Medicine and Health Sciences Commons^™

The Significance Of Percutaneous Aspiration Of The Zygapophysial Facet Joint Synovial Cyst: A Case Series, S. Kamal Fetouh, Nicholas Kaffl, Linqiu Zhou

Department of Rehabilitation Medicine Faculty Papers

Cysts that are clearly associated with threat of progressive neurological loss or intractable, unremitting symptoms should be released by a decompression procedure.

In our case series, percutaneous aspiration has been successfully used for 3 of 4 PTs with marked decrease in size of cyst on imaging and clinical improvement.

Obstructing pathology and ultimately the location of the cyst can be major factors in determining the success of the procedure.

Our study demonstrated that a minimally invasive aspiration of a ZP SC can often achieve clinical improvement.

This may save the PT from undergoing an invasive surgical decompression.

The Significance Of A Triple Flexion Reflex In The Acute Spinal Cord Injured Patient: A Case Report And Review Of The Literature, S. K. Fetouh, S. Kolli, R. J. Marino, N. D. Martin, A. L. Schreiber

Department of Rehabilitation Medicine Faculty Papers

The TFR is a sign of upper motor neuron impairment. It does not typically appear for several days after an injury but in patients with pre-existing myelopathy, an early onset exaggerated Babinski response exhibited as a TFR may occur. It is important not to misinterpret such responses as volitional movements, particularly in patients with cognitive dysfunction where the history and physical examination may be limited. Failure to immobilize the spine and to administer adjunct steroid therapy may be detrimental to the patient. Education of initial response physicians may prevent overlooking an acute SCI.

The Quality-Of-Life Impact Of Prostate Cancer Treatments., Jaspreet Singh, Edouard J. Trabulsi, Leonard G. Gomella

Department of Urology Faculty Papers

Many options exist for the treatment of localized prostate cancer. In the decision to choose a therapeutic option for localized disease, many variables need to be considered such as tumor characteristics, clinical stage, the patient's overall health and life expectancy, and preferences of both the physician and patient. Another important consideration is the health-related quality of life (HRQOL) implications of a given treatment option. The importance of HRQOL relative to the potential side effects of prostate cancer treatments has grown over the past few years. Although our collective awareness has increased, objective data on HRQOL for prostate cancer treatment are …

Inadvertent Respiratory Acidosis Due To Damaged Water Trap Of Capnograph By Isoflurane, Eileen R. Manabat, Md, Richard Berman, Md, Yoogoo Kang, Md

Department of Anesthesiology Faculty Papers

Introduction: A few reports have documented isoflurane leakage causing damage to the water trap in the Drager Apollo anesthesia machine. This case describes an abnormal capnograph tracing yielding falsely normal end-tidal carbon dioxide tension (EtCO2) after breakage of the water trap by isoflurane.

Ask A Different Question, Get A Different Answer: Why Living Wills Are Poor Guides To Care Preferences At The End Of Life., Laraine Winter, Susan M Parks, James J Diamond

Center for Applied Research on Aging and Health Research Papers

CONTEXT: Living wills have a poor record of directing care at the end of life, as a copious literature attests. Some speculation centers on the questionable correspondence between the scenario described in living wills versus the real-life circumstances that typically arise at the end of life.

OBJECTIVE: To assess the strength of association between responses to a standard living will question and preferences for treatments in six end-of-life scenarios.

DESIGN: Cross-sectional.

SETTING: Telephone interviews.

PARTICIPANTS: Two hundred two community-dwelling men and women 70 years of age or older in the greater Philadelphia area.

MAIN OUTCOME MEASURES: Strength of preferences for …

Enhanced Psychosocial Well-Being Following Participation In A Mindfulness-Based Stress Reduction Program Is Associated With Increased Natural Killer Cell Activity., Carolyn Y Fang, Diane K Reibel, Margaret L Longacre, Steven Rosenzweig, Donald E Campbell, Steven D Douglas

Marcus Institute of Integrative Health Faculty Papers

BACKGROUND: Mindfulness-based stress reduction (MBSR) programs have consistently been shown to enhance the psychosocial well-being of participants. Given the well-established association between psychosocial factors and immunologic functioning, it has been hypothesized that enhanced psychosocial well-being among MBSR participants would be associated with corresponding changes in markers of immune activity.

OBJECTIVES: The objectives of this study were to examine changes in psychosocial and immunologic measures in a heterogeneous patient sample following participation in a MBSR program.

DESIGN: A single-group, pretest/post-test design was utilized.

SETTING: The intervention was conducted at an academic health center.

