Medical Specialties Commons^™

Surgical Management Of Pediatric Gastroesophageal Reflux Disease, Hope T. Jackson, Timothy D. Kane

Surgery Faculty Publications

No abstract provided.

Few U.S. Public Health Schools Offer Courses On Palliative And End-Of-Life Care Policy, Dale Lupu, Caroline Deneszczuk, Tara Leystra, Rebecca Mckinnon, Victoria Seng

Physical Therapy and Health Care Sciences Faculty Publications

Background: Palliative care has been identified by the World Health Organization (WHO) as a critical policy element for the relief of suffering, yet palliative care policy receives minimal attention in mainstream U.S. public health journals, conferences, or textbooks. In the ’90s, documentation of the lack of attention to end-of-life and palliative care in medical and nursing curricula led to concerted efforts to improve medical and nursing education in palliative care. No such educational effort has yet been directed toward public health professionals.

Objective: This study's objective was to quantify current course offerings covering palliative and end-of-life care from a public …

False Passage To The Trachea After Emergency Intubation In A Victim Of Near Hanging, Ali Pourmand, Hamid A. Shokoohi

Emergency Medicine Faculty Publications

Emergency medicine physicians should have enough knowledge and experience to deal with emergent and traumatic difficult airway. In this paper, we present a case of near hanging with neck soft tissue injury, tracheal and esophageal rupture that is complicated by a displaced intubation and false passage to the trachea.

Tension Pneumothorax, Pneumoperitoneum, And Cervical Emphysema Following A Diagnostic Colonoscopy, Ali Pourmand, Hamid A. Shokoohi

Emergency Medicine Faculty Publications

Colonoscopy is currently a widespread procedure used in screening for colorectal cancer. Iatrogenic colonic perforation during colonoscopy is a serious and potentially life-threatening complication that can cause significant morbidity and mortality. “Triple pneumo” (a combination of pneumothorax, pneumomediastinum, and pneumoperitoneum) following colonoscopy is a rare but a serious condition requiring immediate diagnosis and emergent intervention. In majority of these cases a colonic perforation is the initial injury that is followed by pneumothorax and pneumomediastinum through the potential anatomical connection with retroperitoneal and mediastinal spaces. In this rare case report we are presenting a case of “triple pneumo” with no evidence …

Impacts Of Social Networking Sites On Patient Care In The Emergency Department, Anne Bennett, Ali Pourmand, Robert Shesser, Jesus Sanchez, Joseph Joyce

Emergency Medicine Faculty Publications

The use of Facebook is ubiquitous among both patients and physicians. Often Facebook intrudes into medical practice, thereby highlighting its potential to be either a positive or negative factor in a patient's medical care. Despite being a “hot topic” in the medical literature, very few real world examples exist of physicians actually using information obtained from Facebook to reach a diagnosis or otherwise affect patient care. We present a case involving a 13-year-old girl who posted photographs and captions on Facebook demonstrating suicidal ideation. The patient's parents were alerted to the girl's statements in her Facebook profile and brought her …

A Syndromic Approach To Emergency Department Surveillance For Skin And Soft Tissue Infections, Larissa S. May, Marcus Rennick, Leah Gustafson, Julia Gunn

Emergency Medicine Faculty Publications

Objective

We sought to describe the epidemiology of emergency department (ED) visits for skin and soft tissue infections (SSTI) in an urban area with diverse neighborhood populations using syndromic surveillance system data for the time period from 2007–2011. Our aims were threefold: to demonstrate a proof of concept using syndromic surveillance for SSTI surveillance in the absence of laboratory data, to estimate the burden of ED visits associated with SSTI, and to determine potential geographic “hotspots” for these infections.

