Digital Commons Network^™

Current Significance Of Meconium Plug Syndrome., Scott J. Keckler, Shawn D. St Peter, Troy L. Spilde, Kuojen Tsao, Daniel J. Ostlie, G W. Holcomb Iii, Charles L. Snyder

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The significance of meconium plug syndrome is dependent on the underlying diagnosis. The incidence of pathologic finding, particularly Hirschsprung's disease, contributing to the presence of these plugs, has been debated. However, there are little recent data in the literature. Therefore, we reviewed our experience with meconium plugs as a cause of abdominal distension to evaluate the associated conditions and incidence of Hirschsprung's disease.

METHODS: We reviewed the records of newborns with meconium plugs found in the distal colon on contrast enema from 1994 to 2007. Demographics, radiologic findings, histologic findings, operative findings, and clinical courses were reviewed.

RESULTS: During …

Lead-Associated Endocarditis: The Important Role Of Methicillin-Resistant Staphylococcus Aureus., Arnold J. Greenspon, Eugene S. Rhim, George Mark, Joseph Desimone, Reginald T. Ho

Division of Cardiology Faculty Papers

BACKGROUND: Infection is a potentially life-threatening complication of cardiac device implantation. Lead-associated endocarditis (LAE) may be the most serious complication since it is associated with a high mortality. METHODS: The medical records of patients referred to our institution for the treatment of LAE between 1999 and 2007 were reviewed. RESULTS: A total of 51 of 107 patients referred for device-related infections met the criteria for LAE. Of these, 19 occurred within 6 months of their most recent procedure (early), while the remaining 32 occurred more than 6 months later (mean = 31.9 months post procedure). Devices included pacemakers in 33 …

Chest Radiograph After Central Line Placement Under Fluoroscopy: Utility Or Futility?, Scott J. Keckler, Troy L. Spilde, Brian Ho, Kuojen Tsao, Daniel J. Ostlie, G W. Holcomb Iii, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Postoperative portable chest films are routinely performed after fluoroscopic placement of central venous catheters to evaluate positioning and to rule out significant complications (eg, pneumothorax). Emerging evidence in the literature has called this practice into question suggesting that routine postoperative chest x-ray is unnecessary. Therefore, we investigated our recent experience to examine the utility of these films, to examine the development of symptoms relative to therapeutic intervention, and to report a cost-benefit analysis.

METHODS: After obtaining institutional review board approval, all charts of patients undergoing central venous catheter placement from January 2004 to December 2005 at our institution were …

Surgical Treatment Of A Rare Primary Renal Carcinoid Tumor With Liver Metastasis, Roberto Gedaly, Hoonbae Jeon, Thomas D. Johnston, Patrick P. Mchugh, Randall G. Rowland, Dinesh Ranjan

Surgery Faculty Publications

BACKGROUND: Carcinoid tumors are characteristically low grade malignant neoplasms with neuroendocrine differentiation that arise in various body sites, most commonly the lung and gastrointestinal tract, but less frequently the kidneys, breasts, ovaries, testes, prostate and other locations. We report a case of a carcinoid of renal origin with synchronous single liver metastases on radiological studies.

CASE PRESENTATION: A 45 year-old patient who presented with abdominal pain was found on CT scan to have lesions in the right ovary, right kidney, and left hepatic lobe. CA-125, CEA, and CA 19-9 were within normal limits, as were preoperative liver function tests and …

Intensive Care For Extreme Prematurity--Moving Beyond Gestational Age, Jon E Tyson, Nehal A Parikh, John Langer, Charles Green, Rosemary D Higgins

Faculty, Staff and Student Publications

BACKGROUND: Decisions regarding whether to administer intensive care to extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients.

