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Zucker School of Medicine at Hofstra/Northwell

Articles 1351 - 1380 of 2014

Full-Text Articles in Medical Specialties

Respiratory Failure With Hilar Mass: Role Of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration In The Medical Intensive Care Unit, A. Chichra, K. W. Lama, S. J. Koenig Jan 2015

Respiratory Failure With Hilar Mass: Role Of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration In The Medical Intensive Care Unit, A. Chichra, K. W. Lama, S. J. Koenig

Journal Articles

We report the case of a 58-year-old man on chronic steroid therapy, who developed a rapidly progressive right upper lobe infiltrate/mass that extended into the right hilum. Respiratory failure necessitated endotracheal intubation. Broad spectrum antibiotics were initiated without clinical improvement and because of his immunosuppressive therapy opportunistic pathogens were considered. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed in the Medical Intensive Care Unit (MICU) with rapid onsite evaluation. Specimens obtained from the right hilar mass revealed organisms suspicious for cryptococcal infection, subsequently confirmed via a culture. No complications occurred during the EBUS procedure despite the patient requiring vasopressor support …

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A Review Of The Nonpressor And Nonantidiuretic Actions Of The Hormone Vasopressin, G. P. Mavani, M. V. Devita, M. F. Michelis Jan 2015

A Review Of The Nonpressor And Nonantidiuretic Actions Of The Hormone Vasopressin, G. P. Mavani, M. V. Devita, M. F. Michelis

Journal Articles

The pressor and antidiuretic actions of arginine vasopressin (AVP) have been well documented. This review focuses on the less widely appreciated actions of AVP which also have important physiologic functions and when better understood may provide important insights into common disease states. These actions include effects on pain perception and bone structure as well as important relationships to the varied components of metabolic syndrome. These include effects on blood glucose, lipid levels, and blood pressure. AVP may also play a role in the progression of chronic kidney disease and effect physiologic changes relating to aging, abnormal social behavior, and cognitive …

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"Saw-Tooth Sign" In Upper Airway Disorders - A Case Report, S. Sahni, A. Blood, S. Paulus, A. Talwar Jan 2015

"Saw-Tooth Sign" In Upper Airway Disorders - A Case Report, S. Sahni, A. Blood, S. Paulus, A. Talwar

Journal Articles

Spirometry flow-volume loop measurement is the screening test of choice to rule out obstructive lung diseases. Flow oscillations occasionally seen on flow volume loops, referred to as a "saw-tooth" sign, are thought to be due to an upper airway obstructive processes associated with upper airway collapsibility. Widely described in obstructive sleep apnea syndrome, flow oscillations have also been linked to many other upper airway pathologies. The mechanism by which flow oscillations occur is centered on the inspiratory and expiratory flow of air. It has been theorized that the mechanism of flow oscillations result from rapid intermittent changes in driving pressure …

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Successful Pregnancy Outcome In Paroxysmal Nocturnal Hemoglobinuria (Pnh) Following Escalated Eculizumab Dosing To Control Breakthrough Hemolysis, R. Sharma, A. Keyzner, J. Liu, T. Bradley, S. L. Allen Jan 2015

Successful Pregnancy Outcome In Paroxysmal Nocturnal Hemoglobinuria (Pnh) Following Escalated Eculizumab Dosing To Control Breakthrough Hemolysis, R. Sharma, A. Keyzner, J. Liu, T. Bradley, S. L. Allen

Journal Articles

Pregnancy in women with paroxysmal nocturnal hemoglobinuria (PNH) is associated with increased maternal and fetal morbidity and mortality. There is limited published experience regarding therapy of PNH during pregnancy. We describe a case of a 30 year old female with hypoplastic myelodysplastic syndrome and PNH. After two years of treatment with eculizumab, she became pregnant. She developed breakthrough hemolysis at 20 weeks gestation. Pharmacokinetic and pharmacodynamic studies demonstrated a subtherapeutic eculizumab level with absence of complement blockade. Escalation of her eculizumab dose successfully controlled hemolysis and restored therapeutic eculizumab level and activity. She delivered a healthy baby at 36 weeks.

