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Baltimore Highlands, MD, United States

Sekhsaria S.,MedStar Union Memorial Hospital
Journal of medical case reports | Year: 2014

INTRODUCTION: Immunodeficiency can occur both in patients undergoing radiation therapy, as well as in patients who have had thymectomies. However, few studies have examined the immune recovery of a patient following both procedures. We aim to emphasize the need for assessment and consistent monitoring of patients with thymoma prior to and after combined treatment of thymectomy and radiation, both of which are likely to result in an increased risk for immunodeficiency.CASE PRESENTATION: We describe the longitudinal progress of a 59-year-old Asian male who underwent thymectomy followed by radiation therapy and subsequently presented with generalized urticaria. Revelation of a low absolute lymphocyte count (615 cells/mcL) on initial evaluation prompted further analysis of his immunoglobulin levels and antigen response to a polysaccharide pneumococcal vaccine (PneumoVax-23). Although his immunoglobulin levels were unremarkable, he failed to respond to 11 of 12 serotypes of the pneumococcal vaccine. As a result, he was placed on Bactrim® (trimethoprim-sulfamethoxazole) prophylaxis to prevent opportunistic infections, and his CD4+ and CD8+ counts were monitored over the course of 8 years. His lymphocyte counts 87 months after thymectomy and 85 months after radiation therapy were as follows: absolute lymphocyte count 956 cells/mcL, absolute CD3+/CD4+ 164/mm3 (16%) and absolute CD3+/CD8+ 257/mm3 (25%). The patient was able to discontinue Bactrim® (trimethoprim-sulfamethoxazole) prophylaxis after 9 years of treatment.CONCLUSIONS: The lymphocytopenia, low CD4+ count, and failed response to pneumococcal vaccination that presented in our patient are consistent with immunodeficiency. After radiation alone, a recovery of T-lymphocytes is usually observed after approximately 3 weeks. Over the course of 8 years, he has still not made a full recovery according to laboratory markers, which seem to have stabilized at chronically low levels. To prevent serious complications, we suggest that patients who have undergone both thymectomy and radiation therapy be monitored for immunodeficiency. This case report informs the practices of allergists, oncologists, and neurologists in the continuing care of patients with thymoma.

Lincoln A.E.,MedStar Sports Medicine Research Center | Caswell S.V.,George Mason University | Almquist J.L.,Fairfax County Public Schools | Dunn R.E.,George Mason University | Hinton R.Y.,MedStar Union Memorial Hospital
American Journal of Sports Medicine | Year: 2013

Background: Boys' lacrosse has one of the highest rates of concussion among boys' high school sports. A thorough understanding of injury mechanisms and game situations associated with concussions in boys' high school lacrosse is necessary to target injury prevention efforts. Purpose: To characterize common game-play scenarios and mechanisms of injury associated with concussions in boys' high school lacrosse using game video. Study Design: Descriptive epidemiological study. Methods: In 25 public high schools of a single school system, 518 boys' lacrosse games were videotaped by trained videographers during the 2008 and 2009 seasons. Video of concussion incidents was examined to identify game characteristics and injury mechanisms using a lacrosse-specific coding instrument. Results: A total of 34 concussions were captured on video. All concussions resulted from player-to-player bodily contact. Players were most often injured when contact was unanticipated or players were defenseless (n = 19; 56%), attempting to pick up a loose ball (n = 16; 47%), and/or ball handling (n = 14; 41%). Most frequently, the striking player's head (n = 27; 79%) was involved in the collision, and the struck player's head was the initial point of impact in 20 incidents (59%). In 68% (n = 23) of cases, a subsequent impact with the playing surface occurred immediately after the initial impact. A penalty was called in 26% (n = 9) of collisions. Conclusion: Player-to-player contact was the mechanism for all concussions. Most commonly, injured players were unaware of the pending contact, and the striking player used his head to initiate contact. Further investigation of preventive measures such as education of coaches and officials and enforcement of rules designed to prevent intentional head-to-head contact is warranted to reduce the incidence of concussions in boys' lacrosse. © 2013 The Author(s).