Introduction

The incidence of and hospitalizations for SSTI have steadily increased over the last decade in the United States, primarily due …

Dysembryoplastic Neuroepithelial Tumor With Atypical Presentation: Mri And Diffusion Tensorcharacteristics, Kalyan Paudel, Samuel Borofsky, Robert V. Jones, Lucien M. Levy

Radiology Faculty Publications

We report the neuroimaging findings of a 26-year-old female patient with a biopsy-proven dysembryoplastic neuroepithelial tumor (DNET). DNETs are an uncommon, usually benign, glial-neural cortical neoplasm of children and young adults who typically present with intractable seizures. DNETs may occur in any region of the supratentorial cortex, but have a predilection for the temporal lobes. Accurate neuroimaging diagnosis is essential since patients with DNET benefit from complete resection. However, accurate differentiation from other cortical lesions may be challenging. Typical conventional Magnetic Resonance Imaging (MRI) features can help in the differentiation from other similar cortical tumors. Diffusion tensor imaging can also …

Unclamped Hand-Assisted Laparoscopic Partial Nephrectomy For Predominantly Endophytic Renal Tumors, Jason D. Engel, Stephen B. Williams

Urology Faculty Publications

PURPOSE: To describe our initial experience with unclamped laparoscopic hand-assisted partial nephrectomy for predominantly endophytic renal masses in the setting of relative contraindication to warm ischemia.

MATERIALS AND METHODS: Unclamped laparoscopic hand-assisted partial nephrectomy was performed on eight consecutive patients from June 2009 to March 2010. All patients had predominantly endophytic renal masses with a preferential enhancing rim noted on the pre-operative computed tomography. The unclamped hand-assisted approach was utilized for no warm ischemia, minimal blood loss, and enhanced visualization of the tumor bed with improved operative exposure.

RESULTS: Mean age of the participants was 55.8 years. All patients underwent …

Wound Care Challenges In Children And Adults With Spina Bifida: An Open-Cohort Study, Katherine Ottolini, Amy B. Harris, June K. Amling, Ann M. Kennelly, Leslie A. Phillips, Laura L. Tosi

Pediatrics Faculty Publications

Skin breakdown is a frequent concern for individuals with spina bifida. We explored wound incidence in patients with spina bifida and how it varies across a person's life span and functional neurologic level. We examined the settings in which skin breakdown most commonly occurred, looking for evidence of chronic, non-healing wounds. We also sought to develop criteria to improve wound monitoring. We identified reported wound episodes in an open-cohort study over a 13-year period, examining the hospital and outpatient clinical records of spina bifida patients at Children's National Medical Center (CNMC). Current age, age at wound presentation, sex, weight, functional …

The Association Of Cd81 Polymorphisms With Alloimmunization In Sickle Cell Disease, Zohreh Tatari-Calderone, Ryad Tamouza, Gama P. Lebouder, Ramita Dewan, Naomi L. Luban, Jacqueline Lasserre, Jacqueline Maury, Francois Lionnet, Rajagopal Krishnamoorthy, Robert Girot, Stanislav Vukmanovic

Pediatrics Faculty Publications

The goal of the present work was to identify the candidate genetic markers predictive of alloimmunization in sickle cell disease (SCD). Red blood cell (RBC) transfusion is indicated for acute treatment, prevention, and abrogation of some complications of SCD. A well-known consequence of multiple RBC transfusions is alloimmunization. Given that a subset of SCD patients develop multiple RBC allo-/autoantibodies, while others do not in a similar multiple transfusional setting, we investigated a possible genetic basis for alloimmunization. Biomarker(s) which predicts (predict) susceptibility to alloimmunization could identify patients at risk before the onset of a transfusion program and thus may have …

Activation Of Human Herpesvirus Replication By Apoptosis, Alka Prasad, Jil Remick, Steven L. Zeichner

Pediatrics Faculty Publications

A central feature of herpesvirus biology is the ability of herpesviruses to remain latent within host cells. Classically, exposure to inducing agents, like activating cytokines or phorbol esters that stimulate host cell signal transduction events, and epigenetic agents (e.g., butyrate) was thought to end latency. We recently showed that Kaposi's sarcoma-associated herpesvirus (KSHV, or human herpesvirus-8 [HHV-8]) has another, alternative emergency escape replication pathway that is triggered when KSHV's host cell undergoes apoptosis, characterized by the lack of a requirement for the replication and transcription activator (RTA) protein, accelerated late gene kinetics, and production of virus with decreased infectivity. Caspase-3 …

