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A 74 Year Old Woman With Left Shoulder Pain, Jane V. Mayrin, MD 2011 Thomas Jefferson University

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 2011 Thomas Jefferson University

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 2011 Thomas Jefferson University

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 2011 Thomas Jefferson University

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 2011 Thomas Jefferson University

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 2011 Thomas Jefferson University

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 2011 Thomas Jefferson University

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 ...


A 32 Year Old Man With Loss Of Consciousness, Dana Dana Critchell, MD 2011 Thomas Jefferson University

A 32 Year Old Man With Loss Of Consciousness, Dana Dana Critchell, Md

The Medicine Forum

A 32-year-old man with no past medical history presented to the emergency department after losing consciousness at the end of a half-marathon. The patient was in his usual state of good health until the last mile of the marathon when he began to feel unsteady on his feet and short of breath. At the end of the race, he collapsed and was found unresponsive by EMS. The patient had no memory of the subsequent events and could only recall waking up in the emergency department feeling “numb” and “confused” several hours later. The patient denied any palpitations, chest pain, nausea ...


Presence Of Concomitant Asymptomatic And Symptomatic Emboli Resulting From Acute Staphylococcus Aureus Endocarditis, Jason T. Bradley, MD, Nicole M. Orr, MD, Siva Ramachandran, MD 2011 Thomas Jefferson University

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 ...


An 18-Year Old Man With Fever And Headache, Amy Baranoski, MD 2011 Thomas Jefferson University

An 18-Year Old Man With Fever And Headache, Amy Baranoski, Md

The Medicine Forum

An 18-year-old man was transferred from an outside hospital for evaluation of recent headache, fevers, and laboratory abnormalities.

The patient had a past medical history significant for attention deficit hyperactivity disorder (ADHD) and had presented to an outside hospital with complaints of fatigue, fever, and headache. He described the headache as frontal, severe, and stabbing in nature without associated neck stiffness, photophobia, or phonophobia. He also reported fevers to 105ºF. He was evaluated one day after the onset of symptoms at a local emergency room where a lumbar puncture was performed. By report of the patient and his mother, the ...


Table Of Contents: The Medicine Forum, Volume 7, 2005, 2011 Thomas Jefferson University

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 2011 Thomas Jefferson University

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 2011 Thomas Jefferson University

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 ...


Public Health And Public Wealth: Social Costs As A Basis For Restrictive Policies, David Courtwright 2011 University of North Florida

Public Health And Public Wealth: Social Costs As A Basis For Restrictive Policies, David Courtwright

David T. Courtwright

Historically, the most important rationale for coercive public health measures has been the prevention of disease and injury to others. However, as noncommunicable diseases and accidents have assumed increased importance as causes of morbidity and mortality, and as the connection between noncommunicable diseases and accidents and individual practices such as smoking and drinking has become more apparent, a new line of argument based on social costs has emerged. My purpose is both to describe and evaluate the social-costs argument, to explain why it has become so popular, and to show what must be done to make it consistent with its ...


Patterns Of 'Leakage' In The Utilisation Of Clinical Guidelines: A Systematic Review, Sharon Mickan, Amanda Burls, Paul Glasziou 2011 University of Oxford

Patterns Of 'Leakage' In The Utilisation Of Clinical Guidelines: A Systematic Review, Sharon Mickan, Amanda Burls, Paul Glasziou

Faculty of Health Sciences & Medicine Publications

Background Research: Evidence is insufficient to change physicians’ behaviour. In 1996, Pathman developed a four step model: that physicians need to be aware of, agree with, adopt, and adhere to guidelines.

Objective: To review evidence in different settings on the patterns of ‘leakage’ in the utilisation of clinical guidelines using Pathman’s awareness-to-adherence model.

Methods: A systematic review was conducted in June 2010. Primary studies were included if they reported on rates of awareness and agreement and adoption and/or adherence.

Results: 11 primary studies were identified, reporting on 29 recommendations. Descriptive analyses of patterns and causes of leakage were ...


