Medical Pathology Commons^™

Myasthenia Gravis And Implications For The Certified Registered Nurse Anesthetist, Matthew Predick

Nursing Student Class Projects (Formerly MSN)

In healthcare and, specifically anesthesia, there are many conditions that require various considerations by the prudent provider. An example of a condition requiring special attention is myasthenia gravis. Myasthenia gravis is an autoimmune disease in which skeletal muscle weakness and rapid fatigue result from destruction of nicotinic acetylcholine receptors [7]. Although the prevalence is not overwhelmingly high with most recent estimates of prevalence around 14 to 20 per 100,000 people in the United States [5] and 20 per 100,000 worldwide [9], inappropriate perioperative management of those with this ailment can result in serious consequences. Understanding the pathophysiology, various treatments (both …

Idiopathic Pulmonary Fibrosis: Understanding Has Led To Exciting Treatments, William Metz

Nursing Student Class Projects (Formerly MSN)

Pulmonary fibrosis can be described as an excessive amounts of fibrous connective lung tissue in the lung. Idiopathic pulmonary fibrosis(IPF) is the most common form of interstitial lung disease(ILD). When an obvious cause cannot be determined, a diagnosis of Idiopathic pulmonary fibrosis is made. The mean survival for patients is approximately 3-5 years from time of diagnosis. IPF is found primarily in men over 50 years of age, with a history of cigarette smoking with concurrent environmental and occupational inhalation exposures(Leslie, 2011, p. 592). Pulmonary fibrosis has been identified by early pathologists at the beginning of the last century. During …

Cervical Spinal Cord Injury, Melissa Schimmel

Nursing Student Class Projects (Formerly MSN)

A spinal cord injury (SCI) can occur at any level of the spinal cord. A SCI involves an interruption between the brain and the body due to an injury or damage to the spinal cord (Sheppard Center, 2011, p1.). The location and extent of the injury is important because it will determine the severity and extent of dysfunction. The higher the injury is to the spinal cord, the more severe the loss of motor function (Sheppard Center, 2011, p.4). The spinal cord injuries are classified by based on the extent of injury, motor and sensory losses. The injury is considered …

Abdominal Aortic Aneurysm: A Silent Killer, Kristen Springer

Nursing Student Class Projects (Formerly MSN)

Rupture of an abdominal aortic aneurysm (AAA) is a significant cause of mortality in the United States. “Often asymptomatic, AAA is considered a silent killer because it frequently remains undiagnosed until the time of rupture or the patient’s death” (Gordon & Toursarkinssian, p. 242). As healthcare professionals, being aware of the pathophysiology, risk factors and symptoms influencing this disease is important in aiding early diagnosis and treatment, helping to reduce complications and mortality rates of those affected.

Pathophysiology And Treatment Of Life-Threatening Angioedema, Stephen J. Hoffman

Nursing Student Class Projects (Formerly MSN)

Angioedema is a potentially lethal swelling of the interstitial space from extravasation of intravascular plasma (Wood, Choromanski, & Orlewicz, 2013). Angioedema may present in any medical setting with a broad range of severity. Angioedema is commonly seen in emergency departments and intensive care units. According to Barbara, Ronan, Maddox, & Warner (2013), “angioedema is of particular importance to anesthesiologists, as it may present at any point in the perioperative period and it may rapidly become life-threatening if it involves airway compromise” (p. 335). Anesthesia professionals may also respond to airway management emergencies throughout the hospital setting and may treat angioedema …

Preparedness Of Nurses For Malignant Hyperthermia, Melissa Flemming

Nursing Student Class Projects (Formerly MSN)

Malignant hyperthermia (MH) is a potentially life threatening disorder that occurs following exposure to certain inhaled anesthetics such as halothane, isoflurane, sevoflurane, desflurane, enflurane, ether, and methoxyflurane alone or in combination with the depolarizing muscle relaxant, succinylcholine (Seifert,, Wahr, Pace, Cochrane, & Bagnola, 2014, p. 189). Patients experiencing malignant hyperthermia may progress to death if it is not recognized and treated early. Patient outcomes improve the earlier an intervention is given. Malignant hyperthermia is not a common condition and, therefore, nurses are frequently unfamiliar with the common signs, symptoms, and treatments. Malignant hyperthermia can occur in a variety of settings …

