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Download Entire Pdf: The Medicine Forum, Vol 7, 2005

The Medicine Forum

Download the entire PDF of The Medicine Forum, Volume 7, 2005.

Varicella Pneumonia, Sivakumar Srinivasan, Md, Rangadham Nagarakanti, Md, Sandhya Nalmas, Md

The Medicine Forum

44 year old Hispanic male with no significant past medical history, recently discharged from prison, presented to the hospital with rash all over the body with itching. The rash started on the face, at the back of the ear and then spread to the trunk and legs. He denied fever, chills, cough, shortness of breath or sick contacts. Physical examination revealed a young, comfortable looking male with stable vital signs except for a temperature of 102 F.

The Spectrum Of Advanced Liver Disease In A Tertiary Care Institution, Kuntal M. Thaker, Md, Kuldip S. Banwait, Md, Maya Spodik, Md, Steven K. Herrine, Md, Victor Navarro, Md

The Medicine Forum

Purpose In population based studies, the rise of HCV infection has surpassed alcoholic liver disease (ALD) as the most common cause of chronic liver disease. However, it is unknown if HCV is becoming the dominant cause of advanced liver disease. The aim of this study was to determine the distribution of etiologies in a cohort of patients presenting with advanced liver disease.

Risk Of Ischemic Stroke Associated With Low-Dose Oral Contraceptive Use: A Meta-Analysis, Dae Hyun Kim, Md, Mph, Joachim Bleys, Md, Mph, Marlis Gonzalez-Fernandez, Md, Rebecca Gottesman, Md, Michelle Hudspeth, Md

The Medicine Forum

Abstract

Context: Oral contraceptive (OC) use has been shown to be associated with increased risk of ischemic stroke. However, most studies were conducted before low-dose OC became available.

Objective: To determine whether low-dose OC use is associated with increased risk of ischemic stroke Data Sources: All relevant human-subject and English-language studies in MEDLINE, EMBASE, and Science Citation Index from January 1970 through February 2005

Study Selection and Data Extraction: All published studies of OC or estrogen with any type of stroke as an outcome were included. Studies were excluded if they included populations at high risk for ischemic stroke …

A 19 Year Old Girl With Lightheadedness And Palpitations, Andrew Rose, Md

The Medicine Forum

A 19 year old patient with a past medical history significant only for recurrent syncope presented to the emergency department after 90 minutes of palpitations, chest tightness, lightheadedness and shortness of breath. Electrocardiogram on admission is shown in Figure 1.

Wellens Syndrome, Nicole Farmer, Md, Michael Cohen, Md

The Medicine Forum

A 76 year-old African-American female with a history of hypertension, type II Diabetes Mellitus, hyperlipidemia, and gatroesphageal reflux presented to emergency room complaining of epigastric pain radiating to left substernum which started the night before presentation. The onset of her sharp pain was at rest, lasted for two hours, and was aggravated by eating and drinking. Her chest pain was followed by gagging and regurgitating of liquid contents. Her chest pain was non-exertional, and not associated with shortness of breath, diaphoresis, nausea, or vomiting. In the Emergency Department, her pain subsided with two sublingual nitroglycerins and 2 milligrams of intravenous …

Recurrent Spontaneous Coronary Artery Dissections, Sivakumar Srinivasan, Md, Rangadham Nagarakanti, Md

The Medicine Forum

A 41-year-old Caucasian female with a history of hypertension presented with exertional chest pain. Her vital signs were stable on admission and physical examination was unremarkable. An Electrocardiogram (EKG) revealed inferior ST segment elevations consistent with acute myocardial infarction and cardiac enzymes were elevated. She was started on heparin, and underwent immediate cardiac catheterization.

Image In Medicine, Amy Baranoski, Md

The Medicine Forum

Pictured here is the back of a man with leprosy who had been treated at Acworth Leprosy Hospital in Mumbai, India. Note the diffuse, macular, hypopigmented rash. Leprosy is a chronic disease caused by infection with Mycobacterium leprae. The disease can affect a variety of organs including peripheral nerves, skin, muscle, eye, bone, and testes. Leprosy is diagnosed clinically by the presence of at least one of the following: hypopigmented patches, loss of cutaneous sensation, thickened nerves, and acid-fast bacilli in nasal or skin smears.

