Medicine and Health Sciences Commons^™

Anorectal Melanomas: Case Series, Jinyu Zhang, Md, Matthew Sochat, Md, Edward R. Feller, Md

The Medicine Forum

INTRODUCTION

Melanoma is the most common tumor to metastasize to the gastrointestinal (GI) tract. 60% of patients who die with malignant melanoma have GI involvement at autopsy1. Symptomatic disease presenting during life is unusual. Anorectal melanoma, a rare tumor that represents 1% of all melanomas and less than 4% of all anal malignancies, manifests with a range of non-specific symptoms and physical exam findings2. In fact, about one-third of lesions may be amelanotic3,4. Initial misdiagnosis as a benign lesion such as hemorrhoid is common.

We report 3 cases of anorectal melanoma presenting as primary GI complaints all without known cutaneous …

Case Report: Uncontrolled Anasarca: Capillary Leak Syndrome, Ankita Mehta, Md, Mansi Shah, Md

The Medicine Forum

INTRODUCTION

Capillary leak syndrome (CLS) is a rare clinical disease that causes edema, hypoproteinemia, episodic hypotension, dyspnea, hyponatremia, and weight gain that can be life threatening1. Although the underlying pathology is currently unknown, CLS is thought to be secondary to a systemic process associated with hyperpermeability of the body's microcirculation, resulting from a diffuse and severe disruption of the endothelium and causing generalized edema and often acute respiratory distress2.

Limitations Of The Perioperative Cardiovascular Evaluation For Assessing Coronary Artery Disease: A Case Report, Rady Ho, Md, Mitul Kanzaria, Md, Paul Walinsky, Md

The Medicine Forum

INTRODUCTION

The American College of Cardiology (ACC) and the American Heart Association (AHA) publ ished pre-operative risk stratification guidelines in 2014. These guidelines have routinely been used by physicians to pre-operatively risk stratify patients. In this case report, a patient was found to have multi-vessel coronary artery disease post-operatively in the setting of unremarkable cardiac work-up preoperatively. This case highlights a limitation of the 2014 ACC/AHA guidelines.

Case Report: Diagnosis Of Dual-Biopsy Negative Severe Cardiac Amyloidosis, Kristin Lohr, Md, Eric Kasprowicz, Md

The Medicine Forum

INTRODUCTION

Amyloidosis is a rare disorder that involves the deposition of misfolded protein in extracellular tissue. Disease manifestations vary depending on the affected organs. Areas most often involved include the kidneys, gastrointestinal tract, heart, nervous system, and musculoskeletal system. The most common type is AL amyloidosis, in which plasma cells produce an abundance of a monoclonal proteins that affect numerous organ systems. A second variety, AA amyloidosis, is associated with inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease. Finally, a heritable version of amyloidosis mediated by mutations in the transthyretin protein (TTR) has a predilection for deposition in …

Coronary Subclavian Steal Syndrome, Rady Ho, Md, Jonathan A. Dunn, Md

The Medicine Forum

INTRODUCTION

Coronary subclavian steal (CSS) syndrome is a rare complication of coronary artery bypass graft surgery (CABG) involving the left internal mammary artery (LIMA) graft to the left anterior descending (LAD) artery. It results from stenosis of the left subclavian artery proximal to the LIMA, which compromises myocardial blood flow. The incidence of CSS syndrome is between 0.1-3.4% in the United States.1 Most cases occur as a result of long-standing subclavian stenosis due to progres-sion of the stenosis following CABG. We report a case of CSS syndrome, which presented as a non-ST elevation myocardial infarction (NSTEMI).

Allergic Inflammatory Mediated Coronary Artery Vasospasm: A Case Report Of Kounis Syndrome, Jonathan Hullman, Ms4, Jaehee Kim, Md, Gregary D. Marhefka, Md, Facc, Facp

The Medicine Forum

INTRODUCTION

Kounis syndrome is an acute coronary syndrome occurring secondary to an anaphylactic reaction. A wide variety of triggers such as drugs and environmental exposures have been described for the so-called allergic myocardial infarction. The pathophysiology of Kounis syndrome is thought to be due to the release of inflammatory mediators such as histamine and cytokines by mast cells and eosinophils resulting in either coronary vasospasm, myocardial infarction or stent thrombosis.

