Medicine and Health Sciences Commons^™

The Role Of Fdg-Pet In The Evaluation Of Hidradenitis Suppurativa: A Systematic Review, Sahithi Talasila, Eric M. Teichner, Robert C Subtirelu, David H Xiang, Cyrus Ayubcha, Thomas Werner, Abass Alavi, Mona-Elisabeth Revheim

Department of Medicine Faculty Papers

Hidradenitis suppurativa (HS) is a chronic skin disorder characterized by nodules, comedones, and sinus tracts that often leave prominent scarring. In recent years, non-invasive imaging techniques have been used to assess the inflammatory activity, vascularization, and treatment response of lesions. Specifically, fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans may aid in identifying systemic inflammation in patients with HS, improving diagnosis. Inflamed hypermetabolic tissues exhibit a greater uptake of FDG due to increased glucose uptake and vascularity. A systematic review was conducted to summarize the utility of nuclear imaging techniques in the diagnosis and treatment follow-up of HS. PubMed, Scopus, …

Current Relevance Of Biomarkers In Diagnosis Of Periprosthetic Joint Infection: An Update., Saksham Tripathi, Saad Tarabichi, Javad Parvizi, Ashok Rajgopal

Rothman Institute Faculty Papers

With a significant rise in the number of arthroplasty procedures performed worldwide, the increasing revision burden posed by periprosthetic joint infection (PJI) is a matter of growing concern. In spite of various attempts to diagnose PJI, there are no defined tests that can be called a gold standard. Given the importance of early diagnosis in PJI, newer tests and biomarkers have been introduced to improve cumulative diagnostic accuracy. Novel biomarkers like calprotectin, lipocalcin, monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and platelet-to-mean platelet volume ratio have demonstrated a potential as diagnostic biomarkers for PJI. This article discusses the relevance of available …

Molecular Diagnostics In The Evaluation Of Thyroid Nodules: Current Use And Prospective Opportunities, Jena Patel, Joshua Klopper, Elizabeth E. Cottrill

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Thyroid cancer is the most common endocrine malignancy with an estimated 43,800 new cases to be diagnosed in 2022 and representing the 7th most common cancer in women. While thyroid nodules are very common, being identified in over 60% of randomly selected adults, only 5-15% of thyroid nodules harbor thyroid malignancy. Therefore, it is incumbent upon physicians to detect and treat thyroid malignancies as is clinically appropriate and avoid unnecessary invasive procedures in patients with benign asymptomatic lesions. Over the last 15-20 years, rapid advances have been made in cytomolecular testing to aid in thyroid nodule management. Initially, indeterminate thyroid …

Editorial: Hallmark Of Cancer: Reprogramming Of Cellular Metabolism, Baljinder Kaur, Yahya Sohrabi, Abhinav Achreja, Michael P. Lisanti, Ubaldo Emilio Martinez-Outshoorn

Department of Medical Oncology Faculty Papers

No abstract provided.

Co-Management Strategies For Acute Myeloid Leukemia Patients In The Community Setting, Christopher Benton, Michael R Grunwald, Hana Safah, Margaret Kasner

Department of Medical Oncology Faculty Papers

The treatment landscape for acute myeloid leukemia (AML) has changed substantially in recent years. The introduction of newer therapies, including oral agents, less myelosuppressive agents, and parenteral regimens suitable for outpatient administration, has made it feasible for select patients to receive therapy in the outpatient setting and in community practices. Thorough patient evaluation (including molecular testing), planned supportive care (eg, transfusion support, antimicrobial prophylaxis), and vigilant patient monitoring (for tumor lysis syndrome and adverse events) by a multidisciplinary team are required for successful management of patients both in the community and at specialized leukemia centers. Some patients are unable or …

Clinical And Radiologic Factors Associated With Adnexal Torsion In Premenarchal And Menarchal Children And Adolescents., Beth I. Schwartz, Rebecca J. Mercier, Sharon Gould, David Saul, Claire Loiselle, Nimali Weerasooriya, Katrina Marcinkowski, Erin A Teeple, Loren Berman

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Adnexal torsion is a gynecologic emergency in children and adolescents but remains a challenging diagnosis, with no consistent clinical or radiologic diagnostic criteria. Our objective was to identify risk factors associated with adnexal torsion in premenarchal and menarchal patients with surgically confirmed torsion compared with those without torsion.

