Medical Specialties Commons^™

The Fate Of The Unexpected Positive Intraoperative Cultures After Revision Total Knee Arthroplasty, Robert L. Barrack, Ajay Aggarwal, R. Stephen J. Burnett, John C. Clohisy, Elie Ghanem, Peter Sharkey, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

Of a consecutive series of 692 revision total knees at 3 centers, intraoperative cultures were unexpectedly found to be positive in 41 cases (5.9%). Of the 41, 29 (71%) cases had a single positive intraoperative culture and were determined to be a probable false positive based on absence of any other evidence of infection, of which 5 were treated with extended course of intravenous antibiotics after hospital discharge and the remaining 24 received no further treatment. None of these 24 patients manifested any sign of infection at follow-up, averaging 46 months (range, 24-74 months). Twelve patients were determined to have …

Beta Blocker Specificity: A Building Block Toward Personalized Medicine., Brent R Degeorge, Walter J Koch

Center for Translational Medicine Faculty Papers

Drugs known as beta blockers, which antagonize the beta-adrenergic receptor (beta-AR), are an important component of the treatment regimen for chronic heart failure (HF). However, a significant body of evidence indicates that genetic heterogeneity at the level of the beta(1)-AR may be a factor in explaining the variable responses of HF patients to beta blockade. In this issue of the JCI, Rochais et al. describe how a single amino acid change in beta(1)-AR alters its structural conformation and improves its functional response to carvedilol, a beta blocker currently used in the treatment of HF (see the related article beginning on …

Department Of Radiology-Annual Executive Summary Report-July 1, 2006 To June 30, 2007, Vijay M. Rao M.D.

Department of Radiology Administrative Documents and Reports

91 page Department of Radiology Annual Executive Summary Report, July 1, 2006 to June 30, 2007, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.

A Non-Pharmacological Intervention To Manage Behavioral And Psychological Symptoms Of Dementia And Reduce Caregiver Distress: Design And Methods Of Project Act3., Laura N Gitlin, Laraine Winter, Marie P Dennis, Walter W Hauck

Center for Applied Research on Aging and Health Research Papers

Project ACT is a randomized controlled trial designed to test the effectiveness of a non-pharmacological home-based intervention to reduce behavioral and psychological symptoms of dementia (BPSD) and caregiver distress. The study targets 272 stressed racially diverse family caregivers providing in-home care to persons with moderate stage dementia with one or more behavioral disturbances. All participants are interviewed at baseline, 4-months (main trial endpoint), and 6-months (maintenance). The four-month intervention involves up to 13 visits from an occupational therapist who works with families to problem-solve potential triggers (communication style, environmental clutter) contributing to behaviors, and instruct in strategies to reduce caregiver …

Evidence Against Roles For Phorbol Binding Protein Munc13-1, Adam Adaptor Eve-1, Or Vesicle Trafficking Phosphoproteins Munc18 Or Nsf As Phospho-State-Sensitive Modulators Of Phorbol/Pkc-Activated Alzheimer App Ectodomain Shedding., Annat F Ikin, Mirsada Causevic, Steve Pedrini, Lyndsey S Benson, Joseph D Buxbaum, Toshiharu Suzuki, Simon Lovestone, Shigeki Higashiyama, Tomas Mustelin, Robert D Burgoyne, Sam Gandy

Farber Institute for Neuroscience Faculty Papers

ABSTRACT: BACKGROUND: Shedding of the Alzheimer amyloid precursor protein (APP) ectodomain can be accelerated by phorbol esters, compounds that act via protein kinase C (PKC) or through unconventional phorbol-binding proteins such as Munc13-1. We have previously demonstrated that application of phorbol esters or purified PKC potentiates budding of APP-bearing secretory vesicles at the trans-Golgi network (TGN) and toward the plasma membrane where APP becomes a substrate for enzymes responsible for shedding, known collectively as alpha-secretase(s). However, molecular identification of the presumptive "phospho-state-sensitive modulators of ectodomain shedding" (PMES) responsible for regulated shedding has been challenging. Here, we examined the effects on …

Idiopathic Granulomatous Mastitis Masquerading As Carcinoma Of The Breast: A Case Report And Review Of The Literature., Richard Tuli, Brian J O'Hara, Janet Hines, Anne L Rosenberg

