscope driven by the stereology software. Regional tissue volume was determined by using the Cavalieri estimator, as well as cell density and cell number were determined by using the optical disector and optical fractionator. This protocol yielded an estimate of 1.5 million total neurons and 0.05 million PV(+) interneurons within the rat hippocampus. The protocol has greater predictive power for absolute counts as it is based on 3D features rather than 2D images. The total neuron counts were consistent with literature values from sophisticated systems, which are more expensive than our stereology system. This unbiased stereology protocol allows for sensitive, medium-throughput counting of total neurons in any brain region, and thus provides a quantitative tool for studies of neuronal injury and neurodegeneration in a variety of acute brain injury and chronic neurological models.
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http://dx.doi.org/10.3389/fnagi.2015.00196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628120PMC
November 2015