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Liver Transplantation In The Face Of Severe Electrolyte Abnormalities: A Discussion Of Management Techniques, Vincent Franze, Md, Rosalba Spiritoso, Md, Elia Elia, Md, Yoogoo Kang, Md

Department of Anesthesiology Faculty Papers

Introduction:

Electrolytes disorders are a common finding in patients with End stage liver disease (ESLD). Liver transplantation (OLT) is frequently associated with massive transfusion and fluid shifts in patients with renal dysfunction, and management of hyponatremla, hyperkalemia and hypervolemia are major concerns for anesthesiologists. This case describes a multimodal approach in treatment of combined severe hyponatremla, hperkalemia and hypervolemia.

Intraoperative Insulin Administration And Hypoglycemia In Diabetic Patients, Eric Schwenk, Md, Richard H. Epstein, Md, Cphims, Boris Mraovic

Department of Anesthesiology Faculty Papers

Introduction:

Although studies are conflicting as to the benefit of intensive insulin therapy (IIT) in the critically ill, there is a 6x increase in hypoglycemia incidence in patients treated with IIT.

Anesthesia masks signs and symptoms of hypoglycemia, making intraop hypoglycemia difficult to detect clinically.

We performed this retrospective, observational analysis to:

Determine the incidence of intraoperative hypoglycemia and severe hypoglycemia

Evaluate possible causes of hypoglycemia

Determine intraop monitoring and treatment practices of diabetic patients at a large academic hospital

Non-Contrast Mri May Predict Safety Of Gadolinium-Enhanced Mri In Patients With Cirrhosis, Jonathan M. Fenkel, Md, Colin L. Smith, Md, Leela Nayak, Md, Steven K. Herrine, Md, Donald G. Mitchell, Md

Division of Gastroenterology and Hepatology Faculty Papers

Background:

Hepatorenal syndrome (HRS) is a relative contraindication to receiving gadolinium-based contrast media secondary to risk of nephrogenic systemic fibrosis (NSF)

Patients with cirrhosis frequently undergo magnetic resonance imaging (MRI) for hepatocellular cancer screening and liver transplant evaluation.

Most centers require documented serum creatinine levels within 10-14 days of performing MRIs on patients with cirrhosis.

Ascites can be readily detected on MRI without contrast enhancement.

Objective:

To determine whether the presence of ascites on MRI can be used to recommend against a diagnosis of HRS without knowledge of a serum creatinine level.

Ambulatory Care Registered Nurse Performance Measurement, Beth Ann Swan, Phd, Crnp, Faan, Sheila A. Hass, Phd, Rn, Faan, Marilyn Chow, Dnsc, Rn, Faan

College of Nursing Faculty Papers & Presentations

Executive Summary:

On March 1-2, 2010, a state-of-the-science invitational conference titled "Ambulatory Care Registered Nurse Performance Measurement" was held to focus on measuring quality at the RN provider level in ambulatory care.

The conference was devoted to ambulatory care RN performance measurement and quality of health care.

The specific emphasis was on formulating a research agenda and developing a strategy to study the testable components of the RN role related to care coordination and care transitions, improving patient outcomes, decreasing health care costs, and promoting sustainable system change.

Clinical And Diagnostic Features Of Patients With Compound Heterozygous A467t/W748s Polg1 Mutations: A Case Report And Review Of Previous Cases, David Roshal, D.O., Andro Zangaladze, Md, Phd

Department of Neurology Faculty Papers

Introduction

Mutations in the POLG1 gene are considered to be the most common gene defect identified in autosomal recessive mitochondrial DNA depletion disorders. POLG1 is a gene encoding the 195kDa catalytic (alpha) subunit of the mitochondrial (gamma) DNA polymerase, located on chromosome 15q25 and is responsible for mtDNA replication. Mutations in POLG1 are associated with chronic progressive external ophthalmoplegia (CPEO). Other genes that have been implicated in causing syndromic and non-syndromic mitochondrial disorders have been found on both mtDNA (3243A>G, 8344A>G, 8993T>G, and 11778A>G) and nDNA (SURF1, POLG1, TWINKLE, and ANT1).

We report a patient with …

Transforming Chronic Care Education: A Longitudal Interprofessional Mentorship Curriculum, Lauren G. Collins, Md, Christine A. Arenson, Md, Christine Jerpbak, Md, Elena Umland, Pharmd, Stephen B. Kern, Phd, Otr/L, Faota, Leigh Ann Hewston, Pt, Med

Department of Family & Community Medicine Faculty Papers

Rationale:

Future state of academic medicine demands preparing students for collaborative, team-based practice.