METHODS: We prospectively studied a cohort of 4446 infants born at 22 to 25 weeks' gestation (determined on the basis of the best obstetrical estimate) in the Neonatal Research Network of the National Institute of Child Health and Human Development to relate risk factors assessable at or before birth to the likelihood of survival, survival without profound neurodevelopmental impairment, and survival without neurodevelopmental impairment at a corrected age of 18 to …

Serum Proteomic Profiles In Inflammatory And Non-Inflammatory Cardiomyopathies: A Novel Approach For Diagnostic Biomarker Discovery, Oyere Onuma

Yale Medicine Thesis Digital Library

The aim of this project is to develop a noninvasive serum test that predicts histologic forms of myocarditis (inflammatory) and dilated (non-inflammatory) cardiomyopathy using proteomic techniques to analyze serum proteins. Idiopathic dilated cardiomyopathy (DCM) and myocarditis (myocardial inflammation) represent a spectrum of heart muscle disease of various etiologies that usually present with progressive heart failure. Together, they constitute the leading cause of heart transplantation in the United States. Currently, the gold standard of diagnosis of myocarditis is by endomyocardial biopsy (EMB) and histopathological classification according to the Dallas Criteria ; however this diagnostic technique is severely limited by its invasiveness, …

Surrogate Markers Of Success In The Bariatric Surgery Population, Alain Ramirez

Yale Medicine Thesis Digital Library

Purpose: The purpose of this study was to examine the associations between pre-operative weight loss, weight loss programs, and clinic attendance relative to the success of gastric bypass in class II and III obese patients. Background: The increasing number of obese children and adults in the United States poses an extensive social problem in the era of managed care. Notwithstanding the stigmatization associated with obesity, the considerable health implications along with the financial burden it imposes create a formidable adversary. Surgical procedures have proved to be superior to conservative and pharmacotherapeutic interventions in the morbidly obese. Despite the overall success …

Surveillance Of Cirrhosis For Hepatocellular Carcinoma: A Cost-Utility Analysis., Coon J Thompson, G. Rogers, P. Hewson, D. Wright, R. Anderson, S. Jackson, S. Ryder, M. Cramp, K. Stein

Peninsula Medical School

Using a decision-analytic model, we evaluated the effectiveness and cost-effectiveness of surveillance for hepatocellular carcinoma (HCC) in individuals with cirrhosis. Separate cohorts with cirrhosis due to alcoholic liver disease, hepatitis B and hepatitis C were simulated. Results were also combined to approximate a mixed aetiology population. Comparisons were made between a variety of surveillance algorithms using alpha-foetoprotein (AFP) assay and/or ultrasound at 6- and 12-monthly intervals. Parameter estimates were obtained from comprehensive literature reviews. Uncertainty was explored using one-way and probabilistic sensitivity analyses. In the mixed aetiology cohort, 6-monthly AFP+ultrasound was predicted to be the most effective strategy. The model …

Meta-Analysis Of Alexithymia In Posttraumatic Stress Disorder., Paul A Frewen, David J A Dozois, Richard W J Neufeld, Ruth A Lanius

Psychology Publications

The authors present a meta-analysis investigating the prevalence of alexithymia in 12 studies encompassing 1,095 individuals with posttraumatic stress disorder (PTSD). A large effect size was found associating PTSD with alexithymia. Effect sizes were higher in studies of male combat PTSD samples in comparison with studies of other PTSD samples. Clinical and research directions are discussed.

The State Of The Art In Evaluating The Performance Of Assistant And Associate Deans As Seen By Deans And Assistant And Associate Deans., David G. Dunning, Timothy M. Durham, Mert N. Aksu, Brian M. Lange

Journal Articles: College of Dentistry

This study explores the little-understood process of evaluating the performance of assistant and associate deans at dental colleges in the United States and Canada. Specifically, this research aimed to identify the methods, processes, and outcomes related to the performance appraisals of assistant/associate deans. Both deans and assistant/associate deans were surveyed. Forty-four of sixty-six deans (66.7 percent) and 227 of 315 assistant/associate deans (72.1 percent) completed surveys with both close-ended and open-ended questions. In addition, ten individuals from each group were interviewed. Results indicate that 75-89 percent of assistant/associate deans are formally evaluated, although as many as 27 percent may lack …

Impaired Endothelium-Dependent Vasodilation In Overweight And Obese Adult Humans Is Not Limited To Muscarinic Receptor Agonists, Gary P. Van Guilder, Brian L Stauffer, Jared J Greiner, Christopher A Desouza

