Hemic and Lymphatic Diseases Commons^™

Isolated Forefoot Juvenile Xanthogranuloma: Unique Case Study And Treatment In A Pediatric Patient, Brian Derner Dpm, Kristine Hoffman, Amy Storfa Md, Dustin Kruse Dpm, Paul A. Stone Dpm, Facfas

Podiatry

Juvenile xanthogranulomas (JXG) are a benign histiocytic cell proliferative disorder in early childhood. They most commonly present within the first two years of life with papular or nodular changes to the skin on the head, neck or upper trunk. Xanthogranulomas are mostly self-limiting, can be singular or multiple, and rarely can infer a systemic disease process1. The purpose of this study was to publish a unique finding of an extra-tendinous solitary mass in an otherwise healthy 17-year old, with surgical and medical treatment after diagnosis.

Bradycardia In The Setting Of Gastric Sarcoidosis, Kameron Black Mph, Michelle Levine Do, Rage Geringer Md, Gregory Hicks Md, Oliwier Dziadkowiec

Internal Medicine

No abstract provided.

Malignant Insulinoma With Multiple Liver Metastases And Hypercalcitoninemia In A Patient With Type 2 Diabetes Mellitus Presenting As Recurrent Episodes Of Diaphoresis Due To Severe Hypoglycemia, Marco Ciacciarelli, Gianluca Caruso, Marco Rengo, Piero Maceroni, Carmen Misurale, Eleonora D'Armiento, Cristina Napoli, Alberto Lombardini, Umberto Ceratti, Ruben Manuel Luciano Colunga Biancatelli, Leonardo Calvosa, Romina Milanese, Sonia Ferri, Teresa Massaro, Andrea Larusso, Veronica Sorrentino, Vincenzo Petrozza

Bioelectrics Publications

Insulinoma is an insulin-producing pancreatic neuroendocrine tumor that can be malignant in about 10% of cases. Locoregional invasion, lymph node metastases, or remote metastases are the main criteria of malignant insulinoma. Its incidence in patients with pre-existing diabetes mellitus (DM) is exceptionally rare. In this report, we describe a 66-year-old man with long-standing type 2 DM who presented with recurrent episodes of diaphoresis due to severe hypoglycemia despite the withdrawal of insulin therapy, hypercalcitoninemia, and biochemical and radiological findings suggestive of metastatic malignant insulinoma. Unfortunately, after few days of diazoxide treatment, edema, hypotension, oliguria, and water retention were observed, patient’s …

Prevalence And Predictors Of Chronic Pain Intensity And Disability Among Adults With Sickle Cell Disease, Nadine Matthie, Coretta Jenerette, Ashley Gibson, Sudeshna Paul, Melinda Higgins, Lakshmanan Krishnamurti

Faculty, Staff and Student Publications

Among 170 adults with sickle cell disease, we evaluated chronic pain impact and disability prevalence, assessed age and gender differences, and identified psychosocial predictors of chronic pain intensity and disability. Most participants had a high level of disability. Chronic pain intensity and disability were significantly associated with pain catastrophizing and chronic pain self-efficacy, and worsened with age. Further research is needed to confirm study findings and develop interventions, including palliative care approaches that address catastrophizing and disability, particularly for young women and middle-aged adults with sickle cell disease. Moreover, consistent clinical assessment of chronic pain and psychosocial health should be …

Acute Lymphoblastic Leukemia Presenting Initially As Spinal Cord Compression: When Chemotherapy Alone Is Enough, Albert Jang, Kallie N Kram, Scott N Berger, Mahmoud R Gaballa, Lee B Lu, David R Dunaway, Courtney N Miller-Chism

Faculty, Staff and Students Publications

Spinal cord compression (SCC) is a rare initial presentation and complication of acute lymphoblastic leukemia (ALL) with nearly all reported cases occurring in the pediatric population. We report a 38-year-old previously healthy man who presented with acute on chronic lower back pain, gait instability, urinary retention, and severe thrombocytopenia. Radiologic examination revealed two soft tissue masses of the thoracic spine associated with compression fractures causing spinal canal narrowing and cord compression. Bone marrow biopsy confirmed the diagnosis of ALL. Immediate initiation of high-dose corticosteroids and systemic chemotherapy resolved the patient's symptoms without radiation therapy or surgical intervention. After two courses …

