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Total Parotidectomy Under Local Anesthesia: A Novel Technique, Kamran Shahid, Bilal Karim Siddiqui, Muhammad Hammad Tahir, Salman Bin Ayub, Ghulam Murtaza Memon, Adnan Yousuf, Arif Hussain, Osmani, Abdul Karim Siddiqui

Department of Biological & Biomedical Sciences

Parotidectomy is a common procedure usually done for a parotid mass necessitating a histological diagnosis. Operation is normally performed under General anesthesia with a nerve stimulator to facilitate facial nerve stimulation. We describe a new technique with reports of three cases, making total parotidectomy under local anesthesia possible. The ascending cervical branch of cervical plexus and the auriculotemporal nerve were anesthetized by bupivacaine 0.25% (2mg/kg) and lignocaine with adrenaline 7 mg/kg. Effective onset of anesthesia was within 15-25 minutes and the operations lasted between 2-3 hours without any complications. This offers advantage in high-risk patients where general anesthesia is contraindicated. …

Cephalalgiaphobia: A Possible Specific Phobia Of Illness., Mario F P Peres, Juliane P P Mercante, Vera Z Guendler, Felipe Corchs, Marcio A Bernik, Eliova Zukerman, Stephen Silberstein

Department of Jefferson Headache Center Papers and Presentations

Psychiatric comorbidity, mainly anxiety and depression, are common in chronic migraine (CM). Phobias are reported by half of CM patients. Phobic avoidance associated with fear of headache or migraine attack has never been adequately described. We describe 12 migraine patients with particular phobic-avoidant behaviours related to their headache attacks, which we classified as a specific illness phobia, coined as cephalalgiaphobia. All patients were women, mean age 42, and all had a migraine diagnosis (11 CM, all overused acute medications). Patients had either a phobia of a headache attack during a pain-free state or a phobia of pain worsening during mild …

Jefferson Scale Of Patient's Perceptions Of Physician Empathy: Preliminary Psychometric Data., Gregory C. Kane, Joanne L. Gotto, Salvatore Mangione, Susan West, Mohammadreza Hojat

Department of Psychiatry and Human Behavior Faculty Papers

AIM: To develop a brief scale for measuring patient's perceptions of their physician's empathic engagement and to provide preliminary evidence in support of aspects of the scale's psychometrics.

METHOD: Study comprised 225 patients, out of 436 patients (52% response rate) seen by 166 residents in the internal medicine residency program at the Jefferson Hospital Ambulatory Clinic as part of their ambulatory training at Thomas Jefferson University Hospital. A 5-item questionnaire entitled the Jefferson Scale of Patient's Perceptions of Physician Empathy was developed and administered to the study participants. Its factor structure, item-total score correlations, and correlations with several relevant criterion …

Revolution Next -The Multidetector Ct, Saba Sohail

Department of Radiology

No abstract provided.

Characteristics And Outcome Of Patients With Drug Overdose At A Tertiary Care Hospital In Karachi., Muhammad Shahid, Junaid Patel, Haider Naqvi Aga Khan University, Muhammad Shoaib Khan

Department of Emergency Medicine

No abstract provided.

Anesthetic Deaths In A Developing Country, Mueenullah Khan, Fauzia A. Khan

Department of Anaesthesia

It is important to ascertain the contribution of anesthesia to perioperative mortality in order to enable improvement in the safety and quality of care. Scanty literature regarding anesthetic mortality from developing countries is available. We present data regarding anesthesia related mortality in a university hospital in a developing country. We reviewed all patient deaths occurring between 1992-2003 occurring within 24 hours of anesthesia, as part of departmental quality assurance activity. The aim of study was to identify any contributing factors associated with mortality, and to compare our data with similar studies from developed and developing countries. 111,289 cases were handled …

Oncolog, Volume 52, Number 02, February 2007, Diane Witter

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• New Findings on Aspirin and Heart Attacks
• Kicking Off a Trend: Cancer-Related Deaths Decline
• House Call: Working Out How to Lower Your Risk of Cancer

Mediastinal Parathyroid Adenoma Causing Primary Hyperparathyroidism, Farhat Abbas, Syed Raziuddin Biyabani, Amanullah Memon, Jamsheer Jehangir Talati