Interprofessional education (IPE) is widely advocated as a key element to promote an effective redesigned healthcare system

Evidence and curricular resources describing effective IPE remain limited

Jefferson Alumni Bulletin – Volume 59, Number 4, Fall 2010

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

Jefferson Alumni Bulletin – Volume 59, Number 4, Fall 2010

Dean's Message, page 2

Findings: Studies Produce New Tumor Growth Theory, Page 4

No Longer Fringe: Integrative Medicine Blends In, page 6

Breathing New Life into CPR, page 12

The Art of Healing: The Gross Clinic Reborn, page 14

Faculty Profile: Charlie Yeo: The Consummate Competitor, page 20

On Campus, page 22

Class Notes, page 26

Giving, page 32

In Memoriam, page 44

By the Numbers, page 46

Clinical Accuracy Of A Hospital Point-Of-Care Glucose Meter, Brian R. Hipszer, Phd, Jennifer B. Lessin, Rn, Kathleen O'Malley, Rn, Zvi Grunwald, Md, Jeffrey I. Joseph, D.O.

Department of Anesthesiology Faculty Papers

Summary: Glucose meter performance was evaluated against the ISO 15197 guidelines in 221 time-matched venous and capillary blood samples. Accuracy decreased when the source of the reference and meter blood samples was not the same.

From Survival To Survivorship: Late Side Effects Become An Issue In High-Grade Glioma., Yaacov R Lawrence, Wenyin Shi, Adam P Dicker

Department of Radiation Oncology Faculty Papers

“For many patients, controlling neurological symptoms, preventing cognitive dysfunction and maintaining functional independence are just as important as prolonging survival.”

Are Roadside Pedestrian Injury Patterns Predictable In A Densely Populated, Urban Setting?, Niels D. Martin, Daniel J. Grabo, Lili Tang, Jacqueline Sullivan, Kris R. Kaulback, Michael S. Weinstein, Gary A. Lindenbaum, Murray J. Cohen

Department of Surgery Faculty Papers

BACKGROUND: Roadside pedestrian injuries represent a significant portion of trauma team activations, especially at urban trauma centers. Patient demographics and severity of injury vary greatly in this patient population. Herein, we hypothesize that injury patterns may be predictable, especially with respect to age.

MATERIALS AND METHODS: All patients with roadside pedestrian injuries evaluated at our urban, level one trauma center from January 2006 through December 2008 were retrospectively reviewed. Data were collected from the institutional trauma registry. Age was used as an independent variable and compared with injury type, substance abuse, discharge setting, and mortality.

RESULTS: There were 226 roadside …

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

Department of Surgery Faculty Papers

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.

S100a1: A Multifaceted Therapeutic Target In Cardiovascular Disease., David Rohde, Julia Ritterhoff, Mirko Voelkers, Hugo A Katus, Thomas G Parker, Patrick Most

Department of Medicine Faculty Papers

Cardiovascular disease is the leading cause of death worldwide, showing a dramatically growing prevalence. It is still associated with a poor clinical prognosis, indicating insufficient long-term treatment success of currently available therapeutic strategies. Investigations of the pathomechanisms underlying cardiovascular disorders uncovered the Ca(2+) binding protein S100A1 as a critical regulator of both cardiac performance and vascular biology. In cardiomyocytes, S100A1 was found to interact with both the sarcoplasmic reticulum ATPase (SERCA2a) and the ryanodine receptor 2 (RyR2), resulting in substantially improved Ca(2+) handling and contractile performance. Additionally, S100A1 has been described to target the cardiac sarcomere and mitochondria, leading to …

Sarcoidosis Cannot Be Reliably Distinguished From Other Causes Of Hepatic Granulomas In A Liver Biopsy Alone, Phililp A. Grieshaber, Md, Whitney Jackson, Md, John L. Farber, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Context:

Hepatic granulomas occur in a variety of circumstances. Sarcoidosis is a common cause with the liver following lymph nodes and the lung in frequency of involvement. The present study aimed to determine where granulomatous hepatisis caused by sarcoidosis can be distinguished in a liver biopsy from other etiologies.

The Added Value Of Molecular Testing In Small Pancreatic Cysts, Adam D. Toll, Md, Marluce Bibbo, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background:

Cystic lesions of the pancreas (CLP) represent a relatively common pathologic entity affecting at least 1% of medical patients and represent a spectrum of lesions from inflammatory pseudocyststo malignant neoplasms. A significant percentage of these cysts are found incidentally during imaging work-up for unrelated conditions and require appropriate diagnostic testing to characterize the nature of the CLP. A multi-disciplinary approach to characterize CLP is currently used involving cytology, imaging, and cyst fluid analysis. The most recent international guidelines recommend resection of pancreatic mucinouscysts >3 cm, or smaller cysts with positive cytology, mural nodules, or symptoms.

Recent work utilized DNA …

Interesting Case Presentation: Placental Site Trophoblastic Tumor, Nicole Qualtieri, Ms, Pa (Ascp), Andrea Gadue, Mhs, Pa (Ascp)

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Case Study:

A 26 year-old female (G3P1) had a D&E in March, 2010 for a blighted ovum. The diagnosis on the uterine contents at an outside institution was placental site trophoblastic tumor. No follow up care was obtained. Four months later (July, 2010), the patient presented to her OB-GYN stating that she had missed a period and had a positive home pregnancy test. An ultrasound examination failed to identify a fetus, and the patient was referred to TJUH.

