Category Archives: Articles

Individual Articles in MSRJ

The Crooked Tree: An Essay and Sculpture

Posted on by

Check out this interesting reflection!

https://msrj.chm.msu.edu/wp-content/uploads/2022/10/212-ePub.pdf

Author: Hettiarachchige  Diluksha  Prasad  Jayawardana, University of Colombo

Abstract: The crooked tree has been adopted as the universal symbol for the field of orthopedics. Each part of this tree has hidden meanings closely related to orthopedic surgery. The purpose of this article is to generate thoughts among medical professionals and stimulate discussion among them on concepts behind the crooked tree and orthopedic surgery.

Generational Giving: Japanese High School Students’ Motivation to Donate Blood

Posted on by

Another new and interesting article from our Fall 2021 Issue!

https://msrj.chm.msu.edu/wp-content/uploads/2022/10/208-ePub.pdf

Authors: Luna Kinoshita¹*, Aya Goto, MD, PhD², Makoto Kashimura, PharmD, PhD3, Norihiko Watanabe, BS4, Kenneth E. Nollet, MD, PhD5

1School of Medicine, Fukushima Medical University, Fukushima, Japan. 2Center for Integrated Science and Humanities, Fukushima Medical University, Fukushima, Japan. 3Education Evaluation Division, Fukushima Medical University, Fukushima, Japan. 4Medical Information and Supply Management Division, Fukushima Red Cross Blood Donor Center, Fukushima, Japan. 5Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan.

Background: As the number of young people in Japan decreases, the proportion of them who donate blood warrants urgent attention. The aims of this investigation were to test whether students’ motivation of “doing good for others” associated with their blood donation behavior and to explore factors associated with their motivation.

Methods: Fukushima Red Cross Blood Donor Center conducted a questionnaire survey in 2018 at 10 high schools in Fukushima Prefecture (N=4506). From the database, we analyzed the factors associated with motivation as assessed by the perception of “doing good for others” using chi-square tests and binomial logistic regression.

Results: The percentage of those answering “doing good for others” as “important” was 67.2%. Students who donated blood more often tended to cite “doing good for others” as important. The probability of regarding this perception as important was significantly higher among females, those with better subjective health, and those knowing their own blood type and donation eligibility criteria.

Conclusion: Health promotion activities that improve subjective perceptions of one’s health may reinforce students’ awareness of blood donation as “doing good for others” that might promote frequent donation. Our results also support greater outreach to male students and improving students’ knowledge related to blood donation.

Key words: blood donation, blood donors, donation behavior, students, Japan

Bypassing the Blood-Brain Barrier to Treat Brain Cancer: A Systematic Review of the Efficacy of Carmustine Wafer Implant Therapy

Posted on by

Here is the abstract of our newest accepted publication, Please follow the link below!

https://msrj.chm.msu.edu/wp-content/uploads/2022/10/198-ePub.pdf

Authors:

Mark Sharobim BSc, MSc1*, Peter A. Tsivis, MD, MBA1,2

1Saba University School of Medicine, The Bottom, Saba, The Caribbean Netherlands
2Rocky Vista University College of Osteopathic Medicine, Ivins, Utah, USA

Introduction:
Gliomas are neoplasms of the central nervous system (CNS). Despite aggressive treatment, median survival of malignant tumors remains poor at 12 – 18 months. Newer treatments allow delivery of therapeutic substances across the selectively permeable blood-brain barrier (BBB). This allows for chemotherapeutics to more easily reach their target location in the CNS. Drug eluting wafers made up of carmustine can be placed in the surgical resection cavity of a tumor and clinical trials to date have demonstrated their utility.

Hypothesis:
Bypassing the BBB to allow greater accumulation of chemotherapeutics in the CNS will improve clinical outcomes in glioma patients.

Methods:
Studies from medical literature databases describing trials using carmustine wafers implanted after glioma resection were obtained. To test our hypothesis, the available data using this therapy was compared to current first line treatment data for glioma as described by Stupp and colleagues. The inclusion criterion for efficacy analysis was histopathologically confirmed primary glioma. Exclusion criteria included presence of metastasis or pediatric tumors.

Results:
10 studies describing wafer therapy use were initially gathered, encompassing over 500 patients. 6 studies met criteria for treatment efficacy analysis. 4 of 6 (75%) trials exhibited significant survival advantage as compared to control treatment. Furthermore, 3 of the 4 (75%) studies showing significance also demonstrated equal or higher percent increase in overall survival from control as compared to data generated from current first line therapy.

