Medicine and Health Sciences Commons^™

A Case Of Pyoderma Gangrenosum, Christopher T. Miller, Md

The Medicine Forum

Case Report

A 60-year-old man with past medical history of hypertension, post-traumatic stress disorder, major depression, hepatic steatosis, chronic kidney disease, and untreated hepatitis C virus (genotype 1b) initially presented to the outpatient primary care clinic with a chief complaint of an extremely painful right lower extremity ulcer that had developed and grown progressively larger after mild trauma against a metal corner 4 months prior to the appointment. He admitted to picking at the granulation tissue that would develop over the ulcer. He was treating the ulcer with antibiotic ointment. On initial exam, the ulcer was about 2x2 cm, located …

Two Cases Of Co-Infection With Babesiosis And Lyme Disease, Anthony Decicco, Md, B. Niluk Peiris, Md, Cecilia Kelly, Md, Michael Latreille, Md, Donald Jungkind, Phd

The Medicine Forum

Case 1

The patient is a 71-year-old female with past medical history significant for hypothyroidism and hyperlipidemia who presented to Thomas Jefferson University Hospital (TJUH) with complaints of myalgias for 6 weeks duration. The patient stated that she had begun an exercise program to lose weight and had subsequently noticed body aches and increased fatigue. She had presented to an outside hospital with these complaints, was told that the etiology was musculoskeletal, and was prescribed naproxen for pain relief. The pain did improve slightly with the naproxen but she noticed a rash and hives after starting the medication and stopped …

A Case Of A 32-Year-Old Female With Right-Sided Facial Droop And Numbness, Jason Schoenfeld, Msiii, Efstathia Andrikopoulou, Md

The Medicine Forum

Case Presentation

A 32-year-old Hispanic female with a past medical history of asthma, depression and insomnia presented to the emergency room with complaints of right-sided facial droop associated with ipsilateral facial numbness and diminished taste for the past three days. In addition, she reported a moderate to severe pulsatile headache for the past day. This headache was initially right-sided and frontal, but then became right-sided and occipital in location. She had a history of a similar headache episode four years ago. Additionally, she noted moderately severe intermittent chest pain described as sharp then dull occurring over the past day. On …

Mycobacterium Fortuitum Device Infection With Subsequent Endocarditis, Paurush Shah, Md, Alec Vishnevsky, Md

The Medicine Forum

Case

A 78-year-old female with a past medical history of mild dementia, hypertension, diabetes, coronary artery disease status post automatic implantable cardioverter defibrillator (AICD) for congestive heart failure presented with suspected bacterial endocarditis and AICD lead infection from an outside hospital (OSH). The patient initially presented to the OSH with chest wall tenderness, fevers up to 101° F, chills, decreased appetite, weakness and weight loss. She was diagnosed with a non-ST segment myocardial infarction based on elevated troponin levels without electrocardiogram changes. At the OSH, blood acid fast bacillus (AFB) cultures were checked after routine blood cultures and fungal cultures …

A 55-Year-Old Man With Rapid Onset Rectosigmoid Mass And Hepatic Metastases With An Afp Of > 3 Million Ng/Ml, Francis Kim, Md

The Medicine Forum

Case

A 55-year-old male with a past medical history of ulcerative colitis diagnosed in 1999, Barrett’s esophagus, hyperlipidemia, and diabetes mellitus presented with a 2-week duration of daily constant abdominal pain. He described the pain as a sharp, epigastric pain not worsened with food intake or bowel movements. He was unable to tolerate any oral intake for a week prior to admission secondary to increased epigastric pain. He stated an increase in bowel movements to 1 per day that was softer and less formed than usual. He also stated he had a near syncopal episode on the day of admission …

Not Your Typical Case Of Ascites: Pancreatic Ascites In A Patient With Cirrhosis And Pancreatic Duct Leak, Philip Montemuro, Md, Abhik Roy, Md