Health and Nutritional Sciences Faculty Publications

Muscarinic receptor agonists have primarily been used to characterize endothelium-dependent vasodilator dysfunction with overweight/obesity. Reliance on a single class of agonist, however, yields limited, and potentially misleading, information regarding endothelial vasodilator capacity. The aims of this study were to determine 1) whether the overweight/obesity-related reduction in endothelium-dependent vasodilation extends beyond muscarinic receptor agonists and 2) whether the contribution of nitric oxide (NO) to endothelium-dependent vasodilation is reduced in overweight/obese adults. Eighty-six middle-aged and older adults were studied: 42 normal-weight (54 +/- 1 yr, 21 men and 21 women, body mass index = 23.4 +/- 0.3 kg/m(2)) and 44 overweight/obese (54 …

Fat Embolism Syndrome., Renu Saigal, M Mittal, A Kansal, Y Singh, P R. Kolar, Shobhit Jain

Manuscripts, Articles, Book Chapters and Other Papers

Fat embolism syndrome is a rare complication occurring in 0.5 to 2% of patients following a long bone fracture. It is believed to be caused by the toxic effects of free fatty acids. Diagnosis is clinical, based on respiratory, cerebral and dermal manifestations. Treatment is only supportive, directed mainly at maintaining respiratory functions.

Preventing Cardiovascular Disease In Kentucky: Epidemiology, Trends, And Strategies For The Future, Sarah Sartini Rugg, Alison L. Bailey, Steven R. Browning

Internal Medicine Faculty Publications

Cardiovascular disease (CVD) is the leading cause of death in the United States despite dramatic improvements in the treatment of heart disease in recent years. Kentucky leads the nation in the prevalence of several individual risk factors for cardiovascular disease, the prevalence of multiple risk factors, and in cardiovascular mortality. While trends in the prevalence of some of these cardiac risk factors have shown improvement, others have remained unchanged or have worsened. The increased prevalence of obesity and diabetes, especially among young persons, is one of the most worrisome trends. The prevalence of smoking in Kentucky remains high, and has …

Retinal Pigment Epithelial Tears After Intravitreal Bevacizumab Injection For Exudative Age-Related Macular Degeneration., Sunir Garg, Roy Brod, David Kim, R Gary Lane, Joseph Maguire, David Fischer

Wills Eye Hospital Papers

PURPOSE: To determine the incidence of and the risk factors for the development of retinal pigment epithelial (RPE) tears after intravitreal bevacizumab (Avastin) injection for the treatment of exudative age-related macular degeneration (AMD).

METHODS: A retrospective, multicentre, consecutive interventional case series of all patients with subfoveal exudative AMD treated with intravitreal bevacizumab between August 2005 and April 2007. The main outcome measures were pre- and post-RPE tear visual acuity and choroidal neovascular membrane lesion types, incidence of tears and time from first injection until development of the tear.

RESULTS: A total of 920 eyes with exudative AMD were treated with …

The Effect Of Dexmedetomidine On The Mini-Cog Score And High-Mobility Group Box 1 Levels In Elderly Patients With Postoperative Neurocognitive Disorders Undergoing Orthopedic Surgery, Joan M Mastrobattista, Mark A Klebanoff, J Christopher Carey, John C Hauth, Cora A Macpherson, J Ernest, Margaret Cotroneo, Kenneth J Leveno, Ronald Wapner, Michael Varner, Jay D Iams, Atef Moawad, Baha M Sibai, Menachem Miodovnik, Mitchell Dombrowski, Mary J O'Sullivan, J Peter Vandorsten, Oded Langer

Faculty, Staff and Student Publications

Our objective was to determine the effect of body mass index (BMI) on response to bacterial vaginosis (BV) treatment. A secondary analysis was conducted of two multicenter trials of therapy for BV and TRICHOMONAS VAGINALIS. Gravida were screened for BV between 8 and 22 weeks and randomized between 16 and 23 weeks to metronidazole or placebo. Of 1497 gravida with asymptomatic BV and preconceptional BMI, 738 were randomized to metronidazole; BMI was divided into categories: < 25, 25 to 29.9, and > or = 30. Rates of BV persistence at follow-up were compared using the Mantel-Haenszel chi square. Multiple logistic regression was used to evaluate the effect …