Squamous Cell Carcinoma Metastatic To The Heart Mimicking St-Elevation Myocardial Infarction, Jason Chen, Md, Colin Craft, Md, Andrew W. Panakos, Md, Gregary D. Marhefka, Md, Facc, Facp

The Medicine Forum

INTRODUCTION

Heart disease remains the leading cause of mortality in the United States, accounting for about one quarter of all deaths in 20131. Acute ischemic heart disease is a major subpopulation of this group, and typically presents with characteristic electrocardiographic (EKG) changes. The most concerning of these findings are ST-elevations, as ST Elevation Myocardial Infarction (STEMI) typically indicates the need for emergent reperfusion therapy because 30-day mortality of untreated STEMI is approximately 10-15% versus 5% in treated cases2. As a result, clinicians are taught to recognize the symptoms and signs of myocardial ischemia and STEMI in order to achieve timely …

Table Of Contents

The Medicine Forum

Table of Contents The Medicine Forum

The Journal of Thomas Jefferson University Hospital

Department of Internal Medicine

Volume 17, 2015-2016

From The Desk Of The Residency Director, Emily Stewart, Md, Facp

The Medicine Forum

I am honored to be writing my first message for the Forum as the Residency Program Director. This journal, now in its 17th edition, continues to exemplify the dedication, inquisitiveness, passion and talent of our Internal Medicine residents.

It has been an exciting year of changes at Jefferson, which began with Dr. Gregory Kane being appointed Chair of the Department of Medicine. As a new Program Director I could not have asked for a leader who is more dedicated to the educational needs of the residents, and has such a keen understanding of the ever changing residency training environment. This …

The Α-Arrestin Arrdc3 Regulates The Endosomal Residence Time And Intracellular Signaling Of The Β2-Adrenergic Receptor., Xufan Tian, Roshanak Irannejad, Shanna L. Bowman, Yang Du, Manojkumar A. Puthenveedu, Mark Von Zastrow, Jeffrey L. Benovic

Department of Biochemistry and Molecular Biology Faculty Papers

Arrestin domain-containing protein 3 (ARRDC3) is a member of the mammalian α-arrestin family, which is predicted to share similar tertiary structure with visual-/β-arrestins and also contains C-terminal PPXY motifs that mediate interaction with E3 ubiquitin ligases. Recently, ARRDC3 has been proposed to play a role in regulating the trafficking of G protein-coupled receptors, although mechanistic insight into this process is lacking. Here, we focused on characterizing the role of ARRDC3 in regulating the trafficking of the β2-adrenergic receptor (β2AR). We find that ARRDC3 primarily localizes to EEA1-positive early endosomes and directly interacts with the β2AR in a ligand-independent manner. Although …

The Mitochondrial Unfoldase-Peptidase Complex Clpxp Controls Bioenergetics Stress And Metastasis., Jae Ho Seo, Dayana B. Rivadeneira, M. Cecilia Caino, Young Chan Chae, David W. Speicher, Hsin-Yao Tang, Valentina Vaira, Silvano Bosari, Alessandro Palleschi, Paolo Rampini, Andrew V. Kossenkov, Lucia R. Languino, Dario C. Altieri

Department of Cancer Biology Faculty Papers

Mitochondria must buffer the risk of proteotoxic stress to preserve bioenergetics, but the role of these mechanisms in disease is poorly understood. Using a proteomics screen, we now show that the mitochondrial unfoldase-peptidase complex ClpXP associates with the oncoprotein survivin and the respiratory chain Complex II subunit succinate dehydrogenase B (SDHB) in mitochondria of tumor cells. Knockdown of ClpXP subunits ClpP or ClpX induces the accumulation of misfolded SDHB, impairing oxidative phosphorylation and ATP production while activating "stress" signals of 5' adenosine monophosphate-activated protein kinase (AMPK) phosphorylation and autophagy. Deregulated mitochondrial respiration induced by ClpXP targeting causes oxidative stress, which …

The Immunomodulatory Role Of Adjuvants In Vaccines Formulated With The Recombinant Antigens Ov-103 And Ov-Ral-2 Against Onchocerca Volvulus In Mice., Jessica A. Hess Ligas, Bin Zhan, April R. Torigian, John B. Patton, Nikolai Petrovsky, Tingting Zhan, Maria Elena Bottazzi, Peter J. Hotez, Thomas R. Klei, Sara Lustigman, David Abraham