Conclusion:
Treatments bypassing the BBB are not currently standard-of-care for patients with glioma. We uncovered that most trials using carmustine implants post tumor resection describe increased overall survival, however in specific cohorts. Diverting the BBB in general may also have fewer side effects in contrast to classical routes of therapy. Future work is needed to develop similar therapeutics that improve outcomes in all age, gender, and prognostic risk factor populations.

Key words: Glioblastoma, Glioblastoma Multiforme, Blood-Brain Barrier, Drug Delivery Systems, Carmustine, Carmustine Wafers, Blood-Brain Barrier Disruption.

A Narrative Review of the Current Evidence of Fecal Microbiota Transplant as Curative Therapy for Recurrent Clostridioides difficile Infection

Posted on by

Interested in the gut microbiome?  Read the abstract and click the link below for our newest accepted publication!

http://msrj.chm.msu.edu/wp-content/uploads/2022/10/218-ePub.pdf

Authors: Divya Lakshmi Yerramsetty, Dipendra R. Pandeya, Ph.D.
Medical University of the Americas, Devens, MA, USA

Hypothesis: Compared to the flawed antimicrobial interventions, fecal microbiota transplantation (FMT) is more efficacious and safer in offering a significant clinical resolution of recurrent Clostridioides difficile (rCDI) – the world’s leading hospital-acquired infection.

Methods: An electronic search using Medscape, PubMed, and Google Scholar databases, limited only to articles published in academic journals with full-text access within the past ten years (2010-2020). Selection criteria consisted of quality research studies with relevant findings from patient follow-up post-FMT, considering both primary and secondary endpoints of the investigations. An evidence table was created to organize and evaluate the notable features of each source.

Results: Three RCTs, two retrospective cohort studies, and two systematic reviews and meta-analyses have established that FMT is an effective alternative to standard care in treating rCDI. Multiple infusions of FMT as a monotherapy and rescue treatment demonstrated near-complete clinical resolution in patients with rCDI. Further management of rCDI with the recommended first-line agents (e.g., vancomycin and fidaxomicin) proved counterproductive to FMT in comparative studies.

Conclusions: With its unappealing aesthetics and under-researched long-term implications, there is increased reluctance to FMT’s regular use. Before declaring the novel procedure as the best form of medical practice, future studies should have a stronger emphasis on vancomycin and fidaxomicin to allow for the effective comparison of FMT to non-FMT treatments. Despite the existing limitations, including insufficient sample sizes, FMT has still shown overwhelming promise as a curative treatment for rCDI.

Keywords: Dysbiosis, gut microbiome, FMT, human feces, rCDI, treatment

Establishing the Hormonal Relationship between Polycystic Ovary Syndrome and Hypothyroidism: A Literature Review

Posted on by

Here is the abstract of our newest accepted publication, Please follow the link below!

http://msrj.chm.msu.edu/wp-content/uploads/2020/08/MSRJ2019187.pdf

Deborah Anuoluwapo Aina, Saba University School of Medicine, Devens, MA, USA, Dutch Caribbean

Objective: The aim of this literature review is to evaluate the hormonal relationship between polycystic ovary syndrome and hypothyroidism.

Methods: Electronic databases such as Ebscohost and PubMed were searched, using words and phrases specific to the topic. Journal articles were filtered for publications from no earlier than 2008 to ensure accuracy and relevance.

Results: Anti-thyroid peroxidase antibodies and thyroid-stimulating hormone were significantly higher in polycystic ovary syndrome patients compared to controls (P<0.05). Polycystic ovary syndrome patients also had a statistically significant higher prevalence of autoimmune thyroiditis (P=0.035) and subclinical hypothyroidism (P=0.0133) compared to controls. In polycystic ovarian syndrome patients with thyroid-stimulating hormone levels ≥2.5 mIU/L, a significantly increased insulin resistance (P=0.007) and a significantly decreased insulin sensitivity (P=0.003) were observed compared to same patients with thyroid-stimulating hormone levels <2.5 mIU/L. Serum triglycerides were significantly higher in polycystic ovary syndrome patients with subclinical hypothyroidism compared to same patients with normal thyroid function (P=0.013). A significant positive correlation was present between luteinizing hormone and thyroid volume (P=0.007) and between anti-thyroid peroxidase antibodies and thyroid volume (P<0.0001). With thyroid hormone replacement, there was a significant increase in insulin sensitivity and free T3 /T4 levels, with a corresponding decrease in serum thyroid-stimulating hormone, prolactin, estradiol, insulin resistance, and free testosterone in polycystic ovary syndrome patients with untreated hypothyroidism. The polycystic-appearing ovaries and ovarian volumes in these patients also significantly regressed (P<0.05).