METHODS: We conducted a retrospective chart review of all patients who underwent surgery between January 2016 and December 2019 for possible adnexal torsion. Data on demographics, clinical characteristics, radiologic variables, and operative findings were compared using descriptive statistics. Independent predictors of torsion were then examined in multivariate logistic regression models.

RESULTS: …

Editorial: Nk/T-Cell Lymphoma: Biology, Prognostics, Prediction, And Treatment, Jean El Cheikh, Khodr Terro, Layal Sharrouf, Anjali Mishra, Marcos De Lima

Department of Medical Oncology Faculty Papers

No abstract provided.

Utility Of S100a12 As An Early Biomarker In Patients With St-Segment Elevation Myocardial Infarction, Xiaolin Zhang, Minghui Cheng, Naijing Gao, Yi Li, Chenghui Yan, Xiaoxiang Tian, Dan Liu, Miaohan Qiu, Xiaozeng Wang, Bo Luan, Jie Deng, Shouli Wang, Hongyan Tian, Geng Wang, Xin-Liang Ma, Gregg W Stone, Yaling Han

Department of Emergency Medicine Faculty Papers

Importance: S100A12 is a calcium binding protein which is involved in inflammation and progression of atherosclerosis.

Objective: We sought to investigate the utility of S100A12 as a biomarker for the early diagnosis and prognostication of patients presenting with ST-segment elevation myocardial infarction (STEMI).

Design, Setting, and Participants: S100A12 was measured in 1023 patients presenting to the emergency department with acute chest pain between June 2012 and November 2015. An independent cohort of 398 patients enrolled at 3 different hospitals served as a validation cohort.

Main Outcomes and Measures: The primary clinical endpoint of interest was major adverse cardiac and cerebral …

A Review Of Fixed Drug Eruption With A Special Focus On Generalized Bullous Fixed Drug Eruption., Hannah J. Anderson, Jason B. Lee, Md

Department of Dermatology and Cutaneous Biology Faculty Papers

Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by the onset of rash at a fixed location on the body each time a specific medication is ingested. With each recurrence, the eruption can involve additional sites. Lesions can have overlying vesicles and/or bullae, and when they cover a significant percentage of body surface area, the eruption is referred to as generalized bullous fixed drug eruption (GBFDE). Due to the widespread skin denudation that can be seen in this condition, GBFDE may be confused clinically with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). While treatments described for GBFDE include supportive …

Advances In The Diagnosis And Treatment Of Krabbe Disease, David A Wenger, Paola Luzi, Mohammad Rafi

Department of Neurology Faculty Papers

Krabbe disease is an autosomal recessive leukodystrophy caused by pathogenic variants in the galactocerebrosidase (GALC) gene. GALC activity is needed for the lysosomal hydrolysis of galactosylceramide, an important component of myelin. While most patients are infants, older patients are also diagnosed. Starting in 1970, a diagnosis could be made by measuring GALC activity in leukocytes and cultured cells. After the purification of GALC in 1993, the cDNA and genes were cloned. Over 260 disease-causing variants as well as activity lowering benign variants have been identified. While some pathogenic variants can be considered “severe,” others can be considered “mild.” The combination …

Figo (International Federation Of Gynecology And Obstetrics) Initiative On Fetal Growth: Best Practice Advice For Screening, Diagnosis, And Management Of Fetal Growth Restriction, Nir Melamed, Ahmet Baschat, Yoav Yinon, Apostolos Athanasiadis, Federico Mecacci, Francesc Figueras, Vincenzo Berghella, Amala Nazareth, Muna Tahlak, H David Mcintyre, Fabrício Da Silva Costa, Anne B Kihara, Eran Hadar, Fionnuala Mcauliffe, Mark Hanson, Ronald C Ma, Rachel Gooden, Eyal Sheiner, Anil Kapur, Hema Divakar, Diogo Ayres-De-Campos, Liran Hiersch, Liona C Poon, John Kingdom, Roberto Romero, Moshe Hod

Department of Obstetrics and Gynecology Faculty Papers

No abstract provided.