Oximetry Signal Processing Identifies Rem Sleep-Related Vulnerability Trait In Asthmatic Children, Geovanny F. Perez, Maria J. Gutierrez, Shehlanoor Huseni, Krishna Pancham, Carlos E. Rodriguez-Martinez, Cesar L. Nino, Gustavo Nino

Pediatrics Faculty Publications

Rationale. The sleep-related factors that modulate the nocturnal worsening of asthma in children are poorly understood. This study addressed the hypothesis that asthmatic children have a REM sleep-related vulnerability trait that is independent of OSA.

Methods. We conducted a retrospective cross-sectional analysis of pulse-oximetry signals obtained during REM and NREM sleep in control and asthmatic children (n=134). Asthma classification was based on preestablished clinical criteria. Multivariate linear regression model was built to control for potential confounders (significance level p ≤ 0.05).

Results. Our data demonstrated that (1) baseline nocturnal respiratory parameters were not significantly different in asthmatic versus control children, …

Low Plasma Citrulline Levels Are Associated With Acute Respiratory Distress Syndrome In Patients With Severe Sepsis, Lorraine B. Ware, Jordan A. Magarik, Nancy Wickersham, Gary Cunningham, Todd W. Rice, Brian W. Christman, Arthur P. Wheeler, Gordon R. Bernard, Marshall Summar

Pediatrics Faculty Publications

Introduction: The role of nitric oxide synthase (NOS) in the pathophysiology of acute respiratory distress syndrome (ARDS) is not well understood. Inducible NOS is upregulated during physiologic stress; however, if NOS substrate is insufficient then NOS can uncouple and switch from NO generation to production of damaging peroxynitrites. We hypothesized that NOS substrate levels are low in patients with severe sepsis and that low levels of the NOS substrate citrulline would be associated with end organ damage including ARDS in severe sepsis.

Methods: Plasma citrulline, arginine and ornithine levels and nitrate/nitrite were measured at baseline in 135 patients with severe …

Can Coronary Artery Involvement In Kawasaki Disease Be Predicted?, Sunil J. Ghelani, Neha Kwatra, Christopher F. Spurney

Pediatrics Faculty Publications

Background: Coronary artery involvement is seen in approximately 15–20% of children with Kawasaki disease. There is conflicting literature regarding the clinical and laboratory findings associated with coronary artery involvement. In this retrospective study, we attempt identification of predictive factors for coronary artery involvement at our institute and review the existing literature.

Methods and results: A review of 203 patients (65% males) with Kawasaki disease was performed, of whom 33 (16.3%) had coronary artery involvement. High erythrocyte sedimentation rate, high platelet count, low hematocrit, low albumin levels, and refractory Kawasaki disease showed significant association with coronary artery involvement. High …

Clinical Characteristics And Visual Outcomes In Infectious Scleritis: A Review, Emeline Radhika Ramenaden, Veena Rao Raiji

Ophthalmology Faculty Publications

Infection is a very important but rare cause of scleritis, occurring in about 5%–10% of all patients presenting with scleral inflammation. However, due to the similarity of its presentation, infectious scleritis is often initially managed as autoimmune, potentially further worsening its outcome. The overall visual outcome in infectious scleritis is generally worse than its autoimmune counterparts, perhaps because of the delay in diagnosis or because of the aggressive nature of associated microbes. Thus, there is a definite need for insight into the diagnostic approach and treatment options for this ocular disease process. Several studies and case reports have been published …

Enhancing Communication Between Scientists, Government Officials, And The Lay Public: Advancing Science And Protecting The Public's Welfare Through Better Multi-Stakeholder Interfacing, Clark J. Lee, Patrick P. Rose, Earl Stoddard Iii

Homeland Security Publications

No abstract provided.