Department of Surgery Faculty Papers

BACKGROUND: Idiopathic granulomatous mastitis is an uncommon, benign entity with a diagnosis of exclusion. The typical clinical presentation of idiopathic granulomatous mastitis often mimics infection or malignancy. As a result, histopathological confirmation of idiopathic granulomatous mastitis combined with exclusion of infection, malignancy and other causes of granulomatous disease is absolutely necessary. CASE PRESENTATION: We present a case of a young woman with idiopathic granulomatous mastitis, initially mistaken for mastitis as well as breast carcinoma, and successfully treated with a course of corticosteroids. CONCLUSION: There is no clear clinical consensus regarding the ideal therapeutic management of idiopathic granulomatous mastitis. Treatment options …

A Turner Syndrome Neurocognitive Phenotype Maps To Xp22.3., Andrew R Zinn, David Roeltgen, Gerry Stefanatos, Purita Ramos, Frederick F Elder, Harvey Kushner, Karen Kowal, Judith L Ross

Department of Pediatrics Faculty Papers

BACKGROUND: Turner syndrome (TS) is associated with a neurocognitive phenotype that includes selective nonverbal deficits, e.g., impaired visual-spatial abilities. We previously reported evidence that this phenotype results from haploinsufficiency of one or more genes on distal Xp. This inference was based on genotype/phenotype comparisons of individual girls and women with partial Xp deletions, with the neurocognitive phenotype considered a dichotomous trait. We sought to confirm our findings in a large cohort (n = 47) of adult women with partial deletions of Xp or Xq, enriched for subjects with distal Xp deletions. METHODS: Subjects were recruited from North American genetics and …

Breast-Fed Low Birth Weight Premature Infants: A Description Of Nutritional Intake In The First Six Months Of Life, Ksenia Zukowsky

Selected Works of Ksenia Zukowsky, CRNP, PhD

This is a secondary analysis of a larger project entitled "Breast-feeding Services for LBW Infants-Outcomes and Costs" (L. Brown, RN, Ph.D., Principal Investigator), funded by NINR at NIH, (NR 03881). The larger project was a randomized clinical trial, of women planning to breast-feed their LBW infant. The control group received routine breast-feeding care and an intervention group received a structured program of breast-feeding services provided by an advanced practice nurse.

Healthy premature LBW infants from the control group were selected as subjects for this secondary analysis. One question of this secondary analysis was to describe the nutrition of healthy premature …

Family Medicine Predoctoral Education: 30-Something, Howard K. Rabinowitz

Department of Family & Community Medicine Faculty Papers

From the introduction:

The specialty of family medicine is now more than 30 years old. Fitting for its stage of life, family medicine predoctoral education has achieved appropriate maturity and parity with other core clinical departments and has assumed its role and responsibility in medical education within the academic health center. Of course, this wasn’t always true.

The Interplay Of Obesity And Asthma, James Plumb, Rickie Brawer, Nancy Brisbon

Department of Family & Community Medicine Faculty Papers

The relationships, interactions, and association between obesity and asthma are complex, and are active sources of hypotheses and research. An association between obesity and asthma has been reported in many studies, although considerable debate about the existence of the association and its meaning still exists. Potential associative relationships may result from genetics, immune system modifications, and mechanical mechanisms. The rising prevalence of asthma and obesity in children and adults, and the significant morbidity from both, makes it imperative that clinicians recognize the importance of weight management in patients with and without asthma.

Homocysteine Levels In Preterm Infants: Is There An Association With Intraventricular Hemorrhage? A Prospective Cohort Study., Wendy J Sturtz, Kathleen H Leef, Amy B Mackley, Shailja Sharma, Teodoro Bottiglieri, David A Paul