Contrast-Enhanced Ultrasound In Association With Serum Biomarkers For Differentiating Combined Hepatocellular-Cholangiocarcinoma From Hepatocellular Carcinoma And Intrahepatic Cholangiocarcinoma., Jie Yang, Ya-Han Zhang, Jia-Wu Li, Ying-Yu Shi, Jia-Yan Huang, Yan Luo, Ji-Bin Liu, Qiang Lu

Department of Radiology Faculty Papers

BACKGROUND: Combined hepatocellular-cholangiocarcinoma (CHC) is a rare type of primary liver cancer. Due to its complex histopathological characteristics, the imaging features of CHC can overlap with those of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC).

AIM: To investigate the possibility and efficacy of differentiating CHC from HCC and ICC by using contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) and tumor biomarkers.

METHODS: Between January 2016 and December 2019, patients with histologically confirmed CHC, ICC and HCC with chronic liver disease were enrolled. The diagnostic formula for CHC was as follows: (1) LR-5 or LR-M with elevated alpha-fetoprotein …

Inflammatory Myopathies: Update On Diagnosis, Pathogenesis And Therapies, And Covid-19-Related Implications., Marinos C. Dalakas

Department of Neurology Faculty Papers

The inflammatory myopathies constitute a heterogeneous group of acquired myopathies that have in common the presence of endomysial inflammation. Based on steadily evolved clinical, histological and immunopathological features and some autoantibody associations, these disorders can now be classified in five characteristic subsets: Dermatomyositis (DM) Polymyositis (PM), Necrotizing Autoimmune Myositis (NAM), Anti-synthetase syndrome-overlap myositis (Anti-SS-OM), and Inclusion-Body-Myositis (IBM). Each inflammatory myopathy subset has distinct immunopathogenesis, prognosis and response to immunotherapies, necessitating the need to correctly identify each subtype from the outset to avoid disease mimics and proceed to early therapy initiation. The review presents the main clinicopathologic characteristics of each subset …

Diagnostic Journey And Impact Of Enzyme Replacement Therapy For Mucopolysaccharidosis Iva: A Sibling Control Study., Can Ficicioglu, Dena R Matalon, Nicole Luongo, Caitlin Menello, Tracy Kornafel, Andrew J Degnan

Abington Jefferson Health Papers

BACKGROUND: Mucopolysaccharidosis (MPS) IVA, also known as Morquio A syndrome, is a rare autosomal recessive lysosomal storage disorder caused by a deficiency in the enzyme N-acetylgalactosamine-6-sulfatase. Early recognition, diagnosis, and treatment of this progressive, multisystem disease by enzyme replacement therapy (ERT) can lead to improved outcomes and reduced mortality.

METHODS: This report documents the diagnostic journey and treatment with ERT of three siblings with MPS IVA. Clinical outcome measures included growth, endurance, imaging, cardiac, respiratory, ophthalmology, and laboratory evaluations.

RESULTS: Three siblings, diagnosed at 14.7, 10.1, and 3.2 years of age, demonstrated clinical improvement with weekly infusions of 2.0 mg/kg …

Absence-To-Bilateral-Tonic-Clonic Seizure: A Generalized Seizure Type., Sándor Beniczky, Guido Rubboli, Athanasios Covanis, Michael R Sperling

Department of Neurology Faculty Papers

OBJECTIVE: To test the hypothesis that absence seizures can evolve to generalized tonic-clonic seizures, we documented electroclinical features of this novel seizure type.