Conclusion: Polycystic ovary syndrome is associated with hypothyroidism. Hence, achieving euthyroidism may improve the clinical and morphologic characteristics of polycystic ovary syndrome.

Keywords: PCOS, hypothyroidism, levothyroxine, polycystic ovary, hormone, thyroid, autoimmune, insulin resistance

Ultrasound vs CT for Diagnosing Acute Appendicitis and Appendicitis Treatment Altering Conditions

Posted on by

Interested in imaging modalities and their effectiveness in diagnostics?  Read the abstract and click the link below for our newest accepted publication!

 

Ultrasound vs CT for Diagnosing Acute Appendicitis and Appendicitis Treatment Altering Conditions

Christopher Borowy, MS-IV1*, Luke Rond, D.O2, John Ashurst, D.O2, and Stefan Merrill, M.D2
1Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
2Department of Emergency Medicine, Kingman Regional Medical Center, Kingman, AZ, USA

Introduction: Acute appendicitis is the most common cause of atraumatic abdominal pain in children over 1 year of age. Even though diagnostic imaging modalities have evolved over the past 20 years, accurate diagnosis of acute appendicitis still presents as a challenge. Computed tomography (CT) is currently the most commonly used radiographic test for acute appendicitis. Unlike CT, ultrasound (US) does not require ionizing radiation which is harmful to the patient. Even though the specificity of US has been well studied in acute appendicitis, CT is still commonly requested after a positive US. Till date, there has been no published research evaluating the utility of US in changing management in appendicitis.

Purpose: The purpose of the study is to compare the ability of US and CT to diagnose pathology proven acute appendicitis and to predict Appendicitis Treatment Altering Conditions (ATAC).

Methods: This is a retrospective cohort study that compares the positive predictive value (PPV) and the ATAC rate of US and CT when diagnosing acute appendicitis.

Results: There were 432 appendicitis cases reported between 1 October 2012 and 30 June 2017. Of those cases, 409 were diagnosed by CT and 23 were diagnosed by US. The PPV of both modalities was above 90% (CT = 97%, US = 95%), and the ATAC rates were statistically similar (CT = 14%, US = 22%, P = 0.21).

Conclusion: The study supports that a positive US for appendicitis is as diagnostic as a positive CT. Therefore, adding on a CT scan after a positive US does not help recognize other sources of intra-abdominal pathology that would negate doing a laparoscopy.

Keywords: US, ultrasound, CT, CAT, ATAC, appendicitis, sensitivity, positive predictive value, PPV

 

Transfemoral Aortic Valve-in-Valve Replacement in Patient with Aortic Root Pseudoaneurysm

Posted on by

Another new and interesting article from our Fall 2019 Issue!  Read the abstract below and click on the link for the full article.

Transfemoral Aortic Valve-in-Valve Replacement in Patient with Aortic Root Pseudoaneurysm (Click link for full PDF)

 

Authors: Mark A. Nolan, P.E., M.Eng1, Stephane Leung Wai Sang, M.D., MSc2

Background: Transcatheter aortic valve replacement (TAVR) was successfully performed to treat aortic regurgitation (AR) in a patient with a failed aortic valve replacement complicated by aortic root pseudoaneurysm.

Case Presentation: A 92-year-old male presented with acute decompensated congestive heart failure secondary to AR of a previously implanted stentless aortic bioprosthesis, complicated by a 2.5 x 1.7 cm pseudoaneurysm of the aortic root.

Conclusions: Complex aortic root and valve disease can be safely and effectively addressed through the use of TAVR in high-risk patients. The presence of a pseudoaneurysm should not preclude successful TAVR.

 

Association between Total Knee Arthroplasty and Subtalar Joint Changes: A Cadaver Study

Posted on by

New article from the MSRJ 2019 Fall issue is now up on the site! Read the abstract or click on the link below for the full article.

Association between Total Knee Arthroplasty and Subtalar Joint Changes: A Cadaver Study (Click link for full PDF article)

Authors: Dominick J. Casciato, B.A.1*, Natalie A. Builes, B.A.2, Luis A. Rodriguez Anaya, DPM1, Bibi N. Singh, DPM1

Background: Total knee arthroplasty (TKA) has become the procedure of choice for those suffering from debilitating degenerative joint disease of the knee; however, new research suggests that functional changes in the rearfoot occur following the procedure to compensate for gait changes. This pilot study investigates subtalar joint (STJ) changes in cadavers with TKAs.

