Medicine and Health Sciences Commons^™

Splenic Infarction: An Uncommon Presentation Of Acute Infectious Mononucleosis, Madhulika Urella, Roma Srivastava, Waseem Ahmed, Yehuda Lebowicz

Yehuda Z. Lebowicz, MD

Splenic infarction is a relatively uncommon diagnosis. It occurs when the splenic artery or one of its sub-branches is occluded with an infected or bland embolus or clot. Splenic infarction may be caused by atrial fibrillation, bacterial endocarditis, sickle cell disease, antiphospholipid syndrome, and trauma whereas an infectious etiology is uncommon. It is considered a rare presentation of acute infectious mononucleosis. Currently, its pathogenesis is still unclear. We describe a 24-year-old African American female who was admitted for evaluation of left-sided chest pain. Chest imaging, abdominal ultrasound, and initial laboratory data were normal, followed by a negative hypercoagulability panel. Signs …

Velamentous Cord: A Dangerous Case Complicated By A Rural Population, Adam Franks, Md, Carolyn Curtis, Md, Shawndra Barker, Md

Carolyn A. Curtis, MD

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population …

Management Of Co-Existing Lung Cancer And Endobronchal Hamartomas, Mark H. Cooper, Md

Mark Hayden Cooper, MD, PhD

Abstract: The coexistence of lung cancer with an endobronchial hamartoma is infrequent, and requires accurate oncologic evaluation of the endobronchial lesion prior to potential surgical treatment of the lung cancer. We describe a patient who presented with an undiagnosed endobronchial mass and and a biopsy-proven lung cancer which were successfully managed by a staged approach using initial bronchoscopic resection of the endobronchial lesion and subsequent lobectomy for squamous cell lung cancer.

Traumatic Posterior Tibial Pseudoaneursym: A Rare Late Complication Repaired Conventionally, Farzad Amiri, Md, Zachary Sanford, Constantinous Constantinou, Md

Constantinous Constantinou, MD

Posterior tibial artery pseudoaneurysms are extremely rare. They commonly present as a late complication of trauma or iatrogenic injury. Diagnosis can be elusive. Treatment has been described in the context of open primary repair, endovascular stenting, and coil embolization. There has been increasing interest in the use of endovascular treatment options for this type of injury. If left untreated, pseudoaneurysms can rupture, partially thrombose, expand and cause adjacent local compression and compartment syndrome. The following case presented is of a young gentleman with a posterior tibial pseudoaneurysm incidentally discovered after stepping on glass and the management of his posterior tibial …

An Unusual Migration Of A Stent: A Case Report, Fikadu G. Tekleyes Md, Melissa D. Lester Md, Mark A. Studeny Md, Ellen A. Thompson Md, Steven Craig Md

Ellen A. Thompson

Stent dislodgment and embolization is a rare complication of coronary stenting. There are reports of intra-coronary stent entrapment, stripping, and dislodgement during percutaneous coronary interventions causing potentially life threatening complications, including intra-coronary or systemic embolization. Reports of dislodgment and migration of previously placed drug eluting intra-coronary stent several months after deployment are very limited in the literature. We describe a drug eluting stent dislodgment and migration in an 88 year-old male 10 months after its deployment.

Patient Satisfaction With The Annual Wellness Visit, Maria Espiridion, Raghavendra Mulinti, Md, Suzanne E. Kemper, Mph, Lynne J. Goebel, Md

Lynne J. Goebel

OBJECTIVES - To determine patient satisfaction with the Annual Wellness Visit (AWV) DESIGN – Survey SETTING- Charleston Area Medical Center and Marshall Health PARTICIPANTS – 66 volunteers, average age 74 years MEASUREMENTS – Patient satisfaction was assessed with a 13 item survey. RESULTS - Of 1,537 eligible patients, 211 (14%) of these agreed to schedule their AWV. From 66 patients surveyed, 87% of patients said the visit “met expectations,” “would recommend to friends,” and “would do it again.” Only 5 (8%) were disappointed that new problems were not addressed and 2 (3%) were dissatisfied that physical exams and blood tests …