METHODS: In 4 large video-EEG databases, we identified recordings of seizures starting with impaired awareness that, without returning to baseline interictal state, evolved to generalized tonic-clonic seizures. We extracted the detailed semiologic and electrographic characteristics of these seizures, and we documented the clinical background, diagnoses, and therapeutic responses in these patients.

RESULTS: We identified 12 seizures from 12 patients. All seizures started with a period of impaired awareness and bursts of generalized spike or polyspike and slow-wave …

The Vaso-Occlusive Pain Crisis In Sickle Cell Disease: Definition, Pathophysiology, And Management., Deepika S. Darbari, Vivien A. Sheehan, Samir K. Ballas

Cardeza Foundation for Hematologic Research

Early diagnosis, treatment, and prevention of a vaso-occlusive crisis (VOC) are critical to the management of patients with sickle cell disease. It is essential to differentiate between VOC-associated pain and chronic pain, hyperalgesia, neuropathy, and neuropathic pain. The pathophysiology of VOCs includes polymerization of abnormal sickle hemoglobin, inflammation, and adhesion. Hydroxyurea, L-glutamine, crizanlizumab, and voxelotor have been approved by the US Food and Drug Administration for reducing the frequency of VOCs; the European Medicines Agency has approved only hydroxyurea. Other novel treatments are in late-stage clinical development in both the United States and the European Union. The development of agents …

Evaluation And Management Of Common Anorectal Complaints, Krys Foster, Md, Mph

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives:

• Review the anatomy of the rectum and anus
• Learn skills to perform an appropriate H&P for anorectal complaints
• Appreciate key diagnostic features to common anorectal diagnoses
• Recognize risk factors and red flag signs/symptoms that prompt further evaluation and possible referral

Can Contrast Enhanced Ultrasound Differentiate Intrahepatic Cholangiocarcinoma From Hepatocellular Carcinoma?, Jia-Yan Huang, Jia-Wu Li, Wen-Wu Ling, Tao Li, Yan Luo, Ji-Bin Liu, Qiang Lu

Department of Radiology Faculty Papers

BACKGROUND: Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) differ in treatment and prognosis, warranting an effective differential diagnosis between them. The LR-M category in the contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) was set up for lesions that are malignant but not specific to HCC. However, a substantial number of HCC cases in this category elevated the diagnostic challenge.

AIM: To investigate the possibility and efficacy of differentiating ICC from HCC classified in the LR-M category according to the CEUS LI-RADS.

METHODS: Patients with complete CEUS records together with pathologically confirmed ICC and LR-M HCC (HCC classified …

Characterization Of Adnexal Masses Using Contrast-Enhanced Subharmonic Imaging: A Pilot Study., Lauren J. Delaney, Priscilla Machado, Mehnoosh Torkzaban, Andrej Lyshchik, Corinne Wessner, Christine H. Kim, Md, Norman G Rosenblum, Scott D. Richard, Kirk Wallace, Flemming Forsberg

Department of Radiology Faculty Papers

OBJECTIVES: This pilot study evaluated whether contrast-enhanced subharmonic imaging (SHI) could be used to characterize adnexal masses before surgical intervention.

METHODS: Ten women (with 12 lesions) scheduled for surgery of an ovarian mass underwent an SHI examination of their adnexal region using a modified LOGIQ E9 scanner (GE Healthcare, Waukesha, WI) with an endocavitary transducer, in which digital clips were acquired by pulse destruction-replenishment SHI across the lesions. Time-intensity curves were created offline to quantitatively evaluate SHI parameters (fractional tumor perfusion, peak contrast intensity, time to peak contrast enhancement, and area under the time-intensity curve), which were compared to pathologic …

Contemporary Nstemi Management: The Role Of The Hospitalist., Charles V Pollack, Alpesh Amin, Tracy Wang, Steven Deitelzweig, Marc Cohen, David Slattery, John Fanikos, Christopher Dilascia, Regan Tuder, Scott Kaatz