SUBJECTS: This pilot study involved 24 participants (aged …

Endoscopic Repair Of High-Flow Cranial Base Defects Using A Bilayer Button., Adam J. Luginbuhl, Peter G. Campbell, James Evans, Marc Rosen

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES/HYPOTHESIS: Repair of the skull base still begins with a direct repair of the dural defect. We present a new button closure for primary repair of the dura for high flow defects.

STUDY DESIGN: Retrospective review.

METHODS: We reviewed our 20 cases of primary button grafts and compared the results to the previous 20 high-flow open-cistern cerebrospinal fluid (CSF) cases. Subjects were excluded if they had no violation of the arachnoid space or potential for low-flow CSF leak. The button is constructed so that the inlay portion is at least 25% larger than the dural defect, and the onlay portion …

Pregnancy Outcomes In Female Liver Recipients Transplanted Under The Age Of 21, Carlo B. Ramirez, Warren R. Maley, Cataldo Doria, Lisa A. Coscia, Michael J. Moritz, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions: Liver recipients transplanted under the age of 21 are able to maintain pregnancy with 75% resulting in a livebirth. Pregnancy, potential risks for mother and newborn, and long-term maternal survival should be discussed with the recipient and the parents of the recipient. Transplant centers are encouraged to report pregnancy outcomes in these recipients to the NTPR.

Workshop Enhances Clinical Faculty Development, Joseph F. Lipscomb, Crna, Ms

College of Nursing Faculty Papers & Presentations

Enhanced clinical faculty teaching strategies and skills. Consistent approaches to clinical education. Increased faculty and student satisfaction. Positive student outcomes. Strengthened alliance with clinical affiliates.

Evolution Of The Sensory Integration Frame Of Reference., Roseann C. Schaaf, Patricia L. Davies

Department of Occupational Therapy Faculty Papers

No abstract provided.

The Assessment Of Disability Related To Vision Performance-Based Measure In Diabetic Retinopathy., Kevin J. Warrian, Luciano L. Lorenzana, Dara Lankaranian, Jyoti Dugar, Sheryl S. Wizov, George L. Spaeth

Wills Eye Hospital Papers

PURPOSE: To validate a third-generation performance-based measure of visual function titled "Assessment of Disability Related to Vision" (ADREV) in a study population of patients with diabetic retinopathy.

DESIGN: Prospective, cross-sectional study.

METHODS: Patients with nonproliferative or proliferative diabetic retinopathy, free from ocular comorbidity, were recruited from a single institute and completed the ADREV, the 25-Item National Eye Institute Visual Functioning Questionnaire (VFQ-25), and a clinical ophthalmic examination. Correlation, regression, and bootstrap analysis were conducted to determine the relationship between ADREV scoring and each of the study's clinical and self-report measures of visual ability, while controlling for potential confounders.

RESULTS: Ninety-one …

Examining The Neuroscience Evidence For Sensory-Driven Neuroplasticity: Implications For Sensory-Based Occupational Therapy For Children And Adolescents., Shelly J. Lane, Roseann C. Schaaf

Department of Occupational Therapy Faculty Papers

When Ayres first presented the theory of sensory integration (SI), she grounded it in the neuroscience literature. Neuroplasticity was then, and is today, considered to be at the heart of this theory. This evidence-based review sought to critically examine the basic science literature to specifically identify evidence for the assumptions and tenets of Ayres' theory of SI. We reviewed literature between 1964 and 2005, within psychological, physiological, and biomedical areas, addressing neuroplasticity. The review focused on sensorimotor-based neuroplasticity; explored the data that addressed the links among sensory input, brain function, and behavior; and evaluated its relevance in terms of supporting …

Cocaine And The Heart., Suraj Maraj, Vincent M. Figueredo, M.D., D Lynn Morris

Division of Cardiology Faculty Papers

The use of cocaine may be associated with either acute or chronic toxicity, and approximately 5% to 10% of emergency department visits in the United States are believed to be secondary to cocaine usage. Chest pain is the most common cocaine-related medical problem, leading to the evaluation of approximately 64,000 patients annually for possible myocardial infarction, of which approximately 57% are admitted to the hospital, resulting in an annual cost greater than $83 million. There is a plethora of cocaine-related cardiovascular complications, including acute myocardial ischemia and infarction, arrhythmias, sudden death, myocarditis, cardiomyopathy, hypertension, aortic ruptures, and endocarditis. There is …

Solid-Organ Transplant Recipients And Breastfeeding While On Immunosuppression, Schweta Arakali, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

The relatively small amount of drug transferred in breast milk and the lack of reported adverse effects along with the known benefits of breastfeeding may outweigh the risk of drug exposures in the transplant population.

The threshold for determining the level of exposure of an immunosuppressive agent that is acceptable is not known at present.

