Medical Specialties Commons^™

Rehabilitation Of A Patient With Diabetic Myonecrosis: A Case Report, Nethra S. Ankam, Md, Vishal Kancherla, Do, Stanley R. Jacobs, Md

Department of Rehabilitation Medicine Faculty Papers

Setting: Inpatient rehabilitation unit at a university hospital

Patient: 37-year-old male with diabetic myonecrosis.

Case Description: The patient had a long-standing history of uncontrolled diabetes mellitus with multiple comorbidities, including end-stage renal disease on dialysis and diabetic myonecrosis of the left biceps femoris diagnosed by biopsy and magnetic resonance imaging (MRI.) On this admission, he presented with right leg pain and swelling, found to be a reoccurrence of diabetic myonecrosis in the vastus lateralis, medialis, and intermedius, diagnosed by MRI only. Prior to admission, he lived alone in a wheelchair inaccessible duplex and required minimal assistance with housekeeping.

Assessment/Results: …

Patient Education In Glaucoma: What Do Patients Know About Glaucoma?, Vital Paulino Costa, George L Spaeth, Maura Smith, Cordelia Uddoh, José Paulo Cabral Vasconcellos, Newton Kara-José

Wills Eye Hospital Papers

PURPOSE: To evaluate the knowledge glaucoma patients have about their disease and its treatment.

METHODS: One hundred and eighty-three patients were interviewed at the Glaucoma Service of Wills Eye Hospital (Philadelphia, USA, Group 1) and 100 at the Glaucoma Service of University of Campinas (Campinas, Brazil, Group 2). An informal, relaxed atmosphere was created by the interviewer before asking a list of 18 open-ended questions.

RESULTS: In Group 1, 44% of the 183 patients did not have an acceptable idea about what glaucoma is, 30% did not know the purpose of the medications they were taking, 47% were not aware …

Bibliography Of Secondary Sources On The History Of Dermatology Iii. Books, Monographs, And Chapters In English Supplemented Through 2005., Lawrence Charles Parish, John Thorne Crissey, Jennifer L Parish, Daniel H Parish

Department of Dermatology and Cutaneous Biology Faculty Papers

Providing supplements to the history of dermatology bibliographic record has been a continuous project for the past four decades. When the endeavor was initiated, the original authors decided that only contributions in English and those directly related to dermatology, excluding sexually transmitted diseases as such, would be indexed.

There is the perennial question of whether such a manually created bibiliographic project has a need. The obvious answer remains yes. While Index Medicus has expanded the number of journals that are indexed, the number of dermatology publications currently included by Index Medicus is just over fifty. Granted, most of the papers …

Dermatology Is A Specialty; Dermatology Is Not A Subspecialty., Lawrence Parish, Larry E Millikan

Department of Dermatology and Cutaneous Biology Faculty Papers

Specialization began in American medicine about the time of the War Between the States. Several factors spurred the direction of practitioners away from being the so-called “complete physicians. Most important were the advances in instrumentation made by the 1860’s, which allowed ophthalmology and otolaryngology to develop into distinct divisions of allopathic medicine; sometimes, they even joined together, viz eye, ear, nose, and throat specialist. Dermatology, too, became one of the early specialties for a myriad of reasons ranging from the obvious – visual inspection - to the mundane, viz. default – syphilis was too ugly and complicated for every physician …

Gnrh Agonist And Antagonist: Options For Endometriosis Pain Treatment , Frances R. Batzer

Department of Obstetrics and Gynecology Faculty Papers

Basic science research into the mechanism of the development of endometriosis, its persistence and resulting pain has begun to improve our understanding of how various therapeutic options work. While none of the available treatments resolves the underlying disease process, there are a growing number of alternatives. One of the more recent classes of medical options includes the GnRH agonist and antagonists. While at present this class of medical options is the most expensive and involved in implementation, they prove invaluable in terms of offering an aggressive, successful alternative for many patients. Furthermore, they may act directly on endometrial lesions in …

Carah's Bookshelf

CenterPieces

Occupational Therapy and Dementia Care: The Home Environmental Skills-Building Program for Individuals and Families

by Laura N. Gitlin, PhD and Mary Corcoran, PhD, OTR/L with contributors, published by AOTA Press, the American Occupational Therapy Association, Inc.