Sarcoid Cardiomyopathy, Sivakumar Srinivasan, Md, Emanuel Chryssos, Md

The Medicine Forum

The patient is a 40 year old African-American female with no significant past medical history who presented to the ED with a 2 week history of lower extremity edema and shortness of breath. She also noticed intermittent palpitations, dry cough, easy fatigue and a 30 pound weight loss. On examination, the patient’s temperature was 98.9F orally, pulse was 155-170 beats per minute, and blood pressure was 133/93 mmHg. EKG revealed long P-R tachycardia with heart rate of 170. Chest X- ray was done and showed large right pleural effusion with compressive atelectasis and small left pleural effusion. Transthoracic echocardiogram at …

A 53-Year-Old Woman With Worsening Rash And Diarrhea, Bryan Kavanaugh, Md

The Medicine Forum

A 53-year-old white female was admitted to the Bone Marrow Transplant Unit with a worsening pruritic rash.

The patient had a history of IgG lambda multiple myeloma status post autologous stem cell transplant one year prior and more recently, matched sibling allogenic transplant. Since transplantation, she had a history of rash, which was diagnosed as graft-versus-host disease (GVHD) by skin biopsy. During that same hospitalization, she had a transjugular liver biopsy to rule out GVHD which was complicated by a large intrahepatic and subcapsular hematoma. A catheter to drain the hematoma was placed by interventional radiology, which was still in …

Rupture Recurrence After Surgical Repair Of A Postinfarction Ventricular Septal Rupture In The Reperfusion Era, Apurva D. Shah, Md, Alan K. Tannenbaum, Md

The Medicine Forum

A 63-year-old male is admitted to the CCU for chest pain, shortness of breath, and an elevated troponin.

The patient is a 63-year-old male with a past medical history significant for hypertension and hypercholesterolemia who presented to the emergency room with a chief complaint of shortness of breath and chest pain. The chest pain began two days prior and was associated with nausea. The patient proceeded to have increasing shortness of breath over the subsequent two days which brought him to the emergency room for evaluation.

A 74 Year Old Woman With Left Shoulder Pain, Jane V. Mayrin, Md

The Medicine Forum

A 74 year old woman presented to the emergency department complaining of two weeks of left shoulder pain. The pain was sharp, 8 out of 10 in intensity, located in the left shoulder, made worse with breathing, and associated with mild chest discomfort, diaphoresis, and neck pain. There was no radiation and the pain was not worsened with exertion. The patient has a history of Warthin tumor of the left parotid gland and had undergone laryngoscopy and polypectomy two weeks prior to presentation. Around this time she developed the shoulder pain along with overall weakness. At the time of presentation …

A 56-Year-Old Man With Vertigo And Hypercalcemia, Veronica Rivera, Andrew Rose, Md

The Medicine Forum

A 56-year-old Man with a past medical history significant for lower back pain and GERD was admitted to the hospital for dizziness and laboratory abnormalities.

Five days prior to admission, the patient noted that he felt dizzy and unsure while walking. These symptoms persisted without change and he went to see his primary care doctor the day prior to admission. The patient was given meclizine for his dizziness and routine labs were drawn. He received a call from his doctor on the day of admission instructing him to be evaluated for an elevated serum calcium.

55 Year Old Woman With Pneumonia, Andra Popescu, Md

The Medicine Forum

A 55 year old Caucasian female smoker, with past medical history significant for hypertension and peptic ulcer disease presented to the emergency department with a four day complaint of malaise, fever, and myalgias. She was seen by her primary care physician who started her on amoxicillin clavulanate for possible strep throat infection. Her family reported a productive cough with green sputum, pleuritic chest pain, nausea, vomiting and diarrhea for one week. They also felt she was getting more confused over the past several hours.

Liver Transplant Recipient With Bilateral Leg Swelling, Kuntal M. Thaker, Md, Maya Spodik, Md, Kuldip S. Banwait, Md, Steven K. Herrine, Md, Victor Navarro, Md

The Medicine Forum

A 50-year-old white male was admitted to the hospital with erythema and swelling of both lower extremities.

The patient had a medical history significant for liver transplant five years prior for end-stage liver disease secondary to alcoholic cirrhosis. Following transplant, he developed mitral valve insufficiency with heart failure and pulmonary hypertension. He had been in his usual state of health until approximately a week prior to admission when he noticed that his lower extremities had increased in girth. For several days, he noted that there had also been increased redness and pain over the affected area.