The Medicine Forum

Case

A 55-year-old male with a history of hepatic cirrhosis secondary to Hepatitis C and alcohol abuse presented to an outside hospital with progressive abdominal pain and distension. The patient initially complained of “punching” right upper quadrant and epigastric abdominal pain that was 10/10 in intensity and non-radiating. Although the pain had started one to two days prior to presentation, the patient had been experiencing several weeks of increasing abdominal distension. He reported drinking eight 40oz beers daily for over 40 years, and he felt that the abdominal pain improved slightly with cessation of alcohol use. The patient complained of …

Strongyloides Stercoralis Infection In A Patient With Aids, Abhik Roy, Md, Gregory Young, Md, Geoffrey Koff, Md, Tasha Kouvatsos, Md

The Medicine Forum

Case

A 46-year-old male with a past medical history significant for acquired immune deficiency syndrome (AIDS) presented with constant, non-radiating epigastric pain, nausea, non-bloody emesis, weakness, and lethargy. He had emigrated from Honduras twenty years prior. The patient denied fever, chills, recent travel, animal exposures, or sick contacts. His medications included efavirenz/emtricitabine/tenofovir, valganciclovir, trimethoprim/sulfamethoxazole, fluconazole, and iron.

Large, Solitary, High-Grade Duodenal Tubular Adenoma In A Patient Presenting With Gi Bleed, Paurush Shah, Md

The Medicine Forum

Case

A 71-year-old male with past medical history of hypertension, hyperlipidemia, aortic stenosis, and atrial flutter on warfarin presented to his primary care physician (PCP) a few days prior to admission with complaints of lethargy, lightheadedness, and mild shortness of breath (SOB) for about five days prior to admission. He stated that he had also been experiencing dark stools for one week while therapeutic on warfarin. His blood pressure in the office was slightly low, and he was told drink extra fluids as his symptoms were likely due to dehydration. The patient returned to his PCP a few days later …

An Indonesian Male With Abdominal Pain And Weight Loss: Abdominal Tuberculosis Presenting With Cervical Lymph Node Enlargement, Leah Duke Kaye, Md, Jayne Littlejohn, Md

The Medicine Forum

Case

A 21-year-old Indonesian male presented with a 6-month history of abdominal pain. The pain was described as a diffuse cramping that was worse with movement and after meals. He reported early satiety, and the pain was improved at rest. Associated with the pain, he reported a seventy pound weight loss, chills, decreased energy, and fatigue over the same time period. He denied nausea, vomiting, fevers, cough, dyspnea, or chest pain.

The patient emigrated from Indonesia to the United States in 2007 and has since had no travel or foreign visitors. He denied incarceration or military duty for both himself …

Hematemesis, A Distended Abdomen, And Pulseless Electrical Activity – An Unusual Presentation Of Boerhaave’S Syndrome, Andrew Garrett, Md, Marie Nguyen, Md, Lindsay Wilde, Md, Andrew Toscano, Md, Philip Pancari, Md, Andrew Lerner, Md

The Medicine Forum

Case Presentation

An 82-year-old male with a past medical history significant for coronary artery disease with three stents placed over the last 15 months, diastolic heart failure with preserved EF, atrial fibrillation on warfarin, colon cancer status-post sigmoid resection and prostate cancer status-post prostatectomy who presented with three episodes of melena, hematemesis, and weakness. The patient was in his usual state of health prior to these symptoms. He had no history of gastrointestinal (GI) bleeding or other GI pathology and was a non-drinker and non-smoker. He denied frequent use of non-steroidal anti-inflammatory medications.