ISBN: 1569002037

Based on over 15 years of research, the book presents the Home Environmental Skill-building Program (ESP), an evidence-based intervention to support families and persons with dementia and enhance quality of life. The book provides the theoretical and empirical evidence for the program and describes its protocols in depth.

Physical Function in Older Adults: A Comprehensive Guide to Its Meaning and Measurement

by …

Download The Pdf Of The Full Issue

CenterPieces

For easy printing, the full newsletter is available as a single PDF.

We Are Seeking Participants For The Following Studies

CenterPieces

Title: Experience of Suffering in Old Age

Funding Source: National Institute on Aging

Principal Investigator: Helen K. Black, PhD

Target population: Philadelphia area residents over the age of 80 years old.

This 4-year study examines the experience of suffering and its relation to health, gender, and ethnicity among community dwelling elders aged 80+ using the open-ended interview schedule as its primary tool. This project explores through qualitative research the under-studied construct of suffering in later life and how suffering affects mental, physical and spiritual health.

Participants are interviewed in their homes on three occasions and are paid for their interviews. …

New Award: Carah And Germantown's Center In The Park Awarded $2.2 Million To Study Mental Health Of Older African-American Adults

CenterPieces

Why do older African-Americans tend to report less depression than Whites although they have poorer health and higher rates of chronic illness?

Research from the past 15 years consistently shows health disparities between Whites and minorities in the United States. African-Americans, in particular, are at higher risk than Caucasians for serious health conditions such as stroke, diabetes, cancer, cardiovascular disease and mild cognitive impairment. These chronic conditions typically contribute to depression in elders as a whole. However, the rates of depression for African-Americans are unclear with many studies reporting lower depression than in Whites and others reporting the reverse.

This …

Project Able Featured By Reuters Health Service

CenterPieces

CARAH's randomized trial, Project ABLE (Advancing Better Living for Elders), funded by the National Institute on Aging, and published in the May, 2006 issue of the Journal of the American Geriatric Society, was recently featured by Reuters Health service, the world's leading provider of medical and healthcare news.

This study tested a six-month intervention in which people received four 90-minute visits with an occupational therapist, as well as one 20-minute telephone contact, and one 90-minute physical therapy visit and home modifications provided by the Philadelphia Corporation for Aging. Of 319 men and women 70 years of age and older, half …

Geriatric Education Update

CenterPieces

Despite extensive government cutbacks in funding for aging research and elimination of federal support for geriatric and gerontological training, Jefferson has launched exciting new programs in this area. The year-old Division of Geriatric Medicine, housed within the Dept. of Family and Community Medicine, is under the directorship of Dr. Christine Arenson. In collaboration with CARAH, the Dept. of Occupational Therapy and the Dept. of Nursing, the Division has received funding for a Geriatric Education Center. In addition to Drs. Arenson and Gitlin, participants in this initiative include Dr. Cecelia Borden (Dept. of Nursing), Stephen Kern (Dept. of Occupational Therapy), Nancy …

2005 Dementia Conference Attracts Record Turn Out

CenterPieces

The 6th annual Dementia Management Conference - "New Directions in Providing Care to Patients and their Families" - was held on February 4, 2005 in the Bluemle Auditorium. This successful conference was co-sponsored by the Center for Applied Research on Aging and Health, Thomas Jefferson University Hospital and the Farber Institute for Neurosciences. In attendance were over 115 health care professionals, including physicians, nurses, occupational and physical therapists, social workers, researchers, and family members.

Attendees had the opportunity to learn from and ask questions of a panel of nationally recognized experts in the field of Alzheimer’s disease and related dementias. …

Message From Dean Erdman, James B. Erdman

CenterPieces

Congratulations to the Center and its Director, Dr. Laura Gitlin, on the inaugural issue of CARAH’s newsletter. In our discussions of the development of CARAH, one of the principal goals of the Center is its educational mission as is clear from the other information contained in this publication. Committed as the Center’s research professionals are to improving the health and quality of life of our seniors, it is not enough to conduct research that has the potential to provide significant help and support for patients and their caregivers. Those findings must also be disseminated, must be translated into action, must …

Graduating "Seniors" Of Center In The Park's Harvest Health Program

CenterPieces

"I have been to many health classes but none like this. This class was great and well organized."