Department of Microbiology and Immunology Faculty Papers

BACKGROUND: In some regions in Africa, elimination of onchocerciasis may be possible with mass drug administration, although there is concern based on several factors that onchocerciasis cannot be eliminated solely through this approach. A vaccine against Onchocerca volvulus would provide a critical tool for the ultimate elimination of this infection. Previous studies have demonstrated that immunization of mice with Ov-103 and Ov-RAL-2, when formulated with alum, induced protective immunity. It was hypothesized that the levels of protective immunity induced with the two recombinant antigens formulated with alum would be improved by formulation with other adjuvants known to enhance different types …

High Crlf2 Expression Associates With Ikzf1 Dysfunction In Adult Acute Lymphoblastic Leukemia Without Crlf2 Rearrangement., Zheng Ge, Yan Gu, Gang Zhao, Jianyong Li, Baoan Chen, Qi Han, Xing Guo, Juan Liu, Hui Li, Michael D. Yu, Justin Olson, Sadie Steffens, Kimberly J. Payne, Chunhua Song, Sinisa Dovat

Student Papers, Posters & Projects

Overexpression of cytokine receptor-like factor 2 (CRLF2) due to chromosomal rearrangement has been observed in acute lymphoblastic leukemia (ALL) and reported to contribute to oncogenesis and unfavorable outcome in ALL. We studied B-ALL and T-ALL patients without CRLF2 rearrangement and observed that CRLF2 is significantly increased in a subset of these patients. Our study shows that high CRLF2expression correlates with high-risk ALL markers, as well as poor survival. We found that the IKZF1-encoded protein, Ikaros, directly binds to the CRLF2 promoter and regulates CRLF2 expression in leukemia cells. CK2 inhibitor, which can increase Ikaros activity, significantly increases Ikaros binding in …

Accelerating Design And Transforming Baccalaureate Nursing Education To Foster A Culture Of Health, Mary Bouchaud, Beth Ann Swan, Angela Gerolamo, Kathleen Black, Karen Alexander, Jennifer Bellot, Kathryn Shaffer, Catherine Levonian, Denise Brown, Susan Egger, Rachel Scherzer, Dori Taylor Sullivan

College of Nursing Faculty Papers & Presentations

Healthcare reform and changing population health demographics call for a radical transformation in healthcare delivery and the education of healthcare providers. Nurses comprise the largest proportion of healthcare providers making it necessary to ensure that they are prepared to address the challenges that arise from the evolving healthcare delivery system. A key message of the Institute of Medicine’s The Future of Nursing: Leading Change, Advancing Health, is that nurses must lead healthcare change. To accomplish this, nurses must recognize their role in educating the new nursing workforce about creating a culture of health. Specifically, nurse educators must act as …

Bibliography Of Secondary Sources On The History Of Dermatology Ii. Obituaries And Biographies In English Supplemented Through 2015, Sarah Brenner, Md (Editor), Lawrence Parish, Md, Michael J. Lavery, Mb Bch Bao; Mrcp, Andrzej Grzybowski, Md, Phd, Jennifer L. Parish, Md, Daniel H. Parish, Md, Jd

Department of Dermatology and Cutaneous Biology Faculty Papers

Introduction

A bibliographic record on the history of dermatology has been a project that started over 4 decades ago. It is a collection of all forms of history, ranging from dermatologic conditions, to famous dermatologists and physicians who have advanced the field of both dermatology and medicine, to the different countries that promoted the development of scientists, researchers and physicians alike.

It was decided that the bibliographic record would encompass journals, books and a compilation of obituaries. A pertinent question is whether a manually created bibliographic project is still warranted in the 21^st century. In short, yes. While Index …

Bibliography Of Secondary Sources On The History Of Dermatology, Sarah Brenner, Md (Editor), Lawrence Parish, Md, Michael J. Lavery, Mb Bch Bao; Mrcp, Andrzej Grzybowski, Md, Phd, Jennifer L. Parish, Md, Daniel H. Parish, Md, Jd

Department of Dermatology and Cutaneous Biology Faculty Papers

Introduction

A bibliographic record on the history of dermatology has been a project that started over 4 decades ago. It is a collection of all forms of history, ranging from dermatologic conditions, to famous dermatologists and physicians who have advanced the field of both dermatology and medicine, to the different countries that promoted the development of scientists, researchers and physicians alike.