Department of Pediatrics Faculty Papers

BACKGROUND: The purpose of this study was to characterize total homocysteine (tHcy) levels at birth in preterm and term infants and identify associations with intraventricular hemorrhage (IVH) and other neonatal outcomes such as mortality, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, and thrombocytopenia. METHODS: 123 infants < 32 weeks gestation admitted to our Level III nursery were enrolled. A group of 25 term infants were enrolled for comparison. Two blood spots collected on filter paper with admission blood drawing were analyzed by a high performance liquid chromatography (HPLC) method. Statistical analysis included ANOVA, Spearman's Rank Order Correlation and Mann-Whitney U test. RESULTS: The median tHcy was 2.75 micromol/L with an interquartile range of 1.34 - 4.96 micromol/L. There was no difference between preterm and term tHcy (median 2.76, IQR 1.25 - 4.8 micromol/L vs median 2.54, IQR 1.55 - 7.85 micromol/L, p = 0.07). There was no statistically significant difference in tHcy in 31 preterm infants with IVH compared to infants without IVH (median 1.96, IQR 1.09 - 4.35 micromol/L vs median 2.96, IQR 1.51 - 4.84 micromol/L, p = 0.43). There was also no statistically significant difference in tHcy in 7 infants with periventricular leukomalacia (PVL) compared to infants without PVL (median 1.55, IQR 0.25 - 3.45 micromol/L vs median 2.85, IQR 1.34 - 4.82 micromol/L, p = 0.07). Male infants had lower tHcy compared to female; prenatal steroids were associated with a higher tHcy. CONCLUSION: In our population of preterm infants, there is no association between IVH and tHcy. Male gender, prenatal steroids and preeclampsia were associated with differences in tHcy levels.

Hemicrania Continua-Like Headache Associated With Carotid Dissection May Respond To Indomethacin, Avi Ashkenazi, Muhammad A. Abbas, Dinesh K. Sharma, Stephen D. Silberstein

Department of Neurology Faculty Papers

Hemicrania continua (HC) is an idiopathic, chronic disorder characterized by a continuous, strictly unilateral headache associated with ipsilateral cranial autonomic symptoms. The symptoms of HC typically respond dramatically to indomethacin therapy. We describe a patient with traumatic internal carotid artery (ICA) dissection, who presented with a clinical picture mimicking HC that initially responded to indomethacin. Patients with a clinical picture similar to HC should be managed with a high index of suspicion for a possible cervical arterial dissection.

Department Of Pathology, Thomas Jefferson University, Identification Of Conserved Gene Expression Features Between Murine Mammary Carcinoma Models And Human Breast Tumors., Jason I Herschkowitz, Karl Simin, Victor J Weigman, Igor Mikaelian, Jerry Usary, Zhiyuan Hu, Karen E Rasmussen, Laundette P Jones, Shahin Assefnia, Subhashini Chandrasekharan, Michael G Backlund, Yuzhi Yin, Andrey I Khramtsov, Roy Bastein, John Quackenbush, Robert I Glazer, Powel H Brown, Jeffrey E Green, Levy Kopelovich, Priscilla A Furth, Juan P Palazzo, Olufunmilayo I Olopade, Philip S Bernard, Gary A Churchill, Terry Van Dyke, Charles M Perou

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND: Although numerous mouse models of breast carcinomas have been developed, we do not know the extent to which any faithfully represent clinically significant human phenotypes. To address this need, we characterized mammary tumor gene expression profiles from 13 different murine models using DNA microarrays and compared the resulting data to those from human breast tumors. RESULTS: Unsupervised hierarchical clustering analysis showed that six models (TgWAP-Myc, TgMMTV-Neu, TgMMTV-PyMT, TgWAP-Int3, TgWAP-Tag, and TgC3(1)-Tag) yielded tumors with distinctive and homogeneous expression patterns within each strain. However, in each of four other models (TgWAP-T121, TgMMTV-Wnt1, Brca1Co/Co;TgMMTV-Cre;p53+/- and DMBA-induced), tumors with a variety of …

Recurrent Burner Syndrome Due To Presumed Cervical Spine Osteoblastoma In A Collision Sport Athlete - A Case Report., Ilan Elias, Michael A Pahl, Adam C Zoga, Maurice L Goins, Alexander R Vaccaro

Department of Orthopaedic Surgery Faculty Papers

We present a case of a 35-year-old active rugby player presenting with a history of recurrent burner syndrome thought secondary to an osteoblastoma involving the posterior arch of the atlas. Radiographically, the lesion had features typical for a large osteoid osteoma or osteoblastoma, including osseous expansion, peripheral sclerosis and bony hypertrophy, internal lucency, and even suggestion of a central nidus. The patient subsequently underwent an en bloc resection of the posterior atlas via a standard posterior approach. The surgery revealed very good clinical results. In this report, we will discuss in detail, the presentation, treatment, and return to play recommendations …

Up-Regulation Of Interferon-A/Apobec3g Signal Pathway Potently Inactivates Hiv-1 Infectivity In Resting Cd4-T Cells, Keyang Chen, Jialing Huang, Chune Zhang, Sophia Huang, Giuseppe Nunnari, Feng-Xiang Wang, Xiangrong Tong, Ling Gao, Kristi Nikisher, Hui Zhang

Department of Medicine Faculty Papers

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Jefferson Journal of Psychiatry

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Editorial Board

Jefferson Journal of Psychiatry

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Mourning, Salman Akhtar M.D.