The Longitudinal Parallel Process Analysis Of Biomarkers Of Oxidative Stress, Symptom Clusters, And Cognitive Function In Children With Leukemia, Mary C Hooke, Daniel Hatch, Marilyn J Hockenberry, Susan Whitman, Ida Moore, David Montgomery, Kari Marano, Pauline Mitby, Michael E Scheurer, Olga Taylor, Wei Pan

Faculty, Staff and Students Publications

Background: During treatment for acute lymphoblastic leukemia (ALL), children report co-occurring symptoms of fatigue, sleep disturbance, pain, nausea, and depression as a symptom cluster. Central nervous system–directed ALL therapies also put children at risk for cognitive impairments. Cancer therapies can cause an increase in oxidative stress, which may contribute to treatment-related symptoms. This study examined the longitudinal relationships between biomarkers of oxidative stress in the cerebrospinal fluid, the Childhood Cancer Symptom Cluster–Leukemia (CCSC-L), and cognition, in children over the first year of ALL treatment. Methods: Glutathione (GSH) biomarkers of oxidative stress were measured in cerebrospinal fluid collected during treatment lumbar …

Outbreak Of Ebola Virus Disease, Alexandra Dimit, Tiffany Kneuss, Joelle Farano, Haley Armstrong, Jodi Otte, Andrew M. Roecker

Pharmacy and Wellness Review

Ebola virus disease (EVD) has existed as a major health concern with devastating and, many times, fatal symptoms. The recent outbreaks of EVD in West Africa and the Democratic Republic of the Congo (DRC) have incited international concern. In this article, the implications of EVD will be discussed including the etiology, transmission, signs and symptoms, diagnosis and treatment of the disease. In addition to this discussion, the manner in which major health care organizations, including the World Health Organization (WHO), are dealing with treating infected patients and containing spread of the disease will be covered.

Rare Obscure Cause Of Upper Gastrointestinal Bleeding: Bleeding Duodenal Lymphangiectasia, Sufian Sorathia, Rulz Cantave, Vivek Choksi, Kairavee D. Dave, Steven Kaplan

Gastroenterology

Introduction: While ulcerative and erosive mucosal changes are more commonly the culprit lesion of upper gastrointestinal bleeding, bleeding can also occur from traumatic, malignant or vascular lesions. An unusual and infrequent vascular cause of bleeding is from a focal intestinal lymphangiectasia (IL). We describe a patient who presented with bleeding from a duodenal IL.

Case Description/Methods: A 94-year-old female was sent by her nursing home for witnessed melena and new onset normocytic anemia with a hemoglobin of 7 g/dl. She was unable to provide a reliable history due to her advanced dementia. Her medical history was unknown. She was hypotensive …

Iron Pill-Induced Gastropathy In Elderly Patients: A Case Series Report, Isin Y. Comba Md, Richard Henriquez, Sundeep Kumar, Ruthvik Srinvasa-Murthy, Maria Wallis-Crespo, Lakhinder Bhatia Md, Joshua Shultz

Gastroenterology

Introduction: Iron deficiency anemia is a global health problem with an estimated two billion cases worldwide. Oral iron supplementation is considered the first line treatment. However, recent studies favor the use of short-term IV iron especially in patients with drug tolerance and efficacy concerns. In this report, we present three cases of iron pill gastropathy in patient's whose clinical courses were complicated by gastric erosion, ulcer or gastrointestinal (GI) bleeding. All of our patients had a history of iron deficiency anemia and were being treated with oral ferrous sulfate.

Case Description/Methods: The first case involved a 72-year-old male with multiple …

Guillain Barre Syndrome In A Patient With Sickle Cell Anemia, Kunjan Udani Md, Pooja Patel, Dveet Patel, Hajra Awwab, Nino Balanchivadze

Internal Medicine

No abstract provided.

