Medical Specialties Commons^™

Mixed Goblet Cell Carcinoid-Adenocarcinoma: A Case Series, Jairo Espinosa M.D., Timothy Truong, Julia Miladore M.D., John T. Collins, Saad Shebrain M.D., Gitonga Munene M.D.

Research Day

INTRODUCTION: Mixed goblet cell carcinoid-adenocarcinoma (GCC) tumors are a group of rare heterogenous neoplasms of the appendix accounting for < 5% of all primary appendiceal tumors. They are characterized as an intermediate between classic carcinoid tumors and appendiceal adenocarcinomas, exhibiting both neuroendocrine and glandular/mucinous morphology that most commonly presents in Caucasian females in the fifth and sixth decades. We present three cases of mixed GCC presenting as acute appendicitis. CASE PRESENTATION: Case #1 A 65-year-old male presented with RLQ pain, nausea, emesis, and leukocytosis. CT of the abdomen revealed perforated appendicitis. The patient underwent a laparoscopic appendectomy. Pathology revealed a high-grade adenocarcinoma ex goblet cell carcinoid, signet ring type extending through the muscularis propria into the mesoappendix measuring >3cm. The patient subsequently underwent a colonoscopy that revealed diverticulosis, but was otherwise normal. Patient then underwent a right hemicolectomy and partial omentectomy. Pathology revealed normal ileal, omental, and colonic tissue without evidence of carcinoma. 0/12 nodes were positive. Case #2 A 49-year-old male presented with periumbilical pain, nausea, emesis, and leukocytosis. CT of the abdomen revealed appendicitis. The patient underwent a laparoscopic appendectomy. Pathology revealed a high-grade, poorly differentiated, adenocarcinoma ex goblet cell carcinoid invading through the muscularis propria into …

A Case Of Successful Treatment Of Skin Excoriation Disorder With N-Acetyl Cysteine, Nauman Khan M.D., Priya Mahajan M.D., Sadia Shaukat M.D., Matthew Lacasse D.O., Mark Kanzawa D.O.

Research Day

Introduction: We present a case of a middle age patient with skin excoriation disorder since age 15 who experienced significant improvement with augmentation of her treatment regimen with N-acetyl cysteine. This improvement occurred despite a recurrence of her depression, alcohol use disorder, and stimulant use disorder. Case Presentation: A 59 year-old-female with 44 years of unsuccessful treatment of self-excoriation disorder presented with symptoms of unspecified depression, OCD and stimulant use disorder. She was referred by her surgeon who had to postpone a revision of her hip replacement as she was self-excoriating the right axillary lymphadenectomy site. Initial administration of PHQ-9 …

Traumatic Stab Wound To The Chest: A Rare Cause Of Pituitary Apoplexy, Jairo Espinosa M.D., Tim Wysozan, Chris Sloffer

Research Day

INTRODUCTION: Pituitary apoplexy is an uncommon condition that results from infarction and hemorrhage of an established pituitary adenoma. Based on our review of the literature, this is the first description of pituitary apoplexy presenting after a knife stab wound to the deltopectoral region. 
CASE PRESENTATION: A 44 year-old male presented to the trauma bay as a tier 1 trauma activation status post stabbing to the left deltopectoral groove. The patient was found to be hypotensive, tachycardic and actively exsanguinating from the stab wound. He was taken to the operating room where the wound was explored and the left cephalic vein …

Traumatic Laceration Of The Posterior Tibial Tendon Treated With Novel Technique, Nicholas Miladore, Robert Gorman

Research Day

Abstract Title: TRAUMATIC LACERATION OF THE POSTERIOR TIBIAL TENDON TREATED WITH NOVEL TECHNIQUE Abstract ID: 249 Abstract Category: Clinical Research INTRODUCTION: Posterior tibial tendon (PTT) insufficiency is a common entity, and can result in chronic tendon disruption. Acute disruption is a rare occurrence, but has been described in the literature. Most reported cases are associated with ipsilateral ankle fractures. Laceration of the posterior tibial tendon has also been described, typically in the operative setting as a result of iatrogenic injury. 
CASE REPORT: A 15 year old male presented to the clinic with complaints of right ankle pain and weakness. 2.5 …

Gallbladder Duplication: Case Report Of A Rare Congenital Anomaly Treated By Single-Incision Laparoscopic Cholecystectomy In A Pediatric Patient, Jairo Espinosa M.D., Peter White, Michael Leinwand M.D.