Jefferson Journal of Psychiatry

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Neuroleptic Malignant Syndrome, With Attention To Its Occurrence With Atypical Antipsychotic Medication: A Review, Sarah Guzofski M.D. (Pgy2), Ruben Peralta M.D.

Jefferson Journal of Psychiatry

The neuroleptic malignant syndrome (NMS) is an idiopathic, life-threatening reaction to antipsychotic medication. NMS was traditionally attributed to potent dopamine antagonism of typical antipsychotics, but cases of NMS have now been reported for each of the newer antipsychotics. When NMS is caused by a newer, atypical antipsychotic the presentation differs somewhat; fever, rigidity, and, possibly, death may be less frequent. Diagnostic features, predisposing factors, and treatment are discussed, as is the important matter of reinstituting antipsychotic treatment.

A Kind Of Poem For My Friend And Me, Hilary O'Neill M.D. (Pgy4)

Jefferson Journal of Psychiatry

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First-Known Hypnopompic Hallucination Occurring In-Hospital: Case Report, Paul Ballas D.O. (Pgy2)

Jefferson Journal of Psychiatry

Despite the high prevalence of hypnopompic hallucinations in the community, to our knowledge there are no reports that have been published in the English literature of these phenomenon observed by staff in the hospital setting. Psychiatric or neurological evaluation often ensues if a patient reports hallucinations in other circumstances, but when they are reported in connection with sleep, further evaluation is rarely performed because such events are common in the general populace. Our report emphasizes the distinction between hypnopompic and hypnagogic hallucination as an ongoing feature of life that someone is aware of, which we believe to be the case …

No More Cuts: The Curious Fate Of Self-Mutilation In Its Development, Zhabiz Kazeminezhad M.D. (Pgy4), Salman Akhtar M.D.

Jefferson Journal of Psychiatry

In this article, we present descriptions of four young women with relatively severe personality disorders. All four were in psychodynamic psychotherapy and all had the symptom of self-cutting. During their treatment, it became evident that their self-cutting had undergone a transformation and a new symptom had appeared in its place. In three, self-cutting was substituted by behaviors that we might call "cutting equivalents" and, in the fourth, by an enhanced self-reflective attitude and by journal-writing. We suggest that symptom-replacement for self-cutting may be common in its developmental course or in its course as it becomes influenced by psychotherapy, and that …

Psychiatric Diagnoses In Patients With Williams Syndrome And Their Families, Janet C. Kennedy M.D. (Pgy1), David L. Kaye M.D., Laurie S. Sadler M.D.

Jefferson Journal of Psychiatry

Williams Syndrome (WS) is a genetic disorder associated with mental retardation (MR) and a distinct behavioral phenotype including a friendly and outgoing personality. This population, like others with MR, has been reported to have an increased rate of symptoms of mental illness; however, few studies have used DSM-IV criteria to quantify specific psychiatric diagnoses in WS and the prevalence of psychiatric illness in relatives of individuals with WS and the possible relationship between family and patient diagnoses is currently unknown.

Methods: Twenty-one families participated; the patients’ average age was 16 years. DSM-IV diagnoses were applied by using the Anxiety …

Psychogenic Stuttering Following A Gastric Bypass Operation: Case Report, Deborah B. Raphael M.D. (Pgy2), Frank B. Schoenfeld M.D.

Jefferson Journal of Psychiatry

We evaluated a 44-year-old female with bipolar affective disorder who presented with a 4-month history of severe stuttering and vague neurologic complaints. She had lost 200 pounds after gastric bypass surgery two years before. A childhood sexual-abuse victim, she admits that she "hid" in her weight for most of her life. Neurological evaluation of this patient was negative, and speech-pathology evaluation revealed highly atypical stuttering. Gastric bypass patients with a history of psychiatric disorders and childhood sexual abuse may be particularly vulnerable to somatoform disorders.