34 Year Old Woman With Thrombocytopenia And Weakness, M. Paula Martinez, Md, Ubaldo E. Martinez, Md

The Medicine Forum

Patient is a 34 year old Liberian Female with past medical history significant for Systemic Lupus Erythematosus (SLE) that was recently admitted to the hospital for weakness and was diagnosed with encephalomyelitis due to SLE. At that time the patient was also noted to have low platelets felt secondary to Immune Thrombocytopenic Purpura (ITP). She has history of thrombocytopenia with her four pregnancies. During this past admission the patient was treated with hydroxychloroquine and high dose steroids for the CNS involvement of SLE but no platelet response was noted with administration of steroids. She was discharged to a rehabilitation facility, …

A Post-Partum Woman With Dyspnea, Saaron Laighold, Md

The Medicine Forum

A G1P1 40 year-old Caucasian female without significant past medical history presented to an outside hospital with worsening shortness of breath and hemoptysis. The patient was 10 days status post caesarian section for preeclampsia. Her course after delivery was complicated by a stay in the ICU for shortness of breath. She was discharged home 7 days post-delivery and then returned to the hospital 3 days later. The patient was intubated at the outside hospital for hypoxia (O2 sats of 50% on room air) and transferred to TJUH for further management.

41 Year Old Women With Fevers And Shortness Of Breath, Jonathan Jun, Md

The Medicine Forum

A 41 year-old African American female with a history of asthma, hypertension, and schizophrenia presented to the ER in February 2005 with shortness of breath, wheezing, and a “wet-sounding” but nonproductive cough. She reported chills, subjective fever, rhinorrhea, and malaise for five days prior. Her only medication was albuterol, which she normally used twice weekly as needed. She was never intubated for asthma. On review of systems, she had progressive dyspnea on exertion of less than two blocks for the last year. She denied night sweats, weight loss, or sick contacts, HIV exposure, alcohol or drug abuse. She admitted to …

A 32 Year Old Man With Loss Of Consciousness, Dana Dana Critchell, Md

The Medicine Forum

A 32-year-old man with no past medical history presented to the emergency department after losing consciousness at the end of a half-marathon. The patient was in his usual state of good health until the last mile of the marathon when he began to feel unsteady on his feet and short of breath. At the end of the race, he collapsed and was found unresponsive by EMS. The patient had no memory of the subsequent events and could only recall waking up in the emergency department feeling “numb” and “confused” several hours later. The patient denied any palpitations, chest pain, nausea, …

Presence Of Concomitant Asymptomatic And Symptomatic Emboli Resulting From Acute Staphylococcus Aureus Endocarditis, Jason T. Bradley, Md, Nicole M. Orr, Md, Siva Ramachandran, Md

The Medicine Forum

A 25-year-old male intravenous heroin user with Hepatitis C presented with a syncopal episode and left sided weakness. Examination revealed sub-conjunctival hemorrhages and diffuse bilateral petechiae on his lower extremities. He had multiple irregular, erythematous, painless macules on his hands and feet, and linear, red, subungal lesions bilaterally. These findings were consistent with Janeway lesions and splinter hemorrhages, respectively. His vital signs were stable on admission. Cardiac auscultation revealed a grade 2/6 holosystolic apical murmur radiating to the axilla. A brain MRI revealed multiple areas of hyperdensity, particularly in the right parietal lobe (Figure 1). Blood tests revealed leukocytosis and …

An 18-Year Old Man With Fever And Headache, Amy Baranoski, Md

The Medicine Forum

An 18-year-old man was transferred from an outside hospital for evaluation of recent headache, fevers, and laboratory abnormalities.

The patient had a past medical history significant for attention deficit hyperactivity disorder (ADHD) and had presented to an outside hospital with complaints of fatigue, fever, and headache. He described the headache as frontal, severe, and stabbing in nature without associated neck stiffness, photophobia, or phonophobia. He also reported fevers to 105ºF. He was evaluated one day after the onset of symptoms at a local emergency room where a lumbar puncture was performed. By report of the patient and his mother, the …

Table Of Contents: The Medicine Forum, Volume 7, 2005

The Medicine Forum

Table of Contents for Volume 7 of the Medicine Forum.

From The Editors, Betty Lim, Md, Andrew Rose, Md, Karl Kwok, Md

The Medicine Forum

Welcome to the 7th Edition of the Jefferson Medicine Forum! In this edition we have highlighted some of the many interesting and diverse cases encountered by our Internal Medicine students, residents, and fellows.

From The Residency Program Director, Gregory C. Kane Md

The Medicine Forum

The ideal of a University is that we live and work together as a community of scholars dedicating ourselves to the advancement of Medicine. Our community is at its best when we share ideas, knowledge, perspective, and a passion for Medicine. As a routine, this can occur at Morning Report or Noon Conference, but also on rounds or hopefully at the bedside when dealing with a particularly challenging case.