Robotic Dismembered Pyeloplasty In A Horseshoe Kidney After Failed Endopyelotomy., Mark L. Pe, Steven N. Sterious, Ji-Bin Liu, Costas D. Lallas

Department of Urology Faculty Papers

We report our experience performing a robot-assisted dismembered pyeloplasty on a patient with a ureteropelvic junction obstruction in a horseshoe kidney and a prior history of endopyelotomy. We provide 18-month follow-up demonstrating that robotic pyeloplasty is a reasonable second treatment option for patients with horseshoe kidneys with failed prior endourological management.

Abstracts In High Profile Journals Often Fail To Report Harm, Enrique Bernal-Delgado, Elliot S. Fisher

Dartmouth Scholarship

To describe how frequently harm is reported in the abstract of high impact factor medical journals. We carried out a blinded structured review of a random sample of 363 Randomised Controlled Trials (RCTs) carried out on human beings, and published in high impact factor medical journals in 2003. Main endpoint: 1) Proportion of articles reporting harm in the abstract; and 2) Proportion of articles that reported harm in the abstract when harm was reported in the main body of the article. Analysis: Corrected Prevalence Ratio (cPR) and its exact confidence interval were calculated. Non-conditional logistic regression was used.

The Acute Effects Of Elevated Blood Lipid Levels On Endothelial Function, Alexander Nissen

Yale Medicine Thesis Digital Library

The association between prolonged elevation of blood lipid levels and coronary artery disease is well established. Research focusing on the acute effects of hyperlipidemia is not as abundant, and often looks only at large-sized arteries. The purpose of our study was to measure the acute effects of elevated blood lipid levels on microvascular endothelial function, non-invasively, by means of laser Doppler flowmetry and the administration of vasoactive challenges. With IRB approval, six healthy subjects were recruited for a three-session study in which they were given isocaloric meals with variable fat content (non-fat meal = NM; fatty meal = FM; or …

The Use And Safety Of Vascular Occlusion Techniques: A Survey Of Practicing Surgeons, Ryan Kelly

Yale Medicine Thesis Digital Library

Vascular occlusion techniques can be divided into two categories ¡V transfixion and non-transfixion. Transfixion techniques are defined by the passage of suture material or staples through the vascular tissue. Non-transfixion techniques are defined as suture, metal, or polymer material placed solely around the vascular tissue. The purpose of this study was to survey surgeons in various specialties to determine which vascular control technique they believe is safest and most appropriate to manage medium-sized arteries 6-10mm in diameter. A survey was distributed to surgeons in the following specialties: general surgery, urology, thoracic surgery, vascular surgery, obstetrics and gynecology, and colon and …

A Technological Approach To Reaching A Hidden Population Of Problem Drinkers., Daniel Z Lieberman, Suena W Huang

Psychiatry and Behavioral Sciences Faculty Publications

OBJECTIVE: The most common obstacle to the treatment of individuals with drinking problems is that most do not seek treatment. This study compared a group of treatment-seeking patients with users of an alcohol-evaluation Web site to determine whether an Internet application could reach a population of problem drinkers who are distinct from those served by currently available forms of care.

METHODS: An open-source application was developed that was modeled on the Drinker's Check-Up, which has been shown to increase motivation for behavior change while presenting itself as a nonthreatening evaluation. To recruit non-treatment seekers, the program was offered as a …

Verb Generation In Children With Spina Bifida, Maureen Dennis, Derryn Jewell, Ross Hetherington, Christine Burton, Michael E. Brandt, Susan E. Blaser, Jack M Fletcher

