Medicine and Health Sciences Commons^™

From The Residency Program Director, Gregory C. Kane Md, Facp, Fccp

The Medicine Forum

Can an art masterpiece embody the spirit of a University?

This question was not considered at Jefferson before this year or until the University pursued the sale of Thomas Eakins’ seminal work, The Gross Clinic.

The depiction of Dr. Samuel Gross, Professor of Surgery, at work in the surgical amphitheatre captured the emergence of American Medicine from the shadow of Europe and foreshadowed the American century which was yet to come.

Viewed in this light, the work is indeed an important part of the history of Jefferson, Philadelphia, the medical/scientific community, and the entire nation. Even more significant is the …

Download Entire Pdf: The Medicine Forum, Vol 7, 2005

The Medicine Forum

Download the entire PDF of The Medicine Forum, Volume 7, 2005.

Varicella Pneumonia, Sivakumar Srinivasan, Md, Rangadham Nagarakanti, Md, Sandhya Nalmas, Md

The Medicine Forum

44 year old Hispanic male with no significant past medical history, recently discharged from prison, presented to the hospital with rash all over the body with itching. The rash started on the face, at the back of the ear and then spread to the trunk and legs. He denied fever, chills, cough, shortness of breath or sick contacts. Physical examination revealed a young, comfortable looking male with stable vital signs except for a temperature of 102 F.

The Spectrum Of Advanced Liver Disease In A Tertiary Care Institution, Kuntal M. Thaker, Md, Kuldip S. Banwait, Md, Maya Spodik, Md, Steven K. Herrine, Md, Victor Navarro, Md

The Medicine Forum

Purpose In population based studies, the rise of HCV infection has surpassed alcoholic liver disease (ALD) as the most common cause of chronic liver disease. However, it is unknown if HCV is becoming the dominant cause of advanced liver disease. The aim of this study was to determine the distribution of etiologies in a cohort of patients presenting with advanced liver disease.

Risk Of Ischemic Stroke Associated With Low-Dose Oral Contraceptive Use: A Meta-Analysis, Dae Hyun Kim, Md, Mph, Joachim Bleys, Md, Mph, Marlis Gonzalez-Fernandez, Md, Rebecca Gottesman, Md, Michelle Hudspeth, Md

The Medicine Forum

Abstract

Context: Oral contraceptive (OC) use has been shown to be associated with increased risk of ischemic stroke. However, most studies were conducted before low-dose OC became available.

Objective: To determine whether low-dose OC use is associated with increased risk of ischemic stroke Data Sources: All relevant human-subject and English-language studies in MEDLINE, EMBASE, and Science Citation Index from January 1970 through February 2005

Study Selection and Data Extraction: All published studies of OC or estrogen with any type of stroke as an outcome were included. Studies were excluded if they included populations at high risk for ischemic stroke …

A 19 Year Old Girl With Lightheadedness And Palpitations, Andrew Rose, Md

The Medicine Forum

A 19 year old patient with a past medical history significant only for recurrent syncope presented to the emergency department after 90 minutes of palpitations, chest tightness, lightheadedness and shortness of breath. Electrocardiogram on admission is shown in Figure 1.

Wellens Syndrome, Nicole Farmer, Md, Michael Cohen, Md

The Medicine Forum

A 76 year-old African-American female with a history of hypertension, type II Diabetes Mellitus, hyperlipidemia, and gatroesphageal reflux presented to emergency room complaining of epigastric pain radiating to left substernum which started the night before presentation. The onset of her sharp pain was at rest, lasted for two hours, and was aggravated by eating and drinking. Her chest pain was followed by gagging and regurgitating of liquid contents. Her chest pain was non-exertional, and not associated with shortness of breath, diaphoresis, nausea, or vomiting. In the Emergency Department, her pain subsided with two sublingual nitroglycerins and 2 milligrams of intravenous …

Recurrent Spontaneous Coronary Artery Dissections, Sivakumar Srinivasan, Md, Rangadham Nagarakanti, Md

The Medicine Forum

A 41-year-old Caucasian female with a history of hypertension presented with exertional chest pain. Her vital signs were stable on admission and physical examination was unremarkable. An Electrocardiogram (EKG) revealed inferior ST segment elevations consistent with acute myocardial infarction and cardiac enzymes were elevated. She was started on heparin, and underwent immediate cardiac catheterization.

