Medicine and Health Sciences Commons^™

Resected Serous Cystic Neoplasms Of The Pancreas: Locally Aggressive Behavior As A Predictor Of Malignant Disease? A Review Of 158 Patients With Recommendations For Treatment., Charles Galanis, Amir Zamani, John L. Cameron, Kurtis A. Campbell, Keith D. Lillemoe, David Caparrelli, David Chang, Ralph H. Hruban, Charles Yeo

Department of Surgery Faculty Papers

Background: Serous cystic neoplasms of the pancreas are regarded as a benign entity with rare malignant potential. Surgical resection is generally considered curative. Objective: To perform the largest single institution review of patients who underwent surgical resection for serous cystic neoplasms of the pancreas in the hopes of guiding future management. Methods: Between June 1988 and January 2005, 158 patients with serous cystic neoplasms of the pancreas underwent surgical resection. A retrospective analysis was performed. Univariate and multivariate models were used to determine factors influencing perioperative morbidity and mortality. Major complications were defined as pancreatic fistula or anastomotic leak, postoperative …

Nonlinear Dynamical Analysis Of Brain Electrical Activity Due To Exposure To Weak Environmentally Relevant Electromagnetic Fields, Erik Alfonso Nilsen

Doctoral Dissertations

The reports dealing with the effects of weak electromagnetic fields (EMFs) on brain electrical activity have been inconsistent. We suspected that the use of linear models and their associated methods accounted for some of the variability, and we explored the issue by using a novel approach to study the effects of EMFs on the electroencephalogram (EEG) from rabbits and humans. The EEG was embedded in phase space and local recurrence plots were calculated and quantified to permit comparisons between exposed and control epochs from individual subjects. Statistically significant alterations in brain activity were observed in each subject when exposed to …

Gangliocytic Paraganglioma: Case Report And Review Of The Literature, Agnes Witkiewicz, Avi Galler, Charles Yeo

Department of Surgery Faculty Papers

Gangliocytic paraganglioma is a rare tumor, which occurs nearly exclusively in the second portion of the duodenum. Generally, this tumor has a benign clinical course, although rarely, it may recur or metastasize to regional lymph nodes. Only one case with distant metastasis has been reported. We present a case of duodenal gangliocytic paraganglioma treated first by local resection followed by pylorus-preserving pancreaticoduodenectomy. Examination of the first specimen revealed focal nuclear pleomorphism and mitotic activity, in addition to the presence of three characteristic histologic components: epithelioid, ganglion, and spindle cell. In the subsequent pancreaticoduodenectomy specimen, there was no residual tumor identified …

Quality Of Weight Loss Advice On Internet Forums, Kevin O Hwang, Kiran Farheen, Craig W Johnson, Eric J Thomas, Ann S Barnes, Elmer V Bernstam

Faculty, Staff and Student Publications

BACKGROUND: Adults use the Internet for weight loss information, sometimes by participating in discussion forums. Our purpose was to analyze the quality of advice exchanged on these forums.

METHODS: This was a retrospective analysis of messages posted to 18 Internet weight loss forums during 1 month in 2006. Advice was evaluated for congruence with clinical guidelines; potential for causing harm; and subsequent correction when it was contradictory to guidelines (erroneous) or potentially harmful. Message- and forum-specific characteristics were evaluated as predictors of advice quality and self-correction.

RESULTS: Of 3368 initial messages, 266 (7.9%) were requests for advice. Of 654 provisions …

Recurrent Pineal Apoplexy In A Child, Kashif Majeed, S. Ather Enam

Department of Surgery Docs

No abstract provided.

Energizing Mirna Research: A Review Of The Role Of Mirnas In Lipid Metabolism, With A Prediction That Mir-103/107 Regulates Human Metabolic Pathways, Bernard R. Wilfred, Wang-Xia Wang, Peter T. Nelson

Sanders-Brown Center on Aging Faculty Publications

MicroRNAs (miRNAs) are powerful regulators of gene expression. Although first discovered in worm larvae, miRNAs play fundamental biological roles-including in humans-well beyond development. MiRNAs participate in the regulation of metabolism (including lipid metabolism) for all animal species studied. A review of the fascinating and fast-growing literature on miRNA regulation of metabolism can be parsed into three main categories: (1) adipocyte biochemistry and cell fate determination; (2) regulation of metabolic biochemistry in invertebrates; and (3) regulation of metabolic biochemistry in mammals. Most research into the 'function' of a given miRNA in metabolic pathways has concentrated on a given miRNA acting upon …

Relationships Between Scores On The Jefferson Scale Of Physician Empathy, Patient Perceptions Of Physician Empathy, And Humanistic Approaches To Patient Care: A Validity Study., Karen M. Glaser, Fred W. Markham, Herbert M. Adler, Patrick R. Mcmanus, Mohammadreza Hojat

Department of Psychiatry and Human Behavior Faculty Papers

BACKGROUND: Empathy is the backbone of a positive physician-patient relationship. Physician empathy and the patient's awareness of the physician's empathic concern can lead to a more positive clinical outcome.