Prostate Cancer: Can Multiparametric Mr Imaging Help Identify Patients Who Are Candidates For Active Surveillance?, B. Turkbey, H. Mani, O. Aras, J. Ho, A. Hoang, A. R. Rastinehad, H. Agarwal, V. Shah, M. Bernardo, P. L. Choyke, +8 Additional Authors

Journal Articles

PURPOSE: To determine whether multiparametric magnetic resonance (MR) imaging can help identify patients with prostate cancer who would most appropriately be candidates for active surveillance (AS) according to current guidelines and to compare the results with those of conventional clinical assessment scoring systems, including the D'Amico, Epstein, and Cancer of the Prostate Risk Assessment (CAPRA) systems, on the basis of findings at prostatectomy. MATERIALS AND METHODS: This institutional review board-approved HIPAA-compliant retrospectively designed study included 133 patients (mean age, 59.3 years) with a mean prostate-specific antigen level of 6.73 ng/mL (median, 4.39 ng/mL) who underwent multiparametric MR imaging at 3.0 …

Use Of Desipramine For The Treatment Of Overactive Bladder Refractory To Antimuscarinic Therapy, J. H. Hillelsohn, S. Rais-Bahrami, N. Bagadiya, M. Kashan, G. H. Weiss

Journal Articles

Purpose: To evaluate the use of desipramine in the treatment of overactive bladder (OAB). Materials and Methods: We retrospectively evaluated 43 patients who were treated with desipramine for OAB refractory to antimuscarinic therapy. These OAB patients were stratified by the presence or absence of bladder pain. Results: Forty-three patients were evaluated with a mean follow up time of 12.2 +/- 4.6 months. The mean age of the patients was 71 16 years. Twelve patients (28%) discontinued desipramine, 9 due to perceived lack of efficacy, 2 due to central anticholinergic side effects, and 1 due to the development of oropharyngeal sores. …

Comparison Of Endorectal Coil And Nonendorectal Coil T2w And Diffusion-Weighted Mri At 3 Tesla For Localizing Prostate Cancer: Correlation With Whole-Mount Histopathology, B. Turkbey, M. J. Merino, E. C. Gallardo, V. Shah, O. Aras, A. R. Rastinehad, W. M. Linehan, B. J. Wood, P. A. Pinto, P. L. Choyke, +3 Additional Authors

Journal Articles

PURPOSE: To compare utility of T2-weighted (T2W) MRI and diffusion-weighted MRI (DWI-MRI) obtained with and without an endorectal coil at 3 Tesla (T) for localizing prostate cancer. MATERIALS AND METHODS: This Institutional Review Board-approved study included 20 patients (median prostate-specific antigen, 8.4 ng/mL). Patients underwent consecutive prostate MRIs at 3T, first with a surface coil alone, then with combination of surface, endorectal coils (dual coil) followed by robotic assisted radical prostatectomy. Lesions were mapped at time of acquisition on dual-coil T2W, DWI-MRI. To avoid bias, 6 months later nonendorectal coil T2W, DWI-MRI were mapped. Both MRI evaluations were performed by …

A Quantitative Link Between Face Discrimination Deficits And Neuronal Selectivity For Faces In Autism, Xiong Jiang, Angela Bollich, Patrick Cox, Eric Hyder, Joette James, Saqib Ali Gowani, Nouchine Hadjikhani, Volker Blanz, Dara S. Manoach, Jason J.S. Barton, William D. Gaillard, Maximilian Reisenhuber

Psychiatry and Behavioral Sciences Faculty Publications

Individuals with Autism Spectrum Disorder (ASD) appear to show a general face discrimination deficit across a range of tasks including social–emotional judgments as well as identification and discrimination. However, functional magnetic resonance imaging (fMRI) studies probing the neural bases of these behavioral differences have produced conflicting results: while some studies have reported reduced or no activity to faces in ASD in the Fusiform Face Area (FFA), a key region in human face processing, others have suggested more typical activation levels, possibly reflecting limitations of conventional fMRI techniques to characterize neuron-level processing. Here, we test the hypotheses that face discrimination abilities …