Image In Medicine, Amy Baranoski, Md

The Medicine Forum

Pictured here is the back of a man with leprosy who had been treated at Acworth Leprosy Hospital in Mumbai, India. Note the diffuse, macular, hypopigmented rash. Leprosy is a chronic disease caused by infection with Mycobacterium leprae. The disease can affect a variety of organs including peripheral nerves, skin, muscle, eye, bone, and testes. Leprosy is diagnosed clinically by the presence of at least one of the following: hypopigmented patches, loss of cutaneous sensation, thickened nerves, and acid-fast bacilli in nasal or skin smears.

Sarcoid Cardiomyopathy, Sivakumar Srinivasan, Md, Emanuel Chryssos, Md

The Medicine Forum

The patient is a 40 year old African-American female with no significant past medical history who presented to the ED with a 2 week history of lower extremity edema and shortness of breath. She also noticed intermittent palpitations, dry cough, easy fatigue and a 30 pound weight loss. On examination, the patient’s temperature was 98.9F orally, pulse was 155-170 beats per minute, and blood pressure was 133/93 mmHg. EKG revealed long P-R tachycardia with heart rate of 170. Chest X- ray was done and showed large right pleural effusion with compressive atelectasis and small left pleural effusion. Transthoracic echocardiogram at …

A 53-Year-Old Woman With Worsening Rash And Diarrhea, Bryan Kavanaugh, Md

The Medicine Forum

A 53-year-old white female was admitted to the Bone Marrow Transplant Unit with a worsening pruritic rash.

The patient had a history of IgG lambda multiple myeloma status post autologous stem cell transplant one year prior and more recently, matched sibling allogenic transplant. Since transplantation, she had a history of rash, which was diagnosed as graft-versus-host disease (GVHD) by skin biopsy. During that same hospitalization, she had a transjugular liver biopsy to rule out GVHD which was complicated by a large intrahepatic and subcapsular hematoma. A catheter to drain the hematoma was placed by interventional radiology, which was still in …

Rupture Recurrence After Surgical Repair Of A Postinfarction Ventricular Septal Rupture In The Reperfusion Era, Apurva D. Shah, Md, Alan K. Tannenbaum, Md

The Medicine Forum

A 63-year-old male is admitted to the CCU for chest pain, shortness of breath, and an elevated troponin.

The patient is a 63-year-old male with a past medical history significant for hypertension and hypercholesterolemia who presented to the emergency room with a chief complaint of shortness of breath and chest pain. The chest pain began two days prior and was associated with nausea. The patient proceeded to have increasing shortness of breath over the subsequent two days which brought him to the emergency room for evaluation.

A 74 Year Old Woman With Left Shoulder Pain, Jane V. Mayrin, Md

The Medicine Forum

A 74 year old woman presented to the emergency department complaining of two weeks of left shoulder pain. The pain was sharp, 8 out of 10 in intensity, located in the left shoulder, made worse with breathing, and associated with mild chest discomfort, diaphoresis, and neck pain. There was no radiation and the pain was not worsened with exertion. The patient has a history of Warthin tumor of the left parotid gland and had undergone laryngoscopy and polypectomy two weeks prior to presentation. Around this time she developed the shoulder pain along with overall weakness. At the time of presentation …

A 56-Year-Old Man With Vertigo And Hypercalcemia, Veronica Rivera, Andrew Rose, Md

The Medicine Forum

A 56-year-old Man with a past medical history significant for lower back pain and GERD was admitted to the hospital for dizziness and laboratory abnormalities.

Five days prior to admission, the patient noted that he felt dizzy and unsure while walking. These symptoms persisted without change and he went to see his primary care doctor the day prior to admission. The patient was given meclizine for his dizziness and routine labs were drawn. He received a call from his doctor on the day of admission instructing him to be evaluated for an elevated serum calcium.