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Tubular Cell Phenotype In Hiv-Associated Nephropathy: Role Of Phospholipid Lysophosphatidic Acid, K. R. Ayasolla, P. Rai, S. Rahimipour, M. Hussain, A. Malhotra, P. C. Singhal Jan 2015

Tubular Cell Phenotype In Hiv-Associated Nephropathy: Role Of Phospholipid Lysophosphatidic Acid, K. R. Ayasolla, P. Rai, S. Rahimipour, M. Hussain, A. Malhotra, P. C. Singhal

Journal Articles

Collapsing glomerulopathy and microcysts are characteristic histological features of HIV-associated nephropathy (HIVAN). We have previously reported the role of epithelial mesenchymal transition (EMT) in the development of glomerular and tubular cell phenotypes in HIVAN. Since persistent tubular cell activation of NF kappa B has been reported in HIVAN, we now hypothesize that HIV may be contributing to tubular cell phenotype via lysophosphatidic acid (LPA) mediated downstream signaling. Interestingly, LPA and its receptors have also been implicated in the tubular interstitial cell fibrosis (TIF) and cyst formation in autosomal dominant polycystic kidney disease (PKD). Primary human proximal tubular cells (HRPTCs) were …

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Vascular Smooth Muscle Cells Contribute To Apol1-Induced Podocyte Injury In Hiv Milieu, X. Lan, H. Wen, M. A. Saleem, J. Mikulak, A. Malhotra, K. Skorecki, P. C. Singhal Jan 2015

Vascular Smooth Muscle Cells Contribute To Apol1-Induced Podocyte Injury In Hiv Milieu, X. Lan, H. Wen, M. A. Saleem, J. Mikulak, A. Malhotra, K. Skorecki, P. C. Singhal

Journal Articles

Clinical reports have demonstrated that higher rates of non-diabetic glomerulosclerosis in African Americans can be attributed to two coding sequence variants (G1 and G2) in the APOL1 gene; however, the underlying mechanism is still unknown. Kidney biopsy data suggest enhanced expression of APOL1/APOL1 variants (Vs) in smooth muscle cells (SMCs) of renal vasculature. Since APOL1 is a secretory protein of relatively low molecular weight (41kDa), SMCs may be a contributory endocrine/paracrine source of APOL1 wild type (WT)/APOL1Vs in the glomerular capillary perfusate percolating podocytes. In the present study, we tested the hypothesis that an HIV milieu stimulated secretion of APOL1 …

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Vitamin D Receptor And Epigenetics In Hiv Infection And Drug Abuse, N. Chandel, A. Malhotra, P. C. Singhal Jan 2015

Vitamin D Receptor And Epigenetics In Hiv Infection And Drug Abuse, N. Chandel, A. Malhotra, P. C. Singhal

Journal Articles

Illicit drug abuse is highly prevalent and serves as a powerful co-factor for HIV exacerbation. Epigenetic alterations in drug abuse and HIV infection determine expression of several critical genes such as vitamin D receptor (VDR), which participates in proliferation, differentiation, cell death under both physiological and pathological conditions. On that account, active vitamin D, the ligand of VDR, is used as an adjuvant therapy to control infection, slow down progression of chronic kidney diseases, and cancer chemotherapy. Interestingly, vitamin D may not be able to augment VDR expression optimally in several instances where epigenetic contributes to down regulation of VDR; …

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Lps Down-Regulates Specificity Protein 1 Activity By Activating Nf-Kappab Pathway In Endotoxemic Mice, X. Ye, H. Liu, Y. S. Gong, S. F. Liu Jan 2015

Lps Down-Regulates Specificity Protein 1 Activity By Activating Nf-Kappab Pathway In Endotoxemic Mice, X. Ye, H. Liu, Y. S. Gong, S. F. Liu

Journal Articles

BACKGROUND: Specificity protein (Sp) 1 mediates the transcription of a large number of constitutive genes encoding physiological mediators. NF-kappaB mediates the expression of hundreds of inducible genes encoding pathological mediators. Crosstalk between Sp1 and NF-kappaB pathways could be pathophysiologically significant, but has not been studied. This study examined the crosstalk between the two pathways and defined the role of NF-kappaB signaling in LPS-induced down-regulation of Sp1 activity. METHODS AND MAIN FINDINGS: Challenge of wild type mice with samonelia enteritidis LPS (10 mg/kg, i.p.) down-regulated Sp1 binding activity in lungs in a time-dependent manner, which was concomitantly associated with an increased …