Signaling Mechanisms Of Vav3, A Guanine Nucleotide Exchange Factor And Androgen Receptor Coactivator, In Physiology And Prostate Cancer Progression, Leah S. Lyons, Kerry L. Burnstein

Faculty Books and Book Chapters

The Rho GTPase guanine nucleotide exchange factor (GEF) Vav3 is the third member of the Vavfamily of GEFS and is activated by tyrosine phosphorylation. Through stimulation of Rho GTPaseactivity, Vav3 promotes cell migration, invasion, and other cellular processes. Work from our laboratory first established that Vav3 is upregulated in models of castration-resistant prostate cancer progression and enhances androgen receptor as well as androgen receptor splice variant activity. Recent analysis of clinical specimens supports Vav3 as a potential biomarker of aggressive prostate cancer. Consistent with a role in promoting castration-­resistant disease, Vav3 is a versatile enhancer of androgen receptor …

Physical Mistreatment In Persons With Alzheimer’S Disease, Gregory Paveza, Carla Vandeweerd, Margaret Walsh, Jaime Corvin

Library Scholarship

Physical mistreatment has been estimated to affect 2 million older persons each year and dramatically affects health outcomes. While researchers have attempted to examine risk factors for specific forms of abuse, many have been able to focus on only victim or perpetrator characteristics, or a limited number of psychosocial variables at any one time. Additionally, data on risk factors for subgroups such as persons with Alzheimer’s disease who may have heightened and/or unique risk profiles has also been limited. This paper examines risk for physical violence in caregiver/patient dyads who participated in the Aggression and Violence in Community-Based Alzheimer’s Families …

Metabolic Causes Of Epileptic Encephalopathy, Joe Yuezhou Yu, Phillip L. Pearl

Neurology Faculty Publications

Epileptic encephalopathy can be induced by inborn metabolic defects that may be rare individually but in aggregate represent a substantial clinical portion of child neurology. These may present with various epilepsy phenotypes including refractory neonatal seizures, early myoclonic encephalopathy, early infantile epileptic encephalopathy, infantile spasms, and generalized epilepsies which in particular include myoclonic seizures. There are varying degrees of treatability, but the outcome if untreated can often be catastrophic. The importance of early recognition cannot be overemphasized. This paper provides an overview of inborn metabolic errors associated with persistent brain disturbances due to highly active clinical or electrographic ictal activity. …

Imaging Findings Associated With Cognitive Performance In Primary Lateral Sclerosis And Amyotrophic Lateral Sclerosis, Avner Meoded, Justin Y. Kwan, Tracy L. Peters, Edward D. Huey, Laura E. Danielian, Edythe Wiggs, Arthur Morrissette, Tianxia Wu, James W. Russell, Elham Bayat, Jordan Grafman, Mary Kay Floeter

Neurology Faculty Publications

Introduction: Executive dysfunction occurs in many patients with amyotrophic lateral sclerosis (ALS), but it has not been well studied in primary lateral sclerosis (PLS). The aims of this study were to (1) compare cognitive function in PLS to that in ALS patients, (2) explore the relationship between performance on specific cognitive tests and diffusion tensor imaging (DTI) metrics of white matter tracts and gray matter volumes, and (3) compare DTI metrics in patients with and without cognitive and behavioral changes.

