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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.

Jefferson Kimmel Cancer Center Support Groups

Bodine Journal

Listing of Jefferson Kimmel Cancer Center Support Groups.

Young Investigator Awards

Bodine Journal

Robert Den, MD, Laura Doyle, MS, Nitin Ohri, MD and Evan Wuthrick, MD

New Faculty Members

Bodine Journal

New faculty members: Voichita (Voika) Bar Ad, MD and Wenyin Shi, MD, PhD.

The Gucy2c Tumor Suppressor Is The Nexus Of A Paracrine Hormone Axis Preventing Radiotherapy-Induced Gastrointestinal (Gi) Toxicity, E. J. Wuthrick, P. Li, J. E. Lin, A. P. Dicker, D. Leeper, S. A. Waldman

Bodine Journal

Purpose/Objective: Radiation-induced GI toxicity is the primary dose limitation compromising therapy in cancer patients treated with radiation therapy. GUCY2C is the intestinal receptor for diarrheagenic bacterial enterotoxins and the endogenous paracrine hormones guanylin and uroguanylin. Following genomic insult, cyclic (c)GMP produced by ligand activation of GUCY2C enhances DNA damage sensing and repair in intestinal cells. Here, we show that the GUCY2C-cGMP axis mediates p53-dependent radioprotection of intestinal epithelial cells.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA

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

Bodine Journal

Purpose/Objective(s): In light of public concerns regarding the quality of radiation treatment delivery, we surveyed the utilization of “chart rounds” or peer-review quality assurance meetings, within North American academic institutions.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA

Potential For Dose-Escalation In The Post-Prostatectomy Setting With Intensitymodulated Radiation Therapy: A Dosimetric Study Using Eortc Consensus Guidelines For Target Volume Contours, M. Studenski, A. Harrison, S. Anamalayil, A. Harvey, E. Trabulsi, Y. Xiao, Y. Yu, A. P. Dicker, T. N. Showalter

Bodine Journal

Purpose: Radiation therapy (RT) is delivered after radical prostatectomy (RP) for prostate cancer (PC). Although intensity modulated radiation therapy (IMRT) has become standard in definitive RT for PC, dosimetric data in support of post-RP IMRT are limited. This study was designed to quantify benefits of IMRT versus 3D conformal RT (3DCRT) with respect to dose sparing of rectum and bladder and target volume coverage. Motivated by the desire to deliver higher radiation doses and to quantify the dosimetric impact of IMRT, we retrospectively analyzed images in order to: 1) identify a preferred IMRT beam arrangement; 2) evaluate the dosimetric advantages …

Costs Of Early Adjuvant Radiation Therapy After Radical Prostatectomy: A Decision Analysis, T. N. Showalter, K. A. Foley, E. Jutkowitz, C. Lallas, A. J. Harvey, E. J. Trabulsi, L. G. Gomella, A. P. Dicker, L. T. Pizzi

Bodine Journal

Purpose/Objective(s): Prospective, randomized trials support adjuvant radiation therapy (RT) for adverse pathologic features after radical prostatectomy (RP). However, adjuvant RT is not universally delivered in this setting. Criticisms of adjuvant RT include toxicity, financial costs, potential overtreatment, and effectiveness of salvage RT. The objective of this study was to construct a decision analytic model to estimate real world cost of RT vs. no RT within the context of the effectiveness of early adjuvant RT for prostate patients based on published clinical results of the Southwest Oncology Group prospective trial of adjuvant RT (SWOG 8794).

American Society for Therapeutic Radiation Oncology …

Mirab: An Image-Guided Multichannel Robot For Prostate Brachytherapy, T. Podder, I. Buzurovic, K. Huang, Y. Yu

Bodine Journal

Purpose: To date, twelve robotic systems have been developed worldwide for brachytherapy, especially for seed implantation. However, the only system that has provision for simultaneous insertion of multiple needles is the MIRAB system. This article reports the feasibility and efficacy of the MIRAB robot as ultrasound image-guided autonomous delivery of radioactive seeds for treating prostate cancers.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA

Intensity Modulated Radiation Therapy Compared With 3d Conformal Radiotherapy For Craniospinal Irradiation In Adults – Do We Gain Anything?, X. Shen, M. Studenski, A. Harrison, Y. Xiao, T. Biswas