MATERIAL/METHODS: The Jefferson Scale of Physician Empathy (JSPE) was completed by 36 physicians in the Family Medicine residency program at Thomas Jefferson University Hospital, and 90 patients evaluated these physicians by completing the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and a survey about physicians' humanistic approaches to patient care.

RESULTS: A statistically significant correlation was found between scores of the JSPE and JSPPPE (r=0.48, p

CONCLUSIONS: These findings …

Survival After Bidirectional Cavopulmonary Anastomosis: Analysis Of Preoperative Risk Factors., Mark A. Scheurer, Elizabeth G Hill, Nagavardhan Vasuki, Scott Maurer, Eric M. Graham, Varsha Bandisode, Girish S. Shirali, Andrew M. Atz, Scott M. Bradley

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Prognostic factors for survival after bidirectional cavopulmonary anastomosis for functionally single ventricle are not well defined. We analyzed preoperative hemodynamic and echocardiographic data to determine risk factors for death or transplantation at least 1 year after bidirectional cavopulmonary anastomosis.

METHODS: Data for all patients who underwent bidirectional cavopulmonary anastomosis before 5 years of age at our institution from September 1995 through June 2005 were analyzed. Available preoperative echocardiograms and catheterizations were reviewed. Survivors were compared with those who died or underwent transplantation. Bivariable associations between demographic and clinical risk factors and survival status (alive without transplantation vs dead or …

Ictus Emeticus: Case Reports And Literature Review, Ismail A. Khatri, Umar S. Chaudhry, Abdul Majeed Khatri, Zahid F. Cheema

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Blindness In Children At The Ida Rieu School For The Blind And Deaf, Sadia Javed Khan, Afshan Hassan, Laila Khalid, Uzma Karim, Erum Hashmi, Fariha Gul, Imtiaz Jehan

Community Health Sciences

Objective: To identify the causes of blindness at the Ida Rieu school for the blind and deaf, Karachi, Pakistan.Methods: A cross sectional study was conducted at the Ida Rieu School for the blind and deaf. The data collected from medical record of students was entered into the WHO/PBL eye examination form for children with blindness and low vision.Results: Records of 144 pupils aged between 4-30 years were reviewed, including 67% males and 33% females. One third (31%) children had visual impairment (< 6/18-6/60) and 69% were blind (< 3/60-NPL). The commonest anatomical site was retina (41%) and whole globe (20%). The etiology was unknown in 49% cases. In 33% of cases, the data suggested hereditary cause as the etiology, 40% of cases were preventable and 13% treatable.CONCLUSION: Avoidable causes of blindness were seenin 53% of children, 58% of which were preventable and 19 were treatable.

A Randomized Controlled Study Ofmagnesium Sulfate Versusdihydroergotamine In The Management Ofacute Migraine Attacks, Abolghasem Rahimdel, Mohammad Hassan Eslami, Ahmad Zeinali

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Electroconvulsive Therapy: An Esoteric Treatment, Haider A. Naqvi, Murad M. Khan

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Allergic Contact Dermatitis From Tea Tree Oil

Department of Family & Community Medicine Faculty Papers

The sudden appearance of a pruritic confluent erythematous rash on the anterior neck and upper back prompted a 30-year-old woman to seek medical attention. She had recently started applying 5% tea tree oil to the area to treat chronic, recurrent tinea versicolor. An herbal specialist had recommended this therapy.

Adequacy Of Postoperative Pain Relief After Discharge, Samina Ismail, Aziza M. Hussain

Department of Anaesthesia

Day care surgery has shown a remarkable development over the last two decades, comprising approximately 60-70% of all surgical procedures. Therefore major proportions of surgical patients are recovering at home and have little or no assessment of the adequacy of their pain relief. The aim of our audit was to compare suggested postoperative pain indicators with targets for best practice. This audit was done at the Aga Khan University Hospital day care unit for a period of three months. On the day of surgery patients having the contact numbers were informed about the telephone call 24 hrs after the surgery …