Lbrutinib (Lmbruvica™) For Treatment Of Mantle Cell Lymphoma, Brittany Crowe, Joy Hoffman, Hannah Stewart, Alison Steinbrunner, Mark E. Olah

Pharmacy and Wellness Review

Mantle cell lymphoma (MCL) is a rare and moderately aggressive form of non-Hodgkin's lymphoma (NHL) that predominantly presents at an advanced stage in older males. Patients often present with multiple involvement in the lymph nodes, blood, spleen, bone marrow and gastrointestinal tract (GIT). Some patients may be asymptomatic in early stages or present with an incurable, indolent (slow progressing) form, while other patients display rapid growth of more aggressive lymphomas. Overall survival for patients diagnosed with MCL is four to five years and treatment should be initiated in those who are symptomatic. Mantle cell lymphoma responds well to first-line treatment, …

Treatment Of Podoconiosis With Complicating Polyinfections Within Rural African Villages: A Case Study, Amanda R. Beering, Abigail R. Florence, Soon Bahrami Md

Journal of Refugee & Global Health

This case study aims to provide a treatment plan for the treatment of podoconiosis with complicating polyinfections in a resource poor setting. A second objective is to help healthcare providers teach preventive measures to villagers in affected regions.

Infant With Protein C Deficiency And Stroke In The Setting Of Iron Deficiency Anemia, Tahseen Jalal Karim, Dustin J Paul, Regina M Troxell, Rajan Patel, Ian J Butler

Faculty, Staff and Student Publications

We report an 18-month-old infant with ischemic stroke, neurocognitive impairment, and psychomotor retardation in the setting of severe iron deficiency anemia. Although an uncommon outcome in anemic children, stroke is important to consider as a cause for developmental delay in children with iron deficiency anemia.

In Vitro Characterization Of Sonothrombolysis And Echocontrast Agents To Treat Ischemic Stroke, Himanshu Shekhar, Robert T Kleven, Tao Peng, Arunkumar Palaniappan, Kunal B Karani, Shaoling Huang, David D Mcpherson, Christy K Holland

Faculty, Staff and Student Publications

The development of adjuvant techniques to improve thrombolytic efficacy is important for advancing ischemic stroke therapy. We characterized octafluoropropane and recombinant tissue plasminogen activator (rt-PA)-loaded echogenic liposomes (OFP t-ELIP) using differential interference and fluorescence microscopy, attenuation spectroscopy, and electrozone sensing. The loading of rt-PA in OFP t-ELIP was assessed using spectrophotometry. Further, it was tested whether the agent shields rt-PA against degradation by plasminogen activator inhibitor-1 (PAI-1). An in vitro system was used to assess whether ultrasound (US) combined with either Definity or OFP t-ELIP enhances rt-PA thrombolysis. Human whole blood clots were mounted in a flow system and visualized …

Heavy Menstrual Bleeding In Adolescent Females With Platelet Function Disorders, Lauren Amos Md

Research Days

No abstract provided.

Initial Evaluation Of Adolescent Females Hospitalized With Heavy Menstrual Bleeding, Lauren Amos Md

Research Days

No abstract provided.

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 …

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.

Dual Therapy Treatment Of Pediatric Acute Lymphoblastic Leukemia With Blinotumomab And A Standard Chemotherapy Regimen, Tori I. Scheffler

Selected Honors Theses

Leukemia is the number one cancer affecting children in the nation, with acute lymphoblastic leukemia being the most prevalent classification.1 While new and innovative treatment protocols have greatly increased the success rate of primary cancer patients, those who face relapse receive a much more dismal prognosis. Recent studies have shown that patients who relapse quite frequently have developed drug-resistant clones of the original cancer cells, leading to a need for various secondary treatment options. The drug-resistance is due to clonal mutations that take place within the cancer cell, most often because of an outside pressure or stress within the environment …

Clinical Pharmacology Of Tisagenlecleucel In B-Cell Acute Lymphoblastic Leukemia., Karen Thudium Mueller, Edward Waldron, Stephan A. Grupp, John E. Levine, Theodore W. Laetsch, Michael A. Pulsipher, Michael W. Boyer, Keith August, Jason Hamilton, Rakesh Awasthi, Andrew M. Stein, Denise Sickert, Abhijit Chakraborty, Bruce L. Levine, Carl H. June, Lori Tomassian, Sweta S. Shah, Mimi Leung, Tetiana Taran, Patricia A. Wood, Shannon L. Maude

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: Tisagenlecleucel is an anti-CD19 chimeric antigen receptor (CAR19) T-cell therapy approved for the treatment of children and young adults with relapsed/refractory (r/r) B-cell acute lymphoblastic leukemia (B-ALL).