"When I wake up I start exercising in bed. The Harvest Health classes have motivated me. I am now exercising 6 days a week."

"I use a motorized wheelchair, and I walk only a few steps. Thanks to the support from my classmates and the instructors, I achieved my action plan and am now walking in the corridor at Center in the Park. The program has motivated me to achieve my goals."

These are the accolades that Project Director Delores Palmer hears …

Message From Dr. Laura Gitlin, Director Of Carah, Laura N. Gitlin

CenterPieces

Welcome to the first issue of CenterPieces, the newsletter of the Center for Applied Research on Aging and Health.

Aging is a highly personal phenomenon. It obviously affects each of us on an individual, familia, and socio-political-economic level. Only a short 50 years ago, aging was viewed as a disease rather than a natural and important stage of human development. Although older people are at increased risk for heart disease, cancer, stroke, falls and cognitive impairments, more so than any other age group, new scientific breakthroughs show that frailty and physical and cognitive decline is a complex phenomenon and not …

P5l Mutation In Ank Results In An Increase In Extracellular Inorganic Pyrophosphate During Proliferation And Nonmineralizing Hypertrophy In Stably Transduced Atdc5 Cells, Raihana Zaka, David Stokes, Arnold S. Dion, Anna Kusnierz, Fei Han, Charlene J. Williams

Center for Translational Medicine Faculty Papers

Ank is a multipass transmembrane protein that regulates the cellular transport of inorganic pyrophosphate. In the progressive ankylosis (ank) mouse, a premature termination mutation at glutamic acid 440 results in a phenotype characterized by inappropriate deposition of basic calcium phosphate crystals in skeletal tissues. Mutations in the amino terminus of ANKH, the human homolog of Ank, result in familial calcium pyrophosphate dihydrate deposition disease. It has been hypothesized that these mutations result in a gain-of-function with respect to the elaboration of extracellular inorganic pyrophosphate. To explore this issue in a mineralization-competent system, we stably transduced ATDC5 cells with wild-type Ank …

Sixty-Four-Slice Multidetector Computed Tomography: The Future Of Ed Cardiac Care, Alexander T. Limkakeng, Ethan Halpern, Kevin M. Takakuwa

Department of Radiology Faculty Papers

Multidetector computed tomography (MDCT) imaging, a technological advance over traditional CT, is a promising possible alternative to cardiac catheterization for evaluating patients with chest pain in the emergency department (ED). In comparison with traditional CT, MDCT offers increased spatial and temporal resolution that allows reliable visualization of the coronary arteries. In addition, a "triple scan," which includes evaluation for pulmonary embolism and thoracic aortic dissection, can be incorporated into a single study. This test will enable emergency physicians to rapidly evaluate patients for life-threatening illnesses and may allow safer and earlier discharges of many patients with chest pain in comparison …

Celecoxib Decreases Prostaglandin E2 Concentrations In Nipple Aspirate Fluid From High Risk Postmenopausal Women And Women With Breast Cancer, Edward R. Sauter, Wenyi Quin, Lisa Schlatter, John E. Hewett, John T. Flynn

Department of Molecular Physiology and Biophysics Faculty Papers

Background

Celecoxib inhibits PGE2 production in cancerous tissue. We previously reported that PGE2 levels in nipple aspirate fluid (NAF) and plasma were not decreased in women at increased breast cancer risk who received celecoxib 200 mg twice daily (bid). The endpoints of the current study were to determine if a short course of celecoxib 400 mg bid would decrease PGE2 levels in women 1) at increased breast cancer risk, and 2) with established breast cancer.

Methods

NAF and plasma samples were collected before, 2 weeks after taking celecoxib 400 mg bid, and two weeks after washout from 26 women who …

Malignant Melanoma Metastacizing To The Thyroid Gland: A Case Report And Review Of The Literature, Brian Kung, Saba Aftab, Moira Wood, David Rosen

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Oral presentation 2006 AAO-H&NS Annual Meeting

Toronto, Canada September 17-20, 2006.