Methods: Four embalmed cadavers with a unilateral TKA were disarticulated at the STJ and the calcaneal articular facets were imaged. The length, width, and area of these facets ipsilateral to the joint replacement were measured using image analysis software and compared to the contralateral side.
Results: All cadavers exhibited evidence of anatomical changes at the STJ. Moreover, a transition to an anatomically unstable STJ was observed.

Conclusions: This study suggests that biomechanical compensation at the STJ may result in anatomical changes in the joint in which form of the joint follows function. Though this pathology may have developed prior to such arthroplasty, the unilateral nature of the facet changes emphasizes the need to further investigate and address gait abnormalities before and after joint replacement to optimize biomechanics in the arthritic knee.

 

 

 

Malignant Chondroid Syringoma of the Foot – A Case Report

Posted on by

Authors: Megan Masten, MS41*, Raouf Mikhail, MD2

Author Affiliations:

1Michigan State University College of Human Medicine, Flint, Michigan, United States
2Surgical Oncologist, Hurley Medical Center, Flint, Michigan

Full Text Article PDF

*Corresponding Author: Megan Masten; mastenme@msu.edu

Key Words: Malignant; chondroid; syringoma; foot; adnexal cancer; cutaneous tumor

Abstract:

Background: This case report is about a very rare tumor – a malignant chondroid syringoma. The objective of this piece is to review both the case presented along with the current literature on cutaneous adnexal tumors.

Case Presentation: The patient is a 73-year-old Caucasian female with a past medical history of treated colon and breast cancer who presented with a 2-year history of a slow-growing, painful cutaneous lesion on the medial aspect of her right foot. The patient presented to her primary care physician (PCP) for right foot pain, which was attributed to bunions. The PCP encouraged the patient to see a podiatrist for this issue. Upon presentation to the podiatrist, the patient had a right foot biopsy. The pathology report showed a mixed malignant chondroid syringoma with positive margins. A re-excision to ensure complete removal was recommended. The patient presented to surgical oncology and subsequently she underwent complete excision of the right foot mass. At the time of her last visit, 7 months postoperatively, the patient continued to have issues with wound healing and continuous drainage of her surgical wound.

Discussion: This case differs from much of the current literature surrounding cutaneous adnexal tumors as it is a malignant chondroid syringoma of the foot, which is exceedingly rare. There are only three other published case reports of similar malignancies in similar places. This case study is important due to the uniqueness of the case. This case serves as a reminder of the importance of biopsy for diagnosis prior to management, as it is unlikely that such rare soft tissue tumors can be diagnosed without biopsy.

Conclusion: The take away lesson of the case is that it is important to biopsy unknown masses, and to have follow up with specific specialists.

Published: Spring, 2019

References:

1. Martinez SR, Barr KL, Canter RJ. Rare tumors through
the looking glass: an examination of malignant cutaneous adnexal tumors. Arch Dermatol 2011; 147(9): 1058–62.
doi: 10.1001/archdermatol.2011.229

2. Malik R, Saxena A, Kamath N. A rare case of malignant chondroid syringoma of scalp. Indian Dermatol Online
J 2013; 4(3): 236–8.

3. Mayur K, Neha M, Rajiv K, Shubhada K. Malignant chondroid syringoma of thigh with late metastasis to lung:
a very rare case report. Indian J Pathol Microbiol 2017;
60(3): 428–30.

4. Shashikala P, Chandrashekhar HR, Sharma S, Suresh KK. Malignant chondroid syringoma. Indian J Dermatol Venereol Leprol 2004; 70: 175–6.

5. American Joint Committee on Cancer TNM staging system for cutaneous squamous cell carcinoma. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

6. Lu H, Chen L, Chen Q, Shen H, Liu Z. A rare large cutaneous chondroid syringoma involving a toe: a case report. Medicine 2018; 97(5): e9825.

7. Madi K, Attanasio A, Cecunjanin F, Garcia R, Vidershayn A, Lucido, J. Chondroid syringoma of the foot: a rare diagnosis.
J Foot Ankle Surg 2016; 55: 373–8.

8. Sundling R, Logan D. Chondroid syringoma: a case report in the foot and ankle. Foot Ankle Specialist 2016; 10: 167–9.

9. Kazakov DV, McKee PH, Michal M, Kacerovska D. Cutaneous adnexal tumors. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins Health; 2012.

10. Conill C, Toscas I, Morilla I, Mascaró JM. Radiation therapy as a curative treatment in extraocular sebaceous carcinoma. Br J Dermatol 2003; 149(2): 441–2.

