Medical Specialties Commons^™

Gabapentin In The Treatment Of Bipolar Disorder, Wendy M. Waits, Donald P. Hall Jr., M.D.

Jefferson Journal of Psychiatry

Gabapentin, a relatively new anti-epileptic drug (AED), is emerging as a therapeutic option for treatment refractory and rapid-cycling bipolar illnesses. Pharmacotherapy for bipolar disorders traditionally involves valproate, carbamazapine, or lithium, drugs which are associated with numerous adverse effects. Conversely, gabapentin has an attractive pharmacokinetics profile and relatively few side effects. There are no large randomized controlled clinical trials to date examining gabapentin’s role in mood stabilization. However, informal reports have cited encouraging results in up to 80% of patients and general tolerance to side effects. These findings make the new drug a possible choice for patients who have failed to …

The Somatization Of Depression In Native Pakistani Women, Rubeena H. Mian M.D., Linda S. Grossman Ph.D.

Jefferson Journal of Psychiatry

Previous studies have pointed out the comorbidity of somatization and depression among non-Western psychiatric patients. We studied the somatization of depression in Pakistani women. Two groups were studies: inpatients with DSM-III-R diagnoses of major depression and a comparison sample of women living in the community without psychiatric diagnoses. Both groups were administered a rating scale for somatization. Results indicated that patients reported significantly more somatic symptoms than nonpatients. These findings support the concept that somatization may be a cultural mode of mental distress among Pakistani women, as has been observed for other non-Western populations.

Folie Á Deux: Two Case Reports, Mohammad Y. Abu-Salha M.D.

Jefferson Journal of Psychiatry

Two cases of “Shared Psychotic Disorder” were diagnosed over a period of less than a year in a children’s psychiatric center. Shared Psychotic Disorder is one of the differential diagnoses that need to be entertained when evaluating a delusional patient. Including the patient’s family and/or significant others in the assessment increases the possibility of diagnosing Shared Psychotic Disorder. An eight-year-old girl was admitted after exhibiting psychotic behavior with paranoid delusions she shared with her mother. Specifically, she reported that “neighbors next door were repeatedly breaking into her house, pinning her down, raping her, and injecting her with I.V. drugs.” An …

Early Detection Of Autism In The Population, John D. Mclennan M.D., Ph.D.

Jefferson Journal of Psychiatry

Frequently there is a delay in the diagnosis of autism in children which may result in a lost opportunity to provide early intervention. Signal detection studies have suggested that single items have good predictability for autism which suggests simple screening procedures may be helpful in the early detection of an autistic disorder. Studies of autism in the very young have found that specific social deficits appear to characterize this group. A three stage procedure is presented as a possible approach to detect autism at an early age in the population thereby allowing for early intervention.

Editor's Column, Tanis Gaitens M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Children And Adolexcents Of Distinction - Culturally Diverse Children And Adolescents: Assessment, Diagnosis, And Treatment By Ian A. Canino, M.D. And Jeanne Spurlock, M.D., Lloyda R. Broomes M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Stevens-Johnson Syndrome Following Treatment With Carbamazepine For A Mood Disorder, Albert Coleman M.D., M.P.H., B. Trappler M.D.

Jefferson Journal of Psychiatry

A case of Stevens-Johnson Syndrome (SJS) induced by carbamazepine in a psychiatric patient with schizo-affective disorder is reported. The patient also had diabetes mellitus and was on glyburide which posed an initial dilemma at the onset of SJS as to the causative drug. In view of the expanding use of carbamazepine in psychiatric patients and the potentially lethal consequences of SJS, the authors suggest a risk management approach when initiating Carbamazepine therapy to reduce the incidence and morbidity of the syndrome.

Steroid-Induced Psychosis Presenting As "Alice In Wonderland" Syndrome, Vinobha Gorriah M.D., Frank W. Favazza M.D., Migdalia Fort-Ramirez M.D.

Jefferson Journal of Psychiatry

A 40 year old overweight male with a history of bronchial asthma, hypertension, and “schizophrenia” was admitted for intractable bronchial asthma. He did not have a history of drug or alcohol use.

Upon admission, he was treated with high doses of IV methyl prednisone, oral prednisone, and triamcinolone inhaler. He developed complex visual hallucinations which decreased following tapering of prednisone and discontinuation of the triamcinolone. EEG showed diffuse slowing suggesting a toxic metabolic state.

