Medicine and Health Sciences Commons^™

Pregnancy Outcomes In Female Liver Transplant Recipients With A Transplant-To-Conception Interval >- 5 Years, Carlo B. Ramirez, Adam Frank, Warren R. Maley, Cataldo Doria, Lisa A. Coscia, Vincent T. Armenti

Adam M. Franks, MD

Conclusions: Successful pregnancy outcomes have been reported in female liver recipients with a transplant-to-conception interval greater than or equal to 5 years. Long-term graft survival should be discussed with recipients as a component of preconception counseling. All transplant centers are encouraged to report pregnancies to the NTPR.

How To Cite Sources According To Apa 6th Edition, Scott Memorial Librarians

Daniel G. Kipnis

6 page handout on how to cite sources according to APA 6th edition. Additional questions can be asked by contacting the Scott Memorial Librarians at: Email: askalibrarian@jefferson.edu Phone: 215.503.6994 Chat live with a librarian: http://jeffline.jefferson.edu/Ask/

Chart Rounds In The Digital Age: A Survey Of North American Institutions, M. A. Whiton, A. P. Dicker, E. J. Wuthrick, L. Doyle, A. S. Harrison, Y. R. Lawrence

Yaacov R. Lawrence

Purpose: Recent reports of medical errors in radiaKon treatment delivery have emphasized the importance of quality assurance (QA) pracKces. Strict guidelines exist for medical physics QA, but not for QA procedures as applied to clinicians. We sought to document how clinical quality assurance (QA) meeKngs or “chart rounds” are performed across academic North American RadiaKon Oncology departments.

Ecmo-State Of The Art, Nicholas Cavarorocchi, Md

Nicholas C Cavarocchi MDJ

Dr. Cavarocchi is an Associate Professor of Surgery who holds a faculty appointment in the Department of Surgery at Thomas Jefferson University Hospital in Philadelphia, PA. He is also the Director of Cardiac Critical Care and Surgical Care Unit at Jefferson. In 2007, he was names as one of the countries top surgeons. He specializes in cardiothoracic surgery.

Presentation runs for 1 hour and 2 minutes.

Sickle Cell Pain: A Critical Reappraisal., Samir K. Ballas, Kalpna Gupta, Patricia Adams-Graves

Department of Medicine Faculty Papers

Sickle cell pain includes 3 types: acute recurrent painful crises, chronic pain syndromes, and neuropathic pain. The acute painful crisis is the hallmark of the disease and the most common cause of hospitalization and treatment in the emergency department. It evolves through 4 phases: prodromal, initial, established, and resolving. Each acute painful episode is associated with inflammation that worsens with recurrent episodes, often culminating in serious complications and organ damage, such as acute chest syndrome, multiorgan failure, and sudden death. Three pathophysiologic events operate in unison during the prodromal phase of the crisis: vaso-occlusion, inflammation, and nociception. Aborting the acute …

From The Editors, Andrew Lerner, Md, Tasha Kouvatsos, Md, Andrea Fennelly, Md

The Medicine Forum

The editorial staff would like to acknowledge the support of Dr. Diemer and Dr. Kane in producing this year’s Jefferson Forum. We appreciate your guidance and thank you for all that you have done to help bring this issue to print. We would also like to thank our internal medicine resident colleagues for contributing interesting and unique case reports, review articles, original research, travel experiences, and poetry. This issue of the Jefferson Forum could not have been done without your hard work and enthusiasm.

From The Desk Of The Residency Program Director, Gretchen Diemer, Md, Facp

The Medicine Forum

To the Friends of the Department of Medicine:

I am honored to be given the opportunity to lead this talented group of residents as they travel down the path toward completion of their residency training. On September 1st, Dr. Gregory Kane took the reins as the Interim Chair of the Department of Medicine here at Jefferson. A new Program Director could not ask for a more staunch supporter of education to occupy that role than Dr. Kane.

This edition of The Forum showcases the broad variety of patients our residents and students encounter during their training. The submissions to this …

Optical Guidance System Vs. Cbct For Phantom And Patient Setup, L. Fu, H. Perera, H. Liu, Y. Xiao, Y. Yu

Hua Kun Liu

Purpose: To quantify the discrepancy between Varian optical guidance (OG) frameless localization system and Varian Trilogy on board imaging (OBI) system for setting up phantom and SRS patient. American Association of Physicists in Medicine (AAPM) 52nd Annual Meeting July 18-22, Philadelphia, PA

A Procedure For Standardizing Mlc Quality Assurance For Elekta Linac, K. Yan, M. Studenski, H. Liu, I. Buzurovic, Y. Cui, L. Shabason, A. Harrison, Y. Yu, M. Hossain, Y. Xiao

Hua Kun Liu

Purpose: As specified in TG142, MLC position accuracy needs to be tested on weekly/monthly basis, with 1mm tolerance. This study focuses on developing techniques, hardware and software tools for implementation of MLC QA tests for Elekta Linacs. American Association of Physicists in Medicine (AAPM) 52nd Annual Meeting July 18-22, Philadelphia, PA

16-Year Trends In The Infection Burden For Pacemakers And Implantable Cardioverter-Defibrillators In The United States 1993 To 2008., Arnold J Greenspon, Jasmine D Patel, Edmund Lau, Jorge A Ochoa, Daniel R Frisch, Reginald T Ho, Behzad B Pavri, Steven M Kurtz

Department of Medicine Faculty Papers

OBJECTIVES: We analyzed the infection burden associated with the implantation of cardiac implantable electrophysiological devices (CIEDs) in the United States for the years 1993 to 2008.