Lamina Spreader Technique Improves Debridement Of Loose Bone And Cement In Total Knee Arthroplasty, Sinan E. Ozgur, Ali Oliashirazi, Grant S. Buchanan, Franklin D. Shuler

Franklin D. Shuler

Abstract Loose bone and cement can promote polyethylene wear that may lead to failure in total knee arthroplasty. The authors propose a technique to enhance the debridement of loose bodies by distracting the cemented components with a lamina spreader following standard debridement with pulsatile lavage. Cement and bone/soft tissue debris was recovered from 51 consecutive primary total knee arthroplasty patients. This technique facilitated the removal of hidden debris in 80% of patients (41/51). On average, 2.6 fragments measuring 158 mm3 were removed per patient. The authors advocate that distraction with a lamina spreader be used to reduce potential sources of …

A Comparison Of Imaging Modalities For The Diagnosis Of Osteomyelitis, Brandon J. Smith, Md, Grant S. Buchanan, Md, Franklin D. Shuler, Md, Phd

Franklin D. Shuler

Osteomyelitis is an increasingly common pathology that often poses a diagnostic challenge to clinicians. Accurate and timely diagnosis is critical to preventing complications that can result in the loss of life or limb. In addition to history, physical exam, and laboratory studies, diagnostic imaging plays an essential role in the diagnostic process. This narrative review article discusses various imaging modalities employed to diagnose osteomyelitis: plain films, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, bone scintigraphy, and positron emission tomography (PET). Articles were obtained from Pubmed and screened for relevance to the topic of diagnostic imaging for osteomyelitis. The authors …

Lamina Spreader Technique Improves Debridement Of Loose Bone And Cement In Total Knee Arthroplasty, Sinan E. Ozgur, Ali Oliashirazi, Grant S. Buchanan, Franklin D. Shuler

Franklin D. Shuler

A lamina spreader was introduced to the non-articulating, posterior aspect of the tibial and femoral components, and gentle distraction was applied to improve the inspection of the posterior compartment

Vitamin K2 (Menaquinone) Supplementation And Its Benefits In Cardiovascular Disease, Osteoporosis, And Cancer, Grant S. Buchanan, Md, Thomas Melvin, Brandon Merritt, Charles Bishop, Md, Franklin D. Shuler, Md, Phd

Franklin D. Shuler

Vitamin K is known to play an essential role in the coagulation cascade; however, a growing body of research has found that a subtype of this vitamin, vitamin K2 (menaquinone) may have a beneficial effect in osteoporosis, cardiovascular disease, and cancer. This purpose of this article is to provide a comprehensive review of recent literature regarding menaquinone and its role in human health. This review discusses the physiology of menaquinone, its clinical benefits in cardiovascular disease, osteoporosis, and cancer, and how it may interact with certain medications. The authors conclude that menaquinone supplementation has been shown to improve carboxylation of …

Lamina Spreader Technique Improves Debridement Of Loose Bone And Cement In Total Knee Arthroplasty, Sinan E. Ozgur, Ali Oliashirazi, Grant S. Buchanan, Franklin D. Shuler

Ali Oliashirazi

A lamina spreader was introduced to the non-articulating, posterior aspect of the tibial and femoral components, and gentle distraction was applied to improve the inspection of the posterior compartment

Lamina Spreader Technique Improves Debridement Of Loose Bone And Cement In Total Knee Arthroplasty, Sinan E. Ozgur, Ali Oliashirazi, Grant S. Buchanan, Franklin D. Shuler

Ali Oliashirazi

Abstract Loose bone and cement can promote polyethylene wear that may lead to failure in total knee arthroplasty. The authors propose a technique to enhance the debridement of loose bodies by distracting the cemented components with a lamina spreader following standard debridement with pulsatile lavage. Cement and bone/soft tissue debris was recovered from 51 consecutive primary total knee arthroplasty patients. This technique facilitated the removal of hidden debris in 80% of patients (41/51). On average, 2.6 fragments measuring 158 mm3 were removed per patient. The authors advocate that distraction with a lamina spreader be used to reduce potential sources of …

Technique To Improve Cement Penetration In Total Knee Arthroplasty, Richard Boe Jr, Ali Oliashirazi

