Atlantic Health System

About: Atlantic Health System is a healthcare organization based out in Morristown, New Jersey, United States. It is known for research contribution in the topics: Health care & Medicine. The organization has 277 authors who have published 299 publications receiving 6594 citations.

Giant Cell Arteritis: An Atypical Presentation Diagnosed with the Use of MRI Imaging.

Abstract: Giant cell arteritis (GCA) is the most common primary systemic vasculitis in western countries in individuals over the age of 50. It is typically characterised by the granulomatous involvement of large and medium sized blood vessels branching of the aorta with particular tendencies for involving the extracranial branches of the carotid artery. Generally the diagnosis is straightforward when characteristic symptoms such as headache, jaw claudication, or other ischemic complications are present. Atypical presentations of GCA without “overt” cranial ischemic manifestations have become increasingly recognised but we report for the first time a case of GCA presenting as mild upper abdominal pain and generalized weakness in the context of hyponatremia as the presenting manifestation of vasculitis that was subsequently diagnosed by MRI scanning. This case adds to the literature and emphasises the importance of MRI in the evaluation of GCA patients without “classic” cranial ischemic symptoms.

Outside-in transobturator midurethral sling and the dorsal nerve of the clitoris.

Abstract: An anatomical study on fresh cadavers was done to determine the vulnerability of the dorsal nerve of the clitoris to injury during “outside–in” transobturator sling procedures. The dorsal nerve of the clitoris was identified bilaterally in ten fresh cadavers. Transfixing needles marked the inferomedial border of the obturator foramen. The distance between the foramen border and the nerve was measured. The nerve ran medially in close approximation to the ischiopubic ramus and inferior to the obturator foramen in all specimens. In no instance did the nerve follow an aberrant course traversing the obturator foramen. The mean distance between the inferomedial border of the obturator foramen and the nerve was 9.3 mm, range 3–14 mm. When the “outside–in” technique is used, the introducer cannot come into contact with the dorsal nerve of the clitoris because the introducer would have to pass through the ischio-pubic ramus. This is not anatomically possible.

Preparing adult patients for international travel.

Abstract: More than 50 million Americans engage in international travel annually. Travel to developing countries can expose patients to a myriad of infectious diseases. Primary care clinicians can provide counseling, immunizations, and drugs to keep patients healthy while traveling. This article reviews risk assessment and required and recommended immunizations. Patients can greatly reduce their risk for travel-acquired illness by updating immunizations, taking prophylactic drugs, and observing recommended health behaviors.

Antenatal calcium channel blocker exposure and subsequent patent ductus arteriosus in extremely low-birth-weight infants.

Abstract: This study aimed to assess whether tocolytic fetal exposure to antenatal calcium channel blockers (aCCB) increases the risk for hemodynamically significant patent ductus arterioses (hsPDA) in extremely low-birth-weight (ELBW) infants. This case-control study investigated ELBW infants (<1,000 g) without cardiac defects in a level 3 neonatal intensive care unit who had survived at least 7 days. Nifedipine was the only aCCB used for this study population. The measurements included the history of aCCB exposure, selected maternal data, hsPDA diagnosis, gestational age at birth, birth weight, mode of delivery, sex, maternal race, location of birth, Apgar scores, and selected neonatal morbidities. The end point of the study was hsPDA, defined as an echocardiographically confirmed PDA with clinical symptoms. A total of 180 infants met the study criteria. The diagnosis was hsPDA for 56% of these patients, 20% of whom had aCCB exposure. Of the infants without hsPDA, 11% had aCCB exposure (p = 0.09). No statistically significant associations were found between aCCB exposure and hsPDA after adjustment for gestational age (odds ratio [OR], 1.5; 95% confidence interval [CI], 0.6–3.7) or for gestational age and cumulative aCCB exposure of 100 mg or more (OR, 2.0; 95% CI, 0.6–6.5). A history of aCCB exposure does not appear to increase hsPDA risk in ELBW infants. Studies using neonatal serum nifedipine concentrations after antenatal exposure should be performed to confirm this conclusion.