11. Duke WH, Sherrod TT, Lupton GP. Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited). Am J Surg Pathol 2000; 24(6): 775–84. 12. Tolkachjov SN, Hocker TL, Camilleri MJ, Baum CL. Mohs micrographic surgery in the treatment of trichilemmal

carcinoma: the Mayo Clinic experience. J Am Acad Dermatol 2015; 72(1): 195.

13. Hamman M, Jiang S. Management of Trichilemmal Carcinoma: an update and comprehensive review of the literature. Dermatol Surg 2014; 40(7): 711–17.

14. Metzler G, Schaumburg-Lever G, Hornstein O, Rassner G. Malignant chondroid syringoma: immunohistopathology. Am J Dermatopathol 1996; 18: 83–9.

15. Webb JN, Stott WG. Malignant chondroid syringoma of the thigh. Report of a case with electron microscopy of the tumour. J Pathol 1975; 116: 43–6.

16. Mathiasen RA, Rasgon BM, Rumore G. Malignant chondroid syringoma of the face: a first reported case. Otolaryngol Head Neck Surg 2005; 133: 305–7.

17. Hirsch, P, Helwig, EB. Chondroid Syringoma. Arch. Derm. 1961; 84: 835–847.

Primary Intestinal Lymphangiectasia: A Case Report

Posted on by

Authors: Ridwaan Albeiruti1*, MD, Patrick Gleeson2, MD, Theodore Kelbel3, MD, Tracy Fausnight, MD3

Author Affiliations:

1Department of Medicine, West Virginia University, Morgantown, WV; Department of Internal Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA; 2Department of Internal Medicine, Temple University, Philadelphia, PA, USA; 3Helen DeVos Children’s Hospital, Spectrum Health, Grand Rapids, MI, USA

Full Text Article PDF

*Corresponding Author: Ridwaan Albeiruti; albeiru4@msu.edu

Key Words: primary intestinal lymphangiectasia; Waldmann’s disease; protein-losing enteropathy

Abstract:

Primary intestinal lymphangiectasia (Waldmann’s disease) is a rare protein-losing enteropathy which is mostly seen in young children. A 22-month-old male baby presented with a 1-week history of abdominal distension, chronic loose stools, recurrent ear infections, and failure to thrive. He had edematous eyelids and non-pitting edema of his hands and feet. The patient was diagnosed via endoscopic visualization and biopsy of the lymphangiectasia in the small bowel. He was managed through dietary restriction with a high-protein, low-fat diet. The patient subsequently had resolution of the diarrhea and an increase in albumin and total protein on labs. We describe a rare case of primary intestinal lymphangiectasia and highlight its clinical presentation, diagnosis, and treatment.

Published: Spring, 2019

References:

1. Vignes S, Bellanger J. Primary intestinal lymphangiectasia (Waldmann’s disease). Orphanet J Rare Dis 2008; 3: 5.
doi: 10.1186/1750-1172-3-5

2. Wen J, Tang Q, Wu J, Wang Y, Cai W. Primary intestinal lymphangiectasia: four case reports and a review of the literature. Dig Dis Sci 2010; 55(12): 3466–72. doi: 10.1007/ s10620-010-1161-1

3. Hokari R, Kitagawa N, Watanabe C, Komoto S, Kurihara C, Okada Y, et al. Changes in regulatory molecules for lymphangiogenesis in intestinal lymphangiectasia with enteric protein loss. J Gastroenterol Hepatol 2008; 23(7 Pt 2): e88–95. doi: 10.1111/j.1440-1746.2007.05225.x

4. Katoch P, Bhardwaj S. Lymphangiectasia of small intestine presenting as intussusception. Indian J Pathol Microbiol 2008; 51(3): 411–12.

5. Dierselhuis MP, Boelens JJ, Versteegh FG, Weemaes C, Wulffraat NM. Recurrent and opportunistic infections in children with primary intestinal lymphangiectasia. J Pediatr Gastroenterol Nutr 2007; 44(3): 382–5. doi: 10.1097/01. mpg.0000233192.77521.2f

6. Ingle SB, Hinge Ingle CR. Primary intestinal lymphangiectasia: minireview. World J Clin Cases 2014; 2(10): 528–33. doi: 10.12998/wjcc.v2.i10.528

7. Xinias I, Mavroudi A, Sapountzi E, Thomaidou A, Fotoulaki M, Kalambakas A, et al. Primary intestinal lymphangiectasia: is it always bad? Two cases with different outcome. Case Rep Gastroenterol 2013; 7(1): 153–63. doi: 10.1159/000348763