Ali Oliashirazi

In total knee arthroplasty, infection has always been cited as being the number one cause of failure. However, more recent studies have shown aseptic loosening as the top reason for failure now. Proper cement technique is an important factor in reducing the occurrence of aseptic loosening. Clean and dried bone are important in achieving rigid cement fixation. Subchondral cysts may be hidden below the cut bone surface and may interfere with cement interdigitation. During a recent total knee arthroplasty case, a simple technique was developed for identifying and clearing out these cysts. By only using the suction tip, the gentle …

Technique To Improve Cement Penetration In Total Knee Arthroplasty, Richard Boe, Ali Oliashirazi

Ali Oliashirazi

Pre-operative and post-operative AP radiographs of initial patient using described technique with the evacuated cyst filled with cement highlighted

Surgical Management Of Penile Cancer--Report Of Two Cases., M Amjad Noor, Hammad Ather, M Nasir Sulaiman, Farhat Abbas

Hammad Ather

Introduction

Penile carcinoma (PC) is a rare tumor, accounting for 0.4-0.6% of all male malignancies. There are remarkable racial and geographic differences in the prevalence of penile cancer. In United States, 1% of all male cancers are penile malignancies, with annual incidence of 1-2 new cases per 100,000 men. In certain areas of South America, Asia and Africa the frequency is as high as 10-20% of all male cancers. Many areas in Asia however, have very low figures; in Taiwan for example it comprised only 0.25% of all male cancers¹. Penile carcinoma is most frequent in uncircumcised males …

Predictors Of Lymph Node Involvement In Bladder Cancer Treated With Radical Cystectomy, Zaheer Alam, M Hammad Ather, Anila Jamshaid, Khurram Muhammad Siddiqui, Muhammad Nasir Sulaiman

Hammad Ather

OBJECTIVE: To identify the clinical variables associated with prevalence of lymph node metastasis in patients with bladder cancer treated by radical cystectomy and lymphadenectomy for primary bladder cancer.

METHODS: Review of records of Ninety-five patients who underwent radical cystectomy and pelvic lymph node (LN) dissection during the period of 1995-2008 from a prospectively maintained database. Eighteen patients were excluded due to lack of data on the nodal status, leaving 77 evaluable patients. Associations between LN metastasis and age, gender, duration of disease, number of transurethral resection (TUR) prior to cystectomy, pathological grade and tumour stage was analyzed. Data was analyzed …

Expression Of Ps2 In Prostate Cancer Correlates With Grade And Chromogranin A Expression But Not With Stage, Hammad Ather, Farhat Abbas, Nuzhat Faruqui, M Israr, Shahid Pervez

Hammad Ather

Background: The biological potential of prostate cancer is extremely variable. Particular interest is focused on markers not expressed in normal prostatic tissues. pS2 protein expression has been demonstrated in a range of malignant tissues in an oestrogen-independent pathway. Recently, it has been demonstrated that pS2, in prostate cancer, is closely associated with neuro-endocrine differentiation. In the present study, we have analyzed, the potential of Neuro-endocrine and pS2 (TFF1) expression in human prostate cancer determined by immunohistochemistry, in primary adenocarcinoma of the prostate and attempted to correlate this with the clinico-pathologic features of the patient and neuroendocrine expression.

Methods: Ninety-five malignant …

Grading Complication Following Radical Cystectomy And Ileal Conduit For Bladder Cancer Using Clavien Grading System., Syed Johar Raza, M Hammad Ather, Faisal Aziz Khan, Zaheer Alam

Hammad Ather

Objective: To determine the 30-day complication rate of radical cystectomy and urinary diversion using a validated system.

Study Design: An analytical descriptive study. Place and

Duration of Study: The Aga Khan University Hospital, Karachi, from 1990 to 2010.

Methodology: Patients who had undergone ileal conduit (IC) formation, following radical cystectomy (RC) for muscle invasive transitional cell carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, complications were noted and graded according to the modified Clavien grading system (CG). Results were presented using descriptive statistics.