Research Day

Introduction: Gallbladder duplication is a rare congenital anomaly. Preoperative diagnosis is essential for prevention of intra operative complications. Based on our review of the literature, this is the first description of gallbladder duplication treated with single-incision laparoscopic surgery (SILS) in a pediatric patient.

Case Presentation: A 14 year-old girl presented to the pediatric surgery clinic with a 4-month history of right upper quadrant abdominal pain, nausea, and low- grade fevers. Preoperative imaging revealed gallbladder duplication. The single incision laparoscopic technique was employed. Intra operative ndings included two gallbladders that appeared to share a common wall. There were two parallel cystic …

Mechanical Loading As Potential Treatment For Wnt Inhibitor Induced Bone Loss, Juraj Zahatnansky Md, Daniel Dick, Gabrielle Foxa, Robert Baker, Bart Williams Phd

Research Day

The Wnt signaling pathway has been shown to play a role in bone homeostasis and carcinogenesis. On the one hand, a decrease in signaling has been associated with a decrease in bone mass, on the other, an increase in signaling with cancer development. LGK974 is a Wnt signaling inhibitor currently being investigated as a potential cancer therapeutic agent. This molecule inhibits Porcupine, a transmembrane protein necessary for Wnt ligand secretion. In light of the above and based on our preliminary data, treatment with LGK974 leads to bone mass loss. Our investigation aims to address whether such bone loss can be …

Pheochromocytoma With Ivc Invasion: Case Report & Systematic Review Of Literature, Jennifer Kim Bs, Ms2, Gitonga Munene M.D., David Schutter Md, Pgy3

Research Day

Surgical management and outcome of pheochromocytoma with invasion of the inferior vena cava (IVC) has not been thoroughly reported or widely available in the literature. As determining the malignancy of pheochromocytoma has yet to be clearly defined and the experience of surgical resection of this condition is underrepresented, we include a case report and a systematic literature review on this condition. A literature search in PubMed was performed based on a recent review article by Kassahun et al. (2016). The search yielded 13 case reports between 1988 and 2014 from which data was extracted based on the following variables: patient’s …

Mycobacterial Disease Overlooked In A Frail Diabetic Male Treated For Pneumonia, Aydin Tavakoli Md Msc, Glenn V. Dregansky Do

Research Day

Mycobacterial disease has been characterized to cause human illness since the 1950’s but practitioners whom address pulmonary disease can overlook its insidious presentation. This case report documents the presentation of a mycobacterial illness treated as a severe pneumonia. This is the case of a critically ill 43-year-old male, with poorly treated diabetes who presented with severe, long-standing respiratory distress in DKA. He had a history of weight loss, night sweats, decreased oral intake, and weakness for about a month. He was treated for euglycemia and his pulmonary disease was characterized as a bacterial pneumonia. Common pathogens were ruled out in …

Utility Of Fern Test To Determine Rupture Of Membranes, Wesley Eichorn, Susan Jevert-Eichorn

Research Day

Introduction: The fern test was first described by Kardos and Tamasi in 1955 as a test used to determine rupture of amniotic membranes. The test is done by collection of fluid from the vagina which is then allowed to dry for 10 minutes on a slide. The slide is then inspected with microscopy for evidence of ferning. Accurate determination of rupture of membranes is important due to its significant implications on the management of obstetrical patients. Case: EC is a 23 year old G1P0 at 40 and 3/7 weeks gestation who presented to an outpatient facility with a chief complaint …

Improving Productivity Through Scheduling At The Wmed Family Medicine Residency Clinic, Alex Witte Md, Susan Jevert-Eichorn, Alison Radigan Md, Larry Mann Do, Jamie Mccartney Md, Aisha Shakoor Md

