EDITOR VOLUME 170 NUMBER 1 • JANUARY | FEBRUARY 2018 ESTABLISHED 1844 D. LUKE GLANCY, MD ASSOCIATE EDITOR L.W. JOHNSON, MD BOARD OF TRUSTEES CHAIR, GEOFFREY W. GARRETT, MD VICE CHAIR, K. BARTON FARRIS, MD SECRETARY/TREASURER, RICHARD PADDOCK, MD ANTHONY P. BLALOCK, MD D. LUKE GLANCY, MD JOURNAL LESTER W. JOHNSON, MD OF THE LOUISIANA STATE MEDICAL SOCIETY FRED A. LOPEZ, MD EDITORIAL BOARD MURTUZA J. ALI, MD RONALD AMEDEE, MD SAMUEL ANDREWS, II, MD BOB BATSON, MD EDWIN BECKMAN, MD FEATURED ARTICLES GERALD S. BERENSON, MD C. LYNN BESCH, MD JOHN BOLTON, MD 2 ASSESSING PSYCHOLOGICAL RESILIENCE AMONG PRE-SURGERY PLIF PATIENTS BRIAN BOULMAY, MD MICHELLE BOURQUE, JD IN LOUISIANA: PSYCHOMETRIC EVALUATION OF THE BRIEF RESILIENT COPING JAMES N. BRAWNER, III, MD SCALE BRETT CASCIO, MD Scott Wilks, PhD, Stephen Guillory, PA-C, Jennifer Geiger, MSW, Kevin Goodson, MD, QUYEN CHU, MD WILLIAM PATRICK COLEMAN III, MD Tatiana Begault, BS, Zibei Chen, MSW, Jorge Isaza, MD RICHARD COULON, MD LOUIS CUCINOTTA, MD VINCENT A. CULOTTA, JR., MD 6 COMBINED SURGICAL ONCOLOGY AND NEUROSURGERY APPROACH FOR JOSEPH DALOVISIO, MD RESECTION OF SACRAL CHORDOMA NINA DHURANDHAR, MD Racheal Wolfson, MD, Richard Menger, MD, MPA, Ouyen Dinh Chu, MD, MBA, JAMES DIAZ, MD, MPH & TM, DR. PH JOHN ENGLAND, MD Anthony Sin, MD JULIO FIGUEROA, MD ELIZABETH FONTHAM, MPH, DR. PH 10 INTRACRANIAL SEPTUM PELLUCIDUM DYSEMBRYOPLASTIC NEUROEPITHELIAL EDWARD FOULKS, MD BEN GUIDER, MD TUMOR: CASE PRESENTATION AND REVIEW OF PEDIATRIC SEPTUM PELLUCIDUM HENRY G. HANLEY, MD TUMORS ELIAS B. HANNA, MD LYNN H. HARRISON, JR., MD Rimal Dossani, MD, Devi Patra, MD, Nimer Adeeb, MD, Elizabeth Wild, MD, ROBERT HEWITT, MD Abhilasha Ghildyal, MD, Marjorie Fowler, MD, Christina Notarianni, MD MICHAEL HILL, MD LARRY HOLLIER, MD JOHN HUNT, MD 15 NEWBORN SCREENING FOR CONGENITAL ADRENAL HYPERPLASIA: REVIEW OF BERNARD JAFFE, MD UNDETECTED CASES IN LOUISIANA NEERAJ JAIN, MD TRENTON L. JAMES, II, MD Dania Felipe, MD, Joseph Ortenberg, MD, Ricardo Gomez, MD, Aaron Martin, MD, MPH, STEPHEN KANTROW, MD Robin Ortenburg, MD, Michael Marble, MD KEVIN KRANE, MD MAUREEN LICHTVELD, MD, MPH FRED A. LOPEZ, MD 18 STRONGYLOIDIASIS: A TICKING TIME BOMB IN VIETNAM WAR VETERANS F. BROBSON LUTZ, JR., MD James Diaz, MD DAVID MARTIN, MD JORGE A. MARTINEZ, MD, JD ELIZABETH MCBURNEY, MD ELLEN MCLEAN, MD REINHOLD MUNKER, MD DAVID MUSHATT, MD DEPARTMENTAL ARTICLES STEVE NELSON, MD NORA OATES, MD DONALD PALMISANO, MD, JD, FACS 25 CLINICAL CASE OF THE MONTH PATRICK W. PEAVY, MD NEW ONSET HYPERTENSION AND DIABETES IN A 24 YEAR-OLD MAN PAUL PERKOWSKI, MD PETERMAN RIDGE PROSSER, MD Elizabeth Smith, MD, Catherine Pisano, Robert Richards, MD, Taniya DeSilva, MD, ROBERTO QUINTAL, MD Fred Lopez, MD RAOULT RATARD, MD, MS, MPH & TM ROBERT RICHARDS, MD DONALD RICHARDSON, MD 28 ECG CASE OF THE MONTH WILLIAM C. ROBERTS, MD CYANOTIC CONGENITAL HEART DISEASE AND DIARRHEA IN A 42-YEAR-OLD MAN DONNA RYAN, MD JERRY ST. PIERRE, MD D. Luke Glancy, MD, Chun Tan, MD, and Frederick Helmcke, MD CHARLES SANDERS, MD OLIVER SARTOR, MD 31 RADIOLOGY CASE OF THE MONTH CHARLES SCHER, MD ROGER SMITH, MD HYPOVOLEMIC SHOCK COMPLEX RICHARD SPECTOR, MD Logan Bisset, MD, Justine Kemp, BS, Jeremy Nguyen, MD LEE STEVENS, MD JACK P. STRONG, MD PRAMILLA N. SUBRAMANIAM, MD KEITH VAN METER, MD DIANA VEILLON, MD HECTOR VENTURA, MD CHRIS WINTERS, MD GAZI B. ZIBARI, MD JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY Assessing Psychological Resilience among Pre-Surgery PLIF Patients in Louisiana: Psychometric Evaluation of the Brief Resilient Coping Scale Scott Wilks, PhD, Stephen Guillory, PA-C, Jennifer Geiger, MSW, Kevin Goodson, MD, Tatiana Begault, BS, Zibei Chen, MSW, Jorge Isaza, MD The purpose of this study was to examine psychometric properties of the Brief Resilience Coping Scale (BRCS), a measure of psychological resilience, to determine its applicability among pre-spine surgery patients. The sample comprised 85 adults in south Louisiana scheduled for posterior lumbar interbody fusion (PLIF). We utilized a prospective survey design with independent self-report data one week pre-surgery. Empirical measures included the BRCS, Oswestry Index (back functioning), and three coping strategy scales; the latter measures for descriptive and validity purposes. The typical participant was a 65-year-old married, Caucasian male; no histories of diabetes, heart disease, smoking; moderate back functioning yet a high degree of resilience. BRCS factor analysis revealed its items loading on a single factor, presumably resilience. BRCS reliability was strong. Validity findings were somewhat mixed. The BRCS appears to be an applicable measure of resilience for pre-spine surgery patients, though further research is warranted to endorse BRCS validity. INTRODUCTION METHODS