BACKGROUND: Recent data suggest that the rate of infection following CIED implantation may be increasing.

METHODS: The Nationwide Inpatient Sample (NIS) discharge records were queried between 1993 and 2008 using the 9th Revision of the International Classification of Diseases (ICD-9-CM). CIED infection was defined as either: 1) ICD-9 code for device-related infection (996.61) and any CIED procedure or removal code; or 2) CIED procedure code along with systemic infection. Patient health profile was evaluated …

Capacity Building For Participatory Health Services Research In Housing First, Lara Carson Weinstein, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Background:

Pathways to Housing ends chronic homelessness for individuals with serious mental illness (SMI) by providing housing first, and then combining that housing with supportive treatment services in the area of mental and physical health, substance abuse, education, and employment. Housing is provided in apartments scattered throughout a community. This "scattered site" model fosters a sense of home and self-determination, and it helps speed client's reintegration into the community. The Pathways model has been remarkable successful in addressing chronic homelessness.

Research Question

What are the chronic physical disease self management support needs of Pathways to Housing clients?

Primary Provider Beliefs And Practice Patterns Contribute To The Lack Of Hiv/Hcv Coinfected Patients Undergoing Liver Transplantation In The United States, Jonathan M. Fenkel, Md, Victor J. Navarro, Md

Division of Gastroenterology and Hepatology Faculty Papers

Conclusions:

1. The majority of primary providers were ambivalent toward or against LT for HIV/HCV coninfected patients.

2. Half of all respondents were unlikely to refer cirrhotic coinfected patients for LT evaluation.

3. HIV specialists were significantly more likely to believe transplant should be offered, but reported no difference in likelihood of LT referral.

4. These findings suggest that primary provider beliefs and self-reported practice patterns may partially explain the paucity of coinfected US liver transplant recipients.

Table Of Contents: The Jefferson Journal Of Psychiatry, Volume 2, Number 1, January 1984

Jefferson Journal of Psychiatry

Table of Contents: The Jefferson Journal of Psychiatry, Volume 2, Number 1, January 1984.

Dedication

Jefferson Journal of Psychiatry

Dedication to Paul J. Fink, MD.

Editors: The Jefferson Journal Of Psychiatry

Jefferson Journal of Psychiatry

Chief Editor, Associate Editors, Former Editors, Cover Design and Faculty Advisor.

Meningitis Presenting As Depression: A Case Report, Karl Doghramji, Md

Jefferson Journal of Psychiatry

The relationship between psychiatric and medical illness has long been recognized by clinicians. Of special importance to psychiatrists are the diagnostic dilemmas posed by medical illnesses presenting as psychiatric disorders. In a review of recent studies, LaBruzza found that "at least one out of every twenty patients receiving an initial psychiatric evaluation may have an underlying medical illness which accounts for the psychiatric symptoms." This was especially true with inpatients, where between 5% and 30% of patients, with a weighted average of 12%, had medical illnesses accounting for their psychiatric complaints 11). One medical illness which can resemble psychiatric illness …

Attention Deficit Disorder, Residual Type- A Case Study, James Stanch, Md

Jefferson Journal of Psychiatry

The syndrome of Minimal Brain Dysfunction (MBD) in children has been well described by a number of authors. Such children were first described in 1941 by Werner and Strauss(1) who made a distinction between brain injury and -simple- mental retardation. In the past such terms as Hyperactive Child Syndrome, Minimal Brain Damage, and Hyperkinetic Behavior Syndrome have been used to describe this syndrome.

A Case Of Recurrent Dissociative Episodes In A Patient With Congenital Defects, Mark Miller, Md

Jefferson Journal of Psychiatry

Case Report

Marie, a 30 year old American-born Hispanic female, was first seen in the emergency room with suicidal ideation (the impulse to jump in front of an oncoming car), depression, anxiety, and distress about "always getting attacked so much."

Interpersonal Relationships As Sources Of Medical Student Stress, Beverly Jones, Md

Jefferson Journal of Psychiatry

Introduction

The issue of physician impairment, that is , decreased ability or quality of functioning due to intemperate use of drugs or alcohol, emotional or psychiatric dysfunction, has recently received attention (1,5) . Studies have indicated the risks physicians face of substance abuse problems(6,7), marital discord(8,9), suicide (lO,ll), and psychiatric problems (l2-14). studies have also addressed the difficulties faced by medical students (15-20).