Research Day

INTRODUCTION: The Accreditation Council for Graduate Medical Education (ACGME) requires every family medicine residency program to have a practice site that supports, “continuous, comprehensive, convenient, accessible, and coordinated patient care”. The WMed Family Medicine Resident Clinic (Team Oakland), located within the Family Health Center (FHC) – Paterson location, has long been plagued by scheduling difficulties, as evidenced by high no-show rates, empty appointment slots, and frequent cancellations threatening the ability of our residents to achieve the required number of outpatient visits mandated by the Family Medicine Residency Review Committee (RRC) and the requirement for continuity from the ACGME. We believe …

Acquired Craniosynostosis In A Patient With Iatrogenic Vitamin D Intoxication, Wesley Eichorn, Kristi Vanderkolk Md

Research Day

Introduction: Craniosynostosis, which refers to premature fusion of cranial sutures, is an uncommon diagnosis in the pediatric patient, occurring with an incidence of approximately 1 in 2,000 individuals. It is most often associated with X-Linked hypophosphatemic rickets. The implications of craniosynostosis, especially with a delayed diagnosis, are severe. Case Report: MJ is an African American male born at term via cesarean section with an unremarkable immediate postnatal period. He was diagnosed with rickets at the age of 7 months but treatment was not immediately initiated. He presented again at age 9 months with an upper respiratory infection and failure to …

Benefit Of Ultrasound Curriculum Development For Family Medicine Residents, Nithin Natwa, Uzair Munshey, Duncan Vos, Robert Baker

Research Day

Introduction/Purpose: Musculoskeletal problems comprise some of the most common reasons for ambulatory care encounters in the United States, accounting for 8.3% of the 1.2 billion visits per year according to the CDC. Musculoskeletal Ultrasound use has become more common in primary care for diagnosis and therapeutics. In Family Medicine Residency (FMR) Programs there is a deficiency of a structured, competency-based musculoskeletal ultrasound (MSK US) training despite its growing popularity. Currently, there is no formalized requirement for Ultrasound education as in other residency programs in spite of its benefit. Methods: We received a positive response on our needs analysis survey for …

Childhood Idiopathic Pulmonary Hypertension: A Case Report, Nathaniel Balmert, Joseph Prahlow

Research Day

Introduction: Pulmonary arterial hypertension (PAH) is characterized as average pulmonary artery pressure of greater than 25mm Hg at rest. Childhood idiopathic pulmonary hypertensions (CIPH) is distinguishable from PAH by the absence of family history or underlying disease. Symptoms of CIPH include dyspnea, exercise limitation, and syncope. Common organ-specific changes include right ventricular hypertrophy and right ventricular strain. We present the case of a 6-year-old girl presenting with idiopathic pulmonary arterial hypertension aggravated by esophageal intubation. Methods: This case is from the files of one of the authors, a forensic pathologist. Case Report and Discussion: Diagnosed with pulmonary arterial hypertension when …

A Case Of Native Valve Staphylococcus Epidermidis Endocarditis With Cardiac Abscess Formation, Emily Cordes, Chris Jacob, Mark Loehrke

Research Day

Introduction: Staphylococcus epidermidis is the most common commensal bacteria of the skin; however it can be pathogenic and is the most frequent cause of medical device associated endocarditis. It is also a well-known cause of endocarditis in IV drug abuse (IVDA). However, in individuals without obvious disruption of the skin barrier, it is a relatively rare, but emerging entity of native valve endocarditis. Coagulase negative staphylococci account for only 1-5% of community acquired native valve infective endocarditis and most resolve with treatment. We report a case of a 56 year old male with an aggressive strain of community acquired Staphylococcus …

Challenges In The Diagnosis And Management Of Pediatric Pulmonary Tuberculosis In Madagascar, Emily Cordes, Richard Roach