At Jefferson an MRI showed a poorly defined uterine mass that extended into the myometrium. The slides from the original D&E were …

Proteoglycans In Health And Disease: Novel Regulatory Signaling Mechanisms Evoked By The Small Leucine-Rich Proteoglycans., Renato V. Iozzo, Liliana Schaefer

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The small leucine-rich proteoglycans (SLRPs) are involved in many aspects of mammalian biology, both in health and disease. They are now being recognized as key signaling molecules with an expanding repertoire of molecular interactions affecting not only growth factors, but also various receptors involved in controlling cell growth, morphogenesis and immunity. The complexity of SLRP signaling and the multitude of affected signaling pathways can be reconciled with a hierarchical affinity-based interaction of various SLRPs in a cell- and tissue-specific context. Here, we review this interacting network, describe new relationships of the SLRPs with tyrosine kinase and Toll-like receptors and critically …

Factors Influencing The One- And Two-Year Growth Response In Children Treated With Growth Hormone: Analysis From An Observational Study., Judith Ross, Peter A Lee, Robert Gut, John Germak

Department of Pediatrics Faculty Papers

To assess gender-, pubertal-, age-related differences in change from baseline height standard deviation score (ΔHSDS), data from 5,797 growth hormone (GH) naïve pediatric patients (<18 >years) with growth hormone deficiency (GHD), multiple pituitary hormone deficiency (MPHD), Turner syndrome (TS), small for gestational age (SGA), Noonan syndrome (NS), and idiopathic short stature (ISS) were obtained from the ANSWER (American Norditropin Studies: Web-enabled Research) Program registry. For patients with SGA, ΔHSDS at year 1 was significantly greater for males versus females (P = .016), but no other gender differences were observed. For patients with GHD, ΔHSDS was greater in prepubertal than in …

Using Hospital Discharge Abstract Data To Identify Incident Breast Cancer Cases And Assess Quality Of Care, Elaine J. Yuen, Daniel Z. Louis, Carol Rabinowitz, Vittorio Maio, L. Cisbani, R. Depalma, R. Grilli

College of Population Health Faculty Papers

No abstract provided.

Research Priorities In Hypertrophic Cardiomyopathy: Report Of A Working Group Of The National Heart, Lung, And Blood Institute., Thomas Force, Robert O Bonow, Steven R Houser, R John Solaro, Ray E Hershberger, Bishow Adhikari, Mark E Anderson, Robin Boineau, Barry J Byrne, Thomas P Cappola, Raghu Kalluri, Martin M Lewinter, Martin S Maron, Jeffery D Molkentin, Steve R Ommen, Michael Regnier, W H Wilson Tang, Rong Tian, Marvin A Konstam, Barry J Maron, Christine E Seidman

Center for Translational Medicine Faculty Papers

Hypertrophic cardiomyopathy (HCM) is a myocardial disorder characterized by left ventricular (LV) hypertrophy without dilatation and without apparent cause (ie, it occurs in the absence of severe hypertension, aortic stenosis, or other cardiac or systemic diseases that might cause LV hypertrophy). Numerous excellent reviews and consensus documents provide a wealth of additional background.1–8 HCM is the leading cause of sudden death in young people and leads to significant disability in survivors. It is caused by mutations in genes that encode components of the sarcomere. Cardiomyocyte and cardiac hypertrophy, myocyte disarray, interstitial and replacement fibrosis, and dysplastic intramyocardial arterioles characterize the …

Physician Leadership And Medical Group Performance: A National Study

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Changing Social Environments To Promote Health: Evidence, Opportunities And Challenges

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Consumer Health Informatics And Healthcare Disparities

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Online Presence And Social Media: The Jsph Experience, Laura Kimberly Mbe, Msw, Lisa Chosed Ma, Emily Frelick Ms

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

How Pennsylvania's Budget Shapes Service Delivery

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Greater Philadelphia Schweitzer Program Welcomes New Fellows, Nicole Moore Ma

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Functional: Students Taking An Active Role In Shaping Health Policy, Bridget Peterson, Irmina Haq

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

The Value Of Interdisciplinary Education: Learning Together Helps Make Care Safer, Valerie P. Pracilio Mph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Moving Philadelphia! Creating Healthier Communities, Laura Kimberly Msw, Mbe

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Improving The Appopriateness Of Prescribing Medicine In The Elderly: A Comprehensive Approach In The Local Health Unit Of Parma, Italy, Karina Herrera Ms, Stefano Del Canale Md, Phd, Ettore Brianti Md, Massimo Fabi Md, Daniel Louis Ms, Vittorio Maio Pharmd, Ms, Msph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Arthur C. Bachmeyer Memorial Lecture, David B. Nash Md, Mba

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.