Continued study and follow-up of all breast-fed transplant recipient offspring is warranted.

Centers are encouraged to report all pregnancies in transplant recipients to the NTRR.

Pregnancy Outcomes In Female Lung Transplant Recipients, Julie Shaner, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Female lung recipients appear to face higher risks related to pregnancy when compared to other solid organ transplant recipients.

Although successful pregnancies have been reported in female lung recipients, analyses of larger numbers of cases may help to identify pre-pregnancy factors predictive of adverse outcomes.

Centers are encouraged to report all pregnancies in transplant recipients to the NTPR.

Pregnancy Outcomes With Exposure To The Mycophenolic Acid Products (Mpa), To Dung K. Nguyen, Faith Carlin, Lisa A. Coscia, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Reports to NTPR to date continue to reveal an increased incidence of birth defects in transplant recipients maintained on MPA products during gestation compared to those not maintained on these agents.

Structural birth defects consisting of microtia (ear deformity) and facial defects suggest a pattern of malformations.

Evaluation of the higher incidence of non-viable outcomes requires further study in this cohort.

Centers are encouraged to report all pregnancy exposures in transplant recipients to the NTPR.

Pregnancy Outcomes In Pancreas-Kidney Vs. Kidney-Alone Diabetic Female Transplant Recipients, Lyuba Gitman, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

The high incidences of hypertension, preeclampsia, and infection during pregnancy underscore the high-risk nature of pregnancy in both pancreas-kidney and kidney alone recipients.

Although overall offspring outcomes are similar in both PK and K groups, pregnancy in PK recipients may be associated with higher incidences of maternal infections and overall graft loss.

Centers are encouraged to report all pregnancies in transplant recipients to the NTPR.

Immunosuppressive Therapy For Autoimmune Disease And Pregnancy Outcomes, Karolina Paziana, Faith Carlin, Lisa A. Corcia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Cyclosporine exposure during pregnancy in the transplant population does appear to be associated with premature delivery and low infant birthweight.

Data from the NPR show that cyclosporine exposure during pregnancy in women with psoriasis does not appear to be associated with low gestational age or low infant birthweight.

Maternal comorbidities or other factors, such as multiple drug regimens, likely play a role in the higher rates of premature delivery and low birthweight infants in the kidney transplant population.

Further investigation is warranted to evaluate the impact of comorbidities and other factors on pregnancy outcomes of women taking Neoral®.

The Type 1 Insulin-Like Growth Factor Receptor In Hepatocellular Carcinoma Cell Lines, Zhengyu Wei, Phd, Tiziana Deangelis, M.S., Reginald Hurtt, B.S., Renato Baserga, M.D., Cataldo Doria, M.D., Ph.D

Department of Surgery Faculty Papers

Summary:

1. Human HCC cells have higher expression levels of IGF-1R, IRS1, and c-Met.

2. IRS1 interacts with c-Met. The role of IGF-1R in human HCC should be revisited.

3. Lentivirus-mediated shRNA delivery system targeting IGF-1R showed significant suppressive effects on HCC cell growth, promising a potential therapeutic treatment for human HCC.

Decision Analytic Model For Evaluation Of Suspected Coronary Disease With Stress Testing And Coronary Ct Angiography., Ethan J Halpern, David Fischman, Michael P Savage, Anish R Koka, Matthew Decaro, David C Levin

Department of Radiology Faculty Papers

RATIONALE AND OBJECTIVES: The aim of this study was to apply a decision analytic model for the evaluation of coronary artery disease (CAD) to define the optimal utilization of coronary computed tomographic angiography (cCTA) and stress testing.

MATERIALS AND METHODS: The model tested in this study assumes that CAD is evaluated with a stress test and/or cCTA and that a patient with positive evaluation results undergoes cardiac catheterization. On the basis of values of sensitivity, specificity, and radiation dose from the published literature and test costs from the Medicare fee schedule, a decision tree model was constructed as a function …

Evaluation Of A Novel Method For Measuring Cea Levels From Pancreas Cyst Aspirates, Vinay K. Katukuri, Md, Darren Andrade, Md, David E. Loren, Md, Thomas E. Kowalski, Md

Division of Internal Medicine Faculty Papers & Presentations

Conclusions:

The novel commercial method of cyst fluid analysis allows for accurate measurement of cyst fluid CEA even on cyst fluid aspirates of less than 1ml, and potentially less than 100ul of fluid.

This measurement tool increases the yield of EUS FNA for pancreatic cysts, particularly for those in whom cyst fluid volumes are small.

By optimizing specimen handling, it is possible to satisfy information needs more effectively thereby contributing to more comprehensive and better diagnosis and management.