Research Day

Introduction: Tuberculosis (TB) remains an important cause of morbidity and mortality in Madagascar. According to the World Health Organization (WHO), in 2015, the estimated incidence of TB was 57,000 and 11,000 of those cases were of patients less than 14 years old. Of the reported cases, 89% were bacteriologically confirmed. However, it is well established that bacteriologic confirmation of TB in children is especially difficult. Therefore, the incidence of TB in the pediatric population in Madagascar, and likely worldwide, is under estimated. We report a case of a 4 year old male that illustrates the challenges in diagnosis and management …

Widening The Differential: A Case Of Hemophagocytic Lymphohistiocytosis Disguised As A Fever Of Unknown Origin, Emily Cordes

Research Day

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is an under recognized, aggressive inflammatory disease characterized by excessive activity of histiocytes and lymphocytes. According to the HLH-2004 guidelines, five of the following eight criteria must be met to diagnose HLH: fever >38.5¡ã C, splenomegaly; cytopenias affecting ¡Ý two cell lines; hypertriglyceridemia/hypofibrinogenemia; evidence of hemophagocytosis in the bone marrow, spleen or lymph nodes; hyperferritinemia; low NK cell activity; or high levels of soluble CD25. Once a diagnosis of HLH is established, investigations for infectious, malignant or autoimmune etiologies must be pursued. We report a case of fever of unknown origin (FUO) that presented multiple times …

Social Determinants - Impacting Or Causing Disparities In Patient Care?, Shaena Faye Freeman Md, Kristi Vanderkolk Md

Research Day

Health disparities secondary to social factors including socioeconomic status, race, gender and ethnicity are well known to the health community and are a troubling issue in the United States. Social determinants are defined by the WHO as the structural “conditions people are born, live, grow, work and age in…determined by wealth distribution and available resources…that are mostly responsible for health inequalities.” We present here the case of TL, a 49 year old African American female who presented to the emergency department three times with atypical coronary disease symptoms in the setting of recent NSTEMI with subsequent 3 vessel CABG. At …

Cryptococcal Empyema: A Rare Manifestation Of Disease, Mohamed Mortagy, Larry Lutwick, Stephen Breisach

Research Day

Introduction: Cryptococcus neoformans is a pathogenic yeast that is generally acquired by man from the environment via the respiratory route. Despite this route of acquisition, overt pulmonary infection is uncommonly diagnosed and the disease is usually manifest as a subacute meningitis which is mostly manifest in individuals who are celluarly immunoincompetent such as those on cancer chemotherapy, receiving anti-solid organ rejection medications and those with HIV/AIDS. Infection of the pleural space with C. neoformans is quite uncommon. We report a non-immunosuppressed man who was found to have infection of the pleural in the wake of bacterial empyema who was successfully …

Infection-Associated Mycobacterium Fortuitum Infection, Dennis T. Huang, Larry Lutwick

Research Day

Introduction: Mycobacterial species are unusual causes of skin and soft tissue infections and can be difficult to diagnose in the absence of consideration as they often require specific culture media and longer incubation times. We report a Mycobacterium fortuitum subcutaneous abscess in a diabetic related to medication injection that was initially diagnosed without specialized media or prolonged incubation times. Case Report: A 48 year old diabetic female developed a progressive subcutaneous swelling in the tissues of the right lower abdominal wall where she had been injecting liraglutide. Because of continued enlargement "to almost egg size" with pain, she was empirically …

Acute Hypoxic Respiratory Failure As A Complication Of A Urinary Tract Infection During Pregnancy: A Case Presentation, Manpreet S. Narwal, Susan Jevert-Eichorn, Narinder Nina Clair

Research Day

Urinary tract infections (UTI), as well as asymptomatic bacteriuria, have the potential to cause serious morbidity during pregnancy making it imperative to identify and treat them promptly. If left untreated, a UTI can lead to pyelonephritis and sepsis. More importantly, UTIs are independently associated with intrauterine growth restriction (IUGR), premature rupture of membranes (PROM), preterm delivery, pulmonary edema, acute respiratory distress syndrome (ARDS), preeclampsia, and cesarean delivery. We report the case of NC, a 19 year old G1P0 at 36 weeks and 3 days GA who presented to the hospital with concern for rupture of membranes with associated back and …