A group of medical students at the University of North Carolina came together to investigate the subject of medical student impairment . A survey was constructed in order to ascertain the sources of stress in medical school. …

Olfaction And Sexuality, Michael Buxbaum, Md

Jefferson Journal of Psychiatry

A patient who describes himself as "sanitary" told me of his concern with odors. Whenever he thinks about establishing a sexual relationship , he develops a fear that his partner may smell offensive, especially around her genital area. He describes signs and symptoms of sympathetic overactivity when he engages in foreplay, and is afraid that he might be impotent if he smells anything offensive. In fact, he has to insert a finger into his partner's vagina during foreplay, to test the nature of the odor. He feels relieved when the smell is neutral or perfumed, and demonstrates enhanced sexual performance. …

Editors' Column

Jefferson Journal of Psychiatry

With this issue, The Jefferson Journal of Psychiatry , a Resident Publication, comes into being.

The purpose of this journal is to provide a forum for the presentation of ideas, data, and discussion. We are trying to give residents a setting in which to communicate in a way more formal than the seminars of residency training, but less forbidding than national journals.

Download Entire Issue-The Medicine Forum, Volume 12, 2010

The Medicine Forum

Download entire issue-The Medicine Forum, Volume 12, 2010

Poem, Andrew Lerner, Md

The Medicine Forum

She is a small lady,

85 years old.

Digital Clubbing, Yiu Tak Leung, Md, Phd

The Medicine Forum

This is a 66 year-old male with a history of cirrhosis who came into the office for a routine check-up and was noted to have “drumbstick fingers” or digital clubbing. Digital clubbing is a clinical sign most commonly associated with pulmonary diseases, such as lung cancer and interstitial lung disease, cyanotic heart disease and cirrhosis of the liver, but clubbing also may be idiopathic or congenital.

Chronic Tophaceous Gout, Sara Beltz, Md

The Medicine Forum

Gout, existing since antiquity as “the king of diseases and the disease of kings,” can present as an acute gouty arthritis or as achronic depositional arthropathy (chronic tophaceous gout). If left untreated, chronic tophaceous gout will develop in up to 30% of acute gout patients over 5 years.

Calciphylaxis, Darren Andrade, Md

The Medicine Forum

A 51-year-old man with a history of end-stage renal disease on hemodialysis and diabetes mellitus presents with suprapubic pain and a worsening penile ulcer that he first noticed two months ago. What finally prompted the patient to go to the emergency

Rare Gram-Negative Sepsis In A Non-Ventilated Neutropenic Patient With Aml, Jay Sellers, Md, Paurush Shah, Md

The Medicine Forum

Case Report

A 57-year-old man with history of hypertension, hyperlipidemia,and gout presented for evaluation of both a perioral infection and an infection in his right great toe from an injury on the beach at his shore house. The toe trauma was complicated by a massive hematoma and phlebitis, which required antibiotics. His primary care physician ordered basic laboratory studies thatshowed an anemia and thrombocytopenia. He was sent to a Hematology and Oncology specialist and subsequently directly admitted to Thomas Jefferson University Hospital for blood transfusion and further work-up. Upon further questioning, thepatient admitted to chills starting 2 weeks prior to …

Post-Pneumonectomy Changes, Charles-Lwanga Bennin, Md

The Medicine Forum

Case

A 71-year-old woman, with a history of non-small cell lung cancer (NSCLC) with subsequent pneumonectomy presented with worsening dyspnea on exertion and non-productive cough.

The patient first noted the shortness of breath and cough 4 weeks prior to presentation, which were refractory to albuterol nebulization. The patient also reported a 6 lb. weight loss duringthis time period. She denied fevers, chills, night sweats or chestpain. The patient was diagnosed with NSCLC 11 years ago andunderwent a right-sided extrapleural pneumonectomy at that time. She received no radiation or chemotherapy. She did not require home oxygen and reported a generally good …

A 35-Year-Old Man With New Onset Blindness, Cecilia Kelly, Md, Claire Raab, Md, Aimee Lee, Msiv

The Medicine Forum

Case Report

A 35 year-old homosexual male from Trinidad with no known past medical history presented with a complaint of new-onset blindness. He stated that his vision had become increasingly “dim” to the point that at presentation, he had minimal light perception in either eye. This decrease in vision had occurred over the course of a week. He denied any trauma, eye pain, headache, nausea or vomiting.

Peripancreatic Tuberculosis With Involvement Of The Porta Hepatis In A 41-Year-Old Thai Female Diagnosed Via Fine Needle Aspiration, Paurush Shah, Md, Ali Siddiqui, Md

The Medicine Forum

Case Report

A 41-year-old Thai female with past medical history of gastroesophagealreflux disease and duodenal ulcer who immigrated to the United States six years ago presented with a complaint of intermittent right upper quadrant (RUQ) pain for the last several years. Over the last year, she reported that the pain had significantly increased in intensity. She described the pain as crampy, beginning in the RUQ and radiating around to her back. There was no associated nausea, vomiting or weight loss. The patient had initially presented to an outside hospital a few months prior, was diagnosed with costochondritis, and was subsequently …