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Malignancies, Particularly B-Cell Lymphomas, Are A Frequent Cause Of Mortality In Human Immunodeficiency Virus-1 Patients Despite Highly Active Antiretroviral Therapy, D. O. Griffin, M. Metzger, K. Poeth, K. Deng, A. Dharsee, J. C. Rico, J. Mcgowan Jan 2015

Malignancies, Particularly B-Cell Lymphomas, Are A Frequent Cause Of Mortality In Human Immunodeficiency Virus-1 Patients Despite Highly Active Antiretroviral Therapy, D. O. Griffin, M. Metzger, K. Poeth, K. Deng, A. Dharsee, J. C. Rico, J. Mcgowan

Journal Articles

Human immunodeficiency virus (HIV)-1-infected individuals are affected by diseases at rates above those of their HIV-negative peers despite the increased life expectancy of the highly active antiretroviral therapy era. We followed a cohort of approximately 2000 HIV-1-infected patients for 5 years. The most frequent cause of death in this HIV-1-infected cohort was malignancy, with 39% of all classified deaths due to cancer. Among the cancer deaths, B-cell lymphomas were the most commonly seen malignancy, representing 34% of all cancer deaths. These lymphomas were very aggressive with a median survival ofdiagnosis.

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Non-Small-Cell Lung Cancer Clinicopathologic Features And Survival Outcomes In Asian Pacific Islanders Residing In The United States: A Seer Analysis, M. S. Hamid, R. Shameem, K. Gafoor, J. George, B. Mina, K. Sullivan Jan 2015

Non-Small-Cell Lung Cancer Clinicopathologic Features And Survival Outcomes In Asian Pacific Islanders Residing In The United States: A Seer Analysis, M. S. Hamid, R. Shameem, K. Gafoor, J. George, B. Mina, K. Sullivan

Journal Articles

Background. The objective of our study was to ascertain racial/ethnic disparities in Asian/Pacific Islanders (API) for non-small-cell lung cancer (NSCLC) clinicopathologic features and survival outcomes based on various tumor characteristics and treatment modalities. Method. SEER database identified invasive NSCLC cases from 2004 to 2010. Variables included American Joint Committee on Cancer (AJCC) stage 7, tumor grade, tumor size, histology, age, marital status, radiation, surgery, and reason for no surgery. The Kruskall-Wallis test and the Z test were used to examine differences between races/ethnicities and the referent, non-Hispanic white (NHW). Multivariate Cox proportional analyses were used to establish the weight of …

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An Overlapping Case Of Lupus Nephritis And Igg4-Related Kidney Disease, M. Zaarour, C. Weerasinghe, A. Eter, S. El-Sayegh, E. El-Charabaty Jan 2015

An Overlapping Case Of Lupus Nephritis And Igg4-Related Kidney Disease, M. Zaarour, C. Weerasinghe, A. Eter, S. El-Sayegh, E. El-Charabaty

Journal Articles

We report a case of a 71-year-old Filipino female who was admitted to the hospital for abdominal pain, vomiting and diarrhea of 8 days duration. The patient was found to have marked acute kidney injury (AKI), which required hemodialysis in the next 3 days. Extensive workup revealed hematuria, subnephrotic range proteinuria, elevated anti-nuclear antibody (ANA) and elevated total immunoglobulin G (IgG) levels, with normal IgG4 and anti-dsDNA levels. On kidney biopsy, mild membranous glomerulonephritis was found, along with autoimmune tubulointerstitial nephritis (TIN) with a "full-house" pattern of immune deposits. These findings were suggestive of lupus interstitial nephritis. However, IgG4+ plasma …

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Patient Considerations In The Management Of Ulcerative Colitis - Role Of Vedolizumab, M. Kothari, P. Mudireddy, A. Swaminath Jan 2015