The Importance Of Evaluation And Management Of Sepsis, Severe Sepsis, And Septic Shock, Katherine Herda

Nursing Student Class Projects (Formerly MSN)

Sepsis is a life-threatening and complicated host response to the presence of infection that is affecting millions of individuals around the world each year (Dellinger et al., 2013, p. 583). According to Gray et al. (2013), sepsis is not only one of the primary causes of hospital admission but it is also a leading cause of morbidity and mortality worldwide (p. 397). Severe sepsis and septic shock are the more advanced and detrimental stages of sepsis, which are starting to increase in incidence and are killing one in four (and sometimes more) individuals infected (Dellinger et al., 2013, p. 583). …

Low Level Lead Exposure Impairs Attentional Set Shifting Task Performance Depending Upon Sex And Developmental Periods Of Exposure, L.S. Neuwirth, D.W. Anderson, J. S. Schneider

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Introduction

Exposure to low levels of lead (Pb) impairs a variety of cognitive processes. Although children exposed to Pb developmentally present with a variety of cognitive impairments that include deficits in learning, memory, language, and executive functioning, experimental work on Pb toxicity in rats has focused mostly on learning and memory deficits and less on executive functions. However, detrimental effects on executive functioning could lead to or even underlie a variety of other cognitive problems attributed to Pb exposure. In this study, we examined the ability of Long Evans rats (control and Pb-exposed: 150ppm Pb-acetate in food given perinatally (gestation …

Strategic Distribution Of The Mitochondrial Ca2+ Uniporter In Cardiac Mitochondria, Sergio De La Fuente, Caitlin Vail, Elorm J. Agra, Kira Holmstrom, Junhui Sun, Jyotsna Mishra, Toren Finkel, Elizabeth Murphy, Shey-Shing Sheu, György Csordás

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background:

1) Control of the mitochondrial ATP production by SR-derived Ca²⁺ signals includes local, nanodomain Ca²⁺ transfer from ryanodine receptors (RyR2) to the mitochondrial matrix (excitation-bioenergetics coupling).

2) Ca²⁺ crosses the inner mitochondrial membrane (IMM) via the mtCU, a low-affinity Ca²⁺-activated Ca²⁺ channel complex.

3) The surface area of cardiac IMM is extensively enhanced by cristae folding; however, mitoplast patch clamp studies showed mtCU current density the lowest amongst a range of tissues (Fieni 2012. Nat Commun).

Desmin Common Mutation Is Associated With Multi-Systemic Disease Manifestations And Depletion Of Mitochondria And Mitochondrial Dna., Elizabeth M. Mccormick, Lawrence C. Kenyon, Marni J. Falk

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Desmin (DES) is a major muscle scaffolding protein that also functions to anchor mitochondria. Pathogenic DES mutations, however, have not previously been recognized as a cause of multi-systemic mitochondrial disease. Here, we describe a 45-year-old man who presented to The Children's Hospital of Philadelphia Mitochondrial-Genetics Diagnostic Clinic for evaluation of progressive cardiac, neuromuscular, gastrointestinal, and mood disorders. Muscle biopsy at age 45 was remarkable for cytoplasmic bodies, as well as ragged red fibers and SDH positive/COX negative fibers that were suggestive of a mitochondrial myopathy. Muscle also showed significant reductions in mitochondrial content (16% of control mean for citrate synthase …

Novel Advances In Alzheimer's Disease, Jacob P. Naumann

The Downtown Review: An Interdisciplinary Journal Written and Peer-Reviewed by Mandel Honors College Students at Cleveland State University

Alzheimer’s disease, the most common form of dementia in adults, is a progressive degenerative neurological disease that affects memory, cognition, and behavior. Dr. Alois Alzheimer discovered and diagnosed the irreversible disease in 1906 after documenting the famous case of Auguste Deter.¹ Since the discovery of the disease, numerous advances have made it possible to not only better understand the causal factors, but also to improve the medical diagnosis and preventative measures that healthcare providers can implement. For the first time since 1984, the National Institute on Aging (NIAA) and the Alzheimer’s Association (AA) proposed and published new diagnostic guideline …