Objectives: The thyroid gland is a relatively uncommon site for secondary malignancy. Even lesscommon is metastasis of malignant melanoma to the thyroid gland. We present a case of malignantmelanoma metastatic to the thyroid gland presenting as thyroid enlargement.

Study Design: This is a case report which utilizes chart review, intraoperative photographs,radiographic images, and pathology slides.

Methods: A 68 year old patient with no prior evidence of primary skin melanoma presented witha neck mass which tested positive for melanoma. A year and a half following modified radical neckdissection, the patient …

Surgical Correction Of Severe Bilateral Thumb Pincer-Nail Deformity, Scott T. Van Duzer, John S. Taras

Department of Orthopaedic Surgery Faculty Papers

A 53 year old woman presented to the office with complaint of severe bilateral thumb nail pain and the deformity shown (Figure 1). She denied previous trauma to her thumb nails and had no history of previous bacterial or fungal infections of her nails. Based on the curvature of her nails, which increased from proximal to distal, a diagnosis of bilateral thumb pincer nail deformity was made.

Photo Quiz - Pruritic Rash After Ocean Swim, James Studdiford

Department of Family & Community Medicine Faculty Papers

No abstract provided.

A Phase Ii Study Of Acute Toxicity For Celebrex(Tm) (Celecoxib) And Chemoradiation In Patients With Locally Advanced Cervical Cancer: Primary Endpoint Analysis Of Rtog 0128, David K. Gaffney, Kathryn Winter, Adam P. Dicker, Brigitte Miller, Patricia J. Eifel, Janice Ryu, Vilija Avizonis, Mitch Fromm, Kathryn Greven

Department of Radiation Oncology Faculty Papers

Purpose: To determine treatment-related acute toxicity rates in patients with locally advanced cervical cancer treated by oral celecoxib, i.v. cisplatin and 5-FU, and concurrent pelvic radiation therapy.

Methods and Materials: Eligible patients on this RTOG Phase I-II study for advanced cervix cancer included FIGO Stage IIB-IVA or patients with FIGO Stage IB through IIA with biopsy proven pelvic node metastases ortumor size >5 cm. Patients were treated with pelvic radiotherapy and brachytherapy. Celecoxib was prescribed at 400 mg twice daily beginning on day 1 for 1 year. Cisplatin (75 mg/m2) and 5-FU (1g/m2 for 4 days) were administered every 3 …

Conference Brochure: 7th Annual Demential Management Conference

Center for Applied Research on Aging and Health Conferences

No abstract provided.

Peritoneal Perfusion With Oxygenated Perfluorocarbon Augments Systemic Oxygenation., Shamus R Carr, Joshua P Cantor, Atul S Rao, Thiru V Lakshman, Joshua E Collins, Joseph S Friedberg

Department of Surgery Faculty Papers

BACKGROUND: Despite maximal ventilatory support, many patients die from hypoxia in the setting of potentially reversible pulmonary failure. There remains a pressing need for additional pulmonary supportive care measures, especially techniques that do not require systemic anticoagulation. The objective of our experiments was to determine whether systemic oxygenation could be increased in a large animal, with induced hypoxia, by perfusing the abdominal cavity with oxygenated perfluorocarbons.

METHODS: Fifteen pigs with a mean (+/- SD) weight of 45 +/- 5 kg were intubated and rendered hypoxic by ventilating them with a blend of nitrogen and oxygen to achieve subatmospheric concentrations of …

Preventive Treatment Of Migraine, Stephen Silberstein

Department of Neurology Faculty Papers

Migraine is a common episodic pain disorder, the treatment of which can be acute to stop an attack or preventive to reduce the frequency, duration or severity of attacks. Preventive treatment is used when attacks are frequent or disabling. Many different medication groups are used for preventive treatment, including β-blockers, antidepressants and antiepileptic drugs. Their mechanisms of action include raising the threshold to migraine activation, enhancing antinociception, inhibiting cortical spreading depression, inhibiting peripheral and central sensitization, blocking neurogenic inflammation and modulating sympathetic, parasympathetic or 5-HT tone. In this article, I review evidence of the effectiveness of migraine preventive drugs. I …