PATIENTS AND METHODS: We evaluated the cellular kinetics of tisagenlecleucel, the effect of patient factors, humoral immunogenicity, and manufacturing attributes on its kinetics, and exposure-response analysis for efficacy, safety and pharmacodynamic endpoints in 79 patients across two studies in pediatric B-ALL (ELIANA and ENSIGN).

RESULTS: Using quantitative polymerase chain reaction to quantify levels of tisagenlecleucel transgene, responders (N = 62) had ≈2-fold higher tisagenlecleucel expansion in peripheral blood than nonresponders ( …

Hyperhomocysteinemia As A Risk Factor For Vascular Contributions To Cognitive Impairment And Dementia, Brittani R. Price, Donna M. Wilcock, Erica M. Weekman

Physiology Faculty Publications

Behind only Alzheimer’s disease, vascular contributions to cognitive impairment and dementia (VCID) is the second most common cause of dementia, affecting roughly 10–40% of dementia patients. While there is no cure for VCID, several risk factors for VCID, such as diabetes, hypertension, and stroke, have been identified. Elevated plasma levels of homocysteine, termed hyperhomocysteinemia (HHcy), are a major, yet underrecognized, risk factor for VCID. B vitamin deficiency, which is the most common cause of HHcy, is common in the elderly. With B vitamin supplementation being a relatively safe and inexpensive therapeutic, the treatment of HHcy-induced VCID would seem straightforward; however, …

Evaluating The Impact Of A Standardized Education Class On A Person Diagnosed With Chronic Kidney Disease, Stage Iv, Nancy K. Uhland, Dnp, Msn, Rn, Fnp-C

Doctor of Nursing Practice Projects

Background: Chronic kidney disease (CKD) is a complex, progressive, and costly disease impacting more than 26 million Americans. Providing effective education is necessary so the patient may actively participate in managing the disease process, but the effectiveness of the delivery of education to the patient with CKD is not well-known.

Objective: To evaluate the effectiveness of a standardized education class on the basic kidney knowledge of persons diagnosed with CKD, stage IV.

Method: This pilot study, using a one-group pre and post-test design, was conducted in an outpatient nephrology clinic located in Washington, D.C. The study participants, recruited using census …

A Healthcare Improvement Initiative To Increase Multidisciplinary Pain Management Referrals Of Youth With Sickle Cell Disease, Rae Ann Kingsley, Gail Robertson, Lynne Covitz, Areli Ramphal

Posters

No abstract provided.

Medication Timeliness In Emergency Department In Pediatric Sickle Cell Disease Population Presenting With Vaso-Occlusive Episode, Derrick Goubeaux, Kaitlyn Hoch, Gerald Woods, Julie Routhieaux, Maureen Guignon, Valerie Mcdougall Kestner

Posters

No abstract provided.

The Evaluation Of Mefloquine Drug Repurposing On Acute Myeloid Leukemia, Jessica L. Phan, Bhavuk Garg, Hrishikesh Mehta, Seth Corey

UROP Posters

The aim of this study is to observe cell proliferation, cell viability, apoptosis, and autophagy on acute myeloid leukemia (AML) cell lines, NB4 and U937, with the drug repurposing of mefloquine (MQ). Methods such as the 3-(4,5-Dimethylthiazol-2-Yl)-2,5-Diphenyltetrazolium Bromide (MTT) assay and trypan blue staining have shown a decrease in live cells with high concentrations of mefloquine. Using their average perspective IC50 values of MQ concentration, Western blotting was applied by means of apoptosis and autophagy markers to determine if the induction of apoptosis and inhibition of autophagy was present in MQ-treated AML cells. The experiment will be continued with more …

Robustness Of A Newly Proposed Risk Schema For Lymphatic Dissemination In Endometrioid Endometrial Cancer, Danielle M. Greer, Jessica J.F. Kram, Callie M. Cox Bauer, Scott A. Kamelle

Journal of Patient-Centered Research and Reviews

Background: Surgical management for endometrioid endometrial cancer (EEC) includes complete lymph node dissection for all patients at risk of lymphatic dissemination. The standard risk schema, defined by Mayo Clinic, identifies low-risk patients as those with grade 1/2 EEC, myometrial invasion (MI) ≤ 50%, and tumor diameter (TD) ≤ 2 cm. We recently proposed (and published) a risk schema containing modified forms of grade, MI and TD that suggests a significant decrease in false-negative rate and need for lymphadenectomy in low-risk women.