Section of Urology

An ectopically placed parathyroid adenoma in the anterior mediastinum is a rare cause of persistent or recurrent primary hyperparathyroidism (PHPT) and is recognized as an important cause of failed primary neck exploration. We encountered 3 such cases amongst 70 surgically treated patients with PHPT (4.3%) over a 20-year period. In 2 cases, the offending adenoma could be removed at first exploration whereas in the 3rd case, it was successfully removed with mediastinal exploration after 2 failed neck explorations. In established cases of PHPT with equivocal preoperative localization studies or negative neck explorations, an ectopically placed parathyroid adenoma should be considered …

Clinical, Biochemical And Ultrasonographic Features Of Infertile Women With Polycystic Ovarian Syndrome, Fauzia Haq, Omar Aftab, Javed Rizvi

Department of Obstetrics & Gynaecology

Objective: To evaluate and compare the clinical, biochemical and ultrasonic features of infertile women with PCOS from the two infertility centers of Karachi, The Aga Khan University Hospital and Concept Fertility Centre.
Study Design: Cross-sectional, analytical study. Place and Duration of Study: The Aga Khan University Hospital, and Concept Fertility Centre, Karachi, Pakistan, from January 2003 till December 2004.
Patients and Methods: Patients attending the Infertility Clinics of Aga Khan University Hospital, Karachi and Concept Fertility Centre, Karachi, were evaluated for their clinical features. Complete biochemical evaluation was performed by day 2 FSH, LH, serum prolactin, serum testosterone and fasting …

Family Systems: Perceptions Of Elderly Patients And Their Attendents Presenting At A University Hospital In Karachi, Pakistan, Ahmed Itrat, Ather Mohammed Taqui, Fahd Qazi, Waris Qidwai

Department of Family Medicine

Objective:

To know the present status of family systems in Pakistan, changes they are undergoing and implications of such trends on health of the elderly population.

Methods:

A cross-sectional study was carried out at the out-patient clinics, AgaKhan University Hospital, using convenience sampling method. Verbal informed consent was taken from the participants. The questions included demographic profile, satisfaction with current family system, opinions about changing trends of family systems, and their implications on health. Analysis was done using SPSS 13.0.

Results:

Four hundred subjects aged 65 and above were interviewed, out of which 226 (56.5%) were living in the …

Toward A Biopsychosocial Understanding Of The Patient-Physician Relationship: An Emerging Dialogue, Herbert M. Adler

Department of Family & Community Medicine Faculty Papers

Complexity theory has been used to view the patient-physician relationship as constituted by complex responsive processes of relating. It describes an emergent, psychosocial relational process through which patients and physicians continually and reciprocally influence each other's behavior and experience. As psychosocial responses are necessarily biopsychosocial responses, patients and physicians must likewise be influencing each other's psychobiology. This mutual influence may be subjectively experienced as empathy, and may be skillfully employed by the clinician to directly improve the patient's psychobiology.

An Unusual Abdominal Mass: Case Report, H. Saidi, U. Mohammed, M. Machoki

General Surgery, East Africa

The causes of intra-abdominal masses associated with chronic abdominal pain range from the benign to malignant; common to bizarre and some raise major medical legal issues. We present a case of a 40-year old African lady who presented with chronic right-sided abdominal pain with an associated mass on the right mid-abdomen. She had had a Caesarian section one year prior to presentation. Antecedent history of surgery and typical imaging features enabled a preoperative diagnosis of abdominal mass secondary to retained surgical gauze.The case illustrates the fallibility of the men and women in the operating theatres and the vital role of …

Pakistani Physicians And The Repatriation Equation, Saad Shafqat, Anita K. M. Zaidi

Section of Neurology

In Pakistan, students who are accepted into medical school are congratulated — only half-jokingly — on three counts: that they will become doctors, that they will become certified by the American Board of Medical Specialties, and that they will soon be living in the United States.

Bleomycin Induced Pneumonitis: A Case Successfully Managed With High-Dose Steroids, Shahid Javed Husain, Ali Bin Sarwar Zubairi, Muhammad Irfan

Department of Medicine

No abstract provided.

Prevalence Of Gastric Varices And Results Of Sclerotherapy With N-Butyl 2 Cyanoacrylate For Controlling Acute Gastric Variceal Bleeding., Mumtaz J Khan, Shahid Majid,, Syed H Shah, Kashif Hameed, Ashfaq Ahmed, Saeed Hamid, Wasim Jafri

Department of Medicine

Aim: To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC) sclerotherapy of gastric varix (GV).