Clinical Features And Management Of Merkel Cell Carcinoma, Ahmed Nadeem Abbasi

Department of Radiation Oncology

Merkel cell carcinoma (MCC) is an aggressive dermal tumour of neuroendocrine origin. MCC is a rare tumour and all information pertaining to its behaviour, therapy and prognosis is based on retrospective reports. The two potentially curative treatment modalities are surgery and radiotherapy. It is a rare, highly malignant primary skin tumour, originally called "trabecular carcinoma" of the skin. MCC poses a challenge to the clinician because of its rarity and poor prognosis. The optimal therapy is customised and tailored for each individual patient with the appropriate use of operative resection and radiation therapy. This review covers reports from several authors …

Incidence, Patterns And Severity Of Reported Unintentional Injuries In Pakistan For Persons Five Years And Older: Results Of The National Health Survey Of Pakistan 1990–94, Zafar Fatmi, Wilbur C. Hadden, Junaid A. Razzak, Huma Qureshi, Adnan A. Hyder, Gregory Pappas

Community Health Sciences

Background

National level estimates of injuries are not readily available for developing countries. This study estimated the annual incidence, patterns and severity of unintentional injuries among persons over five years of age in Pakistan.

Methods

National Health Survey of Pakistan (NHSP 1990–94) is a nationally representative survey of the household. Through a two-stage stratified design, 18, 315 persons over 5 years of age were interviewed to estimate the overall annual incidence, patterns and severity of unintentional injuries for males and females in urban and rural areas over the preceding one year. Weighted estimates were computed adjusting for complex survey design …

Effects Of Colon Cancer Risk Counseling For First-Degree Relatives, Karen Glanz, Alana D. Steffen, Lauren Taglialatela

Faculty Articles

Background: Individuals with a first-degree relative who has had colorectal cancer are at increased risk for colorectal cancer and thus can benefit from early detection. Tailored risk counseling may increase adherence to screening guidelines in these persons. The present study evaluated a culturally sensitive Colon Cancer Risk Counseling (CCRC) intervention for relatives of colorectal cancer patients.

Methods: A randomized trial evaluated personalized CCRC sessions with print materials and follow-up phone calls compared with a comparable General Health Counseling (GHC) intervention. One hundred and seventy-six siblings and children of colorectal cancer patients, living in Hawaii, were assessed at baseline and 4 …

Clear Cell Carcinoma Of Ovary With Associated Mucinous Cystadenoma And Endometriosis, Zeeshan Uddin, Nausheen Yaqoob, Naila Kayani, Sheema H. Hasan

Department of Pathology and Laboratory Medicine

A 45 year old woman presented with right sided ovarian mass with multiple omental deposits and liver metastases. The right ovary was enlarged and showed a partly cystic partly solid cut surface. Histological picture showed clear cell carcinoma with areas of mucinous cystadenoma and endometriosis. Clear cell carcinoma is known to be associated with endometriosis. To the best of author's knowledge, it's association with mucinous cystadenoma has been described only once in the literature, where clear cell carcinoma was shown to be associated with mucinous cystadenoma without any evidence of endometriosis.

Acute Stroke Secondary To Internal Carotid Artery Pseudoaneurysm: Mri Findingsand Treatment With Endovascularcoiling, Mohammad Wasay, Alper Dai, Neeraj Dubey, Saadat Kamran

Department of Medicine

Internal carotid artery pseudoaneurysms are uncommon. We report a young man with history of trivialtrauma who presented with middle cerebral artery stroke.Head CT scan revealed a right parapharyngeal mass. MRI confirmed the diagnosis of internal carotidpseudoaneurysm. Cerebral angiogram showed dissection of internal carotid artery with a large pseudoaneurysm and almost complete occlusion of vessel distal to aneurysm.Vessel was obliterated by fibercoiling and gluing byendovascular technique to diminish risk of furthere mbolization. MRI characteristics of carotid pseudoaneurysms and role of endovascular treatment arediscussed.

Mechanisms Of Perceptual Learning Of Depth Discrimination In Random Dot Stereograms, Liat Gantz, Saumil S Patel, Susana T L Chung, Ronald S Harwerth

Faculty, Staff and Student Publications

Perceptual learning is a training induced improvement in performance. Mechanisms underlying the perceptual learning of depth discrimination in dynamic random dot stereograms were examined by assessing stereothresholds as a function of decorrelation. The inflection point of the decorrelation function was defined as the level of decorrelation corresponding to 1.4 times the threshold when decorrelation is 0%. In general, stereothresholds increased with increasing decorrelation. Following training, stereothresholds and standard errors of measurement decreased systematically for all tested decorrelation values. Post training decorrelation functions were reduced by a multiplicative constant (approximately 5), exhibiting changes in stereothresholds without changes in the inflection points. …

Neural Reprogramming In Retinal Degeneration, Robert E Marc, Bryan W Jones, James R Anderson, Krista Kinard, David W Marshak, John H Wilson, Theodore Wensel, Robert J Lucas

Faculty, Staff and Student Publications

PURPOSE: Early visual defects in degenerative diseases such as retinitis pigmentosa (RP) may arise from phased remodeling of the neural retina. The authors sought to explore the functional expression of ionotropic (iGluR) and group 3, type 6 metabotropic (mGluR6) glutamate receptors in late-stage photoreceptor degeneration.