Managed Mental Health Care: An Oxymoron Of Ethics?, Jonathan M. Metzl M.D.

Jefferson Journal of Psychiatry

No abstract provided.

The Role Of Group Psychotherapy In Psychiatric Residency Training, Shahbaz R. Khan M.D., Katherine A. Cowan M.D., Pedro Ruiz M.D.

Jefferson Journal of Psychiatry

Group psychotherapy has become a well-recognized treatment modality in the mental health field. Educationally, however, group psychotherapy has not reached the priority level it deserves. We described our experiences in using group psychotherapy as a training tool at the University of Texas at Houston. In describing our program, we used case illustrations to better demonstrate the richness of our training experiences. Group psychotherapy should be more extensively used in the training of tomorrow’s mental health professionals.

The Neuroleptic Treatment Of Schizophrenia: Dosing Strategies, Depot Preparations And Novel Medications, Alexander S. Young M.D.

Jefferson Journal of Psychiatry

Significant progress has been made over the past decade in the use of antipsychotic medication. An improved understanding of neuroleptic side effects has led to the development of new clinical strategies for dosing traditional medications. Traditional medications have become widely used in depot preparations. Risperidone, a new medication with an improved side effect profile, has recently become available. Clozapine, a novel medication, has entered widespread use. The use of these new clinical technologies is briefly discussed, along with the implications they have for the role of the psychiatrist in community mental health settings.

Ultradian Cycles Of Mood In Normal And Depressed Subjects, Donald P. Hall Jr., M.D., David Benedek M.D., Audrey Chang

Jefferson Journal of Psychiatry

Objective: To study ultradian cycles of mood in four inpatient groups.

Method: We assessed the mood of depressed and nondepressed subjects, on an hourly basis, between 7:00 a.m. and 10:00 p.m. for two consecutive days using a visual analog scale of mood. Hourly mood scores for each group were plotted against time.

Results: We found ultradian cycles with mean lengths of 3-4 hours in all groups. The major depressive episode and adjustment disorder depression groups, however, had ultradian cycles of significantly greater amplitude than ward staff.

Conclusions: Depressed patients demonstrate greater amplitude in ultradian cycles of mood than nondepressed subjects.

Smoking Rates After Cessation Of Alcohol And/Or Cocaine: A Pilot Study, Timothy R. Jennings M.D.

Jefferson Journal of Psychiatry

Objective: To assess the change in smoking rates in alcohol and/or cocaine dependent patients after the cessation of the primary drug of use.

Design: A self-report questionnaire was administered upon admission to a Residential Treatment Facility, in the fourth week, and in the final (sixth) week of the program. The control group was administered a self-report questionnaire at the time of intake as controls and again four and six weeks later.

Setting: Residential Treatment Facility (RTF) a 30 bed inpatient alcohol and drug treatment unit, at Eisenhower Army Medical Center, Fort Gordon, Georgia.

Patients: A Total of 42 patients; 37 …

Editor's Column, Carmen Z. Harlan M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Newer Agents In Antiplatelet Therapy: A Review., Jennifer Yeung, Michael Holinstat

Cardeza Foundation for Hematologic Research

Antiplatelet therapy remains the mainstay in preventing aberrant platelet activation in pathophysiological conditions such as myocardial infarction, ischemia, and stroke. Although there has been significant advancement in antiplatelet therapeutic approaches, aspirin still remains the gold standard treatment in the clinical setting. Limitations in safety, efficacy, and tolerability have precluded many of the antiplatelet inhibitors from use in patients. Unforeseen incidences of increased bleeding risk and recurrent arterial thrombosis observed in patients have hampered the development of superior next generation antiplatelet therapies. The pharmacokinetic and pharmacodynamic profiles have also limited the effectiveness of a number of antiplatelet inhibitors currently in use …

James Marion Sims, M.D., Ll.D., Jonathan Tavares, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Few physicians have been as celebrated and loathed as James Marion Sims, M.D., LL.D. Dr. Sims’ modest early life and education never could have predicted that he would one day be called the ‘‘Father of American Gynecology.’’1, 2 Lauded by contemporaries and early historians as ‘‘one of the most original and gifted of American surgeons,’’ he performed the first successful operation to correct vesicovaginal fistulas (a condition that prior to 1852 was known as the ‘‘stumbling-block of gynecology’’).1 Today, the same work that earned Dr. Sims fame, fortune, and innumerable honors has been called into question, because of the unethical …

Manifestations Of Rheumatoid Arthritis: Epidural Pannus And Atlantoaxial Subluxation Resulting In Basilar Invagination., Adam L Schreiber, Do, Ma

Department of Rehabilitation Medicine Faculty Papers

Presented in part at the AAPMR 71st Annual Assembly Meeting, Seattle, WA, November 4-7, 2010.