Results: Of all the RC performed at this hospital 89 patients received …

Role Of Estrogens In The Secondary Hormonal Manipulation Of Hormone Refractory Prostate Cancer, Khurram M. Siddiqui, Farhat Abbas, Syed Raziuddin Biyabani, M Hammad Ather, Jamsheer J Talati

Hammad Ather

Objective:

To evaluate the role of Estrogens (Honvan) in the secondary hormonal manipulation of patients with hormone refractory prostate cancer (HRCP).

Methods:

Twelve patients diagnosed as hormone refractory prostate cancer received intravenous estrogens for six days (Fosfestrol, a synthetic phosphorylated estrogen derivative), followed by a maintenance oral dose of 120 mg thrice daily as second line hormonal treatment. During the treatment they were given deep venous thrombosis prophylaxis. Their stage at initial presentation, primary treatment, mode of androgen ablation, prostate specific antigen (PSA) level, duration of remission prior of HRPC status, PSA doubling time before and after estrogen treatment were …

Functional And Clinical Outcome Of Ileal (Studer) Neo-Bladder Reconstruction: Single Centre Experience From Pakistan., Syed M. Nazim, M Hammad Ather, Farhat Abbas

Hammad Ather

OBJECTIVE: To determine the medium and long-term outcome of orthotopic continent urinary diversion with ileal (Studer) neo-bladder following radical cystectomy. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1998 to September 2010. METHODOLOGY: Thirty eight patients underwent radical cystectomy for invasive bladder tumor with ileal neo-bladder (Studer type) reconstruction. Peri-operative and late complications, functional outcome of neo-bladder, urinary continence, metabolic and upper urinary tract status and overall survival were evaluated in all patients. RESULTS: A total of 29 patients (23 males and 6 females) with mean age of …

Examining Evidence Based Resistance Plus Balance Training In Community-Dwelling Older Adults With Complex Health Care Needs: Trial Protocol For The Muscling Up Against Disability Project., Justin W L Keogh, Tim Henwood, Paul Gardiner, Anthony Tuckett, Brent Hodgkinson, Kevin Rouse

Justin Keogh

Progressive resistance plus balance training (PRBT) has been demonstrated as effective in reducing later life physical disability, falls risk and poor health, even among those with complex health care needs. However, few studies have examined the influence of PRBT on health service utilisation, cognitive wellbeing and training modality acceptance or undertaken a cost benefit analysis. This project will investigate the broad scope benefits of PRBT participation among community-dwelling older Australians receiving Government supported aged care packages for their complex health care needs. Using a modified stepped-wedge design, 248 community-dwelling adults 65 years and older with some level of government support …

A New Sv2a Ligand For Epilepsy, Michael A. Rogawski

Michael A. Rogawski

Malnutrition In The Older Australian Rural Rehabilitation Community : Indentification, Patient Outcomes And The Role Of Informal Caregivers, Skye Marshall

Skye Marshall

Enhancing the effectiveness of nutritional care to improve the overall health of older adults will be key in reducing hospital and aged care facility demand, a priority target of current health service research and policy. Engaging informal caregivers as part of the nutrition care team presents an opportunity for improving the nutrition status of older Australians in rehabilitation and the community. This thesis provides evidence to improve malnutrition screening, assessment, diagnosis and resource allocation in rehabilitation facilities. It also makes recommendations to improve nutrition intervention in practice, and for how intervention studies should be designed in this setting. The thesis …

The Physiological, Musculoskeletal And Psychological Effects Of Stand Up Paddle Boarding, Ben Schram, Wayne F. Hing, Michael Climstein

Wayne Hing

Background: Stand up paddle boarding (SUP) is a rapidly growing sport and recreational activity where anecdotal evidence exists for its proposed health, fitness and injury rehabilitation benefits. While limited scientific evidence exists to substantiate these claims, previous studies have shown that high levels of fitness, strength and balance exists amongst participants of this sport. The purpose of this study was to conduct a training intervention on a group of previously untrained individuals to ascertain the potential of SUP on various health parameters. Methods: An intervention study was conducted where after being tested initially, subjects were left for 6 weeks to …

The Physiological, Musculoskeletal And Psychological Effects Of Stand Up Paddle Boarding, Ben Schram, Wayne F. Hing, Michael Climstein