METHODS: Excitation mapping with organic cations and computational molecular phenotyping were used to determine whether retinal neurons displayed functional glutamate receptor signaling in rodent models of retinal degeneration and a sample of human RP.

RESULTS: After photoreceptor loss in rodent models of RP, bipolar cells lose mGluR6 and iGluR glutamate-activated currents, whereas amacrine and ganglion …

The Effect Of Intensity Of Aerobic Vo2max Resting Heart Rate And Blood Pressure, Shannan Elizabeth Gormley

Human Movement Studies & Special Education Theses & Dissertations

The AGSM recommends 20 to 60 minutes of continuous or intermittent activity 3 to 5 times per week to maintain cardio respiratory fitness (Pollock et al., 1998). The 1996 Surgeon General's Report on Physical Activity and Health indicates that Americans are not meeting these physical activity recommendations (DHHS). Several clear consequences of physical inactivity are the appearance of cardiovascular disease risk factors, such as hypertension, hyperlipidemia and obesity. Two recent review articles suggested that higher intensity exercise will elicit a greater reduction in cardiovascular disease risk factors (Swain and Franklin, 2002; Swain and Franklin, 2006). In order to determine whether …

The Depiction Of Alcohol Tobacco And Other Substances In Children's G & Pg-Rated Animated Films Post 2000, Lindsay F. Graham

Sociology & Criminal Justice Theses & Dissertations

This study will analyze the depiction of alcohol, tobacco, and other substances in G and PG-rated animated films from November 1, 2000 to December 31, 2005. These films will include those released in theaters and video in English, at least 60 minutes in length, and of the animated genre during this five-year window. There is evidence that due to recent societal pressures facing the Motion Picture Association of America and their rating guidelines, the presence of alcohol and tobacco in children's animated Grated films has lessened. These incidents of exposure have since moved up the rating totem pole to receive …

Walking The Talk: Doing Science With Perimenopausal Women And Their Health Care Providers, Jerilynn C. Prior, Christine L. Hitchcock, Poornima Sathi, Marg Tighe

Journal of Interdisciplinary Feminist Thought

Perimenopausal high estrogen levels amplify the social stress of changing reproductive status in a culture that places value on women’s youth and beauty. As it was realized that progesterone physiologically counterbalances the effects of estrogen, it would be better to use progesterone, rather than estrogen for appropriate therapy of perimenopause. Based on this new knowledge was designed a three-arm study project comparing the recommended therapy, low dose OC (oral contraceptives) against progesterone therapy. In the pilot project cooperated Health Care Providers (HCP), by whose help was assembled eleven domains, which perimenopausal women find the most problematic. These HCP were also …

Neuropathological Findings Processed By Artificial Neural Networks (Anns) Can Perfectly Distinguish Alzheimer's Patients From Controls In The Nun Study, Enzo Grossi, Massimo P. Buscema, David Snowdon, Piero Antuono

Sanders-Brown Center on Aging Faculty Publications

BACKGROUND: Many reports have described that there are fewer differences in AD brain neuropathologic lesions between AD patients and control subjects aged 80 years and older, as compared with the considerable differences between younger persons with AD and controls. In fact some investigators have suggested that since neurofibrillary tangles (NFT) can be identified in the brains of non-demented elderly subjects they should be considered as a consequence of the aging process. At present, there are no universally accepted neuropathological criteria which can mathematically differentiate AD from healthy brain in the oldest old. The aim of this study is to discover …

Meeting Report: The Role Of Environmental Lighting And Circadian Disruption In Cancer And Other Diseases, Richard G. Stevens, David E. Blask, George C. Brainard, Johnni Hansen, Steven W. Lockley, Ignacio Provencio, Mark S. Rea, Leslie Reinlib