Non-St Elevation Mi As A Unique Presentation Of Angioimmunoblastic T-Cell Lymphoma, Paurush Shah, Md, Gunjan Shah, Md, Avinash Chandra, Md, Lawrence Lee, Msiv, Gregary Marhefka, Md

The Medicine Forum

Case

A 61-year-old Chinese female with a history of hypertension, hyperlipidemia, asthma, and gastroesophageal reflux disease presented with four days of chest pressure that radiated to her left arm and jaw. On exam, her vital signs were within normal limits and cardiac and pulmonary exams were unremarkable. Her initial electrocardiogram (ECG) demonstrated ischemic ST segment depressions in leads II, III, and aVF; her first troponin I was elevated at 2.3 ng/mL (normal <0.05 ng/mL) and peaked at 6.8 ng/mL. She was given sublingual nitroglycerin and metoprolol, which controlled her symptoms, and she was started on a heparin infusion to prevent further ischemia. The patient’s medications included: amlodipine was notable for the following daily medications: amlodipine 5 mg, olmesartan 20mg, atorvastatin 20mg, esomeprazole 20mg, montelukast 10mg, and mometasone 110mcg twice daily. Her family history was significant for a brother who had a coronary stent placed at age 57. She denied drug, tobacco, or alcohol use. She was non-English speaking, and immigrated to the United States from China five years ago.

A 47-Year-Old Female With Shortness Of Breath, Dana Marrero, Md, Kelly Wright, Md

The Medicine Forum

This patient is a 47-year-old female with a history of end-stage liver disease secondary to hepatitis C virus (HCV) complicated by hepatic encephalopathy, obstructive sleep apnea, asthma, and severe peripheral neuropathy who presents to the hospital with complaints of shortness of breath and cough. The patient was recently discharged from an outside hospital 2 days prior to this admission where she was treated for pneumonia and an asthma exacerbation but her symptoms have not improved. She complains of shortness of breath at rest and severely decreased exercise tolerance with dyspnea while walking across the room. Her cough is persistent and …

Table Of Contents, The Medicine Forum, Volume 13, 2011

The Medicine Forum

Table of Contents, The Medicine Forum, Volume 13, 2011

A Case Series Of Lyme Carditis With Complete Heart Block, Rina Shah, Md, Mitul Kanzaria, Md

The Medicine Forum

Case 1

A 25-year-old Caucasian male with a history of a benign functional heart murmur presented to the emergency department for evaluation of 10 days of dyspnea with minimal exertion, such as walking a few blocks or climbing a flight of steps. Dyspnea was accompanied by moderate, dull, left-sided chest pain, which had been progressively worsening over the previous 3-5 days. The symptoms initially occurred only with exertion, but progressed to last 30-45 minutes after discontinuation of activity. He also noticed palpitations during these episodes, but did not try any remedies for his symptoms. Of note, two weeks prior to …

Influence Of The Menstrual Cycle On The Incidence Of Nausea And Vomiting After Laparoscopic Gynecological Surgery: A Pilot Study., Tatjana Simurina, Boris Mraovic, Neven Skitarelić, Tatjana Andabaka, Zdenko Sonicki

Department of Anesthesiology Faculty Papers

STUDY OBJECTIVE: To investigate whether the phase of menstrual cycle influences the incidence of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for elective laparoscopic gynecological surgery.

DESIGN: Prospective, observational, blinded study.

SETTING: General hospital, Postanesthesia Care Unit, and gynecologic floor room.

PATIENTS: 111 ASA physical status 1 and 2 women, aged 18 to 53 years.

INTERVENTIONS: Patients were classified into three groups according to the phase of menstrual cycle at the time of anesthesia: Group F1: follicular phase (menstrual days 1-8; n = 34); Group O2: ovulatory phase (days 9-15; n = 40); and Group L3: luteal …

News In Brief

Jefferson Surgical Solutions

Alejandro Perez, MD, has joined the Jefferson Vascular Center at Methodist Hospital with a dual faculty appointment in the Departments of Medicine and Surgery at Thomas Jefferson University. Dr. Perez completed his residency and fellowship training in vascular medicine at the Cleveland Clinic. He specializes in deep vein thrombosis, pulmonary embolism and hyperbaric oxygen therapy.

Ehyal Shweiki, MD, FACS, has joined the Division of Acute Care Surgery. Dr. Shweiki is fellowship-trained in both cardiothoracic surgery (University of Louisville) and surgical critical care (Washington University/Barnes Jewish Hospital). He also holds an MS in Bioethics. He will serve patients at our …

Adjunct Primer For The Use Of National Comprehensive Cancer Network Guidelines For The Surgical Management Of Cutaneous Malignant Melanoma Patients., Edibaldo Silva

Journal Articles: Oncology and Hematology

Recently, a Surveillance Epidemiology and End Results (SEER) survey of melanoma patterns of care by the Mayo Clinic, Scottsdale showed remarkable deviations from best practice patterns throughout the country. The study, which analyzed the SEER records of 35,126 stage I to III cutaneous malignant melanoma patients treated from 2004 to 2006, showed that adherence to National Comprehensive Cancer Network (NCCN) therapeutic resection margins occurred in less than 36% of patients. Similarly, considerable variation in the quality of melanoma care in the United States when assessed using 26 quality indicators drawn by a panel of melanoma experts was independently reported. These …

Sir William Osler, M.D., C.M., Jonathan Sarik, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Sir William Osler impacted medical education and the practice of medicine like few other physicians. As a writer, he authored nearly 1500 publications and lent his name to numerous eponyms. As a teacher he educated vast numbers of students and through his legacy impacted countless more. Sir William Osler (Fig. 1) epitomized what a physician should be throughout his professional life.

Jefferson Alumni Bulletin – Volume 61, Number 2, Spring 2012

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

Features:

• Cultivating Great Physicians & the Timeless Art of Physical Diagnosis
• Waking Up to a Sleepy Specialty
• Dancing the Hygiene Hustle

Profiling The Ethnic Characteristics Of Domestic Injuries In Children Younger Than Age 5 Years., Tolulope A. Oyetunji, Adrienne A. Stevenson, Aderonke O. Oyetunji, Sharon K. Onguti, Sarah A. Ames, Adil H. Haider, Benedict C. Nwomeh

Manuscripts, Articles, Book Chapters and Other Papers

The home remains a very common location for deadly injuries among children younger than 5 years. The aim of this study is to describe the demographic and injury characteristics of domestic injuries in children younger than 5 years. The National Trauma Data Bank's National Sample Program data set was queried for children younger than 5 years with the injury site classified as home. Bivariate analysis was performed to determine unadjusted differences by ethnicity. Appropriate weight was applied to the sample to determine accurate national estimates. A total of 7,364 children, representing 32,033 children, were analyzed. Overall mortality was 1.6 per …

Financial Position And Adoption Of Electronic Health Records: A Retrospective Longitudinal Study, Jay J. Shen, Gregory O. Ginn

School of Public Health Faculty Research

AIM: Financial barriers are a major factor of slow electronic health record (EHR) adoption among US hospitals. All existing literature focuses on relationships between current or short-term financial position and EHR adoption. This study examines relationship between financial position in previous years and the current level of EHR adoption.

METHODS: Retrospective longitudinal data were extracted from (1) the 2009 American Hospital Association (AHA) EHR implementation survey; (2) the 2002 and 2006 Centers for Medicare & Medicaid Cost Reports; and (3) the 2002 and 2006 AHA Annual Survey containing organizational and operational data. The final sample was 2,701 acute care hospitals …

Fibrinogen, Chronic Obstructive Pulmonary Disease (Copd) And Outcomes In Two United States Cohorts, Deepa Valvi, David M. Mannino, Hana Müllerova, Ruth Tal-Singer

Preventive Medicine and Environmental Health Faculty Publications

BACKGROUND: Fibrinogen is a marker of systemic inflammation and may be important in the pathogenesis and progression of chronic obstructive pulmonary disease (COPD).

METHODS: We used baseline data from Atherosclerosis Risk in Communities and Cardiovascular Health Studies to determine the relation between fibrinogen levels and COPD and to examine how fibrinogen levels at baseline affected outcomes of death, development of COPD, lung function decline, and COPD-hospitalizations.

RESULTS: Our study sample included 20,192 subjects, of whom 2995 died during the follow-up period. The mean fibrinogen level was 307.6 mg/dL and 10% of the sample had levels >393.0 mg/dL. Subjects with Stage …

Download Entire Issue- Jefferson Interprofessional Education And Care Newsletter, Winter, 2012, Volume 3, Issue 2

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Download entire issue- Jefferson Interprofessional Education and Care Newsletter, Winter, 2012, Volume 3, Issue 2.

Download Entire Issue- Jefferson Interprofessional Education And Care Newsletter, Summer, 2011, Volume 3, Issue 1.

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Download entire issue: Jefferson Interprofessional Education and Care Newsletter

Summer 2011, Volume 3, Issue 1.

Upcoming Faculty And Staff Development Programs

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

• Interprofessional Education and Care Practicum
• Manuscript Writing Workshop (2011-2012)
• Collaborating Across Borders III
• Save the Date! - Interprofessional Care for the 21st Century: Redefining Education and Practice

Announcements

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Announcements including:

• Congratulations to JCIPE’s Spring 2011 Interprofessional Education and Care Practicum Pilot AwardRecipients
• Jefferson Award for Excellence in Interprofessional Education
• Health Mentors Program

Developing A Tool To Assess Students' Attitudes Toward Chronic Illness, Jon Veloski

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

The goals of many interprofessional programs involvechanging students' attitudes. Jefferson Attitudes towardChronic Illness Survey (Jefferson CIS), which has beenused to assess the attitudes of perceptions toward chronicillness care of nearly 2,000 Jefferson students since 2007,provides a case study of some of the best practices used todevelop a credible tool to evaluate attitudinal changefollowing curricula designed to improve chronic illnesscare skills. Previous work demonstrates that healthprofessionals and students often report negative biasestowards care of those with chronic illness or disability.1,2,3 Although the details are available elsewhere,4 thefollowing highlights key methods and representativefindings from the initial validation study for the Survey.

Providing For The Medical And Social Needs Of Newly Resettled Refugees In Philadelphia, Amy Szajna, Marc Altshuler, Kevin Scott

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

According to Office of Refugee Resettlement (ORR) data,Pennsylvania received 2,155 refugees during the 2009 fiscalyear.1 The primary countries of origin of these refugees wereBurma, Bhutan, and Iraq. The number of refugees whoresettled to Philadelphia County in 2009 totaled 597 persons.The nationalities of the refugees who resettled to PhiladelphiaCounty are representative of state statistics.

Selected Interprofessional Activities At The University Clinical Skills & Simulation Center, John Duffy

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Interprofessional simulation has been a mainstay of a Jefferson education for almost a decade. Since the opening of the Hamilton Building in 2007, opportunities for interprofessional simulation have grown exponentially at the University. In response to this rapid growth, an Interprofessional Simulation Curriculum Committee (ISCC) was established by Dr. Michael Vergare, Senior Vice President of Academic Affairs in 2010. Committee members include representatives from nursing, medicine, occupational therapy, physical therapy, and pharmacy. The overarching goal of the ISCC is to promote and support the development of interprofessional education via simulation as a teaching/ learning strategy for faculty and students on …

From The Editors, Molly A. Rose, Rn, Phd, Christine A. Arenson, Md

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Welcome to the latest edition of the Jefferson Interprofessional Education and Care Newsletter. We are pleased to describe the launch of two reports essential to interprofessional education and practice in the United States that occurred on May 11, 2011: Core Competencies for Interprofessional Collaborative Practice and Team-Based Competencies, Building a Shared Foundation for Education and Clinical Practice. The first report, Core Competencies for Interprofessional Collaborative Practice, was produced by an expert panel convened in 2009 by the Interprofessional Education Collaborative (IPEC), a unique partnership of six associations - the American Association of Colleges of Nursing, the American Association …