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Department Of Radiology-Annual Executive Summary Report-July 1, 2009 To June 30, 2010, Vijay M. Rao, Md

Department of Radiology Administrative Documents and Reports

86 page Annual Executive Summary Report from Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States

Table of Contents:

Department of Radiology

Chairman, Vice Chairmen 1

Divisions and Directors 1

Committees and Chairmen 1

Radiology Department Faculty Rank 2

Faculty with Secondary Appointments 3

Clinical Divisions 4

Radiology Residents and Fellows 5

Department Organizational Chart 6

Department Administration Chart 7

State of the Department 8

Appendix I: Publications Journal Articles 21

Books and Book Chapters 28

Abstracts 30

Appendix II: Formal Scientific Presentations 39

Appendix III: Honors, Editorial Activities, Service to Regional or National Organizations 59

Appendix IV: …

Patterns Of Fatal Gunshot Injuries In Nairobi: A Prospective Forensic Study, Ancent K. Nzioka

Master of Medicine in Anatomic Pathology

Introduction: Gunshot injuries are one of the leading causes of fatal and non fatal injury in many countries (1) .All over the world, injury studies show an increasing preference for the gun as the weapon of choice for homicides and suicides (2).Firearms are more lethal compared to other portable and concealable weapons (2). Gunshot injuries impact severely on the criminal justice as well as health care systems (3, 4). There is no available published statistics on fatal gunshot injuries inKenya. Some basic statistics are important in understanding the magnitude and severity of the socio-economic burden caused by gunshot injuries. Objective: …

Expression Patterns Of Β–Catenin, Cox-2 And P27 In Colorectal Carcinomas At Aga Khan University Hospital, Nairobi, Patricia Okiro

Master of Medicine in Anatomic Pathology

Introduction: Colorectal cancer is the third most common cancer worldwide, as indicated by WHO. Local published and unpublished data indicate that patients in the developing world with colorectal cancer tend to present at an early age, and possibly at a more advanced stage than described in the developed world. The reason for this difference is unclear, and as yet undefined. The Wnt/APC pathway, Microsatellite instability pathway and the Epigenetic pathway are three pathogenetically distinct pathways that have been implicated in the development of colorectal cancer. Exploration of these patterns may allow us to elucidate possible reasons for these differences. Objectives: …

Anti-Hiv Activity In Cervical-Vaginal Secretions From Hiv-Positive And -Negative Women Correlate With Innate Antimicrobial Levels And Igg Antibodies, Mimi Ghosh, John V. Fahey, Zheng Shen, Timothy Lahey, Susan Cu-Uvin, Zhijin Wu, Kenneth Mayer, Peter F. Wright, John C. Kappes, Christina Ochsenbauer, Charles R. Wira

Dartmouth Scholarship

Background: We investigated the impact of antimicrobials in cervicovaginal lavage (CVL) from HIV(+) and HIV(2) women on target cell infection with HIV. Since female reproductive tract (FRT) secretions contain a spectrum of antimicrobials, we hypothesized that CVL from healthy HIV(+) and (2) women inhibit HIV infection.

Methodology/Principal Findings: CVL from 32 HIV(+) healthy women with high CD4 counts and 15 healthy HIV(2) women were collected by gently washing the cervicovaginal area with 10 ml of sterile normal saline. Following centrifugation, anti- HIV activity in CVL was determined by incubating CVL with HIV prior to addition to TZM-bl cells. Antimicrobials and …

Spontaneous Dural Tear Leading To Intracranial Hypotension And Tonsillar Herniation In Marfan Syndrome: A Case Report, Aqueel H. Pabaney, Farhan A. Mirza, Nadir A. Syed, Humera Ahsan

Section of Neurology

Background:We describe the case of a 38 year old male with Marfan syndrome who presented with orthostatic headaches and seizures. Case Presentation: The Patient was diagnosed with Spontaneous Intracranial Hypotension secondary to CSF leaks, objectively demonstrated by MR Myelogram with intrathecal contrast. Epidural autologus blood patch was administered at the leakage site leading to significant improvement.