Methods: The Delis-Kaplan Executive Function System (D-KEFS), the Mattis Dementia Rating Scale (DRS-2), and other behavior and mood scales were …

Efficacy Of Robot-Assisted Radical Cystectomy In Advanced Bladder Cancer: Results From The International Radical Cystectomy Consortium (Ircc), A. Al-Daghmin, E. C. Kauffman, Y. Shi, K. Badani, M. D. Balbay, E. Canda, P. Dasgupta, R. Ghavamian, L. Richstone, K. A. Guru, +24 Additional Authors

Journal Articles

OBJECTIVES: To characterize the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathologic T4 bladder cancer. SUBJECTS/PATIENTS: Retrospective evaluation of a prospectively maintained IRCC database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomized patients based on pathologic stage (10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for …

Urinary Tract Infections And Post-Operative Fever In Percutaneous Nephrolithotomy, J. Gutierrez, A. Smith, P. Geavlete, H. Shah, A. R. Kural, M. De Sio, J. H. A. Sesmero, A. Hoznek, J. De La Rosette

Journal Articles

To review the incidence of UTIs, post-operative fever, and risk factors for post-operative fever in PCNL patients. Between 2007 and 2009, consecutive PCNL patients were enrolled from 96 centers participating in the PCNL Global Study. Only data from patients with pre-operative urine samples and who received antibiotic prophylaxis were included. Pre-operative bladder urine culture and post-operative fever (> 38.5A degrees C) were assessed. Relationship between various patient and operative factors and occurrence of post-operative fever was assessed using logistic regression analyses. Eight hundred and sixty-five (16.2%) patients had a positive urine culture; Escherichia coli was the most common micro-organism found …

Stereotactic Body Radiotherapy For Localized Prostate Cancer: Disease Control And Quality Of Life At 6 Years, A. J. Katz, M. Santoro, F. Diblasio, R. Ashley

Journal Articles

Background: Stereotactic body radiotherapy (SBRT) may yield disease control for prostate cancer in a brief, hypofractionated treatment regimen without increasing treatment toxicity. Our report presents a 6-year update from 304 low- (n = 211), intermediate- (n = 81), and high-risk (n = 12) prostate cancer patients who received CyberKnife SBRT. Methods: The median PSA at presentation was 5.8 ng/ml. Fifty-seven patients received neoadjuvant hormonal therapy for up to one year. The first 50 patients received a total dose of 35 Gy in 5 fractions of 7 Gy. The subsequent 254 patients received a total dose of 36.25 Gy in 5 …

Mapping The Literature Of Allied Health: Healthcare Chaplaincy, Emily Johnson, Diane Dodd Mccue, Alexander Tartaglia, Jennifer A. Mcdaniel

VCU Libraries Faculty and Staff Publications

OBJECTIVE: This study examined citation patterns and indexing coverage from 2008 to 2010 to determine (1) the core literature of health care chaplaincy and (2) the resources providing optimum coverage for the literature.

METHODS: Citations from three source journals (2008-2010 inclusive) were collected and analyzed according to the protocol created for the Mapping the Literature of Allied Health Professions Project. An analysis of indexing coverage by five databases was conducted. A secondary analysis of self-citations by source journals was also conducted.

RESULTS: The 3 source journals--Chaplaincy Today, the Journal of Health Care Chaplaincy, and the Journal of Pastoral Care and …

Impact Of Varied Low Resolution Phantoms On Intensity Modulated Proton Therapy Dose Distributions, Aarohi Shyam Padhye

Theses Digitization Project

The primary purpose of this thesis is to discuss the usefulness of image segmentation techniques in creating accurate proton dose distribution plans. The calculation of the proton dose distribution has to take into account the material (tissue, bone, brain) in the treatment area of the patients body.

Stereotactic Localization And Targeting Accuracy For Experimental Proton Radiosurgery, Yin Chen

Theses Digitization Project

The purpose of this study was to improve an existing experimental proton radiosurgery system at Loma Linda University Medical Center to reach sub-millimeter accuracy before proton radiosurgery with narrow beams can be used in a clinical trial. Protons, different from photons (i.e., x-rays or gamma rays), are charged with particles that slow down in matter and release a burst of energy near the end of their range (maximum depth of penetration), which is called the Bragg peak, named after the physicist William Henry Bragg who discovered it in 1903. Photon beams deliver most doses over a large area near the …