The Effect Of Hus1 On Ionizing Radiation Sensitivity Is Associated With Homologous Recombination Repair But Is Independent Of Non-Homologous End-Joining, Robert S. Weiss, Xiang Wang, Baocheng Hu, Ya Wang

Department of Radiation Oncology Faculty Papers

Mammalian Hus1 plays an important role in maintaining genomic integrity. Cells lacking mouse Hus1 are hypersensitive to DNA damage inducers including UV and camptothecin (CPT). By using clonogenic assay, we show here that Hus1 deficient mouse cells are hypersensitive to ionizing radiation (IR) compared with their Hus1-positive counterparts. However, these cells show similar induction levels and similar rejoining rates of DNA double strand breaks (DSBs) following IR, indicating that the effect of Hus1 on cell radiosensitivity is independent of non-homologous end-joining (NHEJ). By combining an I-SceI-induced-DNA DSBs system and a siRNA approach, we also show that knocking down Hus1 decreases …

Comparison Of Dynamic (Brush) And Static (Pressure) Mechanical Allodynia In Migraine, C. Lopinto, W. B. Young, Avi Ashkenazi

Department of Neurology Faculty Papers

Allodynia has been described in migraine but has not been fully investigated for the different sensory modalities. The aim of this study was to compare the prevalence of dynamic (brush) and static (pressure) mechanical allodynia in migraine patients and to suggest a practical method of testing them in a clinical setting. Patients with International Headache Society-defined episodic migraine (EM) or with transformed migraine (TM) as defined by Silberstein and Lipton were prospectively recruited from the Jefferson Headache Center out-patient clinic. A questionnaire of migraine features and symptoms of allodynia was administered. Brush allodynia (BA) was tested by cutaneous stimulation with …

Botulinum Toxin Type A In The Prophylactic Treatment Of Chronic Tension-Type Headache: A Multicentre, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study, Stephen D. Silberstein, H. Göbel, R. Jensen, A. H. Elkind, R. Degryse, J. M.C.M. Walcott, C. Turkel

Department of Neurology Faculty Papers

We studied the safety and efficacy of 0 U, 50 U, 100 U, 150 U (five sites), 86 Usub and 100 Usub (three sites) botulinum toxin type A (BoNTA; BOTOX); Allergan, Inc., Irvine, CA, USA) for the prophylaxis of chronic tension-type headache (CTTH). Three hundred patients (62.3% female; mean age 42.6 years) enrolled. For the primary endpoint, the mean change from baseline in the number of TTH-free days per month, there was no statistically significant difference between placebo and four BoNTA groups, but a significant difference favouring placebo vs. BoNTA 150 was observed (4.5 vs. 2.8 tension headache-free days/month; P …

The Objective Structured Assessment Of Technical Skills And The Acgme Competencies, Carmen J. Sultana

Department of Obstetrics and Gynecology Faculty Papers

Objective structured assessments of technical skills (OSATS) are structured operating room or laboratory assessment of residents' surgical skills. They can be used to evaluate and teach both basic and complex skills to residents. The literature on their use is reviewed. Future use of virtual reality simulators is discussed.

Distinct P53 Acetylation Cassettes Differentially Influence Gene-Expression Patterns And Cell Fate., Chad D Knights, Jason Catania, Simone Di Giovanni, Selen Muratoglu, Ricardo Perez, Amber Swartzbeck, Andrew A Quong, Xiaojing Zhang, Terry Beerman, Richard Pestell, Maria Laura Avantaggiati

Kimmel Cancer Center Faculty Papers

The activity of the p53 gene product is regulated by a plethora of posttranslational modifications. An open question is whether such posttranslational changes act redundantly or dependently upon one another. We show that a functional interference between specific acetylated and phosphorylated residues of p53 influences cell fate. Acetylation of lysine 320 (K320) prevents phosphorylation of crucial serines in the NH(2)-terminal region of p53; only allows activation of genes containing high-affinity p53 binding sites, such as p21/WAF; and promotes cell survival after DNA damage. In contrast, acetylation of K373 leads to hyperphosphorylation of p53 NH(2)-terminal residues and enhances the interaction with …