Conclusion:

Our literature search shows that this is the second reported case of a Marfan Patient presenting with symptomatic spontaneous CSF leaks along with tonsillar herniation.

Intelligibility Of Electrolarynx Speech Using A Novel Actuator, Brian Madden, Mark Nolan, Ted Burke, James Condron, Eugene Coyle

Conference Papers

During voiced speech, the larynx provides quasi-periodic acoustic excitation of the vocal tract. Following a laryngectomy, some people speak using an electrolarynx which replaces the excitatory function of the absent larynx. Drawbacks of conventional electrolarynx designs include the buzzing monotonic sound emitted, the need for a free hand to operate the device, and difficulty experienced by many laryngectomees in adapting to its use. Despite these shortcomings, it remains the preferred method of speech rehabilitation for a substantial minority of laryngectomees. In most electrolarynxes, mechanical vibrations are produced by a linear electromechanical actuator, the armature of which percusses against a metal …

The Efficacy And Safety Of Insulin-Sensitizing Drugs In Hiv-Associated Lipodystrophy Syndrome: A Meta-Analysis Of Randomized Trials, Siddharth H. Sheth, Robin J. Larson

Dartmouth Scholarship

HIV-associated lipodystrophy syndrome (HALS) is characterized by insulin resistance, abnormal lipid metabolism and redistribution of body fat. To date, there has been no quantitative summary of the effects of insulin sensitizing-agents for the treatment of this challenging problem. We searched MEDLINE, the Cochrane Library, clinical trial registries, conference proceedings and references for randomized trials evaluating rosiglitazone, pioglitazone or metformin in patients with evidence of HALS (last update December 2009). Two reviewers independently abstracted data and assessed quality using a standard form. We contacted authors for missing data and calculated weighted mean differences (WMD) and 95% confidence intervals (CI) for each …

Ros Accumulation And Igf-Ir Inhibition Contribute To Fenofibrate/Pparalpha -Mediated Inhibition Of Glioma Cell Motility In Vitro, Justyna Drukala, Katarzyna Urbanska, Anna Wilk, Maja Grabacka, Ewa Wybieralska, Luis Del Valle, Zbigniew Madeja, Krzysztof Reiss

School of Medicine Faculty Publications

BACKGROUND: Glioblastomas are characterized by rapid cell growth, aggressive CNS infiltration, and are resistant to all known anticancer regimens. Recent studies indicate that fibrates and statins possess anticancer potential. Fenofibrate is a potent agonist of peroxisome proliferator activated receptor alpha (PPARalpha) that can switch energy metabolism from glycolysis to fatty acid beta-oxidation, and has low systemic toxicity. Fenofibrate also attenuates IGF-I-mediated cellular responses, which could be relevant in the process of glioblastoma cell dispersal. METHODS: The effects of fenofibrate on Glioma cell motility, IGF-I receptor (IGF-IR) signaling, PPARalpha activity, reactive oxygen species (ROS) metabolism, mitochondrial potential, and ATP production were …

Is Phonophobia Associated With Cutaneous Allodynia In Migraine?, Avi Ashkenazi, Irene Yang, Aamir Mushtaq, Michael L. Oshinsky

Department of Neurology Faculty Papers

ABSTRACT

Objective

To determine whether phonophobia and dynamic mechanical (brush) allodynia are associated in episodic migraine (EM).

Methods

Adult patients with EM were prospectively recruited. A structured questionnaire was used to obtain demographic and migraine related data. Phonophobia was tested quantitatively using a real time sound processor and psychoacoustic software. Sound stimuli were pure tones at frequencies of 1000 Hz, 4000 Hz and 8000 Hz, delivered to both ears at increasing intensities, until an aversive level was reached. Allodynia was assessed by brushing the patient’s skin with a gauze pad at different areas. Patients were tested both between and during …

High-Throughput Experimental Studies To Identify Mirna Targets Directly, With Special Focus On The Mammalian Brain, Peter T. Nelson, Marianthi Kiriakidou, Zissimos Mourelatos, Grace S. Tan, Mary H. Jennings, Kevin Xie, Wang-Xia Wang