Patient Considerations In The Management Of Ulcerative Colitis - Role Of Vedolizumab, M. Kothari, P. Mudireddy, A. Swaminath

Journal Articles

Ulcerative colitis (UC) is a subtype of inflammatory bowel disease which causes inflammation of the large intestine and affects approximately 7.6-24.6 per 100,000 persons. The therapeutic goal for UC patients is inducing remission, maintaining remission, and ideally, obtaining mucosal healing. Vedolizumab, approved by the US Food and Drug Administration in May 2014 for the treatment of moderate-to-severe UC and Crohn's disease, is a newly developed anti-integrin therapy. This review focuses on the preclinical development of vedolizumab and data from early trials, and details the results of the landmark trails that led to its approval in the USA with a specific …

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Perioperative Bridging Anticoagulation In Patients With Atrial Fibrillation, J. D. Douketis, A. C. Spyropoulos, S. Kaatz, R. C. Becker, J. A. Caprini, A. S. Dunn, D. A. Garcia, A. Jacobson, A. K. Jaffer, T. L. Ortel, +4 Additional Authors Jan 2015

Perioperative Bridging Anticoagulation In Patients With Atrial Fibrillation, J. D. Douketis, A. C. Spyropoulos, S. Kaatz, R. C. Becker, J. A. Caprini, A. S. Dunn, D. A. Garcia, A. Jacobson, A. K. Jaffer, T. L. Ortel, +4 Additional Authors

Journal Articles

BACKGROUND: It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding. METHODS: We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or …

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Presence Of Anti-Glomerular Basement Membrane Antibodies And Myeloperoxidase Anti-Neutrophilic Cytoplasmic Antibodies In A Case Of Rapidly Progressive Glomerulonephritis, G. P. Mavani, M. Pommier, S. Win, M. F. Michelis, J. Rosenstock Jan 2015

Presence Of Anti-Glomerular Basement Membrane Antibodies And Myeloperoxidase Anti-Neutrophilic Cytoplasmic Antibodies In A Case Of Rapidly Progressive Glomerulonephritis, G. P. Mavani, M. Pommier, S. Win, M. F. Michelis, J. Rosenstock

Journal Articles

A 69-year-old male had initially presented with low-grade proteinuria, microhematuria, and a positive myeloperoxidase anti-neutrophilic antibody (ANCA). He subsequently developed deterioration of kidney function and developed uremic symptoms. Creatinine was 486.2 mumol/L (5.5 mg/dL). Anti-MPO was positive (titer >8 U, normal

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Protein Domains Of Apol1 And Its Risk Variants, X. Q. Lan, H. X. Wen, R. Lederman, A. Malhotra, J. Mikulak, W. Popik, K. Skorecki, P. C. Singhal Jan 2015

Protein Domains Of Apol1 And Its Risk Variants, X. Q. Lan, H. X. Wen, R. Lederman, A. Malhotra, J. Mikulak, W. Popik, K. Skorecki, P. C. Singhal

Journal Articles

Increasing lines of evidence have demonstrated that the development of higher rates of non-diabetic glomerulosclerosis (GS) in African Americans can be attributed to two coding sequence variants (G1 and G2) in the Apolipoprotein L1 (APOL) gene. Recent studies indicate that the gene products of these APOL1 risk variants have augmented toxicity to kidney cells. However, the biological characteristics of APOL1 and its risk variants are not well elucidated. The APOL1 protein can be divided into several functional domains, including signal peptide (SP), pore forming domain (PFD), membrane address domain (MAD), and SEA-interacting domain. To investigate the relative contribution of each …

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Pulmonary Rehabilitation And Exercise In Pulmonary Arterial Hypertension: An Underutilized Intervention, S. Sahni, B. Capozzi, A. Iftikhar, V. Sgouras, M. Ojrzanowski, A. Talwar Jan 2015

Pulmonary Rehabilitation And Exercise In Pulmonary Arterial Hypertension: An Underutilized Intervention, S. Sahni, B. Capozzi, A. Iftikhar, V. Sgouras, M. Ojrzanowski, A. Talwar