Purpose: Evaluate robustness of our proposed schema for lymphatic dissemination risk stratification in a subsequent EEC patient cohort.

Methods: …

Evaluating A Preoperative Protocol That Includes Magnetic Resonance Imaging For Lymph Node Metastasis In The Cholangiocarcinoma Screening And Care Program (Cascap) In Thailand., Metha Songthamwat, Nittaya Chamadol, Narong Khuntikeo, Jadsada Thinkhamrop, Supinda Koonmee, Nathaphop Chaichaya, Jeffrey Bethony, Bandit Thinkhamrop

Microbiology, Immunology, and Tropical Medicine Faculty Publications

BACKGROUND: Treatment planning especially liver resection in cholangiocarcinoma (CCA) depends on the extension of tumor and lymph node metastasis which is included as a key criterion for operability. Magnetic resonance imaging (MRI) offers a rapid and powerful tool for the detection of lymph node metastasis (LNM) and in the current manuscript is assessed as a critical tool in the preoperative protocol for liver resection for treatment of CCA. However, the accuracy of MRI to detect LNM from CCA had yet to be comprehensively evaluated.

METHODS: The accuracy of MRI to detect LNM was assessed in a cohort of individuals with …

Dnmt3a Haploinsufficiency Provokes Hematologic Malignancy Of B-Lymphoid, T-Lymphoid, And Myeloid Lineage In Mice, Garland Michael Upchurch

Theses & Dissertations

DNA methyltransferase 3A (DNMT3A) is a master epigenetic regulator of benign and malignant hematopoiesis. To dissect the biological consequences of homozygous and heterozygous Dnmt3a inactivation in malignant hematopoiesis, we generated Dnmt3a homozygous null (Dnmt3a^Δ/Δ) and Dnmt3a heterozygous (Dnmt3a^+/–) mice and compared the presentations of hematologic malignancies between cohorts. Bi-allelic inactivation of Dnmt3a results in the presentation of mature lymphoid neoplasms resembling chronic lymphocytic leukemia (CLL; B220⁺CD19⁺CD5⁺; 88% penetrance (37/42)) and CD8+ peripheral T-cell lymphoma (PTCL; TCRβ⁺CD3⁺CD8⁺CD4^—; 40% penetrance (17/42)). …

Determining The Longitudinal Validity And Meaningful Differences In Hrql Of The Pedsql™ Sickle Cell Disease Module., Julie A Panepinto, J Paul Scott, Oluwakemi Badaki-Makun, Deepika S Darbari, Corrie E Chumpitazi, Gladstone E Airewele, +Several Additional Authors

Pediatrics Faculty Publications

BACKGROUND: Detecting change in health status over time and ascertaining meaningful changes are critical elements when using health-related quality of life (HRQL) instruments to measure patient-centered outcomes. The PedsQL™ Sickle Cell Disease module, a disease specific HRQL instrument, has previously been shown to be valid and reliable. Our objectives were to determine the longitudinal validity of the PedsQL™ Sickle Cell Disease module and the change in HRQL that is meaningful to patients.

METHODS: An ancillary study was conducted utilizing a multi-center prospective trial design. Children ages 4-21 years with sickle cell disease admitted to the hospital for an acute painful …

Improved Survival After Acute Graft-Versus-Host Disease Diagnosis In The Modern Era, H Khoury, T Wang, Michael T. Hemmer, D Couriel, A Alousi, Mitchell Cairo, J Pidala

NYMC Faculty Publications

Acute graft-versus-host disease remains a major threat to a successful outcome after allogeneic hematopoietic cell transplantation. While improvements in treatment and supportive care have occurred, it is unknown whether these advances have resulted in improved outcome specifically among those diagnosed with acute graft-versus-host disease. We examined outcome following diagnosis of grade II-IV acute graft-versus-host disease according to time period, and explored effects according to original graft-versus-host disease prophylaxis regimen and maximum overall grade of acute graft-versus-host disease. Between 1999 and 2012, 2,905 patients with acute myeloid leukemia (56%), acute lymphoblastic …