Pathology and Laboratory Medicine Faculty Publications

We review the pertinent literature on methods used in high-throughput experimental identification of microRNA (miRNA) "targets" with emphasis on neurochemical studies. miRNAs are short regulatory noncoding RNAs that play important roles in the mammalian brain. The functions of miRNAs are related to their binding of RNAs including mRNAs. Since mammalian miRNAs tend to bind to target mRNAs via imperfect complementarity, understanding exactly which target mRNAs are recognized by which specific miRNAs is a challenge. Based on early experimental evidence, a set of "binding rules" for miRNAs has been described. These have focused on the 5' "seed" region of miRNAs binding …

Desvenlafaxine In Major Depressive Disorder: An Evidence-Based Review Of Its Place In Therapy., Daniel Z Lieberman, Suena H Massey

Psychiatry and Behavioral Sciences Faculty Publications

INTRODUCTION: Desvenlafaxine, the active metabolite of venlafaxine, is a serotonin norepinephrine reuptake inhibitor (SNRI) recently approved for the treatment of major depressive disorder. It is one of only three medications in this class available in the United States.

AIMS: The objective of this article is to review the published evidence for the safety and efficacy of desvenlafaxine, and to compare it to other antidepressants to delineate its role in the treatment of depression.

EVIDENCE REVIEW: At the recommended dose of 50 mg per day the rate of response and remission was similar to other SNRIs, as was the adverse effect …

A Probit- Log- Skew-Normal Mixture Model For Repeated Measures Data With Excess Zeros, With Application To A Cohort Study Of Paediatric Respiratory Symptoms, Sadia Mahmud, W. Y. Wendy Lou, Neil W. Johnston

Community Health Sciences

Background: A zero-inflated continuous outcome is characterized by occurrence of "excess" zeros that more than a single distribution can explain, with the positive observations forming a skewed distribution. Mixture models are employed for regression analysis of zero-inflated data. Moreover, for repeated measures zero-inflated data the clustering structure should also be modeled for an adequate analysis. Methods: Diary of Asthma and Viral Infections Study (DAVIS) was a one year (2004) cohort study conducted at McMaster University to monitor viral infection and respiratory symptoms in children aged 5-11 years with and without asthma. Respiratory symptoms were recorded daily using either an Internet …

Role Of Pknb Kinase In Antibiotic Resistance And Virulence In Community-Acquired Methicillin-Resistant Staphylococcus Aureus Strain Usa300, S. Tamber, J. Schwartzman, A. L. Cheung

Dartmouth Scholarship

The regulation of cellular processes by eukaryote-like serine/threonine kinases is widespread in bacteria. In the last 2 years, several studies have examined the role of serine/threonine kinases in Staphylococcus aureus on cell wall metabolism, autolysis, and virulence, mostly in S. aureus laboratory isolates in the 8325-4 lineage. In this study, we showed that the pknB gene (also called stk1) of methicillin-resistant S. aureus (MRSA) strain COL and the community-acquired MRSA (CA-MRSA) strain USA300 is involved in cell wall metabolism, with the pknB mutant exhibiting enhanced sensitivity to β-lactam antibiotics but not to other classes of antibiotics, including aminoglycosides, ciprofloxacin, …

Knowledge And Awareness About Cervical Cancer And Its Prevention Amongst Interns And Nursing Staff In Tertiary Care Hospitals In Karachi, Pakistan., Syed Faizan Ali, Samia Ayub, Nauman Fazal Manzoor, Sidra Azim, Muneeza Afif, Nida Akhtar, Wassi Ali Jafery, Imran Tahir, Syed Farid-Ul-Hasnian, Najam Uddin

Community Health Sciences

Background and Objective: Cervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. It is imperative for at least health professionals in developing countries like Pakistan to have a sound knowledge about the disease. This study was carried out to assess the knowledge and awareness about cervical cancer and its prevention amongst health professionals in tertiary care hospitals in Karachi, Pakistan.
Methods and Design: A cross-sectional, interview based survey was conducted in June, 2009. Sample of 400 was divided between the three tertiary care centers. Convenience sampling was applied …

Pulmonary Hypertension Is A Frequent Event In Patients With Chronic Myeloid Leukemia Treated With Tyrosine Kinase Inhibitors, Sameh Gaballa, Aref Al-Kali, Hagop Kantarjian, Elias Jabbour, Alfonso Quintas-Cardama, Mohamad Ayoubi, Gautam Borthakur, S. M. O'Brien, J. E. Cortes

Division of Internal Medicine Faculty Papers & Presentations

Poster presented at American Society of Clinical Oncology in Chicago Illinois.