Journal Articles

Pulmonary arterial hypertension (PAH) is a rare and devastating disease characterized by progressive increases in pulmonary arterial pressure and pulmonary vascular resistance which eventually leads to right ventricular failure and death. Early thought process was that exercise and increased physical activity may be detrimental to PAH patients however many small cohort trials have proven otherwise. In addition to the many pharmaceutical options, exercise and pulmonary rehabilitation have also been shown to increase exercise capacity as well as various aspects of psychosomatic health. As pulmonary and exercise rehabilitation become more widely used as an adjuvant therapy patient outcomes improve and physicians …

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A Randomized, Phase 2 Trial Of Docetaxel With Or Without Px-866, An Irreversible Oral Phosphatidylinositol 3-Kinase Inhibitor, In Patients With Relapsed Or Metastatic Head And Neck Squamous Cell Cancer, A. Jimeno, J. E. Bauman, C. Weissman, D. Adkins, I. Schnadig, P. Beauregard, D. W. Bowles, A. Spira, B. Levy, N. Seetharamu, D. Hausman, L. Walker, C. M. Rudin, K. Shirai Jan 2015

A Randomized, Phase 2 Trial Of Docetaxel With Or Without Px-866, An Irreversible Oral Phosphatidylinositol 3-Kinase Inhibitor, In Patients With Relapsed Or Metastatic Head And Neck Squamous Cell Cancer, A. Jimeno, J. E. Bauman, C. Weissman, D. Adkins, I. Schnadig, P. Beauregard, D. W. Bowles, A. Spira, B. Levy, N. Seetharamu, D. Hausman, L. Walker, C. M. Rudin, K. Shirai

Journal Articles

INTRODUCTION: The phosphotidylinositol-3 kinase (PI3K)/serine-threonine kinase (AKT)/mammalian target of rapamycin (mTOR) signaling pathway is frequently altered in head and neck squamous cell cancer (HNSCC). PX-866 is an oral, irreversible, pan-isoform inhibitor of PI3K. Preclinical models revealed synergy with docetaxel and a phase 1 trial demonstrated tolerability of this combination. This randomized phase 2 study evaluated PX-866 combined with docetaxel in patients with advanced, refractory HNSCC. METHODS: Patients with locally advanced, recurrent or metastatic HNSCC who had received at least one and no more than two prior systemic treatment regimens were randomized (1:1) to a combination of docetaxel (75mg/m(2) IV every …

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Dyspnea, Depression And Health Related Quality Of Life In Pulmonary Arterial Hypertension Patients, A. Talwar, S. Sahni, E. J. Kim, S. Verma, N. Kohn Jan 2015

Dyspnea, Depression And Health Related Quality Of Life In Pulmonary Arterial Hypertension Patients, A. Talwar, S. Sahni, E. J. Kim, S. Verma, N. Kohn

Journal Articles

No abstract provided.

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Epigenetic Modulation Of Human Podocyte Vitamin D Receptor In Hiv Milieu, N. Chandel, K. S. Ayasolla, X. Lan, M. Sultana-Syed, A. Chawla, R. Lederman, V. Vethantham, M. A. Saleem, A. Malhotra, P. C. Singhal, +1 Additional Author Jan 2015

Epigenetic Modulation Of Human Podocyte Vitamin D Receptor In Hiv Milieu, N. Chandel, K. S. Ayasolla, X. Lan, M. Sultana-Syed, A. Chawla, R. Lederman, V. Vethantham, M. A. Saleem, A. Malhotra, P. C. Singhal, +1 Additional Author

Journal Articles

HIV (human immunodeficiency virus) has been reported to induce podocyte injury through down regulation of vitamin D receptor (VDR) and activation of renin angiotensin system; however, the involved mechanism is not clear. Since HIV has been reported to modulate gene expression via epigenetic phenomena, we asked whether epigenetic factors contribute to down regulation of VDR. Kidney cells in HIV transgenic mice and HIV-infected podocytes (HIV/HPs) displayed enhanced expression of SNAIL, a repressor of VDR. To elucidate the mechanism, we studied the effect of HIV on expression of molecules involved in SNAIL repressor complex formation and demonstrated that HIV enhances expression …