55 Year Old Woman With Pneumonia, Andra Popescu, Md

The Medicine Forum

A 55 year old Caucasian female smoker, with past medical history significant for hypertension and peptic ulcer disease presented to the emergency department with a four day complaint of malaise, fever, and myalgias. She was seen by her primary care physician who started her on amoxicillin clavulanate for possible strep throat infection. Her family reported a productive cough with green sputum, pleuritic chest pain, nausea, vomiting and diarrhea for one week. They also felt she was getting more confused over the past several hours.

Liver Transplant Recipient With Bilateral Leg Swelling, Kuntal M. Thaker, Md, Maya Spodik, Md, Kuldip S. Banwait, Md, Steven K. Herrine, Md, Victor Navarro, Md

The Medicine Forum

A 50-year-old white male was admitted to the hospital with erythema and swelling of both lower extremities.

The patient had a medical history significant for liver transplant five years prior for end-stage liver disease secondary to alcoholic cirrhosis. Following transplant, he developed mitral valve insufficiency with heart failure and pulmonary hypertension. He had been in his usual state of health until approximately a week prior to admission when he noticed that his lower extremities had increased in girth. For several days, he noted that there had also been increased redness and pain over the affected area.

34 Year Old Woman With Thrombocytopenia And Weakness, M. Paula Martinez, Md, Ubaldo E. Martinez, Md

The Medicine Forum

Patient is a 34 year old Liberian Female with past medical history significant for Systemic Lupus Erythematosus (SLE) that was recently admitted to the hospital for weakness and was diagnosed with encephalomyelitis due to SLE. At that time the patient was also noted to have low platelets felt secondary to Immune Thrombocytopenic Purpura (ITP). She has history of thrombocytopenia with her four pregnancies. During this past admission the patient was treated with hydroxychloroquine and high dose steroids for the CNS involvement of SLE but no platelet response was noted with administration of steroids. She was discharged to a rehabilitation facility, …

A Post-Partum Woman With Dyspnea, Saaron Laighold, Md

The Medicine Forum

A G1P1 40 year-old Caucasian female without significant past medical history presented to an outside hospital with worsening shortness of breath and hemoptysis. The patient was 10 days status post caesarian section for preeclampsia. Her course after delivery was complicated by a stay in the ICU for shortness of breath. She was discharged home 7 days post-delivery and then returned to the hospital 3 days later. The patient was intubated at the outside hospital for hypoxia (O2 sats of 50% on room air) and transferred to TJUH for further management.

41 Year Old Women With Fevers And Shortness Of Breath, Jonathan Jun, Md

The Medicine Forum

A 41 year-old African American female with a history of asthma, hypertension, and schizophrenia presented to the ER in February 2005 with shortness of breath, wheezing, and a “wet-sounding” but nonproductive cough. She reported chills, subjective fever, rhinorrhea, and malaise for five days prior. Her only medication was albuterol, which she normally used twice weekly as needed. She was never intubated for asthma. On review of systems, she had progressive dyspnea on exertion of less than two blocks for the last year. She denied night sweats, weight loss, or sick contacts, HIV exposure, alcohol or drug abuse. She admitted to …

Presence Of Concomitant Asymptomatic And Symptomatic Emboli Resulting From Acute Staphylococcus Aureus Endocarditis, Jason T. Bradley, Md, Nicole M. Orr, Md, Siva Ramachandran, Md

The Medicine Forum

A 25-year-old male intravenous heroin user with Hepatitis C presented with a syncopal episode and left sided weakness. Examination revealed sub-conjunctival hemorrhages and diffuse bilateral petechiae on his lower extremities. He had multiple irregular, erythematous, painless macules on his hands and feet, and linear, red, subungal lesions bilaterally. These findings were consistent with Janeway lesions and splinter hemorrhages, respectively. His vital signs were stable on admission. Cardiac auscultation revealed a grade 2/6 holosystolic apical murmur radiating to the axilla. A brain MRI revealed multiple areas of hyperdensity, particularly in the right parietal lobe (Figure 1). Blood tests revealed leukocytosis and …

Table Of Contents: The Medicine Forum, Volume 7, 2005

The Medicine Forum

Table of Contents for Volume 7 of the Medicine Forum.