Background:  Tyrosine kinase inhibitors (TKI) are the current standard therapy for patients with chronic myeloid leukemia (CML). Fluid retention and pleural effusions have been reported in patients treated with TKIs, particularly with dasatinib. Although TKIs have been shown to reverse pulmonary hypertension (PH) in animal models, there have been some reports of development of reversible PH with dasatinib.

Methods:  We conducted a retrospective analysis on 401 patients diagnosed with CML in chronic phase (CP) who were treated with TKIs (imatinib, dasatinib, or nilotinib) as initial therapy for CML and …

Letter By Harris Et Al Regarding Article, "Outcomes Of Patients With Acute Type A Aortic Intramural Hematoma, Jamie M. Pelzel

Articles

We read with interest the report by Song et al1 outlining the management of ascending aortic intramural hematoma (IMH) at the Asan Medical Center in Seoul, South Korea. This series, the largest of this life-threatening condition, demonstrated that at that institution, 84% of patients (n=85) could be treated with initial medical therapy, resulting in a mortality rate of 7.1%. These results are impressive but are observational rather than a randomized comparison of medical and surgical therapy.

Mitochondria-Centric Activation Induced Cell Death Of Cytolytic T Lymphocytes And Its Implications For Cancer Immunotherapy, Arvind Chhabra

UCHC Articles - Research

Premature death of the adoptively transferred cytolytic T lymphocytes (CTL) by means of activation induced cell death (AICD) represents one of the major constraints in devising an effective anti-cancer immune intervention strategy. Understanding the mechanism of AICD is, therefore, critical for developing methods to interfere with this death process. Although the existing paradigm on AICD centers around the initiation of the cascade of events originating from the engagement of death receptors leading to the activation of effector caspases and eventually resulting in cell death, recent findings have questioned the universal role of caspases as the cell death executioners. We here …

Notch1 Functions As A Tumor Suppressor In A Model Of K-Ras–Induced Pancreatic Ductal Adenocarcinoma, Linda Hanlon, Jacqueline L Avila, Renée M Demarest, Scott Troutman, Megan Allen, Francesca Ratti, Anil K Rustgi, Ben Z Stanger, Fred Radtke, Volkan Adsay, Fenella Long, Anthony J Capobianco, Joseph L Kissil

Rowan-Virtua School of Osteopathic Medicine Departmental Research

K-ras is the most commonly mutated oncogene in pancreatic cancer and its activation in murine models is sufficient to recapitulate the spectrum of lesions seen in human pancreatic ductal adenocarcinoma (PDAC). Recent studies suggest that Notch receptor signaling becomes reactivated in a subset of PDACs, leading to the hypothesis that Notch1 functions as an oncogene in this setting. To determine whether Notch1 is required for K-ras-induced tumorigenesis, we used a mouse model in which an oncogenic allele of K-ras is activated and Notch1 is deleted simultaneously in the pancreas. Unexpectedly, the loss of Notch1 in this model resulted in increased …

Management Of Devastating Ocular Trauma--Experience Of Maxillofacial Surgeons Deployed To A Forward Field Hospital, M. J. Ansell, J. Breeze, Vivian C. Mcalister, M. D. Williams

Surgery Publications

Combat-related eye injuries continue to increase in frequency and are generally secondary to Improvised Explosive Devices. Many ocular injuries are potentially preventable by the wearing of ballistic eye protection. The management of penetrating eye trauma is normally outside the routine practice of maxillofacial surgeons in the UK. The aim of this paper is to describe the surgical techniques used in the modern management of devastating ocular trauma including selected case examples managed by British military maxillofacial surgeons deployed to Afghanistan.