Atlantoaxial instability results from cartilaginous destruction, periarticular erosions, and ligament and tendon attenuation. Instability affects 19%-70% of patients, and basilar invagination from vertical odontoid subluxation through the foramen magnum occurs in 38% of patients. This phenomenon occurs twice as often in women than men, whose age at diagnosis typically ranges from 30-50 years. Along with bony compression, the pannus further decreases the space available for the cord by 3mmor more in approximately 66% of patients (Figures 1-7). The earliest and most common symptom of cervical …

Measurement And Correlates Of Empathy Among Female Japanese Physicians., Hitomi U Kataoka, Norio Koide, Mohammadreza Hojat, Joseph S Gonnella

CRMEHC Faculty Papers

BACKGROUND: The measurement of empathy is important in the assessment of physician competence and patient outcomes. The prevailing view is that female physicians have higher empathy scores compared with male physicians. In Japan, the number of female physicians has increased rapidly in the past ten years. In this study, we focused on female Japanese physicians and addressed factors that were associated with their empathic engagement in patient care.

METHODS: The Jefferson Scale of Empathy (JSE) was translated into Japanese by using the back-translation procedure, and was administered to 285 female Japanese physicians. We designed this study to examine the psychometrics …

Erk2 Phosphorylation Of Serine 77 Regulates Bmf Pro-Apoptotic Activity., Y Shao, A E Aplin

Department of Cancer Biology Faculty Papers

B-cell lymphoma 2 (Bcl-2) homology 3 (BH3)-only proteins represent a class of pro-apoptotic factors that neutralize pro-survival Bcl-2 proteins, and, in some cases, directly activate Bax. The mechanisms of control and the role of BH3-only proteins, such as Bcl-2 like protein 11 extra large and Bad are well studied. By contrast, relatively little is known about the regulation and role of Bcl-2 modifying factor (Bmf). The B-RAF oncogene is mutated in ∼8% of human tumors. We have previously shown that Bmf is upregulated at the transcript level and is required for apoptosis induced by targeting B-RAF signaling in tumor cells …

Sleep Strategies: Sleep In Women A Changing Perspective, Misha Peter, Md, Ritu G. Grewal, Md

Jefferson Sleep Disorders Center in the News

As with many other specialties, sleep medicine has been shifting toward helping clinicians obtain a better understanding of gender-specific issues in disorders and disturbances. It is easier today to appreciate the complex dynamics of biological, psychosocial, and cultural factors that define sleep patterns and problems in women. Sleep in women changes across their life spans, with three major shifts likely due to hormonal differences: at the onset of the menstrual cycle, during pregnancy, and during the perimenopausal period.

Comprehensive Analysis Of Common Serum Liver Enzymes As Prospective Predictors Of Hepatocellular Carcinoma In Hbv Patients., Hie-Won Hann, Shaogui Wan, Ronald E Myers, Richard S Hann, Jinliang Xing, Bicui Chen, Hushan Yang

Department of Medicine Faculty Papers

BACKGROUND: Serum liver enzymes are frequently tested in clinics to aid disease diagnosis. Large observational studies indicated that these enzymes might predict cancer risk and mortality. However, no prospective study has reported on their relationships with the risk of HBV-related hepatocellular carcinoma (HCC). METHODOLOGY/PRINCIPAL FINDINGS: We evaluated the predictive values of four routinely tested liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], and gamma-glutamyltransferase [GGT]) in HCC risk in a prospectively enrolled clinical cohort of 588 Korean American HBV patients. For all four enzymes, the baseline level as well as the average and maximum levels during the …

Patterns Of Acetaminophen Use At A Tertiary Care Center: Exposures Exceeding 4 Grams Daily, Jesse Civan, Victor Navarro, Jeffrey Riggio, Paul Adams, Steven Herrine, Simona Rossi

Jefferson Hospital Staff Papers and Presentations

Unintentional hepatotoxicity due to acetaminophen use at the recommended daily dose of up to four grams daily has increasingly been recognized as a significant problem. The phrase "therapeutic misadventure" has been coined in the literature, in reference to biochemical evidence of hepatocellular injury associated with acetaminophen use at recommended doses. Previous studies have documented a 25% to 40% incidence of two- to three-fold alanie aminotransferase (ALT) elevation, in healty volunteers administered one gram of acetaminophen every six hours.