Relationship Between Motor Symptoms, Cognition, And Demographic Characteristics In Treated Mild/Moderate Parkinson's Disease., Jay S Schneider, Stephanie Sendek, Chengwu Yang

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND: Although Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized primarily by motor symptoms, PD patients, at all stages of the disease, can experience cognitive dysfunction. However, the relationships between cognitive and motor symptoms and specific demographic characteristics are not well defined, particularly for patients who have progressed to requiring dopaminergic medication.

OBJECTIVE: To examine relationships between motor and cognitive symptoms and various demographic factors in mild to moderate, PD patients requiring anti-PD medication.

METHODS: Cognitive function was assessed in 94 subjects with a variety of neuropsychological tests during baseline evaluations as part of an experimental treatment study. Data …

Phylogenetic Tree Construction And “Truncal Loss” Analysis Reveal Hidden Associations Between Loss Of Protein Expression In Swi/Snf Complex Components And Tumor Stage And Survival In Clear Cell Renal Cell Carcinoma (Ccrcc), Wei Jiang, Md, Phd, Essel Dulaimi, Karthik Devarajan, Qiong Wang, Raymond O'Neill, Charalambos C. Solomides, Md, Stephen C Peiper, Phd, Robert Uzzo, Joseph R. Testa, Haifeng Yang, Phd

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

Polybromo-1 (PBRM1), a targeting subunit of the SWI/SNF chromatin remodeling complex, is mutated at a rate of ~40% in clear cell Renal Cell Carcinoma (ccRCC), second only to VHL. Whether its mutation is correlated with tumor stage is controversial. As other components of the SWI/SNF complex were also reported to be mutated in ccRCC, we aim to examine the protein expression patterns of PBRM1, ARID1A, BRG1, and BRM in ccRCC, and to investigate possible association between their loss of expression and tumor stage, as well as survival. We also included a histone modifier, SETD2, which is recently discovered to …

Assessment For Risk Factors Associated With Local Recurrence In Chordoma, John A. Abraham, Md, Wei Jiang, Md, Phd

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

Chordoma is a rare but locally aggressive malignant neoplasm showing notochordal differentiation. The clinical differential diagnoses can be extensive, and definitive diagnosis often relies on histopathologic evaluation. Histologically, chordoma shows dual epithelial and mesenchymal differentiation, with various morphologies. Despite surgical resection and use of adjuvant radiation therapy, the local recurrence rate of chordoma remains high. We aim to establish factors associated with the increased risk of recurrence and help guide treatment decisions.

Age-Related Ebv-Associated Lymphoproliferative Disorder With Widespread Gastrointestinal Involvement And Subsequent Development Of T-Cell Lymphoma, Guldeep Uppal, Md, Alaina Chodoff, Msii, Zi-Xuan Wang, Phd, Jeffrey P. Baliff Md, Jerald Z. Gong, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

Age-related EBV-associated lymphoproliferative disorder (AR-EBVLPD) has emerged as a new subset of B-cell lymphoproliferative disorders. We report a unique case of AR-EBVLPD with a widespread gastrointestinal presentation and subsequent transformation to EBV-associated T-cell lymphoma. To our knowledge, this is the first report of a generalized polymorphic extranodal AR-EBVLPD with subsequent transformation to EBV-induced T-cell lymphoma.