Optimizing Radiology Peer Review: A Mathematical Model For Selecting Future Cases Based On Prior Errors, Yun Robert Sheu, Elie Feder, Igor Balsim, Victor F. Levin, Andrew G. Bleicher, Barton F. Branstetter Iv

Publications and Research

Introduction: Peer review is an essential process for physicians because it facilitates improved quality of patient care and continuing physician learning and improvement. However, peer review often is not well received by radiologists, who note that it is time intensive, subjective, and lacks demonstrable impact on patient care. Current advances in peer review include the RADPEER system with its standardization of discrepancies and incorporation of the peer review process into the PACS itself. Our purpose was to build on RADPEER and similar systems by using a mathematical model to optimally select the types of cases to be reviewed, for each …

Use Of Miltefosine In The Treatment Of Visceral Leishmaniasis In Children At A Tertiary Care Hospital Of Karachi, Khadija Nuzhat Humayun, Taimur Saleem, Umair Khalid, Fyezah Jehan, Sajid Soofi

Department of Paediatrics and Child Health

Existing standard treatment options for visceral leishmaniasis are less than optimal. We report here the use of oral miltefosine in the treatment of two paediatric cases of visceral leishmaniasis at a tertiary care hospital in Karachi, Pakistan. One patient came from Balochistan while the second patient was from Northern Pakistan. Both presented with a prolonged history of fever, massive hepatosplenomegaly, anaemia and thrombocytopenia. Visceral leishmaniasis was diagnosed with bone marrow studies. Amphotericin B was first started in the first patient; however severe hypokalaemia and allergic reaction occurred. Oral miltefosine was then administered. The child showed clinical improvement with regards to …

Post Traumatic Avulsion Of Lumbar Artery: A Rare Cause Of Retroperitoneal Haemorrhage Treated By Glue Embolization, Rana Shoaib Hamid, Haq Tanveer Ul Ul, Ishtiaq Chishti, Muhammad Azeemuddin

Department of Radiology

Lumbar arterial injury after trauma is a rare cause of significant retroperitoneal haemorrhage. Early diagnosis followed by endovascular transcatheter embolization is a very effective treatment to control bleeding in patients who do not respond to conservative management. We present a case of post traumatic avulsion of left fourth lumbar artery which was successfully treated with percutaneous transcatheter arterial embolization with glue.

Labrad : Vol 35, Issue 2 - June 2010, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• The Atypical Lymphocytes
• High Performance Liquid Chromatography (HPLC): An Effective Tool for the Diagnosis of Various Hemoglobinopathies
• Platelet Transfusions: What We Need to Know
• Measuring Homocysteine Levels
• Parathyroid Hormone: A Marker of Vitamin D Deficiency and Insufficiency
• Surrogate Measures of Insulin Sensitivity
• Foetal Autopsy
• Laboratory Diagnosis of Vaginitis due to Trichomonas Vaginalis
• AKU Clinical Laboratory Continuing Medical Education Seminars

Anaesthetic Management Of An Infant With Epidermolysis Bullosa Undergoing Inguinal Hernia Repair, Khalid Maudood Siddiqui, Sobia Khan

Department of Anaesthesia

Epidermolysis bullosa is a group of inherited disorders characterized by blistering of the skin as a result of minor trauma. We managed an infant with epidermolysis bullosa undergoing inguinal hernia repair. Anaesthesia was induced with oxygen/nitrous oxide mixture and sevoflurane. Oral tracheal intubation was done with a lubricated laryngoscope blade with KY jelly using atracurium 0.5 mg/kg and fentanyl 0.1 microgm/kg. To avoid frictions on the skin, endotracheal tube was tied with ribbon gauze and fixed around the neck. Pulse-oximetry probe and electrocardiogram electrodes were placed, and then attached to the patient's skin covered with KY jelly. Peripheral venous access …