This journal serves as an outlet for observations or studies of particular merit. Its publication is an important element of our scholarly focus in the Department. Indeed, nearly a score of …

The Relationship Between Physicians‘ Ownership Of Physical Therapy Services And Referral Patterns To Hospital-Based Outpatient Rehabilitation Centers, Joy Bruce

Theses and Dissertations

Background and Purpose A debate over the practice of physician self-referral has been ongoing in health care since the 1980s. At issue is the practice of physicians who refer patients to facilities in which they share a financial interest, a phenomenon known as referral for profit. Physician investment or ownership interest in ancillary (e.g., physical therapy) services has been shown to have an impact on utilization rates, costs, access to care, and quality of care. What has not been identified in previous research is the influence of physicians‘ selective referral on competing clinics, particularly the hospital-based outpatient centers that share …

Real-World Comparison Of Two Molecular Methods For Detection Of Respiratory Viruses, Syed Asad Ali, James E. Gern, Tina V. Hartert, Kathryn M. Edwards, Marie R. Griffin, E Kathryn Mille, Tebeb Gebretsadik, Tressa Pappas, Wai Ming Lee, John V. Williams

Department of Paediatrics and Child Health

Background: Molecular polymerase chain reaction (PCR) based assays are increasingly used to diagnose viral respiratory infections and conduct epidemiology studies. Molecular assays have generally been evaluated by comparing them to conventional direct fluorescent antibody (DFA) or viral culture techniques, with few published direct comparisons between molecular methods or between institutions. We sought to perform a real-world comparison of two molecular respiratory viral diagnostic methods between two experienced respiratory virus research laboratories.
Methods: We tested nasal and throat swab specimens obtained from 225 infants with respiratory illness for 11 common respiratory viruses using both a multiplex assay (Respiratory MultiCode-PLx Assay [RMA]) …

Interictal Magnetoencephalographic Findings Related With Surgical Outcomes In Lesional And Nonlesional Neocortical Epilepsy, Rui Zhang, Ting Wu, Yingying Wang, Hongyi Liu, Yuanjie Zou, Wen Liu, Jing Xiang, Chaoyong Xiao, Lu Yang, Zhen Fu

Center for Brain, Biology, and Behavior: Faculty Publications

Purpose: To investigate whether interictal magnetoencephalography (MEG) concordant with other techniques can predict surgical outcome in patients with lesional and nonlesional refractory neocortical epilepsy (NE).

Methods: 23 Patients with lesional NE and 20 patients with nonlesional NE were studied. MEG was recorded for all patients with a 275 channel whole-head system. Synthetic aperture magnetometry (SAM) with excess kurtosis (g2) and conventional Equivalent Current Dipole (ECD) were used for MEG data analysis. 27 Patients underwent long-term extraoperative intracranial video electroencephalography (iVEEG) monitoring. Surgical outcomes were assessed based on more than 1-year of post-surgical follow-up using Engel classification system.

Results: As we …

Lymphomas In Sub-Saharan Africa - What Can We Learn And How Can We Help In Improving Diagnosis, Managing Patients And Fostering Translational Research?, Kikkeri N. Naresh, Martine Raphael, Leona Ayers, Nina Hurwitz, Valeria Calbi, Emily Rogena, Shahin Sayed, Omar Sherman, Hazem A.H. Ibrahim, Stefano Lazzi, Vasileios Mourmouras, Patricia Rince, Jessie Githanga, Bessie Byakika, Emma Moshi, Muheez Durosinmi, Babatunde J. Olasode, Olayiwola A. Oluwasola, Effiong E. Akang, Yetunde Akeno` Va,, Melissa Adde, Ian Magrath, Lorenzo Leoncini

Pathology, East Africa

Approximately 30 000 cases of non-Hodgkin lymphoma (NHL) occur in the equatorial belt of Africa each year. Apart from the fact that Burkitt lymphoma (BL) is very common among children and adolescents in Africa and that an epidemic of human immunodeficiency virus (HIV) infection is currently ongoing in this part of the world, very little is known about lymphomas in Africa. This review provides information regarding the current infrastructure for diagnostics in sub-Saharan Africa. The results on the diagnostic accuracy and on the distribution of different lymphoma subsets in sub-Saharan Africa were based on a review undertaken by a team …

Mentoring: Combating Vulnerabilities Of Homeless Children, Julia Lane Mitchell

Florida Public Health Review

Homeless children are at risk for numerous health maintenance, academic performance, job preparedness, and emotional well- being issues. The effects of poverty multiply with time, posing greater risks the longer children are entrenched in homelessness. Expansive, holistic programming can address the special needs ofhomeless children. One-on-one mentoring offers a viable strategy to prevent morbidity emanating from homelessness by providing personal attention, encouragement, and affirmation to these vulnerable children, who with time, may develop a more defined self-identity that results in motivation and success.

Agenda Of 06/28/2011 Hsc Board Of Directors Mtg, Patrice Martin

HSC Committee (A subcommittee of the UNM Board of Regents)

No abstract provided.