The recognition of this problem is reflected in part by recent changes in FDA recommendations, including more stringent controls on the amount …

Preoperative Fdg-Pet/Ct Is An Important Tool In The Management Of Patients With Thick (T4) Melanoma., Rodrigo Arrangoiz, Pavlos Papavasiliou, Carrie A Stransky, Jian Q Yu, Li Tianyu, Elin R Sigurdson, Adam C Berger, Jeffrey M Farma

Department of Surgery Faculty Papers

The yield of preoperative PET/CT (PET/CT) for regional and distant metastases for thin/intermediate thickness melanoma is low. Objective of this study is to determine if PET/CT performed for T4 melanomas helps guide management and alter treatment plans. Methods. Retrospective cohort of 216 patients with T4 melanomas treated at two tertiary institutions. Fifty-six patients met our inclusion criteria (T4 lesion, PET/CT and no clinical evidence of metastatic disease). Results. Fifty-six patients (M: 32, F: 24) with median tumor thickness of 6 mm were identified. PET/CT recognized twelve with regional and four patients with metastatic disease. Melanoma-related treatment plan was altered in …

The Use Of Preoperative Epoetin-Α In Revision Hip Arthroplasty., Lawrence A Delasotta, Ashwin Rangavajjula, Michael L Frank, Jamie Blair, Fabio Orozco, Alvin Ong

Rothman Institute Papers

PURPOSE: To evaluate the efficacy of preoperative epoetin-α on the revision hip arthroplasty patient. We hypothesized that epoetin-α will reduce blood transfusion. A pertinent review of the literature is provided.

METHODS: Forty-six patients were retrospectively reviewed. Sixteen patients received epoetin-α. Patients were case matched by age, preoperative hemoglobin, surgery, gender, and BMI. The clinical triggers for blood transfusion during or after the procedure were determined based on peri- and postoperative hemoglobin levels, ASA score, and/or clinical symptoms consistent with anemia. Blood salvage was not used.

RESULTS: Blood transfusion and length of stay were decreased in the epoetin-α group. Hemoglobin in …

Fractionated Stereotactic Radiation Therapy Improves Cranial Neuropathies In Patients With Skull Base Meningiomas: A Retrospective Cohort Study., Xinglei Shen, David W Andrews, Robert C Sergott, James J Evans, Walter J Curran, Mitchell Machtay, Ruben Fragoso, Harriet Eldredge, Colin E Champ, Matthew Witek, Mark V Mishra, Adam P Dicker, Maria Werner-Wasik

Department of Radiation Oncology Faculty Papers

BACKGROUND: Skull base meningiomas commonly present with cranial neuropathies. Fractionated stereotactic radiation therapy (FSRT) has been used to treat these tumors with excellent local control, but rates of improvement in cranial neuropathies have not been well defined. We review the experience at Thomas Jefferson University using FSRT in the management of these patients with a focus on symptom outcomes.

METHODS: We identified 225 cases of skull base meningiomas treated with FSRT at Thomas Jefferson University from 1994 through 2009. The target volume was the enhancing tumor, treated to a standard prescription dose of 54 Gy. Symptoms at the time of …

Self Expanding Metal Stents (Sems) For Management Of Peri-Pancreatic Fluid Collections (Pfc): A Single Center Experience, Whitney E. Jackson, Jason Korenblit, Vaibhav Mehendiratta, Jason Lewis, Ali A. Siddiqui, Thomas E. Kowalski, David E. Loren

Division of Internal Medicine Faculty Papers & Presentations

Background

Endoscopic management of peri-pancreatic fluid collections (PFC) with or without organizing necrosis has been shown to decrease morbidity and mortality compared to early surgical management. Plastic stents are often used for transmural drainage, although the use of self-expanding metal stents (SEMS) has been reported. Theoretical benefits of SEMS include a large diameter for drainage and facilitation of endoscopic necrosectomy. We report a single-center experience to evaluate the efficacy and safety of SEMS for management of PFC.