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A Framework For Usable And Effective Clinical Decision Support: Experience From The Icpr Randomized Clinical Trial, J. Kannry, L. Mccullagh, A. Kushniruk, D. Mann, D. Edonyabo, T. Mcginn Jan 2015

A Framework For Usable And Effective Clinical Decision Support: Experience From The Icpr Randomized Clinical Trial, J. Kannry, L. Mccullagh, A. Kushniruk, D. Mann, D. Edonyabo, T. Mcginn

Journal Articles

INTRODUCTION: The promise of Clinical Decision Support (CDS) has always been to transform patient care and improve patient outcomes through the delivery of timely and appropriate recommendations that are patient specific and, more often than not, are appropriately actionable. However, the users of CDS-providers-are frequently bombarded with inappropriate and inapplicable CDS that often are not informational, not integrated into the workflow, not patient specific, and that may present out of date and irrelevant recommendations. METHODS: The integrated clinical prediction rule (iCPR) project was a randomized clinical trial (RCT) conducted to determine if a novel form of CDS, i.e., clinical prediction …

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Fungal Infections In Renal Transplant Patients, A. Khan, E. El-Charabaty, S. El-Sayegh Jan 2015

Fungal Infections In Renal Transplant Patients, A. Khan, E. El-Charabaty, S. El-Sayegh

Journal Articles

Organ transplantation has always been considered to be the standard therapeutic interventions in patients with end-stage organ failure. In 2008, more than 29,000 organ transplants were performed in US. Survival rates among transplant recipients have greatly improved due to better understanding of transplant biology and more effective immunosuppressive agents. After transplant, the extent of the immune response is influenced by the amount of interleukin 2 (IL-2) being produced by the T-helper cells. Transplant immunosuppressive therapy primarily targets T cell-mediated graft rejection. Calcineurin inhibitor, which includes cyclosporine, pimecrolimus and tacrolimus, impairs calcineurin-induced up-regulation of IL-2 expression, resulting in increased susceptibility to …

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Healthcare Provider Perceptions Of Clinical Prediction Rules, S. Richardson, S. Khan, L. Mccullagh, M. Kline, D. Mann, T. Mcginn Jan 2015

Healthcare Provider Perceptions Of Clinical Prediction Rules, S. Richardson, S. Khan, L. Mccullagh, M. Kline, D. Mann, T. Mcginn

Journal Articles

Objectives: To examine internal medicine and emergency medicine healthcare provider perceptions of usefulness of specific clinical prediction rules. Setting: The study took place in two academic medical centres. A web-based survey was distributed and completed by participants between 1 January and 31 May 2013. Participants: Medical doctors, doctors of osteopathy or nurse practitioners employed in the internal medicine or emergency medicine departments at either institution. Primary and secondary outcome measures: The primary outcome was to identify the clinical prediction rules perceived as most useful by healthcare providers specialising in internal medicine and emergency medicine. Secondary outcomes included comparing usefulness scores …

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Hepatic Manifestations Of Non-Steroidal Inflammatory Bowel Disease Therapy, R. Hirten, K. Sultan, A. Thomas, D. E. Bernstein Jan 2015

Hepatic Manifestations Of Non-Steroidal Inflammatory Bowel Disease Therapy, R. Hirten, K. Sultan, A. Thomas, D. E. Bernstein

Journal Articles

Inflammatory bowel disease (IBD) is composed of Crohn's disease and ulcerative colitis and is manifested by both bowel-related and extraintestinal manifestations. Recently the number of therapeutic options available to treat IBD has dramatically increased, with each new medication having its own mechanism of action and side effect profile. A complete understanding of the hepatotoxicity of these medications is important in order to distinguish these complications from the hepatic manifestations of IBD. This review seeks to evaluate the hepatobiliary complications of non-steroid based IBD medications and aide providers in the recognition and management of these side-effects.