Traina A.N.,Astrazeneca | Lull M.E.,Astrazeneca | Lull M.E.,St. John Fisher College | Hui A.C.,MedStar Union Memorial Hospital | And 2 more authors.
Canadian Journal of Diabetes | Year: 2014

Objective: The use of once-weekly exenatide in type 2 diabetes mellitus is well supported, but little is known about its effectiveness in type 1 diabetes. The objective of this study was to determine the clinical efficacy of once-weekly exenatide on glycemic control in patients with type 1 diabetes when added to basal-bolus insulin therapy. Methods: For this retrospective study, patients with type 1 diabetes, aged 18 years and older, receiving continuous subcutaneous insulin infusion, using a continuous glucose monitoring device or regularly measuring blood glucose levels and receiving 2 mg of exenatide once weekly for at least 3 months were included. Demographic information, glycated hemoglobin (A1C), body weight, body mass index, systolic and diastolic blood pressures, total daily insulin dose, basal and bolus insulin doses, 28-day continuous subcutaneous insulin infusion glucose average and incidence of hypoglycemia were collected at baseline and 3 months after beginning therapy with once-weekly exenatide. Results: An electronic medical record search identified 11 patients with type 1 diabetes who met the inclusion criteria. Comparing baseline and 3 months after initiation of once-weekly exenatide revealed reductions of 0.6% in A1C (p=0.013), 3.7% in body weight (p=0.008), 1.7 kg/m2 in body mass index (p=0.003), 13% in total daily insulin dose (p=0.011) and 9.3 units in bolus insulin dose (p=0.015). Conclusions: This study revealed that the addition of once-weekly exenatide to insulin therapy for type 1 diabetes patients leads to significant improvements in A1C, body weight, body mass index and insulin doses. © 2014 Canadian Diabetes Association.

Osbahr D.C.,MedStar Union Memorial Hospital
American journal of orthopedics (Belle Mead, N.J.) | Year: 2012

The Orthopaedic In-Training Examination (OITE) has been administered to orthopedic residents to assess knowledge and measure teaching quality. We performed a detailed analysis of the shoulder and elbow (S&E) section of the OITE relating to question content, recommended American Academy of Orthopaedic Surgeons references, and resident performance. S&E questions from the 2005-2009 examinations were analyzed for resident performance scores, tested topics, tested imaging modalities, tested treatment modalities, taxonomy classification, and recommended references. The S&E section made up 5.9% of the OITE. Mean resident performance on the entire OITE and on the S&E section improved during each training year. Imaging modality questions typically involved radiographs, magnetic resonance imaging, and computed tomography. These questions made up 37.5% of the S&E section. Treatment modality questions made up 45% of the S&E section and related mostly to shoulder arthroplasty and rehabilitation. Taxonomy classification showed that recall questions were most common. However, mean resident performance was minimally affected by question type. Recommended references were most commonly journal articles. Results of this study provided unique information related to content, recommended references, and resident performance on the S&E section of the OITE. We hope that use of this information will help improve resident performance and optimize S&E curricula.

Ghanem O.M.,MedStar Union Memorial Hospital | Heitmiller R.F.,MedStar Union Memorial Hospital
Journal of Surgical Education | Year: 2016

Introduction We reviewed the first 100 years of presidential addresses delivered at the fall congress of the American College of Surgeons (ACS). Our hypothesis was that these addresses would be an excellent indicator of the College's position on surgical policy, ethics, methods, and education. Methods All ACS presidential addresses from 1913 to 2013 were identified through the ACS archives website. This included the presenter, title, year, and citation if published in a peer reviewed journal. The text of each address was obtained from the ACS archives, or from the listed citations. Addresses were then classified into 1 of 6 subgroups based on content - surgical credo, medical innovation, medical education, surgical history, business and legal, and personal tribute. The 100-year period was divided into 5 interval each of 20-year and the frequency of each category was graphed over time. Results There were 111 ACS presidential addresses delivered in the study period. Distribution by category was surgical credo (57%), surgical history (14%), medical innovation (10%), medical education (8%), business and legal (6%), and personal tributes (5%). The frequency of surgical credo has remained stable over time. Business and legal emerged as a new category in 1975. The other topics had low, but stable frequency. Conclusion ACS presidential addresses do reflect the College's position on surgical policy and practice. The college has remained consistent in serving its members, maintaining, and defining the role of its organization, the qualifications for membership, and the expectations for the professional conduct of its members. © 2016 Published by Elsevier Inc.

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