In Vitro Three-Dimensional Skin Tissue Constructs, Tinashe Dereck Gombedza

Theses

Human skin provides fortification against peripheral threats which may compromise the integrity and health of the human body. Its presence as the largest human organ forms a protective barrier making it an effective first line of defence against pathogenic, chemical and physical damage. Tissue engineering technology has enabled the development of in vitro three-dimensional (3D) organotypic skin cultures in order to understand the skin's physiology and architecture. This advancement has enabled the use of 3D skin model platforms to study skin diseases and conditions as well as facilitate drug discovery, clinical research and cosmetic product development.

In this study, an …

Effect Of Exercise Position On Percent Changes In Serratus Anterior Muscle Thickness, Joseph M. Day

Physical Therapy Faculty Publications

Objective: A reliable method for measuring SA thickness with ultrasound imaging has been reported, yet the ability to detect differences in levels of contractility has yet to be established. The purpose of this study was to determine if there are differences in the percent change in thickness of the SA during four different exercise positions performed by healthy individuals.

Design: Observational study

Setting: Laboratory

Participants: Twenty-eight healthy participants, mean age 26 (SD 4, 57% female, 100% right handed)

Methods: Volunteers were positioned in a standardized sitting posture and anatomical landmarks were marked for ultrasound probe positioning. Two resting and two …

Widespread Tau Seeding Activity At Early Braak Stages, Jennifer L. Furman, Jaime Vaquer-Alicea, Charles L. White, Nigel J. Cairns, Peter T. Nelson, Marc I. Diamond

Pathology and Laboratory Medicine Faculty Publications

Transcellular propagation of tau aggregates may underlie the progression of pathology in Alzheimer's disease (AD) and other tauopathies. Braak staging (B1, B2, B3) is based on phospho-tau accumulation within connected brain regions: entorhinal cortex (B1); hippocampus/limbic system (B2); and frontal and parietal lobes (B3). We previously developed a specific and sensitive assay that uses flow cytometry to quantify tissue seeding activity based on fluorescence resonance energy transfer (FRET) in cells that stably express tau reporter proteins. In a tauopathy mouse model, we have detected seeding activity far in advance of histopathological changes. It remains unknown whether individuals with AD also …

The Role Of N-Myc Downstream Regulated Gene 1 In Breast Cancer Lipid Metabolism, Christopher James Sevinsky

Legacy Theses & Dissertations (2009 - 2024)

Altered carbohydrate and lipid metabolism are increasingly well characterized hallmarks of aggressive breast cancers. While aerobic glycolysis, or “the Warburg effect”, is a well-established metabolic adaptation exploited by tumor cells, the understanding of unique aspects of cancer lipid metabolism lags behind. This is especially true regarding the coordination of complex lipid synthesis and trafficking pathways, which remains poorly understood. N-Myc Downstream Regulated Gene1 (NDRG1) is overexpressed in many solid tumors, but its function is unclear. The importance of NDRG1 is best exemplified by the effect of null mutations on human physiology: inactivating mutations give rise to the severe autosomal recessive …

Characterization Of A New Chlorovirus Type With Permissive And Non-Permissive Features On Phylogenetically Related Algal Strains, Cristian F. Quispe, Ahmed Esmael, Olivia Sonderman, Michelle Mcquinn, Irina Agarkova, Mohammed Battah, Garry A. Duncan, David D. Dunigan, Timothy P. L. Smith, Cristina Decastro, Immacolata Speciale, Fangrui Ma, James L. Van Etten

Nebraska Center for Virology: Faculty Publications

A previous report indicated that prototype chlorovirus PBCV-1 replicated in two Chlorella variabilis algal strains, NC64A and Syngen 2-3, that are ex-endosymbionts isolated from the protozoan Paramecium bursaria. Surprisingly, plaque-forming viruses on Syngen 2-3 lawns were often higher than on NC64A lawns from indigenous water samples. These differences led to the discovery of viruses that exclusively replicate in Syngen 2-3 cells, named Only Syngen (OSy) viruses. OSy-NE5, the prototype virus for the proposed new species, had a linear dsDNA genome of 327 kb with 44-nucleotide-long, incompletely base-paired, covalently closed hairpin ends. Each hairpin structure was followed by an identical …