Loss Of Stromal Caveolin-1 Independently Predicts Poor Disease-Free Survival And Time To Recurrence In Patients With Prostate Cancer, M. Wagner, A. Dasgupta, F. Sotgia, R. B. West, M. P. Lisanti, A. K. Witkiewicz

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Results:

Of the 167 patients originally included in the study, 43 were either lost to follow up or had insufficient clinical data for comparison. Of the remaining 124 cases, 32 showed loss of stromal Cav-1. Statistical analysis revealed no significant association between stromal Cav-1 loss and the usual markers of disease severity including Gleason grade, stage and presence of metastases. Kaplan-Meier curves showed a significant association between stromal Cav-1 loss and poor disease-free survival and time to recurrence (p<0.05), but no significant association with cancer-specific survival.

The Incidence, Severity And Distribution Of Colonic Bubbles After Bowel Preparation With Split Dose 2l Polyethylene Glycol-Electrolyte Solution With Sodium Sulfate, Sodium Ascorbate And Ascorbic Acid (Peg-Els): A Pilot Study, Carly Rubin, Constantine Daskalakis, Vicki Gordon, Rebecca Matro, David Kastenberg

Division of Internal Medicine Faculty Papers & Presentations

Conclusions:

1. Colonic bubbles that could interfere with polyp detection are present in 35% of patients receiving split dose PEG-ELS.

2. Most bubbles occur in the right and transverse colon.

3. Advanced age is an independent risk for bubbles.

The Use Of The Use Of Negative Pressure Wound Therapy In Vulvar Wounds, E. K. Ricci, Md, J. Brace, Phd, Crn, Bc, Cwocn, Aprn, N. G. Rosenblum, Md, Phd

Department of Obstetrics and Gynecology Faculty Papers

Patients with severe HS or Necrotizing Fasciitis often require extensive surgical debridement.

Traditionally, these wounds have been closed using split-thickness skin grafts with or without the use of the VAC device.

Our case study demonstrates good outcomes using the VAC device alone to achieve complete closure when applied immediately following debridement with frequent VAC changes.

Duration Of Maternal Human Papilloma Virus Infection And Risk Of Spontaneous Preterm Birth, K. Soin, Ms, N. S. Seligman, Md, A. Nnoli, Md, K. Dysart, Md, J. K. Baxter, Md, Mscp

Department of Obstetrics and Gynecology Faculty Papers

Conclusions:

Duration of HPV infection was not a significant risk factor for spontaneous PTB <37 weeks.

Cervical HPV DNA and HPV serology may further delineate the relationship between HPV infection and SPTB <37 weeks.

A larger sample size may be necessary to show a difference.

The 3.5x higher rate of fetal death > 23 weeks in our study (compared to fetal death > 20 weeks in the U.S.) needs further investigation.

Body Mass Index And Cerclage Success, A. Suhag, Md, N. S. Seligman, Md, V. Berghella, Md

Department of Obstetrics and Gynecology Faculty Papers

Conclusions:

Among women with a cerclage, pre-pregnancy BMI was not a significant predictor of SPTB <35 weeks.

There was a non-significant trend toward increased rates of SPTB at all gestational age cutoffs.

Morbidly obese women consistently had worse outcomes than obese and normal/overweight women.

Compared to normal/overweight, GA at delivery decreases by 1 week for obese and 2 weeks for morbidly obese women.

Recent Change In The Incidence Of Cervical Cerclage, Maria Bisulli, Md, Neil S. Seligman, Md, Komal Soin, Ms, Anju Suhag, Md, Vincenzo Berghella, Md

Department of Obstetrics and Gynecology Faculty Papers

Conclusions:

More selective indications for cervical cerclage based on recent randomized studies were associated with decreased cerclage placement.

The decrease in incidence of history-indicated cerclage may be due to the fact that more women with prior PTB are being followed by transvaginal cervical length measurements.

The decrease in incidence of ultrasound-indicated cerclage may be due to the use of 17-hydroxy progesterone caproate in women with PTB.

An Updated History Of The Teratology Society., Thomas H Shepard, Mason Barr, Robert L Brent, Andrew Hendrickx, Devendra Kochhar, Godfrey Oakley, William J Scott, John M Rogers

Department of Pediatrics Faculty Papers

BACKGROUND: The 49-year history of the Teratology Society is reviewed. An abbreviated history is outlined in table form, with listings of the Warkany Lectures, the Continuing Education Courses, and officers of the society. The original article was updated to include the years 2000 to 2010.

METHODS: A year-by-year description of the events is given, including the scientific and social content of the annual meetings and changes in the business of the society, in many cases using comments from the past presidents. The valuable and unique diversity of the members is discussed and illustrated, presenting the disciplines and main research areas …

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