Department of Emergency Medicine Faculty Papers

Non-ST-segment elevation myocardial infarction (NSTEMI) is defined as elevated cardiac biomarkers of necrosis in the absence of persistent ST-segment elevation in the setting of anginal symptoms or other acute event. It carries a poorer prognosis than most ST-segment elevation events, owing to the typical comorbidity burden of the older NSTEMI patients as well as diverse etiologies that add complexity to therapeutic decision-making. It may result from an acute atherothrombotic event ('Type 1') or as the result of other causes of mismatch of myocardial oxygen supply and demand ('Type 2'). Regardless of type and other clinical factors, the hospital medicine specialist …

Clinical Value Of Ultrasonography For Monitoring Angular Pregnancy In First-Trimester, Yanhua Zhen, Md, Xuefeng Lu, Md, Chenyu Wang, Md, Huixia Li, Md, Ji-Bin Liu, Md

Department of Radiology Faculty Papers

Objective: To explore the clinical value of ultrasonography for early detection and monitoring of angular pregnancy during the first-trimester.

Methods: For this retrospective study, we enrolled 23 patients with asymptomatic angular pregnancy who were diagnosed by ultrasound at early pregnancy and who underwent ultrasound follow-up to determine its clinical outcome. An ultrasound unit E8 (GE Healthcare, Milwaukee, WI) associated with a 5-9 MHz convex array transvaginal probe was used to image the gestational sac by both two-dimensional and three-dimensional modes. Transvaginal sonographic observation included the location, size, and shape of the gestational sac, as well as the relationship between the …

Pretty Peachy., Li-Anne Lim, Basil K. Williams, Carol L. Shields

Wills Eye Hospital Papers

No abstract provided.

Left Ventricular Pseudoaneurysm: An Overview Of Diagnosis And Management., Faisal Inayat, Ali Raza Ghani, Iqra Riaz, Nouman Safdar Ali, Usman Sarwar, Raphael Bonita, Hafeez Ul Hassan Virk

Abington Jefferson Health Papers

Left ventricular pseudoaneurysm is a rare but life-threatening disorder that is frequently reported secondary to myocardial infarction or cardiac surgery. In this article, we chronicle the case of a patient with no prior risk factors who presented with a 2-week history of nonexertional atypical left chest pain. Apical 2-chamber transthoracic echocardiography revealed an unexpected outpouching of basal inferoseptal wall of the left ventricle, which had a narrow neck and relatively wide apex. The patient was diagnosed with left ventricular pseudoaneurysm and medical therapy was initiated. He refused to undergo the surgical intervention and subsequently, he was discharged from the hospital …

Spontaneous Coronary Artery Dissection: A Case Series Of 9 Patients With Literature Review., Ali Raza Ghani, Md, Faisal Inayat, Nouman Safdar Ali, Reema Anjum, Michael Viray, Arsalan Talib Hashmi, Iqra Riaz, Bruce D. Klugherz, Hafeez Ul Hassan Virk

Abington Jefferson Health Papers

Spontaneous coronary artery dissection is an increasingly recognized nonatherosclerotic cause of acute coronary syndrome. Reports regarding the prognosis and natural history of this disease are limited. In addition to the diagnostic difficulty, this condition poses a significant therapeutic challenge due to the lack of specific management guidelines. We present here a case series of 9 patients with spontaneous coronary artery dissection. Additionally, this article reviews the incidence, clinical characteristics, risk factors, diagnostic modalities, therapeutic approaches, and patterns of recurrence in patients with spontaneous coronary artery dissection.

Sacral Fractures And Associated Injuries., Ricardo Rodrigues-Pinto, Mark F. Kurd, Gregory D. Schroeder, Christopher K. Kepler, James C. Krieg, Jörg H. Holstein, Carlo Bellabarba, Reza Firoozabadi, F Cumhur Oner, Frank Kandziora, Marcel F. Dvorak, Conor P. Kleweno, Luiz R. Vialle, S. Rajasekaran, Klause J. Schnake, Alexander R. Vaccaro

Rothman Institute Faculty Papers

STUDY DESIGN: Literature review.