The Role Of The Mass Media In Women’S Infant Feeding Decisions: A Dissertation, Paula Bylaska-Davies 2011 University of Massachusetts Medical School

The Role Of The Mass Media In Women’S Infant Feeding Decisions: A Dissertation, Paula Bylaska-Davies

Graduate School of Nursing Dissertations

Breastfeeding has been established as providing the best and most complete nutrition for newborns, as this method promotes the infant’s health and supports infant growth (American Academy of Pediatrics [AAP], 2005). Mass media have been suggested as powerful and universal means of communication with the potential to impact social norms. Thus, this qualitative descriptive study explored, within the context of the Socioecological Framework, women’s decision making on whether to breastfeed or bottle-feed their infants and the effect of mass media on their decision.

Data were collected in individual audiotaped interviews with participants recruited from the Massachusetts Breastfeeding Coalition ...


The Relationship Between Physicians‘ Ownership Of Physical Therapy Services And Referral Patterns To Hospital-Based Outpatient Rehabilitation Centers, Joy Bruce 2011 Virginia Commonwealth University

The Relationship Between Physicians‘ Ownership Of Physical Therapy Services And Referral Patterns To Hospital-Based Outpatient Rehabilitation Centers, Joy Bruce

Theses and Dissertations

Background and Purpose A debate over the practice of physician self-referral has been ongoing in health care since the 1980s. At issue is the practice of physicians who refer patients to facilities in which they share a financial interest, a phenomenon known as referral for profit. Physician investment or ownership interest in ancillary (e.g., physical therapy) services has been shown to have an impact on utilization rates, costs, access to care, and quality of care. What has not been identified in previous research is the influence of physicians‘ selective referral on competing clinics, particularly the hospital-based outpatient centers that ...


The Role Of Pc4 In Oxidative Stress: A Dissertation, Lijian Yu 2011 University of Massachusetts Medical School

The Role Of Pc4 In Oxidative Stress: A Dissertation, Lijian Yu

GSBS Dissertations and Theses

Oxidative stress is a cellular condition where cells are challenged by elevated levels of reactive oxygen species (ROS) that are produced endogenously or exogenously. ROS can damage vital cellular components, including lipid, protein, DNA and RNA. Oxidative damage to DNA often leads to cell death or mutagenesis, the underlying cause of various human disease states. Previously our laboratory discovered that human PC4 gene can prevent oxidative mutagenesis in the bacterium Escherichia coli and that the yeast homolog SUB1 has a conserved function in oxidation protection. In this thesis I examined the underlying mechanisms of PC4’s oxidation protection function. My ...


Presenting A Simplified Assistant Tool For Breast Cancer Diagnosis In Mammography To Radiologists, Ping Zhang, Jenny Doust, Kuldeep Kumar 2011 Bond University

Presenting A Simplified Assistant Tool For Breast Cancer Diagnosis In Mammography To Radiologists, Ping Zhang, Jenny Doust, Kuldeep Kumar

Kuldeep Kumar

This paper proposes a method to simplify a computational model from logistic regression for clinical use without computer. The model was built using human interpreted features including some BI-RADS standardized features for diagnosing the malignant masses. It was compared with the diagnosis using only assessment categorization from BI-RADS. The research aims at assisting radiologists to diagnose the malignancy of breast cancer in a way without using automated computer aided diagnosis system.


Pharmacokinetics Of Topically Applied Ciprofloxacin In Equine Tears, Diane Hendrix, Jamie Stuffle, Sherry Cox 2011 University of Tennessee - Knoxville

Pharmacokinetics Of Topically Applied Ciprofloxacin In Equine Tears, Diane Hendrix, Jamie Stuffle, Sherry Cox

Sherry Cox

Objective:  To evaluate the pharmacokinetics of topically applied ciprofloxacin 0.3% ophthalmic solution in tears of healthy horses.

Animal studied:  Twenty healthy, adult, mixed-breed horses.

Procedures:  Twenty study horses were confirmed free of ophthalmic disease by complete ophthalmic examination. Seventy microliters of 0.3% ciprofloxacin (Ciloxan™) was placed in the ventral cul-de-sac of each eye using a microliter syringe and 19-g cannula. Population kinetics were carried out by sampling the tear film from the lower cul-de-sac of each eye with tear test strips at 5, 10, 15 and 30 min and 1, 2, 4 and 6 h post administration for ...


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