What Investigations Are Ordered In Patients With First-Episode Psychosis?, Allan Shefrin M.D. (Pgy2), Derek Puddester M.D., Stephanie Greenham Ph.D., Lise Bisnaire Ph.D., Hazen Gandy M.D.

Jefferson Journal of Psychiatry

Psychiatrists are often left with the dilemma of which investigations to order in adolescents presenting with a first episode of psychosis. Blood work, urine studies, and neuroimaging studies were tracked in 13 adolescents admitted with a diagnosis of first-episode psychosis over a 13-month period to the Children’s Hospital of Eastern Ontario. Variation was found in the amount of investigation ordered: 85% of patients received a drug screen; 54% a CT scan; 8% an MRI; 92% a CBC with differential; 92% electrolytes. Abnormalities of CT scans were detected in 2 patients (29%); in neither case did the result lead to a …

Nms, And Why We Should Call It (Malignant) Catatonia, Robert Arnold Johnson M.D. (Pgy4)

Jefferson Journal of Psychiatry

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The Diagnosis Of Adrenal Insufficiency In The Critically Ill Patient: Does It Really Matter?, Paul E. Marik

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

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The Sub-Axial Cervical Spine Injury Classification System (Slic): A Novel Approach To Recognize The Importance Of Morphology, Neurology And Integrity Of The Disco-Ligamentous Complex, Alexander R. Vaccaro, R. John Hulbert, Charles Fisher, Marcel Dvorak, Alpesh A. Patel, Ronald A. Lehman Jr., Paul Anderson, James Harrop, F. C. Oner, Paul Arnold, Michael Fehlings, Rune Hedlund, Ignacio Madrazo, Glenn Rechtine, Bizhan Aarabi, Mike Shainline, Spine Trauma Study Group

Department of Orthopaedic Surgery Faculty Papers

Abstract Background Context Despite technological advances in spine surgery, classification of sub-axial cervical spine injuries remains largely descriptive, lacking standardization and any relationship to prognosis or clinical decision making. Purpose The primary purpose of this paper is to define a classification system for sub-axial cervical spine trauma that conveys information about injury pattern and severity as well as treatment considerations and prognosis. The proposed system is designed to be both comprehensive and easy to use. The secondary objective is to evaluate the classification system in the basic principles of classification construction, namely reliability and validity. Study Design/Setting Derivation of the …

Liver Transplant Recipient With Calcineurin-Inhibitor Induced Pain Syndrome: A Case Report, Nethra S. Ankam, Md, Stanley R. Jacobs, Md

Department of Rehabilitation Medicine Faculty Papers

Setting: University Hospital

Patient: 65-year-old female status-post liver transplant secondary to cirrhosis.

Case Description: Prior to the rehabilitation consult on post-operative day 42, she had an episode of acute rejection requiring rapid escalation of cyclosporine dosage, later changed to high dose tacrolimus for immunosuppression, resulting in high blood levels of both calcineurin inhibitors. She then complained of paroxysms of 10/10 pain over her entire body not relieved by opioids despite escalation in medication by the acute pain service. She was not participating in a rehabilitation program because of pain. Examination revealed an anxious woman for whom any tactile stimulation …

The Role Of Allograft Inflammatory Factor 1 In Systemic Sclerosis, Francesco Del Galdo, Carol M. Artlett, Sergio A. Jimenez

Selected Works of Sergio Jiménez, MD, MACR

ABSTRACT

Purpose: To review studies which support the hypothesis that allograft inflammatory factor-1 (AIF-1), a protein initially identified in chronically rejected cardiac allografts, may be involved in the pathogenesis of the progressive fibroproliferative vasculopathy which is a hallmark of systemic sclerosis (SSc).

Recent findings: Recent findings demonstrated elevated AIF-1 expression both in SSc affected tissues and peripheral blood mononuclear cells. A detailed immunohistopathologic study examined the tissue and cellular localization of the protein in affected SSc tissues and demonstrated its expression in the endothelium of dermal and pulmonary vessels, in the pulmonary parenchyma, and in relevant inflammatory cells including T …