OBJECTIVE: The aim of this review is to describe the injuries associated with sacral fractures and to analyze their impact on patient outcome.

METHODS: A comprehensive narrative review of the literature was performed to identify the injuries associated with sacral fractures.

RESULTS: Sacral fractures are uncommon injuries that result from high-energy trauma, and that, due to their rarity, are frequently underdiagnosed and mistreated. Only 5% of sacral fractures occur in isolation. Injuries most often associated with sacral fractures include neurologic injuries (present in up to 50% of sacral fractures), pelvic ring disruptions, hip and lumbar spine …

Clinician-Performed Bedside Ultrasound In Improving Diagnostic Accuracy In Patients Presenting To The Ed With Acute Dyspnea., Dimitrios Papanagnou, Michael Secko, John Gullett, Michael Stone, Shahriar Zehtabchi

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Diagnosing acute dyspnea is a critical action performed by emergency physicians (EP). It has been shown that ultrasound (US) can be incorporated into the work-up of the dyspneic patient; but there is little data demonstrating its effect on decision-making. We sought to examine the impact of a bedside, clinician-performed cardiopulmonary US protocol on the clinical impression of EPs evaluating dyspneic patients, and to measure the change in physician confidence with the leading diagnosis before and after US.

METHODS: We conducted a prospective observational study of EPs treating adult patients with undifferentiated dyspnea in an urban academic center, excluding those …

Evidence-Based Decision Support For Pediatric Rheumatology Reduces Diagnostic Errors., Michael M. Segal, Balu Athreya, Mary Beth F. Son, Irit Tirosh, Jonathan S. Hausmann, Elizabeth Yn. Ang, David Zurakowski, Lynn K. Feldman, Robert P. Sundel

Department of Pediatrics Faculty Papers

BACKGROUND: The number of trained specialists world-wide is insufficient to serve all children with pediatric rheumatologic disorders, even in the countries with robust medical resources. We evaluated the potential of diagnostic decision support software (DDSS) to alleviate this shortage by assessing the ability of such software to improve the diagnostic accuracy of non-specialists.

METHODS: Using vignettes of actual clinical cases, clinician testers generated a differential diagnosis before and after using diagnostic decision support software. The evaluation used the SimulConsult® DDSS tool, based on Bayesian pattern matching with temporal onset of each finding in each disease. The tool covered 5405 diseases …

Neurovascular Disorders: Novel Perspectives On Pathogenesis, Diagnosis, And Treatment., David Hasan, Nohra Chalouhi, Md, Aaron S Dumont, Robert M Starke, Pascal Jabbour Md

Department of Neurosurgery Faculty Papers

No abstract provided.

Parametric Mapping Of Contrasted Ovarian Transvaginal Sonography., Katrina Korhonen, Ryan Moore, Andrej Lyshchik, Arthur C. Fleischer

Department of Radiology Faculty Papers

The purpose of this study was to assess the accuracy of parametric analysis of transvaginal contrast-enhanced ultrasound (TV-CEUS) for distinguishing benign versus malignant ovarian masses. A total of 48 ovarian masses (37 benign and 11 borderline/malignant) were examined with TV-CEUS (Definity; Lantheus, North Billerica, MA; Philips iU22; Philips Medical Systems, Bothell, WA). Parametric images were created offline with a quantification software (Bracco Suisse SA, Geneva, Switzerland) with map color scales adjusted such that abnormal hemodynamics were represented by the color red and the presence of any red color could be used to differentiate benign and malignant tumors. Using these map …

Management Of Cerebral Cavernous Malformations: From Diagnosis To Treatment, Nikolaos Mouchtouris, Nohra Chalouhi, Md, Ameet Chitale, Robert Starke, Stavropoula Tjoumakaris, Robert H. Rosenwasswer Md, P. M. Jabbour

Department of Neurosurgery Faculty Papers

No abstract provided.