Methods: We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophagogastro-duodenoscopy) and in-hospital mortality were analyzed.

Results: The prevalence of GV in patients with portal hypertension was …

Tramadol Versus Nalbuphine In Total Intravenous Anaesthesia For Dilatation And Evacuation, Khalid Maudood Siddiqui, Ursula Chohan

Department of Anaesthesia

Objective: To compare the results of Tramadol with Nalbuphine for dilatation and evacuation with total intravenous anaesthesia technique.Methods: A total of 70 patients (35 in each group) were included in this prospective, double blind randomized study. Intravenous tramadol 1.5 mg/kg and nalbuphine 0.1 mg/kg were compared in total intravenous anaesthesia (TIVA) using a propofol infusion in patients undergoing dilatation and evacuation (D and E). Changes in haemodynamic variables greater than 20% from the base line values were noted.Results: There was no difference found in haemodynamic parameters. There was statistically significant difference found (p < 0.05) in postoperative recovery between the two groups.CONCLUSION: Quality of analgesia was better in nalbuphine group but both drugs provide suitable analgesic supplementation to TIVA.

Phosphorylation Of The Proline-Rich Domain Of Xp95 Modulates Xp95 Interaction With Partner Proteins, Robert E Dejournett, Ryuji Kobayashi, Shujuan Pan, Chuanfen Wu, Laurence D Etkin, Richard B Clark, Oliver Bögler, Jian Kuang

Faculty, Staff and Student Publications

The mammalian adaptor protein Alix [ALG-2 (apoptosis-linked-gene-2 product)-interacting protein X] belongs to a conserved family of proteins that have in common an N-terminal Bro1 domain and a C-terminal PRD (proline-rich domain), both of which mediate partner protein interactions. Following our previous finding that Xp95, the Xenopus orthologue of Alix, undergoes a phosphorylation-dependent gel mobility shift during progesteroneinduced oocyte meiotic maturation, we explored potential regulation of Xp95/Alix by protein phosphorylation in hormone-induced cell cycle re-entry or M-phase induction. By MALDI-TOF (matrix-assisted laser-desorption ionization-time-of-flight) MS analyses and gel mobility-shift assays, Xp95 is phosphorylated at multiple sites within the N-terminal half of the …

The Fate Of The Unexpected Positive Intraoperative Cultures After Revision Total Knee Arthroplasty, Robert L. Barrack, Ajay Aggarwal, R. Stephen J. Burnett, John C. Clohisy, Elie Ghanem, Peter Sharkey, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

Of a consecutive series of 692 revision total knees at 3 centers, intraoperative cultures were unexpectedly found to be positive in 41 cases (5.9%). Of the 41, 29 (71%) cases had a single positive intraoperative culture and were determined to be a probable false positive based on absence of any other evidence of infection, of which 5 were treated with extended course of intravenous antibiotics after hospital discharge and the remaining 24 received no further treatment. None of these 24 patients manifested any sign of infection at follow-up, averaging 46 months (range, 24-74 months). Twelve patients were determined to have …

Beta Blocker Specificity: A Building Block Toward Personalized Medicine., Brent R Degeorge, Walter J Koch

Center for Translational Medicine Faculty Papers

Drugs known as beta blockers, which antagonize the beta-adrenergic receptor (beta-AR), are an important component of the treatment regimen for chronic heart failure (HF). However, a significant body of evidence indicates that genetic heterogeneity at the level of the beta(1)-AR may be a factor in explaining the variable responses of HF patients to beta blockade. In this issue of the JCI, Rochais et al. describe how a single amino acid change in beta(1)-AR alters its structural conformation and improves its functional response to carvedilol, a beta blocker currently used in the treatment of HF (see the related article beginning on …

Contrasting Roles Of Neural Firing Rate And Local Field Potentials In Human Memory, A. Ekstrom, Indre Viskontas, M. Kahana, J. Jacobs, K. Upchurch, S. Bookheimer, I. Fried

Psychology

Recording the activity of neurons is a mainstay of animal memory research, while human recordings are generally limited to the activity of large ensembles of cells. The relationship between ensemble activity and neural firing rate during declarative memory processes, however, remains unclear. We recorded neurons and local field potentials (LFPs) simultaneously from the same sites in the human hippocampus and entorhinal cortex (ERC) in patients with implanted intracranial electrodes during a virtual taxi-driver task that also included a memory retrieval component. Neurons increased their firing rate in response to specific passengers or landmarks both during navigation and retrieval. Although we …

Com Outlook Winter 2007, College Of Osteopathic Medicine

COM Outlook

No abstract provided.