Faculty, Staff and Student Publications

We investigated verb generation in children with spina bifida meningomyelocele (SBM; n = 55) and in typically developing controls (n = 32). Participants completed 6 blocks (40 trials each) of a task requiring them to produce a semantically related verb in response to a target noun and an additional 40 trials on which they were simply required to read target nouns aloud. After controlling for reading response time, groups did not differ significantly in verb generation response time or learning. Children with SBM produced more non-verb errors than controls and tended to repeat their mistakes over blocks. Verb generation performance …

Clinical And Microbiological Aspects Of Linezolid Resistance Mediated By The Cfr Gene Encoding A 23s Rrna Methyltransferase, Cesar A Arias, Martha Vallejo, Jinnethe Reyes, Diana Panesso, Jaime Moreno, Elizabeth Castañeda, Maria V Villegas, Barbara E Murray, John P Quinn

Faculty, Staff and Student Publications

The cfr (chloramphenicol-florfenicol resistance) gene encodes a 23S rRNA methyltransferase that confers resistance to linezolid. Detection of linezolid resistance was evaluated in the first cfr-carrying human hospital isolate of linezolid and methicillin-resistant Staphylococcus aureus (designated MRSA CM-05) by dilution and diffusion methods (including Etest). The presence of cfr was investigated in isolates of staphylococci colonizing the patient's household contacts and clinical isolates recovered from patients in the same unit where MRSA CM-05 was isolated. Additionally, 68 chloramphenicol-resistant Colombian MRSA isolates recovered from hospitals between 2001 and 2004 were screened for the presence of the cfr gene. In addition to erm(B), …

The Management Of Keloids: Hands-On Versus Hands-Off., James Studdiford, Amber Stonehouse, Marc Altshuler, Elliot Rinzler

Department of Family & Community Medicine Faculty Papers

Keloids are benign fibrous growths that appear in scar tissue. The lesions can be severely disfiguring and early recognition of genetic lesions is crucial. This case report outlines and reviews the important management strategies for these lesions and the requirement for extensive counseling for the patient and their family. Many potential medical and surgical interventions exist. Unfortunately, these lesions tend to recur and overall outcomes remain poor. Given patient susceptibility to disfiguring results, surgical intervention should be used with extreme caution.

Computational Models Of Tandem Src Homology 2 Domain Interactions And Application To Phosphoinositide 3-Kinase, Dipak Barua, James R. Faeder, Jason M. Haugh

Chemical and Biochemical Engineering Faculty Research & Creative Works

Intracellular signal transduction proteins typically utilize multiple interaction domains for proper targeting, and thus a broad diversity of distinct signaling complexes may be assembled. Considering the coordination of only two such domains, as in tandem Src homology 2 (SH2) domain constructs, gives rise to a kinetic scheme that is not adequately described by simple models used routinely to interpret in vitro binding measurements. To analyze the interactions between tandem SH2 domains and bisphosphorylated peptides, we formulated detailed kinetic models and applied them to the phosphoinositide 3-kinase p85 regulatory subunit/platelet-derived growth factor β-receptor system. Data for this system from different in …

Using Built Environment Characteristics To Predict Walking For Exercise, Gina S. Lovasi, Anne V. Moudon, Amber L. Pearson, Philip M. Hurvitz, Eric B. Larson, David S. Siscovick, Ethan M. Berke

Dartmouth Scholarship

Environments conducive to walking may help people avoid sedentary lifestyles and associated diseases. Recent studies developed walkability models combining several built environment characteristics to optimally predict walking. Developing and testing such models with the same data could lead to overestimating one's ability to predict walking in an independent sample of the population. More accurate estimates of model fit can be obtained by splitting a single study population into training and validation sets (holdout approach) or through developing and evaluating models in different populations. We used these two approaches to test whether built environment characteristics near the home predict walking for …

Surgical Versus Nonsurgical Therapy For Lumbar Spinal Stenosis., James N Weinstein, Tor D Tosteson, Jon D Lurie, Anna N A Tosteson, Emily Blood, Brett Hanscom, Harry Herkowitz, Frank Cammisa, Todd Albert, Scott D Boden, Alan Hilibrand, Harley Goldberg, Sigurd Berven, Howard An

Rothman Institute Papers

BACKGROUND: Surgery for spinal stenosis is widely performed, but its effectiveness as compared with nonsurgical treatment has not been shown in controlled trials.