Department of Neurology Faculty Papers

Light, including artificial light, has a range of effects on human physiology and behavior and can therefore alter human physiology when inappropriately timed. One example of potential light-induced disruption is the effect of light on circadian organization, including the production of several hormone rhythms. Changes in light-dark exposure (e.g., by nonday occupation or transmeridian travel) shift the timing of the circadian system such that internal rhythms can become desynchronized from both the external environment and internally with each other, impairing our ability to sleep and wake at the appropriate times and compromising physiologic and metabolic processes. Light can also have …

Comparison Of Contrast Enhanced Color Doppler Targeted Biopsy To Conventional Systematic Biology: Impact On Gleason Score, M. Mitterberger, G. M. Pinggera, W. Horninger, G. Bartsch, H. Strasser, G. Schafer, A. Brunner, Ethan J. Halpern, J. Gradl, L. Pallwein, F. Frauscher

Department of Radiology Faculty Papers

Purpose: Prostate cancer grading with Gleason score is an important prognostic factor. This prospective randomized study compares ultrasound systematic biopsy vs contrast enhanced color Doppler targeted biopsy for the impact on Gleason score findings.

Materials and Methods: We examined 690 men (mean age 56 years, range 41 to 77) with a serum total prostate specific antigen of 1.25 ng/ml or greater, a free-to-total prostate specific antigen ratio less than 18% and/or a suspicious digital rectal examination. Contrast enhanced color Doppler targeted biopsies with a limited number of cores (5 or less) were performed in hypervascular areas of the peripheral zone …

Azithromycin In The Extremely Low Birth Weight Infant For The Prevention Of Bronchopulmonary Dysplasia: A Pilot Study, Hubert O. Ballard, Michael I. Anstead, Lori A. Shook

Pediatrics Faculty Publications

BACKGROUND: Azithromycin reduces the severity of illness in patients with inflammatory lung disease such as cystic fibrosis and diffuse panbronchiolitis. Bronchopulmonary dysplasia (BPD) is a pulmonary disorder which causes significant morbidity and mortality in premature infants. BPD is pathologically characterized by inflammation, fibrosis and impaired alveolar development. The purpose of this study was to obtain pilot data on the effectiveness and safety of prophylactic azithromycin in reducing the incidence and severity of BPD in an extremely low birth weight (< or = 1000 grams) population.

METHODS: Infants < or = 1000 g birth weight admitted to the University of Kentucky Neonatal Intensive Care Unit (level III, regional referral center) from 9/1/02-6/30/03 were eligible for this pilot study. The pilot study was double-blinded, randomized, and placebo-controlled. Infants were randomized to treatment or placebo within 12 hours of beginning mechanical ventilation (IMV) and within 72 hours of birth. The treatment group received azithromycin 10 mg/kg/day for 7 days followed by 5 mg/kg/day for the duration of the study. Azithromycin or placebo was continued until the infant no longer required IMV or supplemental oxygen, to a maximum of 6 weeks. Primary endpoints were incidence of BPD as defined by oxygen requirement at 36 weeks gestation, post-natal steroid use, days of IMV, and mortality. Data was analyzed by intention to treat using Chi-square and ANOVA.

RESULTS: A total of 43 extremely premature infants were enrolled in this pilot study. Mean gestational age and …

La Vie À L’Endroit De Rachid Boudjedra : Entre Subjectivité Et Folie, Sonia Zlitni Fitouri

Présence Francophone: Revue internationale de langue et de littérature

In this study of Rachid Boudjedra’s La vie à l’endroit, I will show how the Algerian writer endeavours to put “en abyme” three types of madness (joyful, fatal, hallucinatory); these generate one another in a cause and effect relationship and distance themselves from the delirious discourse of his first novels in order to give an account of a period of terror which struck Algeria under the Muslim fundamentalist threat. We will also show how the character-narrator faces all this madness by setting up his subj bj ectivity as a shield against what he calls “external fear and inner fear”, and …

Adherence To Recommendations For Follow-Up To Abnormal Pap Tests, Katherine S. Eggleston, Ann L. Coker, Kathryn J. Luchok, Tamra E. Meyer

CRVAW Faculty Journal Articles

OBJECTIVE: To evaluate whether timely adherence rates differ by race among women with abnormal Pap tests participating in a cost-free or reduced-cost program.

METHODS: Eligible subjects included women aged 47-64 years who received a referral for follow-up care after an abnormal Pap test from 1999 to 2002 in South Carolina (n=330). Adherence was measured as days to receipt of follow-up care after an abnormal Pap test. Cox proportional hazards modeling was used to estimate risk factors associated with time to adherence within 60 and 365 days by race.

RESULTS: African-American and non-Hispanic white women had similar adherence to follow-up. Among …