Medical Education Digest, Vol. 9 No. 1 (January/February 2007), Nova Southeastern University

Medical Education Digest

No abstract provided.

Enhanced Care Assistant Training To Address The Workforce Crisis In Home Care: Changes Related To Job Satisfaction And Career Commitment, Constance L. Coogle, Iris A. Parham, Rita Jablonski, Jason A. Rachel

Virginia Center on Aging Publications

Changes in job satisfaction and career commitment were observed as a consequence of a geriatric case management training program focusing on skills development among personal care attendants in home care. A comparison of pretraining and posttraining scores uncovered a statistically signifi cant increase in Intrinsic Job Satisfaction scores for participants 18–39 years of age, whereas levels declined among the group of middle aged participants and no change was observed among participants age 52 and older. On the other hand, a statistically signifi cant decline in Extrinsic Job Satisfaction was documented over all participants, but this was found to be primarily …

Re-Imagining The Experience And Study Of Aging, Edward F. Ansello

Director's Editorials from Age in Action

A small group of Japanese and American gerontologists have been working together toward developing a gerontology curriculum that would help people to understand the experience of aging. The group suggested adding business, information technology/communication, and education to the curriculum. The group also acknowledged that a curriculum on aging should include a way to help those of us who are not old to understand the importance for many who are old of the search for the infinite, the true self, the oneness, the spirit, or the divine, at the core of life.

Health Care Reform And Family Caregivers, Edward F. Ansello

Director's Editorials from Age in Action

Health care reform is in the air. Family caregivers need recognition, reinforcement, and a reliable resource of assistance. They need for the Commonwealth to recognize that they are the bedrock of long-term care. Minimizing investment in family caregivers would short circuit any serious effort to improve the health status and care of older Virginians.

Fiscal Year Retrospective, Edward F. Ansello

Director's Editorials from Age in Action

The Virginia Center on Aging relies on the dedication and selflessness of so many collaborating groups, agencies, and individuals to make our work for older Virginians possible. Drawing from official and informal reports from the 2006-2007 fiscal year, we thank them deeply and look forward to continuing these partnerships.

Acute And Chronic Pain Challenges For Arthritis Patients In An Acute Care Setting, Janet M. Bykowski

Case Studies from Age in Action

Educational Objectives

1. Demonstrate the importance of chronic pain management in an acute care environment.

2. Discuss the special impact of co-morbidity of arthritis upon pain management intervention.

3. Provide education to clinicians, patients, and caregivers that would promote an interdisciplinary plan of care for acute and chronic concurrent pain management.

“Powerful Tools For Caregivers”: Teaching Skills That Reduce Stress And Increase Self-Confidence, Ed Rosenberg, Natasha Gouge

Case Studies from Age in Action

Educational Objectives

1. Describe caregiving stress and burnout symptoms and effects experienced by older caregivers.

2. Report implementation and evaluation of the “Powerful Tools for Caregivers” workshop, which is designed to increase knowledge and skills in caring for elders and reduce caregiver stress.

3. Suggest ways to alleviate caregiver burden at both micro and macro levels.

Teens Teaching Alzheimer’S Caregivers To Become Tech- Savvy: The Power Of Community And Intergenerational Partnerships, Ann Bruner Duesing, Marilyn Pace Maxwell

Case Studies from Age in Action

Educational Objectives

1. Describe a successful technology project for Alzheimer’s caregivers in rural, far southwest Virginia which recruited and trained teenagers to teach computer skills to Alzheimer’s caregivers and taught the teenagers about caregiving and the disease.

2. Identify barriers for Alzheimer’s caregivers to learning and using technology to assist and support them in their caregiving, and identify successful ways to address these barriers.

Pace: Program Of All-Inclusive Care For The Elderly, Laura R. Gadsby

Case Studies from Age in Action

Educational Objectives

1. Describe the Program of Allinclusive Care for the Elderly model of care for frail seniors with chronic health care needs.

2. Demonstrate how PACE benefits providers in the delivery of services.

3. Explain how the PACE concept complements Virginia’s Long Term Care Reform, as well as initiatives to develop further the PACE program in Virginia.