Bodine Journal

Purpose: Craniospinal irradiation (CSI) remains one of the most technically challenging planning processes in radiation oncology due to its long shape especially in adults and complex target volume. In addition, CSI is associated with significant acute and late morbidities. We undertook a dosimetric analysis to determine if intensity modulated radiation therapy (IMRT) could improve target coverage while sparing normal tissue structures compared to classic 3D conformal radiation (3D‐CRT) planning.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA

Reirradiation For Recurrent Meningioma, N. Ohri, A. Wojcieszynski, J. J. Evans, D. W. Andrews, M. Werner-Wasik

Bodine Journal

Purpose/Objective(s): Management options for meningioma include observation, surgical resection, and radiation therapy (RT). In cases of progressive or recurrent disease after RT, similar options exist. The control rate following a second course of RT is unknown.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA

Prophylactic Radiation Therapy Is Safe And Effective Treatment For The Prevention Of Recurrent Heterotopic Ossification In Elbow And Knee Joints, M. V. Mishra, L. Austin, J. Parvisi, M. Ramsey, T. N. Showalter

Bodine Journal

Background: Background Prophylactic radiation therapy (RT) is an established adjuvant therapy for heterotopic ossification (HO) of the hip when delivered in the immediate pre- or post-operative setting. Its role in prevention of recurrence after excision of HO is supported by randomized trials for HO of the hip, but there is scant evidence to support a similar approach in non-hip joints. In the current study, we evaluate radiologic and functional outcomes after prophylactic radiation therapy (RT) for prevention of HO of the knee and upper extremity [elbow and metacarpophalangeal (MCP) joints].

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting …

Early Stage Testicular Seminoma: A Multicenter Review Of Treatment Outcomes And Patterns Of Recurrence, M. Kim, E. Wuthrick, A. Lin

Bodine Journal

Purpose/Objective(s): Although overall survival for early stage testicular seminoma is generally excellent, certain pathologic factors can increase recurrence risk for those undergoing observation, while radiation therapy (RT) can be associated with long-term morbidity. We sought to identify disease-related and treatment-related factors that influenced the outcomes, with particular emphasis on recurrence risk, patterns and timing of recurrence, as well as RT-induced malignancy.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA

Substantial Dose-Response Relationship With Clinical Outcome For Lung Stereotactic Body Radiotherapy (Sbrt) Delivered Via Online Image Guidance, L. Kestin, I. Grills, M. Guckenberger, J. Belderbos, A. J. Hope, M. Werner-Wasik, J. J. Sonke, J. P. Bissonnette, Y. Xiao, D. Yan

Bodine Journal

Purpose: To examine potential tumor dose-response relationships with various non-small cell lung cancer (NSCLC) SBRT fractionation regimens delivered with online CT-based image guidance.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA

Poor Pulmonary Function Is Not Associated With Increased Rates Of Toxicity Or Decreased Overall Survival After Stereotactic Body Radiotherapy For Early Stage Non-Small Cell Lung Cancer: Results Of A Multi-Institutional Analysis, M. Guckenberger, J. Belderbos, A. Hope, L. L. Kestin, M. Werner-Wasik, J. J. Sonke, Y. Xiao, D. Yan, J. Wilbert, I. S. Grills

Bodine Journal

Purpose/Objective(s): Stereotactic body radiotherapy (SBRT) is considered as the treatment of choice for stage I non-small cell lung cancer (NSCLC) in medically inoperable patients. It was the purpose of this study to evaluate whether pretreatment pulmonary function is predictive for survival and toxicity after SBRT.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA

A Multi-National Pooled Analysis Of 434 Cases Of Stage I Non-Small Cell Lung Cancer (Nsclc) Treated With Volumetrically Image-Guided Stereotactic Lung Radiotherapy: Results From The Elekta Collaborative Lung Research Group, I. S. Grills, A. J. Hope, M. Guckenberger, L. L. Kestin, M. Werner-Wasik, D. Yan, J. J. Sonke, J. P. Bissonnette, Y. Xiao, J. Belderbos

Bodine Journal

Background: Published lung SBRT outcomes/dose response data for inoperable NSCLC come from small phase I-II studies or larger datasets not requiring image-guided radiotherapy (IGRT) or volumetric prescriptions. This entire cohort of SBRT patients had daily online cone-beam CT.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA

Toxicity Of Phase I Radiation Oncology Trials: Worldwide Experience, C. Glass, R. B. Den, A. P. Dicker, Y. R. Lawrence

Bodine Journal

Introduction: Informed consent involves understanding the risks and benefits of trial enrollment. This is challenging in the phase I setting since true quantitative information is never known. We therefore performed an analysis of published radiation oncology (RO) phase I trials emphasizing patient outcomes. To our knowledge, no such systemic analysis has previously been published.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA

Pathologic Correlation Of Pet-Ct Based Auto Contouring For Radiation Planning In Lung Cancer, S. E. Fogh, A. Farach, C. Intenzo, R. Axelrod, P. Mccue, A. Harper, A. Nelson, M Werner-Wasik

Bodine Journal

Purpose/Objective(s): Radiation therapy in lung cancer relies on CT and functional imaging (FDG-PET) to delineate tumor volumes. Semi-automatic contouring tools have been developed for PET to improve on the inter-observer bias of manual contouring and intrinsic differences in imaging equipment. A common method involves using a threshold at a given percentage of the max activity, which may be less accurate with smaller tumors and tumors with low source to background ratio. To overcome this deficiency, a gradient algorithm, which detects changes in image counts at the border of the tumor, has been developed. Few studies have correlated these methods to …

Igrt After Prostatectomy: Evaluation Of Corrective Shifts And Toxicity Using Online Cone Beam Ct Vs. Weekly Port Films For Target Localization, H. B. Eldredge, M. Studenski, S. Keith, E. J. Trabulsi, A. Harvey, C. Lallas, L. Gomella, A. P. Dicker, T. N. Showalter

Bodine Journal

Purpose/Objective(s): Image guidance (IG) may permit higher radiotherapy (RT) doses (>65 Gy) after radical prostatectomy (RP) without increased toxicity, with improved accuracy and smaller margins. Conebeam (CBCT) allows IGRT with volumetric images. This study evaluated CBCT shifts and toxicity after conformal IGRT, compared to RT with port films.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA

Dosimetric Comparison Of Vmat, Imrt And Proton Therapy For Post- Prostatectomy Radiation Therapy For Prostate Cancer, L. A. Doyle, M. Studenski, A. Harvey, A. P. Dicker, Y. Xiao, Y. Yu, T. N. Showalter, A. Harrison

Bodine Journal

Purpose/Objectives: Radiation therapy (RT) for the treatment of prostate cancer after radical prostatectomy (RP) is widely accepted. With technological advances, radiation treatment technique and dosimetry may vary. The purpose of this study is to quantify dosimetric difference of proton therapy versus VMAT and IMRT focusing on bladder and rectal dose sparing and target coverage.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA

Should Hypopharynx Cancer Continue To Be Included In “Multi-Head And Neck” Trials Within The Rtog?, R. Den, Q. Zhang, D. Cognetti, M. Machtay, J. S. Cooper, A. S. Garden, C. U. Jones, S. Yom, K. K. Ang

Bodine Journal

Purpose/Objective(s): It is becoming increasingly evident that the behavior of cancers from different subsites of the head and neck varies greatly despite similar histologic appearance. As current head and neck trials are focusing more on a risk-based approach, it is unclear into which trials patients with hypopharyngeal primaries (HP) should be included. Thus, we undertook to examine whether patients with HP perform as well as oropharyngeal primaries (OP) in the definitive setting and whether HP perform as well as larynx primaries (LX) in the post-operative setting in the multi-institutional setting. American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting …

Uncertainty And Margin Study For Imrt, Vmat, And Proton Beam Therapy For Treatment After Radical Prostatectomy, Y. Cui, A. S. Harrison, M T. Studenski, T. N. Showalter, J. O. Deasy, Y. Yu, J. M. Galvin, Y. Xiao

Bodine Journal

Purpose/Objective(s): To compare the uncertainties of 3D dose distributions, caused by the geometrical uncertainty of patient setup, in IMRT, VMAT, and proton plans for post-prostatectomy treatment. To test the effectiveness of a common margin recipe in these three types of treatment plans.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA