Diseases Commons^™

Painful Proximal Oriented Large Heterotopic Spur Formation In An Active Adult Non-Traumatic Amputee, Jack Annunziato, Daniel Shor, Shailesh Parikh

Rowan-Virtua Research Day

Heterotopic ossification (HO) is excess bone growth in soft tissues, typically juxta-articular and interfascicular, with varying incidence. HO has been well documented in traumatic amputees but less frequently observed in the non-traumatic amputee population. Symptomatic HO usually includes pain during prosthetic use, with management involving prosthetic adjustments for comfort. This atypical case highlights a non-traumatic amputee developing proximal oriented large spur formation that was painful not with ambulation but with doffing of his prosthesis.

Arthroscopic Medial Meniscus Transplant Utilizing A Multi-Technique Fixation, Elizabeth Ford, Michael Defrance, Sean Mcmillan

Rowan-Virtua Research Day

Arthroscopic medial meniscus transplantation can be a daunting procedure for even the most skilled surgeon. While all-inside suture fixation devices have improved, the ability to successfully perform this procedure via arthroscopy is reliant upon the surgeon's ability to utilize a variety of fixation techniques. Based upon the review of the literature, this paper is the first of it's kind describing the methodology and algorithm for completing an arthroscopic medial meniscus transplant using four techniques.

Atypical Presentation Of Stemi With Cardiac Tamponade Related To Malignancy, Matthew J. Johnson, Rohan Penmetcha

Rowan-Virtua Research Day

Cardiac tamponade and myocardial infarction are rare as the initial presentation of a malignancy. Here, we describe a case with an atypical presentation of a myocardial infarction due to a thrombus in the right coronary artery occurring in the setting of a pericardial effusion causing tamponade physiology related to malignancy. We present this unique case of myocardial infarction and cardiac tamponade as this was not caused by a type-A aortic dissection. In conclusion, we suggest that malignancy be considered in the differential diagnosis when these findings present together.

Occult Renal Cell Carcinoma Presenting As A Palpable Supraclavicular Virchow's Node, Luke Perry, Jandie Schwartz, Gus Slotman, Omar Al Ustwani, Nandini Kulkarni

Rowan-Virtua Research Day

Occult papillary renal cell carcinoma (RCC) is a rare disease process in which there is evidence of metastatic kidney cancer, but no primary kidney tumor can be found on physical exam or imaging. The papillary subtype of RCC accounts for 10-15% of RCC’s. These lesions infrequently present as occult disease. A Virchow’s node can be positive for multiple cancer types, most notably gastric cancer, but also gallbladder, pancreas, kidneys, testicular, and prostate cancer. We describe a case of occult papillary renal cell carcinoma diagnosed by biopsy of a Virchow’s node.

Recurrent Renal Cell Carcinoma Post Radical Nephrectomy: A Case Report, Amarnath Polepalle, Neethi Dasu, Adam Freilich, Jayram Krishnan

Rowan-Virtua Research Day

This is a case of a 73-year-old Caucasian male presenting with an asymptomatic right adrenal mass.

Renal Cell Carcinoma (RCC) constitutes 80 to 85% of primary renal neoplasms. At presentation, up to 25% of patients with RCC will have evidence of metastases or locally advanced disease. [1] Patients will rarely present with any symptoms since the majority of patients are incidentally diagnosed due to radiologic procedures performed for other indications. RCC is considered the most lethal of urologic cancers because a patient without intervention who has stage IV metastatic disease has a 5-year survival rate of 23% in comparison to …

The Interface Between Invasive Species And The Increased Incidence Of Tick-Borne Diseases, And The Implications For Federal Land Managers, Ed Clark, Janis Mcfarland, Blaine Parker, Slade Franklin

National Invasive Species Council

Includes information on the dynamics of tick-borne disease, factors affecting the occurrence and density of ticks, matrices of ties between habitat, human activities, invasive plants, and ticks, federal resources and programs related to ticks and vector-borne disease in the United States, with references and an annotated bibliography of literature on ticks, vector-borne diseases, and invasive species.

Deicing Salts Influence Ranavirus Outbreaks In Wood Frog (Lithobates Sylvaticus) Tadpoles, Sarah Jacobson

Honors Scholar Theses

Ecosystems are increasingly being exposed to anthropogenic stressors that could make animals and thus populations more susceptible to disease. For example, the application of deicing salts to roads is increasing in the northeastern United States. Chronic stress that larval amphibians experience when living in vernal pools with high salinity may alter their susceptibility to ranavirus, a pathogen responsible for mass mortality events worldwide. This project quantifies the effects of road salts and ranavirus exposure on larval wood frog (Lithobates sylvaticus) growth and survival. Using outdoor mesocsoms, we raised wood frog tadpoles in salt treatments and then exposed them …

Group A Beta-Hemolytic Streptococcus Toxic Shock Syndrome Following Elective Termination Of Pregnancy: A Review Of Current Literature And Recommendations, Shannon Alexa, Jandie Schwartz

Rowan-Virtua Research Day

Group A Streptococcal Toxic Shock Syndrome (STSS) occurs as a subset of invasive Group A Streptococcal (GAS) infections accounting for roughly 10% of cases yearly. Of those, Puerpural Streptococcal infections occur only 0.5/10,000 live births but has a mortality rate of nearly 38% if management does not occur early^1,3,4. Despite the overall lower incidence of disease when compared to noninvasive forms, infection rates have started to rise over the last 10 years making it a necessity that practitioners be able to efficiently diagnose and treat infection. Presented here is the case of a 30 year old female who …

The Relationship Of Creatinine, Sodium, Hematocrit And Hemoglobin A1c To 30-Day Hospital Readmission Among Older Adults With Type 2 Diabetes, Shmilah Choudhary, Meet Shah, Sanath Shetty, Terri Ginsberg, Matthew H. Mclaughlin

Rowan-Virtua Research Day

Introduction:Reducing thirty-day hospital readmissions is a top healthcare priority. However, there is little research describing the risk factors of readmission among patients with diabetes, especially for older adults. Understanding what the risk factors are for 30-day hospital readmission for older adults with type 2 diabetes would help identify patients at risk of rehospitalization.

Objective:The aim of this study was to identify factors associated with 30-day unplanned hospital readmissions among older adults with T2DM. Factors to be investigated are: patient demographics and three admission laboratory values.

Methods:Participants were older adult s>65 years old with T2DM, admitted to a community hospital …

The Relationship Of Cardiovascular Disease To 30-Day Hospital Readmission Among Older Adults With Type 2 Diabetes Mellitus, Meet Shah, Shmilah Choudhary, Sanath Shetty, Terrie Ginsberg, Matthew H. Mclaughlin

Rowan-Virtua Research Day

Reducing thirty-day hospital readmissions is a top healthcare priority. However, there is little research describing the risk factors of readmission among patients with diabetes, especially for older adults. Understanding what the risk factors are for 30-day hospital readmission for older adults with type 2 diabetes (T2DM) would help identify patients at risk of rehospitalization. The aim of this study was to identify factors associated with 30-day unplanned hospital readmissions among older adults with T2DM.Factors to be investigated are: patient demographics and whether the patient was hospitalized for cardiovascular disease. Participants were older adults>65 years old with T2DM, admitted to …

Long Term Functional And Esthetic Outcomes After Fibula Free Flap Reconstruction Of The Mandible, I. Petrovic, R. Blaser, Timothy Blackwell, C. Mccarthy, I. Ganley, S. Patel, P. Cordeiro, J.P. Shah

Rowan-Virtua Research Day

Objectives: To report functional and esthetic outcomes, after fibula free flap (FFF) reconstruction of the mandible for oral cancer, assessed by physicians, non-clinicians and patients.

Materials and Methods: Twenty-five long term survivors from oral cancer after FFF reconstruction were recalled for head and neck examination by surgeons and patient reported outcomes, using EORTC, QLQ C-30, H&N-35 and FACE-Q questionnaires.

Results: Physicians reported 64% restoration of functionality compared to normal. Patients reported high scores on QLQ-C30, but lower scores on H&N-35. Esthetic scores were reported higher by clinicians than non-clinicians. The decline in function and appearance was attributed to loss of …

The Correlation Between Obesity, Food Addiction, Anxiety & Depression, Ayham Khrais, Adarsh K. Gupta

Rowan-Virtua Research Day

Obesity is a multifaceted disease with physiological, psychological and social influences. While physiological factors, such as basal metabolic rate, can influence an individual’s BMI (Body Mass Index), obesity is primarily determined by behavior: excess food intake and a sedentary lifestyle greatly contribute to weight gain. An individual’s behavior is influenced by many factors, including their desires, perceptions, and social pressures. Therefore, psychological conditions can greatly impact an individual’s eating habits, thereby affecting that person’s BMI. This endeavor involved exploration of the potential effects of food addiction, anxiety, and depression on obesity. A survey consisting of an amalgamation of the Yale …

A Case Of T-Cell Lymphoma Found In The Liver, Donald Mcmahon, Lucy Joo, Kailash Lal, Neethi Dasu

Rowan-Virtua Research Day

Elevation in liver enzymes can be due to a variety of reasons such as toxins, drugs, autoimmune process, sepsis, malignant infiltration, alcoholic hepatitis, viral hepatitis, and other causes. In this case study, our patient presented with an obstructive pattern of liver test abnormalities. The patient demonstrated alkaline phosphatase levels >1000, with AST and ALT levels < 200. His T-bilirubin initially was 1.5 and increased to 12.4 by the end of his hospital stay. Workup to exclude other causes of liver injury was performed and eventually a liver biopsy was needed to establish etiology. The biopsy revealed a malignant infiltration of likely Peripheral T-Cell Lymphoma.

The Evolving Long-Term Outcome Of Heart Transplantation In Amyloid Patients, Avish Jain, Sadia Dimbil, Ryan Levine, Michele Hamilton, Jon A. Kabashigawa

Rowan-Virtua Research Day

Background: Both amyloid light chain (AL) amyloidosis and transthyretin-related (TTR) amyloid are expanding indications for heart transplantation (HTx). In the past, AL amyloid, in particular, had been a contraindication to HTx given its systemic nature and the increased risk for mortality. Modern treatments including proteasome inhibitors have allowed amyloid patients to receive heart transplants at an increasing rate. We sought to assess long-term post-transplant outcome in amyloid patients in the current era.

Methods: Between 2010 and 2015, we assessed 27 patients (5 AL, 10 TTR-wildtype (wt), 12 TTR-mutant (m)) underwent heart transplant for cardiac amyloidosis at our single center. A …

Mri Findings After A Subchondroplasty Procedure Of The Ankle: A Case Report, Michael E. Calderone, Mansi Patel, Matthew K. Brant

Rowan-Virtua Research Day

Osteoarthritis (OA) of the ankle is a common disease and it is estimated that almost 1% of the world’s adult population have a painful ankle. Often in patients who fail conservative treatment, the use of an MRI is deemed necessary to identify pathologies. Bone marrow lesions (BMLs) seen on MRI have been recognized as a source of the ankle pain. Majority of the BMLs fluctuate in size over time and are seen as hyperintense lesions on MRI.We present MRI findings of a patient following arthroscopy with subchondroplasty.

For Your Eyes Only, Herpes Zoster Ophthalmicus Case Study, Alexander Fishman, Jared Ward, Richard Pescatore

Rowan-Virtua Research Day

Herpes Zoster Ophthalmicus is a reactivation of a latent Varicella Zoster Virus that specifically involves the eye. The reactivation often occurs during immunocompromised states which allows latent virus in the dorsal root ganglia of sensory nerves to begin viral replication an d s pread via peripheral axons. Diagnosis is based on two characteristic findings; herpetic lesions on the eyelids, forehead, or elsewhere within the V1 dermatome, and ocular findings. Symptoms can vary but are often quite painful. Some patients experience a prodrome of tingling sensation prior to the appearance of a zoster dermatitis . HZO can also present initially as …

Postoperative Cholecystitis From Nathanson Liver Retractor During Robotic-Assisted Laparoscopic Partial Nephrectomy, Lauren D. Gleich, Mihir G. Thaker, Gordon A. Brown

Rowan-Virtua Research Day

Proper visualization of the surgical field during any procedure is one of the most imperative elements of surgery. The tools used to obtain this goal come with their own set of risks. This report describes a patient who developed postoperative acalculous cholecystitis (PAC) after use of a Nathan liver retractor. PAC is a rare complication of urologic surgery and is often more severe than acalculous cholecystitis (AC), leading to significant morbidity.

Rare Case Of Hip Pain: Transiliac Lumbar Hernia, Daniel Tran, James Lee, Alan Lucerna, James Espinosa

Rowan-Virtua Research Day

Bone grafts are essential to achieving a solid spinal fusion by encouraging osteoblastic activity and providing a scaffold to guide bone remodeling. The iliac crest, in particular, is a common site for autologous bone grafting and is still considered the gold standard due to its ease of access to cortical and cancellous bone.[1] However, autologous iliac crest bone grafting can be associated with significant morbidity especially when full thickness tricortical grafts are harvested. Common complications include donor site pain, hematoma, thigh dyesthesias, pelvic instability or fracture.[2] Gastrointestinal herniation on the other hand is a much rarer complication with an incidence …

Coronary No-Reflow Following Percutaneous Intervention, Yaser Khalid, Harsh Patel, Adam Levine

Rowan-Virtua Research Day

Normally, coronary revascularization with a percutaneous coronary intervention (PCI) leads to restoration of normal coronary blood flow through the coronary arteries, with reperfusion of the myocardium. However, there is a group of patients who do not benefit from the prompt restoration of antegrade flow, as they fail to show resolution of the indirect signs of ischemia such as electrocardiographic (ECG) changes and improvements in perfusion abnormalities. This condition is referred to as the “no-reflow phenomenon.” In this case report, we will discuss the case of a patient who developed coronary no-reflow immediately following PCI.

The Relationship Of Risk Of Falls And Activities Of Daily Living To 30-Day Hospital Readmission Among Older Adults With Type 2 Diabetes, Sanath Shetty, Shmilah Choudhary, Meet Shah, Terrie Ginsberg, Matthew H. Mclaughlin

Rowan-Virtua Research Day

Introduction: Reducing thirty-day hospital readmissions is a top healthcare priority. However, there is little research describing the risk factors of readmission among patients with diabetes, especially for older adults. Understanding what the risk factors are for 30-day hospital readmission for older adults with type 2 diabetes (T2DM) would help identify patients at risk of rehospitalization.

Objective: The aim of this study was to identify factors associated with 30-day unplanned hospital readmissions among older adults with T2DM. Factors to be investigated are: patient demographics, whether patients were at risk for falling, and patients’ activities of daily living (ADL) at discharge.

Methods: …

Amiodarone Induced Epididymo-Orchitis, Yaser Khalid, Neethi Dasu, Sravan Panuganti, Stephen Daly

Rowan-Virtua Research Day

Amiodarone has a well-established and extensive side effect profile: pulmonary fibrosis, thyroid toxicity, corneal deposits, skin discoloration. However, in some rare instance, epididymitis/orchitis is a side effect of amiodarone. Amiodarone toxicity was first studied in (1, 2) Symptoms range from testicular pain to swelling and erythema (1,2) The mechanism of how this toxicity occurs is unknown. In this case report, we will discuss the case of an elderly patient who developed epididymitis and orchitis after several years of tolerating amiodarone without any adverse events. Our patient underwent a full workup with testicular ultrasound, evaluation by urology and cardiology specialists. Then …

Pre-Operative Clinical Variation By Health Insurance Carrier In 12,285 Male Surgical Patients With Moderate Morbid Obesity, Matthew E. Moore, Gus J. Slotman

Rowan-Virtua Research Day

In the ongoing obesity epidemic, every surgeon now treats patients with weight-related medical problems. In managing these medically fragile surgical patients, every clinical insight helps. While variation according to health insurance has been reported in mixed sex bariatric surgery populations, whether or not clinical characteristics in the subset of moderately obese male surgical patients vary by insurance carrier is unknown. The objective of this study was to identify clinical variation by insurance type in moderately obese men.

Results showed that pre-operative clinical characteristics of moderately obese male surgical patients vary by the health insurance coverage type to which they subscribe. …

Ethnic And Demographic Differences In Colectomy Rates And Timing For Ulcerative Colitis: 2007-2014, Daniel Bodek, Alana Persaud, Brian Blair, Ahlawat Sushil

Rowan-Virtua Research Day

Ulcerative Colitis (UC) is a chronic inflammatory disease of the bowel, with one third of patients requiring a colectomy for fulminant disease and tissue dysplasia. In 2007, infliximab was approved for induction and maintenance of remission in UC, with some evidence to suggest a potential reduction in colectomies. The aim of this study is to examine relative colectomy rates for UC among different ethnicities from 2007 to 2014 in order to evaluate for development of new trends or disparities.

Discrepancies in colectomy rates and timing are seen in our models which mirror closely findings in a prior study from 1999-2003 …

The Effects Of Antenatal Betamethasone On Late Preterm Infants, Jennifer Hummel, Abigail Prest, Xinhua Chen

Rowan-Virtua Research Day

Administration of steroids to mothers expected to deliver in the late preterm period has previously been found to decrease neonatal respiratory morbidity. In this retrospective chart review, there were no significant differences between groups in the primary outcome of required respiratory support for the neonate, incidence of periventricular hemorrhage or neonatal death. However, this study found that their rate of hyperbilirubinemia, need for phototherapy, and NICU stays were longer than their counterparts whose mothers did not receive steroids or who only received one dose.These findings may provide support for future protocols directed to improve neonatal morbidity secondary to jaundice.

Chronic Renal Failure, But Why? A Case Report., Palak Patel, Michael Rothberg

Rowan-Virtua Research Day

Renal failure, both acute and chronic, can present from many different etiologies and if diagnosed with diabetes mellitus, it is commonly assumed to be due to diabetic nephropathy. Monoclonal gammopathy of renal significance (MGRS) is a disorder that combines monoclonal gammopathy of undetermined significance with end stage renal disease. Monoclonal immunoglobulins are secreted by B or plasma cells leading to deposition in the kidney causing end organ damage. Several different subtypes fall under this category of renal diseases including, but not limited to, amyloidosis, C3 glomeruopathy, and light chain proximal tubulopathy, or better known as Fanconi syndrome1. Fanconi syndrome, which …

Something Has Fallen: Pelvic Organ Prolapse Or Vaginal Cuff Dehiscence And Evisceration? A Case Report., Alexandra Nutaitis, Laurie Kane

Rowan-Virtua Research Day

="/">Learning Objectives: 1) Recognize late presenting complications of hysterectomy. 2) Include vaginal cuff dehiscence with evisceration (VCDE) in the differential diagnosis of women suspected of having acute pelvic organ prolapse (POP).3) Appreciate the relative rarity of VCDE in younger women.
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/="/">Case Summary: A 36 year old G0P0 female presented to the ED with a chief complaint of sudden onset excruciating epigastric pain, followed by diarrhea and visible vaginal bulge. Pertinent past medical and surgical history includes breast cancer diagnosed 15 months prior, status post bilateral mastectomy, radiation, chemotherapy, and robotic-assisted prophylactic hysterectomy and BSO 6 months prior. …

A Case Of Atraumatic Posterior Thigh Compartment Syndrome, Nailah Mubin, Brian Katt

Rowan-Virtua Research Day

Compartment syndrome(CS) occurs when intra-compartmental pressures exceeds to a point where arterial, venous and lymphatic circulation of local tissues, muscles and nerves is compromised. CS is most common after a traumatic injury and usually occurs in the leg or forearm and less commonly in the thigh. Thigh compartment syndrome is rare due to its larger size and more compliant borders. We present a case of nontraumatic compartment syndrome in the posterior thigh associated with rhabdomyolysis and a sciatic nerve palsy which then required emergent fasciotomy. The patient's course was further complicated by acute renal failure due to the rhabdomyolysis and …

A Mathematical Investigation On Tumor-Immune Dynamics: The Impact Of Vaccines On The Immune Response, Jonathan Quinonez, Neethi Dasu, Mahboobi Qureshi

Rowan-Virtua Research Day

Mathematical models analyzing tumor-immune interactions provide a framework by which to address specific scenarios in regard to tumor-immune dynamics. Important aspects of tumor-immune surveillance to consider is the elimination of tumor cells from a host’s cell-mediated immunity as well as the implications of vaccines derived from synthetic antigen. In present studies, our mathematical model examined the role of synthetic antigen to the strength of the immune system. The constructed model takes into account accepted knowledge of immune function as well as prior work done by de Pillis et al. All equations describing tumor-immune growth, antigen presentation, immune response, and interaction …

A Rare Manifestation Of A Bleeding Tubulovillous Duodenal Polyp Presenting As An Upper Gastrointestinal Hemorrhage, Neethi Dasu, Yaser Khalid, Herman Suga, Michael Itidiare, Richard Walters

Rowan-Virtua Research Day

• Duodenal polyps are a group of polyps that are fairly uncommon to find on endoscopic evaluation (1).

• They are histologically classified according to mucin phenotype into intestinal and gastric subtypes; the intestinal-type polyps are morphologically subdivided into tubular and tubulovillous adenomas (2)

• We present a case of a 76-year-old male with recurrent hematemesis who was found to have an intestinal-type pedunculated tubulovillous adenoma (TVA) in the descending duodenum • An isolated occurrence of non-ampullary sporadic duodenal adenomas (SDA)’s are a rare finding and presentation as an upper GI hemorrhage is extremely uncommon (3)

• Furthermore, our patient’s …

What Are The Ods? A Case Of Osmotic Demyelination Syndrome Associated With Hemodialysis In End-Stage Renal Disease, Ellen Colleen Bradley, Yvette Wang

Rowan-Virtua Research Day

Osmotic demyelination syndrome (ODS) is the irreversible demyelination of the central pons, among other areas of the brain, that is most often associated with rapid correction of hyponatremia. Per contra, reversible ODS is a rare state that can be seen in patients with end-stage renal disease (ESRD) on hemodialysis (HD). This clinical case offers an alternative problem representation for acute altered mental status in a patient with ESRD on HD.