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Iga-Dominant Post-Infectious Glomerulonephritis Presenting As A Fatal Pulmonary-Renal Syndrome, M. Saad, M. Daoud, P. Nasr, R. Syed, S. El-Sayegh Jan 2015

Iga-Dominant Post-Infectious Glomerulonephritis Presenting As A Fatal Pulmonary-Renal Syndrome, M. Saad, M. Daoud, P. Nasr, R. Syed, S. El-Sayegh

Journal Articles

Over the last decades, post-infectious glomerulonephritis underwent major changes in its epidemiology, pathophysiology, and outcomes. We are reporting a case of IgA-dominant post-infectious glomerulonephritis (IgA-PIGN) presenting as a fatal pulmonary-renal syndrome. An 86-year-old Filipino man presented with worsening dyspnea, hemoptysis, and decreased urine output over 2 weeks. Past medical history is significant for hypertension, chronic kidney disease stage III, and pneumonia 3 weeks prior treated with intravenous cefazolin for methicillin-sensitive Staphylococcus aureus bacteremia. Physical examination was remarkable for heart rate of 109/min and respiratory rate of 25/min saturating 99% on 3 liters via nasal cannula. There were bibasilar rales in …

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Inner Segment Remodeling And Mitochondrial Translocation In Cone Photoreceptors In Age-Related Macular Degeneration With Outer Retinal Tubulation, K. M. Litts, J. D. Messinger, K. B. Freund, Y. Zhang, C. A. Curcio Jan 2015

Inner Segment Remodeling And Mitochondrial Translocation In Cone Photoreceptors In Age-Related Macular Degeneration With Outer Retinal Tubulation, K. M. Litts, J. D. Messinger, K. B. Freund, Y. Zhang, C. A. Curcio

Journal Articles

PURPOSE: To quantify impressions of mitochondrial translocation in degenerating cones and to determine the nature of accumulated material in the subretinal space with apparent inner segment (IS)-like features by examining cone IS ultrastructure. METHODS: Human donor eyes with advanced age-related macular degeneration (AMD) were screened for outer retinal tubulation (ORT) in macula-wide, high-resolution digital sections. Degenerating cones inside ORT (ORT cones) and outside ORT (non-ORT cones) from AMD eyes and unaffected cones in age-matched control eyes were imaged using transmission electron microscopy. The distances of mitochondria to the external limiting membrane (ELM), cone IS length, and cone IS width at …

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Long-Term Visual Outcomes For A Treat And Extend Anti-Vascular Endothelial Growth Factor Regimen In Eyes With Neovascular Age-Related Macular Degeneration, S. Mrejen, J. J. Jung, C. Chen, S. N. Patel, R. Gallego-Pinazo, L. A. Yannuzzi, L. Xu, M. Marsiglia, S. Boddu, K. B. Freund Jan 2015

Long-Term Visual Outcomes For A Treat And Extend Anti-Vascular Endothelial Growth Factor Regimen In Eyes With Neovascular Age-Related Macular Degeneration, S. Mrejen, J. J. Jung, C. Chen, S. N. Patel, R. Gallego-Pinazo, L. A. Yannuzzi, L. Xu, M. Marsiglia, S. Boddu, K. B. Freund

Journal Articles

With the advent of anti-vascular endothelial growth factor (VEGF) therapy, clinicians are now focused on various treatment strategies to better control neovascular age-related macular degeneration (NVAMD), a leading cause of irreversible blindness. Herein, we retrospectively reviewed consecutive patients with treatment-naive NVAMD initially classified based on fluorescein angiography (FA) alone or with an anatomic classification utilizing both FA and optical coherence tomography (OCT) and correlated long-term visual outcomes of these patients treated with an anti-VEGF Treat-and-Extend Regimen (TER) with baseline characteristics including neovascular phenotype. Overall, 185 patients (210 eyes) were followed over an average of 3.5 years (range 1-6.6) with a …

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Idiopathic Multifocal Choroiditis/Punctate Inner Choroidopathy With Acute Photoreceptor Loss Or Dysfunction Out Of Proportion To Clinically Visible Lesions, M. R. Munk, J. J. Jung, K. Biggee, W. R. Tucker, H. N. Sen, U. Schmidt-Erfurth, A. A. Fawzi, L. M. Jampol Jan 2015

Idiopathic Multifocal Choroiditis/Punctate Inner Choroidopathy With Acute Photoreceptor Loss Or Dysfunction Out Of Proportion To Clinically Visible Lesions, M. R. Munk, J. J. Jung, K. Biggee, W. R. Tucker, H. N. Sen, U. Schmidt-Erfurth, A. A. Fawzi, L. M. Jampol