METHODS: Surgical candidates with a history of at least 12 weeks of symptoms and spinal stenosis without spondylolisthesis (as confirmed on imaging) were enrolled in either a randomized cohort or an observational cohort at 13 U.S. spine clinics. Treatment was decompressive surgery or usual nonsurgical care. The primary outcomes were measures of bodily pain and physical function on the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, …

Surgical Versus Nonsurgical Therapy For Lumbar Spinal Stenosis., James N Weinstein, Tor D Tosteson, Jon D Lurie, Anna N A Tosteson, Emily Blood, Brett Hanscom, Harry Herkowitz, Frank Cammisa, Todd J Albert, Scott D Boden, Alan Hilibrand, Harley Goldberg, Sigurd Berven, Howard An

Rothman Institute Papers

BACKGROUND: Surgery for spinal stenosis is widely performed, but its effectiveness as compared with nonsurgical treatment has not been shown in controlled trials.

METHODS: Surgical candidates with a history of at least 12 weeks of symptoms and spinal stenosis without spondylolisthesis (as confirmed on imaging) were enrolled in either a randomized cohort or an observational cohort at 13 U.S. spine clinics. Treatment was decompressive surgery or usual nonsurgical care. The primary outcomes were measures of bodily pain and physical function on the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, …

Switching Language Switches Mind: Linguistic Effects On Developmental Neural Bases Of ‘Theory Of Mind’, Chiyoko Kobayashi, Gary H. Glover, Elise Temple

Dartmouth Scholarship

Theory of mind (ToM)—our ability to predict behaviors of others in terms of their underlying intentions—has been examined through false-belief (FB) tasks. We studied 12 Japanese early bilingual children (8−12 years of age) and 16 late bilingual adults (18−40 years of age) with FB tasks in Japanese [first language (L1)] and English [second language (L2)], using fMRI. Children recruited more brain regions than adults for processing ToM tasks in both languages. Moreover, children showed an overlap in brain activity between the L1 and L2 ToM conditions in the medial prefrontal cortex (mPFC). Adults did not show such a convergent activity …

Sp1 Up-Regulates Camp-Response-Element-Binding Protein Expression During Retinoic Acid-Induced Mucous Differentiation Of Normal Human Bronchial Epithelial Cells, Jeong Soo Hong, Seung-Wook Kim, Ja Seok Koo

Faculty, Staff and Student Publications

CREB [CRE (cAMP-response element)-binding protein] is an important transcription factor that is differentially regulated in cells of various types. We recently reported that RA (retinoic acid) rapidly activates CREB without using RARs (RA receptors) or RXRs (retinoid X receptors) in NHTBE cells (normal human tracheobronchial epithelial cells). However, little is known about the role of RA in the physiological regulation of CREB expression in the early mucous differentiation of NHTBE cells. In the present study, we report that RA up-regulates CREB gene expression and that, using 5'-serial deletion promoter analysis and mutagenesis analyses, two Sp1 (specificity protein 1)-binding sites located …

Clinical And Neural Correlates Of Alexithymia In Posttraumatic Stress Disorder., Paul A Frewen, Ruth A Lanius, David J A Dozois, Richard W J Neufeld, Clare Pain, James W Hopper, Maria Densmore, Todd K Stevens

Psychology Publications

Individuals with posttraumatic stress disorder (PTSD) often exhibit deficits in emotional experience and expression, which suggests that certain individuals with PTSD may be alexithymic. In this study, in a sample of 105 individuals with PTSD, clinical correlates of alexithymia included reexperiencing, hyperarousal, numbing, dissociative symptoms, and retrospectively reported experiences of childhood emotional neglect. In a subsample of 26 individuals with PTSD related to a motor vehicle accident, functional neural responses to trauma-script imagery were associated with severity of alexithymia, including increased right posterior-insula and ventral posterior-cingulate activation and decreased bilateral ventral anterior-cingulate, ventromedial prefrontal, anterior-insula, and right inferior frontal cortex …