From The Editors, Betty Lim, Md, Andrew Rose, Md, Karl Kwok, Md

The Medicine Forum

Welcome to the 7th Edition of the Jefferson Medicine Forum! In this edition we have highlighted some of the many interesting and diverse cases encountered by our Internal Medicine students, residents, and fellows.

From The Residency Program Director, Gregory C. Kane Md

The Medicine Forum

The ideal of a University is that we live and work together as a community of scholars dedicating ourselves to the advancement of Medicine. Our community is at its best when we share ideas, knowledge, perspective, and a passion for Medicine. As a routine, this can occur at Morning Report or Noon Conference, but also on rounds or hopefully at the bedside when dealing with a particularly challenging case.

This journal serves as an outlet for observations or studies of particular merit. Its publication is an important element of our scholarly focus in the Department. Indeed, nearly a score of …

Welcome To The 6th Edition Of The Jefferson Medicine Forum, Nicole Weinberg Md, Betty Lim Md

The Medicine Forum

We are very excited to bring you this
new and improved volume of the Forum
because it exhibits the talents of the
Internal Medicine Residents. This
edition showcases many of the residents’
strengths in writing scholarly projects,
creating research studies, and interpreting
modern diagnostic imaging.

From The Residency Program Director, Gregory C. Kane Md

The Medicine Forum

The goal of a Residency Program in Internal Medicine is
to strive to train the next generation of practitioners and
academicians in Medicine who will become physiciansscholars,
scientists, teachers, and humanists.

We are excited that many of our residents are pursuing
research opportunities in the laboratory or clinic. Such
participation is a requirement for training at Jefferson. In
addition, this journal serves as an outlet for scholarly
work of a variety of types. We are pleased to support
another issue of the Jefferson Forum to continue to
highlight this work. This represents the sixth installment
of the Jefferson Forum, which …

Download Entire Pdf: The Medicine Forum, Vol 5, Winter 2003

The Medicine Forum

Download entire PDF: The Medine Forum, (The Journal of Thomas Jefferson University Hospital, Department of Internal Medicine), Vol 5, Winter 2003.

Clinical Quiz

The Medicine Forum

5 question clinical quiz. Answers after case presentation: A Man with Dyspnea and Diffuse Abdominal Pain by Dominick Galluzzo MD.

Effect Of Intravenous Pulse Cyclophosphamtoe (Cyc) Therapy On Systemic Sclerosis (Ssc) Inflammatory Lung Disease, Nicole Weinberg, Md, Nora Sandorfi, Md, Sergio A. Jimenez, Md

The Medicine Forum

Deterioration of lung function is the most frequent cause
of death in SSc. Alveolitis is considered the initiating
event of SSc lung fibrosis. Effective therapy of SSc
alveolitis is, therefore, of paramount importance. Here
we assessed the use of intravenous CYC on pulmonary
function testing(PFT) and high resolution computerized
tomography (HRCT) abnormalities in 15 patients with
SSc and alveolitis.

Effects Of Walnut Consumption As Part Of Heart Healthy Diet On Atherogenic Lipoprotein Subclasses, Kimberly L. Dulaney, Md, John M. Morgan, Md, David M. Capuzzi, Md

The Medicine Forum

Nutritional therapy is fundamental in the treatment of
cardiovascular disease. Studies that utilized a low-fat diet
supplemented with 64 grams/day of walnuts have shown
a significant reduction in serum levels of total and LDL
cholesterol, and triglycerides. This study was designed to
see if lipoprotein subclasses varied in patients eating a
low-fat walnut supplemented diet.

A Man With Shortness Of Breath And An Abnormal Ecg: A Short Case, David Defeo, Md

The Medicine Forum

An 80 year-old Chinese male with a history of tobacco
use and asthma presented to the ER complaining of
shortness of breath that was unresponsive to
bronchodilator use. The patient’s ECG on admission was
sinus rhythm at 95 beats per minute with minimal ST
elevations in V2-V4. Laboratory results were significant
for a troponin of 7.7. The patient was started on anticoagulation
with heparin. A transthoracic echocardiogram
revealed an ejection fraction of 25%. The patient
underwent coronary catheterization, which revealed
luminal irregularities of his coronary arteries. Figures 1
and 2 show the end diastolic and end systolic left
ventriculograms from …