Methods

A single-center retrospective review was performed of patients undergoing endoscopic management of PFC using SEMS from January through November 2011. Electronic database …

Effect Of 4 Years Of Growth Hormone Therapy In Children With Noonan Syndrome In The American Norditropin Studies: Web-Enabled Research (Answer) Program® Registry., Peter A Lee, Judith Ross, John A Germak, Robert Gut

Department of Pediatrics Faculty Papers

BACKGROUND: Noonan syndrome (NS) is a genetic disorder characterized by phenotypic features, including facial dysmorphology, cardiovascular anomalies, and short stature. Growth hormone (GH) has been approved by the United States Food and Drug Administration for short stature in children with NS. The objective of this analysis was to assess the height standard deviation score (HSDS) and change in HSDS (ΔHSDS) for up to 4 years (Y4) of GH therapy in children with NS.

METHODS: The American Norditropin Studies: Web-Enabled Research (ANSWER) Program®, a US-based registry, collects long-term efficacy and safety information on patients treated with Norditropin® (somatropin rDNA origin, Novo …

Detection Of Evolving Injury To The Brachial Plexus During Transaxillary Robotic Thyroidectomy., Adam Luginbuhl, Daniel M Schwartz, Anthony K Sestokas, David Cognetti, Edmund Pribitkin

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES/HYPOTHESIS: Continuous intraoperative neuromonitoring (IONM) of transcranial electric motor evoked potentials (tceMEPs) and somatosensory evoked potentials (SSEPs) has gained universal acceptance as an efficacious method for detecting emerging positional brachial plexopathy or peripheral nerve compression during spinal and shoulder surgery. This has implications for transaxillary thyroid surgery.

STUDY DESIGN: Case report with literature review.

METHODS: The patient underwent robotic transaxillary thyroid surgery with continuous tceMEP and SSEP monitoring of brachial plexus function. We present detailed IONM data depicting the emergence of positional brachial plexopathy.

RESULTS: Significant amplitude loss of both IONM modalities were identified during an evolving positional plexopathy, which …

Mir-128 Inhibits Tumor Growth And Angiogenesis By Targeting P70s6k1., Zhu-Mei Shi, Jing Wang, Zhiping Yan, Yong-Ping You, Chong-Yong Li, Xu Qian, Yu Yin, Peng Zhao, Ying-Ying Wang, Xie-Feng Wang, Ming-Na Li, Ling-Zhi Liu, Ning Liu, Bing-Hua Jiang

Kimmel Cancer Center Faculty Papers

MicroRNAs are a class of small noncoding RNAs that function as critical gene regulators through targeting mRNAs for translational repression or degradation. In this study, we showed that miR-128 expression levels were decreased in glioma, and identified p70S6K1 as a novel direct target of miR-128. Overexpression of miR-128 suppressed p70S6K1 and its downstream signaling molecules such as HIF-1 and VEGF expression, and attenuated cell proliferation, tumor growth and angiogenesis. Forced expression of p70S6K1 can partly rescue the inhibitory effect of miR-128 in the cells. Taken together, these findings will shed light to the role and mechanism of miR-128 in regulating …

A Novel Survival-Based Tissue Microarray Of Pancreatic Cancer Validates Muc1 And Mesothelin As Biomarkers., Jordan M Winter, Laura H Tang, David S Klimstra, Murray F Brennan, Jonathan R Brody, Flavio G Rocha, Xiaoyu Jia, Li-Xuan Qin, Michael I D'Angelica, Ronald P Dematteo, Yuman Fong, William R Jarnagin, Eileen M O'Reilly, Peter J Allen

Department of Surgery Faculty Papers

BACKGROUND: One-fifth of patients with seemingly 'curable' pancreatic ductal adenocarcinoma (PDA) experience an early recurrence and death, receiving no definable benefit from a major operation. Some patients with advanced stage tumors are deemed 'unresectable' by conventional staging criteria (e.g. liver metastasis), yet progress slowly. Effective biomarkers that stratify PDA based on biologic behavior are needed. To help researchers sort through the maze of biomarker data, a compendium of ∼2500 published candidate biomarkers in PDA was compiled (PLoS Med, 2009. 6(4) p. e1000046).

METHODS AND FINDINGS: Building on this compendium, we constructed a survival tissue microarray (termed s-TMA) comprised of short-term …