Journal Articles

PURPOSE: To report acute/subacute vision loss and paracentral scotomata in patients with idiopathic multifocal choroiditis/punctate inner choroidopathy due to large zones of acute photoreceptor attenuation surrounding the chorioretinal lesions. METHODS: Multimodal imaging case series. RESULTS: Six women and 2 men were included (mean age, 31.5 +/- 5.8 years). Vision ranged from 20/20-1 to hand motion (mean, 20/364). Spectral domain optical coherence tomography demonstrated extensive attenuation of the external limiting membrane, ellipsoid and interdigitation zones, adjacent to the visible multifocal choroiditis/punctate inner choroidopathy lesions. The corresponding areas were hyperautofluorescent on fundus autofluorescence and were associated with corresponding visual field defects. Full-field …

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The Onion Sign In Neovascular Age-Related Macular Degeneration Represents Cholesterol Crystals, C. E. Pang, J. D. Messinger, E. C. Zanzottera, K. B. Freund, C. A. Curcio Jan 2015

The Onion Sign In Neovascular Age-Related Macular Degeneration Represents Cholesterol Crystals, C. E. Pang, J. D. Messinger, E. C. Zanzottera, K. B. Freund, C. A. Curcio

Journal Articles

PURPOSE: To investigate the frequency, natural evolution, and histologic correlates of layered, hyperreflective, subretinal pigment epithelium (sub-RPE) lines, known as the onion sign, in neovascular age-related macular degeneration (AMD). DESIGN: Retrospective observational cohort study and experimental laboratory study. PARTICIPANTS: Two hundred thirty eyes of 150 consecutive patients with neovascular AMD and 40 human donor eyes with histopathologic diagnosis of neovascular AMD. METHODS: Spectral-domain optical coherence tomography (SD OCT), near-infrared reflectance (NIR), color fundus images, and medical charts were reviewed. Donor eyes underwent multimodal ex vivo imaging, including SD OCT, before processing for high-resolution histologic analysis. MAIN OUTCOME MEASURES: Presence of …

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Outer Retinal Tubulation In Advanced Age-Related Macular Degeneration: Optical Coherence Tomographic Findings Correspond To Histology, K. B. Schaal, K. B. Freund, K. M. Litts, Y. Zhang, J. D. Messinger, C. A. Curcio Jan 2015

Outer Retinal Tubulation In Advanced Age-Related Macular Degeneration: Optical Coherence Tomographic Findings Correspond To Histology, K. B. Schaal, K. B. Freund, K. M. Litts, Y. Zhang, J. D. Messinger, C. A. Curcio

Journal Articles

PURPOSE: To compare optical coherence tomography (OCT) and histology of outer retinal tubulation (ORT) secondary to advanced age-related macular degeneration in patients and in postmortem specimens, with particular attention to the basis of the hyperreflective border of ORT. METHOD: A private referral practice (imaging) and an academic research laboratory (histology) collaborated on two retrospective case series. High-resolution OCT raster scans of 43 eyes (34 patients) manifesting ORT secondary to advanced age-related macular degeneration were compared to high-resolution histologic sections through the fovea and superior perifovea of donor eyes (13 atrophic age-related macular degeneration and 40 neovascular age-related macular degeneration) preserved

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Image Artifacts In Optical Coherence Tomography Angiography, R. F. Spaide, J. G. Fujimoto, N. K. Waheed Jan 2015

Image Artifacts In Optical Coherence Tomography Angiography, R. F. Spaide, J. G. Fujimoto, N. K. Waheed

Journal Articles

PURPOSE: To describe image artifacts of optical coherence tomography (OCT) angiography and their underlying causative mechanisms. To establish a common vocabulary for the artifacts observed. METHODS: The methods by which OCT angiography images are acquired, generated, and displayed are reviewed as are the mechanisms by which each or all of these methods can produce extraneous image information. A common set of terminology is proposed and used. RESULTS: Optical coherence tomography angiography uses motion contrast to image blood flow and thereby images the vasculature without the need for a contrast agent. Artifacts are very common and can arise from the OCT …

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