Psychological resilience is a personal characteristic of adaptation Design and Sampling and adjustment when facing hardship, trauma, or substantial exposure to stress. Research has shown resilience to be valuable The current study utilized a prospective survey design with self- not only for psychological health (e.g., mood, emotions, reported data. Pre-surgery was the selected data interval based cognition), but also for immediate and long term physical health on a premise of resilience theory: For resilience to be observed, outcomes, including AIDS mortality, cardiovascular disease demonstrable adversity must be present.5 Logic and research and stroke.1 The physical health outcome in the current study dictate that patients who undergo surgery typically have higher potentially applicable to resilience chronic back pain, specifically physical and psychological health adversity levels at pre-surgery low back pain (LBP). compared to post-surgery.6 Accordingly, we deemed pre- surgery as the optimal period to assess patients’ resilience and Literature distinguishes resilience as a psychosocial predictor of to evaluate the resilience measure. functionality germane to LBP, as well as healthcare utilization and frequency of such related to chronic LBP.2 Regarding surgical One week prior to scheduled posterior lumbar interbody treatment for LBP, the number of spine fusions in the U.S. have fusion (PLIF), adult participants completed questionnaires, trended dramatically upward over the past two decades; lumbar independently self-reported in surgeons’ offices, related to fusions as the majority at 52%.3 Given the aforementioned demographics, psychological coping, and a physical back health identification of resilience as a predictor of healthcare utilization measure (see measures). Participants were under the care of one for LBP and the increasing numbers of lumbar fusions for of two orthopedic surgeons fellowship trained in spine surgery; treatment of LBP, we recognized the relevance of understanding these surgeons practiced at one orthopedic clinic in south psychological resilience for LBP patients and, equally important, Louisiana. Numerical codes were assigned to each participant understanding standardized measures to assess said resilience. to ensure anonymity. Relevant institutional review boards, academic and clinic, approved the study, thereby protecting The purpose of the current study was to conduct an empirical HIPAA compliance. Eighty-five patients (N = 85) voluntarily psychometric assessment of a standardized measure of completed all measures and comprised the total sample. psychological resilience – the Brief Resilient Coping Scale (BRCS).4 This allowed us to assess descriptively the level of Measures psychological resilience of persons seeking LBP treatment while simultaneously testing the psychometric properties of the BRCS. Demographics and health history. The sample consisted of LBP patients in Louisiana scheduled for The following demographics were identified in literature as posterior lumbar interbody fusion (PLIF). potentially influential to spine/spine surgery health, and thus examined: age, ethnicity, marital status, and insurance/payment 2 J La State Med Soc VOL 170 JANUARY/FEBRUARY 2018 JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY type.7-9 Also, the following health risk factors were observed as they were commonly noted by the surgeons prior to surgery: Sample Characterisitics histories of diabetes, heart disease, and smoking. Variable Valid % n Mean (SD, range) Psychological resilience. The measure under psychometric Age 65.0 (10.25, 36-89) focus was the 4-item Brief Resilient Coping Scale (BRCS).4 Content related to creativity to address adversity; locus of control Gender regarding reaction to adversity; personal growth post-adversity; Female 36.4 31 and replacement of loss. The measure contained a 4-point Likert Male 64.5 54 response format ranging from strongly disagree to strongly agree in belief of aforementioned items. Possible global scores in this Ethnicity study ranged from 4-16, with higher scores indicating greater Caucasian/White 84.7 72 psychological resilience. Psychometric properties were reported African American/Black 14.1 12 as adequate-to-strong in the original evaluation among a American Indian 1.2 1 sample of rheumatoid arthritis patients.4 Marital Status Coping. For validity testing with the BRCS, three specific Married 76.5 65 coping strategy measures were included in the study. These Divorced 15.3 13 10 coping scales came from the Proactive Coping Inventory (PCI). Widowed 3.5 3 Each coping strategy scale contains a 4-point Likert response format ranging from 1 – not at all true to 4 – completely true; Never married 2.4 2 higher global scores represent greater likelihood