Ben Schram

Background: Stand up paddle boarding (SUP) is a rapidly growing sport and recreational activity where anecdotal evidence exists for its proposed health, fitness and injury rehabilitation benefits. While limited scientific evidence exists to substantiate these claims, previous studies have shown that high levels of fitness, strength and balance exists amongst participants of this sport. The purpose of this study was to conduct a training intervention on a group of previously untrained individuals to ascertain the potential of SUP on various health parameters. Methods: An intervention study was conducted where after being tested initially, subjects were left for 6 weeks to …

Strength Training For Plantar Fasciitis And The Intrinsic Foot Musculature: A Systematic Review., Dean Huffer, Wayne Hing, Richard Newton, Mike Clair

Wayne Hing

The aim was to critically evaluate the literature investigating strength training interventions in the treatment of plantar fasciitis and improving intrinsic foot musculature strength. A search of PubMed, CINHAL, Web of Science, SPORTSDiscus, EBSCO Academic Search Complete and PEDRO using the search terms plantar fasciitis, strength, strengthening, resistance training, intrinsic flexor foot, resistance training. Seven articles met the eligibility criteria. Methodological quality was assessed using the modified Downs and Black checklist. All articles showed moderate to high quality, however external validity was low. A comparison of the interventions highlights significant differences in strength training approaches to treating plantar fasciitis and …

Epidemiology, Prehospital Care And Outcomes Of Patients Arriving By Ambulance With Dyspnoea: An Observational Study., Anne Maree Kelly, Anna Holdgate, Gerben Keijzers, Sharon Klim, Colin A. Graham, Simon Craig, Win Sen Kuan, Peter Jones, Charles Lawoko, Said Laribi

Gerben Keijzers

Background This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. Methods This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics …

Surviving Difference: Endocrine-Disrupting Chemicals, Intergenerational Justice, And The Future Of Human Reproduction, Robyn Lee, Roxanne Mykitiuk

Roxanne Mykitiuk

Endocrine-disrupting chemicals have been identified as posing risks to reproductive health and may have intergenerational effects. However, responses to the potential harms they pose frequently rely on medicalised understandings of the body and normative gender identities. This article develops an intersectional feminist framework of intergenerational justice in response to the potential risks posed by endocrine-disrupting chemicals. We examine critiques of endocrine disruptors from feminist, critical disability and queer standpoints, and explore issues of race and class in exposures. We argue that responding to the risks posed by endocrine disruptors such as brominated flame retardants (BFRs) and phthalates requires developing a …

Lifetime Prevalence Of Non-Melanoma And Melanoma Skin Cancer In Australia Surfers, James Furness, Mike Climstein, Wayne F. Hing, Joe Walsh

Wayne Hing

Introduction

Surfing is one of the most popular aquatic activities in Australia with an estimated 2.7 million recreational surfers 1 however, Australia has long been recognized as having the highest incidence of melanoma in the world. As a result the expected risk of skin cancer in surfers due to long periods of exposure to ultraviolet radiation is of great concern 2. The aim of this study was to investigate the lifetime prevalence of non-melanoma skin cancers (NMSCs), (basal cell carcinoma (BCC), squamous cell carcinoma (SCC)), and melanoma skin cancers (MSCs) in Australian surfers.

Methods

Given the geographic distribution of surfers …

Lifetime Prevalence Of Non-Melanoma And Melanoma Skin Cancer In Australia Surfers, James Furness, Mike Climstein, Wayne F. Hing, Joe Walsh

James Furness

Introduction

Surfing is one of the most popular aquatic activities in Australia with an estimated 2.7 million recreational surfers 1 however, Australia has long been recognized as having the highest incidence of melanoma in the world. As a result the expected risk of skin cancer in surfers due to long periods of exposure to ultraviolet radiation is of great concern 2. The aim of this study was to investigate the lifetime prevalence of non-melanoma skin cancers (NMSCs), (basal cell carcinoma (BCC), squamous cell carcinoma (SCC)), and melanoma skin cancers (MSCs) in Australian surfers.

Methods

Given the geographic distribution of surfers …