It was decided that the bibliographic record would encompass journals, books and a compilation of obituaries. A pertinent question is whether a manually created bibliographic project is still warranted in the 21^st century. In short, yes. While Index …

Bibliography Of Secondary Sources On The History Of Dermatology Iii. Books, Monographs, And Chapters In English Supplemented Through 2015, Sarah Brenner, Md (Editor), Lawrence Parish, Md, Michael J. Lavery, Mb Bch Bao; Mrcp (Uk, Andrzej Grzybowski, Md, Phd, Jennifer L. Parish, Md, Daniel H. Parish, Md, Jd

Department of Dermatology and Cutaneous Biology Faculty Papers

Introduction

A bibliographic record on the history of dermatology has been a project that started over 4 decades ago. It is a collection of all forms of history, ranging from dermatologic conditions, to famous dermatologists and physicians who have advanced the field of both dermatology and medicine, to the different countries that promoted the development of scientists, researchers and physicians alike.

It was decided that the bibliographic record would encompass journals, books and a compilation of obituaries. A pertinent question is whether a manually created bibliographic project is still warranted in the 21^st century. In short, yes. While Index …

Jefferson Digital Commons Quarterly Report: April-June 2016, Daniel G. Kipnis, Msi, Kelsey Duinkerken, Msi, James Copeland, Libt

Jefferson Digital Commons Reports

This quarterly report includes:

• TJU Archives & Special Collections Adds Content to the DPLA
• JDC Feature write-up in The Bulletin and JCIPE Newsletter
• New Dashboard with amazing metrics
• 8th Annual Faculty Day presentations
• Surgery Residents Research Day presentations
• Commencements videos
• CREATE Day Occupational therapy presentations
• Quality and Safety posters and much more
• What People are saying about the JDC

Editorial: Ferid Murad, At 80: A Legacy Of Science, Medicine, And Mentorship, Atta-Ur-Rahman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

No abstract provided.

Adverse Drug Effects And Preoperative Medication Factors Related To Perioperative Low-Dose Ketamine Infusions., Eric S. Schwenk, Stephen F. Goldberg, Ronak D. Patel, Jon Zhou, Douglas R. Adams, Jaime L. Baratta, Eugene R. Viscusi, Richard H. Epstein

Department of Anesthesiology Faculty Papers

High-dose opioid administration is associated with significant adverse events. Evidence suggests that low-dose ketamine infusions improve perioperative analgesia over conventional opioid management, but usage is highly variable. Ketamine's adverse drug effects (ADEs) are well known, but their prevalence during low-dose infusions in a clinical setting and how often they lead to infusion discontinuation are unknown. The purposes of this study were 3-fold: (1) to identify patient factors associated with initiation of ketamine infusions during spine surgery, (2) to identify specific spine procedures in which ketamine has been used most frequently, and (3) to identify ADEs associated with postoperative ketamine infusions …

Monthly "Grief Rounds" To Improve Residents' Experience And Decrease Burnout In A Medical Intensive Care Unit Rotation., Lindsay Wilde, Brooke Worster, David Oxman

Department of Medicine Faculty Papers

No abstract provided.

Patient Historical Risk Factors Associated With Seizure Outcome After Surgery For Drug-Resistant Nonlesional Temporal Lobe Epilepsy., Ali Akbar Asadi-Pooya, Maromi Nei, Ashwini Sharan, Michael R. Sperling

Department of Neurology Faculty Papers

OBJECTIVE: To investigate the possible influence of risk factors on seizure outcome after surgery for drug-resistant nonlesional temporal lobe epilepsy (TLE).

METHODS: This retrospective study recruited patients with drug-resistant nonlesional TLE who underwent epilepsy surgery at Jefferson Comprehensive Epilepsy Center and were followed for a minimum of one year. Patients had been prospectively registered in a database from 1991 through 2014. Postsurgical outcome was classified into two groups; seizure free or relapsed. The possible risk factors influencing long-term seizure outcome after surgery were investigated.

RESULTS: Ninety-five patients (42 males and 53 females) were studied. Fifty-four (56.8%) patients were seizure free. …

Acute Post-Disaster Medical Needs Of Patients With Diabetes: Emergency Department Use In New York City By Diabetic Adults After Hurricane Sandy., David C. Lee, Vibha K. Gupta, Brendan G. Carr, Sidrah Malik, Brandy Ferguson, Stephen P. Wall, Silas W. Smith, Lewis R. Goldfrank

Department of Emergency Medicine Faculty Papers

OBJECTIVE: To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy.

RESEARCH DESIGN AND METHODS: Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012.