Pathology Encountered During Cadaver Dissection Provides An Opportunity For Integrated Learning And Critical Thinking, Guiyan Zhang, Bruce Fenderson

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Abstract

Cadaver dissection engages medical students in active learning, critical thinking, and problem solving. During dissection, students at SKMC are encouraged to document pathologic findings in their cadavers and discuss the findings with their peers. Here, we describe two cases that provided opportunities for integrating anatomy with pathology and clinical medicine. The first case was a benign ovarian neoplasm. This large pelvic mass displaced the urinary bladder and uterus, and compressed the ureters and rectum. Students discussed clinical complications of this pelvic mass and reviewed pathologic findings that differentiate benign from malignant neoplasms. The second case was breast cancer with …

An Assessment Of The Reliability Of Platelet-Associated Flags Generated By The Sysmex Xe-5000 Automated Hematology Analyzer In Detecting Platelet Clumps, Jennifer M. Hawkins, Do, Gene Gulati, Ph.D, Guldeep Uppal, Md, Jerald Z. Gong, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

XE-5000 is an automated hematology analyzer utilized by clinical laboratories worldwide to perform CBC and differential leukocyte counts on EDTA-anticoagulated blood specimens. The overall reliability of the results generated by this analyzer has been assessed and found acceptable for clinical use. The CBC results generated on some of the blood specimens are, however, flagged by the analyzer for verification of the result of the flagged parameter by other means. One such parameter of clinical significance is the automated platelet count, which is often unreliable if the blood specimen contains platelet clumps.

Loss Of Expression Of Swi/Snf Chromatin Remodeling Complex Components And Setd2 Are Heterogeneous, Widespread, And Co-Occur In Clear Cell Renal Cell Carcinoma, Wei Jiang, Md, Phd, Essel Dulaimi, Theodore Parsons, Qiong Wang, Karthik Devarajan, Raymond O'Neill, Charalambos C. Solomides, Md, Stephen C Peiper, Phd, Jospeh R. Testa, Robert Uzzo, Haifeng Yang

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

The subunits of the SWI/SNF chromatin remodeling complex have one of the highest mutation rate in human cancers (see Figure 1). Polybromo-1 (PBRM1), a subunit of the SWI/SNF complex, is the second most mutated gene (40%) in clear cell Renal Cell Carcinoma (ccRCC). ARID1A, another subunit that competes with PBRM1 for binding to the complex, was infrequently mutated. The protein expressions of BRG1 and BRM (two catalytic subunits of the complex), and SETD2, a histone modifier (10-15% mutation rate), are not known in ccRCC. In this study we examined their protein expressions by immunohistochemistry (IHC) in tissue microarrays (TMAs), …

Molecular Docking And Inhibition Of Matrix Metalloproteinase-2 By Novel Difluorinatedbenzylidene Curcumin Analog, Aamir Ahmad, Afreen Sayed, Kevin R. Ginnebaugh, Vivek Sharma, Anita Suri, Arundhati Saraph, Subhash Padhye, Fazlul H. Sarkar

Department of Pathology

We recently described the synthesis and characterization of a novel difluorinatedbenzylidene analog of curcumin, commonly referred as CDF, which demonstrated significantly enhanced bioavailability and in vivo anticancer activity. CDF targets many factors similar to curcumin, albeit with more potency, as reported previously. To further highlight this differential behavior of CDF, we chose matrix metalloproteinase protein MMP-2 which is involved in the processes of invasion and metastasis of human tumors. Both curcumin and CDF were characterized for their binding characteristics using in silico docking studies; they were also evaluated via biological assays involving gelatin zymography, miRNA analysis, invasion assays and ELISA. …

Cytometric Characterization Of Circulating Tumor Cells Captured By Microfiltration And Their Correlation To The Cellsearch(®) Ctc Test., Daniel L Adams, Steingrimur Stefansson, Christian Haudenschild, Stuart S Martin, Monica Charpentier, Saranya Chumsri, Massimo Cristofanilli, Cha-Mei Tang, R Katherine Alpaugh

Pathology Faculty Publications

Recent studies reporting hundreds, to thousands, of circulating tumor cells (CTCs) in the blood of cancer patients have raised questions regarding the prevalence of CTCs, as enumerated by the CellSearch(®) CTC Test. Although CellSearch has been shown to consistently detect clinically relevant CTCs; the ability to only capture EpCAM positive cells has led to speculation that it captures limited subsets of CTCs. In contrast, alternative approaches to CTC isolation are often cited as capturing large numbers of CTCs from patient blood. Not surprisingly the number of cells isolated by alternative approaches show poor correlations when compared to CellSearch, even when …