Utility Of Peripheral Film Findings And Its Correlation With Automated Analyzer - An Audit From Tertiary Care Hospital, Sidra Asad, Imran Ahmed, Natasha Ali

Department of Pathology and Laboratory Medicine

Background and Objective: With the advent of automated hematology analyzer, the use of traditional microscopy of blood film has become limited. The objective of our study was to determine the percentage of peripheral blood smear review in our institution in the era of automation and to identify reasons of manual review.
Materials and Methods: This was a prospective audit from January 1, 2015, to January 15, 2015. Consecutive complete blood count (CBC) samples and peripheral smear requests made up the sample size. All age groups and genders were included. CBCs were performed on Sysmex XE-5000. The variables to be analyzed …

Papillary Craniopharyngioma: A Clinicopathologic Study Of A Rare Entity From A Major Tertiary Care Center In Pakistan, Muhammad Usman Tariq, Nasir Ud Din, Zubair Ahmad, Wasim Memon

Department of Pathology and Laboratory Medicine

Background: Papillary craniopharyngioma (PCP) are uncommon variants of craniopharyngiomas (CP), which are benign epithelial neoplasms of the sellar and suprasellar region. Histologically, PCPs are typically composed of well-differentiated stratified squamous epithelium; however, focal variations are not uncommon. A distinction from other lesions of the region, despite being difficult to achieve due to the overlapping radiological and clinical features, is important for adequate treatment to be administered.
Objective: Our aim was to study the clinical and histological features of PCP with emphasis on features that are helpful in its distinction from other lesions that are similar in appearance.
Materials and Methods: …

Functions Of Atr/Mec1 In Meiosis And The Cell Cycle, Layne Weatherford

Wayne State University Dissertations

Mec1 is a protein kinase in S. cerevisiae that is critical for the DNA damage checkpoint response, and is the yeast orthologue of the human ATR protein. Cancer cells rely on ATR to arrest the cell cycle and allow sufficient time to repair DNA damage before proceeding through the cell cycle, and ATR inhibitors have been developed as possible anti-cancer agents. DBF4 is the regulatory subunit of DBF4-dependent kinase (DDK) that regulates initiation of DNA replication and is overexpressed in a number of different cancer types. To better understand ATR and DBF4 function, we took advantage of yeast genetics to …

A Behavioral And Neuroimmune System Model Of The Effects Of Chronic Low-Level Lead Exposure In Young Male C57bl/6j Mice, Mayra Gisel Flores-Montoya

Open Access Theses & Dissertations

Chronic low-level lead exposure reduces memory in children however the brain mechanisms mediating these effects are not known. In previous studies we showed that early lead exposure reduced olfactory memory and exploratory behavior in young mice, and reduced microglia cell density in hippocampus/dentate gyrus. The present studies aimed to identify additional behavioral tests that were sensitive to early low-level lead exposure in young mice; and to examine whether microglia upregulated factors known to promote cell migration. Seventy-two C57BL/6J male mice were exposed to 0 ppm (controls), 30 ppm (low-dose), or 430 ppm (high-dose) of lead acetate via dams' milk from …

Self-Reported Adherence To Physical Activity For Cancer Survivors: An Update From The 2015 Nhis Database, Andrew Jackson Shearer

Theses and Dissertations--Kinesiology and Health Promotion

Cancer is the second leading cause of death in America. It’s been suggested that regular physical activity (PA) can improve health outcomes in cancer survivors. An estimate from BRFSS data (2009) suggested that 47% of all cancer survivors met recommended guidelines and that this estimate was not different from the population at large (48%). Several factors were examined from these BRFSS data to determine whether subgroups of survivors existed who might benefit from interventions aimed at improving their PA status. The purpose of this investigation was to obtain more recent estimates of adherence to established PA guidelines for cancer survivors. …