RESULTS: In the highest level evacuation zone in New …

A Comparison Between Optical Coherence Tomography Angiography And Fluorescein Angiography For The Imaging Of Type 1 Neovascularization., Maiko Inoue, Jesse J. Jung, Chandrakumar Balaratnasingam, Kunal K. Dansingani, Elona Dhrami-Gavazi, Mihoko Suzuki, Talisa E. De Carlo, Abtin Shahlaee, Michael A. Klufas, Adil El Maftouhi, Jay S. Duker, Allen C. Ho, Maddalena Quaranta-El Maftouhi, David Sarraf, K. Bailey Freund

Wills Eye Hospital Papers

Purpose: To determine the sensitivity of the combination of optical coherence tomography angiography (OCTA) and structural optical coherence tomography (OCT) for detecting type 1 neovascularization (NV) and to determine significant factors that preclude visualization of type 1 NV using OCTA.

Methods: Multicenter, retrospective cohort study of 115 eyes from 100 patients with type 1 NV. A retrospective review of fluorescein (FA), OCT, and OCTA imaging was performed on a consecutive series of eyes with type 1 NV from five institutions. Unmasked graders utilized FA and structural OCT data to determine the diagnosis of type 1 NV. Masked graders evaluated FA …

Bullous Leukemia Cutis In A Patient With T-Cell Prolymphocytic Leukemia, Sarah Y. Siu, Qiujie Jiang, Ashley Gochoco, Jason B. Lee, Md, Joya Sahu, Onder Alpdogan, Jerald Z. Gong, Md

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

Retinal Ganglion Cell And Inner Plexiform Layer Loss Correlate With Visual Acuity Loss In Lhon: A Longitudinal, Segmentation Oct Analysis., Stephen J Moster, Mark L Moster, Molly Scannell Bryan, Robert C Sergott

Wills Eye Hospital Papers

PURPOSE: Describe changes in the retina as vision loss progresses in Leber's Hereditary Optic Neuropathy (LHON) using spectral-domain optical coherence tomography (SD-OCT) autosegmentation, and determine if relationship exists between retinal changes and vision loss.

METHODS: From patient records we identified nine LHON patients who underwent periodic neuro-ophthalmologic examinations and high-resolution SD-OCT as part of their care. We describe the impact of LHON progression on each retinal layer, and the relationship between these structural changes and visual acuity using generalized estimating equations and nonparametric tests.

RESULTS: The thickness of the ganglion cell layer (GCL) and inner plexiform layer (IPL) decreased immediately …

Amlodipine-Induced Hypersensitivity Reaction Mimicking Cd30(+) Mycosis Fungoides., Ashley Gochoco, Elizabeth Jones, Christine Soutendijk, Onder Alpdogan, Wenyin Shi, Joya Sahu

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

2016 Thomas Jefferson University Commencements In The Jdc, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

Relive the pomp and circumstance by watching the 192nd Thomas Jefferson University commencement ceremonies in the Jefferson Digital Commons.

Cannabinoid Receptor Type-2 Modulates Nociceptive Signaling Molecules In A Model Of Post-Concussion Headache, Jarred M. Stratton, Lan Cheng, Ashley L. Tyburski, Jessica Perino, Melanie B Elliott

Department of Neurosurgery Posters

Abstract

The goal of this study was to investigate the role of the cannabinoid receptor type-2 (CB₂R) in the trigeminal pain pathway in a model of post-concussion headache. Sprague Dawley rats were randomized to receive either a repeated mild closed head injury (CHI) or served as incision controls. Changes in CGRP, nNOS, and IBA-1 were assessed in the trigeminal nucleus caudalis (TNC) and trigeminal ganglia via IHC. A subset of CHI rats received either a cannabinoid receptor type 2 (CB₂R) anti-inflammatory agonist (JWH133), an NSAID (Ketorolac), or vehicle and underwent von Frey testing for trigeminal allodynia. …

Gastric Pepsin In Post-Tympanostomy Tube Otorrhea, Jill N. D'Souza, Md, Erin Fields, Pa-C, Zhaoping He, Phd, Robert O' Reilly, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Introduction

Otorrhea is the most common complication following tympanostomy tube placement, with an incidence commonly reported at around 20%. Topical otic antibiotic drops are typically used for relief of otorrhea in children with tympanostomy tubes. In children with recurrent otorrhea, gastroesophageal reflux and extraesophageal reflux have been postulated to be involved in the pathogenesis of otitis media with effusion¹. Middle ear inflammation is thought to be mediated by proteolytic activity of pepsin, as well as by the decrease in pH associated with reflux of gastric acid through Eustachian tube. The goal of this study is to examine the …