Oncolog Volume 55, Number 06, June 2010, John Lebas

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• The BATTLE Results Are IN: Phase II trial reveals molecular signatures in lung cancer that may guide treatment decisions.
• Endoscopic Repair of Colon Perforations: Nonsurgical techniques for closing gestrointestinal defects may yiels benefits for patients undergoing colonoscopy.
• INBRIEF: Stem Cells Seen Repairing Heart Attack Damage Over Time/Additional Blood Data May Improve Pediatric Leukemia Predictions/Pediatric Patients with Rare Tumor May benefit from Heated Chemotherapy/New Findings Refute Link Between UVA, Melanoma.
• HOUSE CALL: Skin Cancer Screening: What is It and Who Should Get It ?: Types of skin cancer/Who should be screened ?/What to expect/Self-examination: Check your skin regularly and tell your …

Implementing A Maternal Newborn Service Excellence Program: Lessons Learned (Poster), Judith Pfeiffer Bsn, Rnc

Patient Care Services / Nursing

No abstract provided.

Comparison Of Multi-Detector Ct Venography And Venous Sonography For Detecting Lower Limb Deep Venous Thrombosis In Patients With Suspected Pulmonary Embolism, Ruth Wanjohi

Master of Medicine in Imaging and Diagnostic Radiology

Objective: This was a prospective analytic study that aimed to compare the agreement between CT pulmonary angiography (CTPA/CTV) and ultrasonography (US) for diagnosis of thromboembolic disease and determine the sensitivity, specificity, positive and negative predictive values of the 2 tests using the presence of thromboembolic disease as a reference standard. Methods: 76 consecutive patients who were referred for CTPA at the Radiology department of Aga Khan University Hospital over an 8 month period between December 2008 and July 2009 were included in the study. All the patients underwent combined CTPA/CTV according to the usual departmental protocol. They subsequently had bilateral …

Association Between Obesity, Depression, And Inflammation Among Seventh-Day Adventists In The Biopsychosocial Religion And Health Study, Michael Paalani

Loma Linda University Electronic Theses, Dissertations & Projects

The effects of obesity and depression on morbidity and mortality may be mediated by inflammatory processes. Homeostasis within the immune system depends on a balance of pro-inflammatory and anti-inflammatory cytokine molecules, so chronic inflammatory diseases may result from cytokine dysregulation. The target population consisted of 508 Seventh Day Adventists (SDAs) who participated in the Biopsychosocial Religion and Health Study (BHRS), a sub-study of the Adventist Health Study-2. The study was a cross-sectional analysis of the association between obesity, depression, and inflammation after controlling for demographic, socioeconomic, health behavioral, and health status variables among BHRS participants.

Obesity was assessed by body …

Emergency Department Staff Adherence To Bad News Delivery Recommendations, Kristen R. Myers

Loma Linda University Electronic Theses, Dissertations & Projects

Emergency department (ED) staff is responsible for giving bad news regarding death, diagnoses, and other traumatic losses to patients and loved ones. Individuals receiving traumatic and sudden bad news are at increased risk of serious psychological and physiological consequences of disrupted grief. Despite published recommended practices for providers to help prevent maladaptive grief responses, little research is available on actual bad news delivery practices and factors promoting or hindering adherence to recommendations, and no study specifically explored the ED context.

The study used a qualitative design to explore bad news delivery practices, awareness of recommendations, factors perceived to hinder or …

Ricin B Chain-Insulin Fusion Protein Immunomodulation Of Type 1 Diabetes, James Edward Carter Iii

Loma Linda University Electronic Theses, Dissertations & Projects

Type 1 diabetes mellitus (T1D) is a debilitating chronic inflammatory disease of the insulin-producing pancreatic islet β-cells that results from a combination of genetic and environmental factors. Attempts to suppress Th1-mediated autoimmune diseases such as T1D by mucosal delivery of autoantigens for immunotolerization have yielded only partial success. Attainment of satisfactory levels of sustained immunological tolerance remains to be accomplished. To restore self-tolerance requires delivery of sufficient amounts of autoantigen to stimulate regulatory T helper cells that function to survey the gut and induce tolerance to consumed antigens such as food. Oral delivery of autoantigens has previously been shown to …