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Clinical Briefings: Clinical Reports from Penn Medicine™

Endoscopic Endonasal Resection of Orbital Apex Tumor
noreply@blogger.com (Mark) Wed, 01 Sep 2010 09:45:00 -0700
A team comprised of Penn Medicine neurosurgeons, otorhinolaryngologists and oculoplastic surgeons recently performed an intricate minimally invasive endoscopic endonasal surgery to resect a cavernous hemangioma of the orbital apex. Because these benign tumors are resistant to medications and radiation use is limited near the optic nerve, surgical excision is the best option for treatment.Surgery for lesions of the orbital apex are notable for their complexity because access and visualization of the tumors, as well as their removal, is limited by the compact, bony and delicate neurovascular environment of the orbital apex. The risks of surgery include hemorrhage from the ethmoid arteries and the potential for injury to the optic nerve with resultant blindness. Although cavernous hemangiomas are benign vascular tumors that can be relatively indolent and painless, their precarious location can cause serious morbidity. Tumors in the orbital apex can cause proptosis, and visual disturbances typically occur late in their course as a result of tumor growth. At Penn, preoperative preparation and surgery for complex tumors of the orbital apex and skull base are performed by specialists in neurosurgery, otorhinolaryngology and oculoplastic surgery.In addition, Penn radiologists use high-definition MRI and other advanced diagnostic modalities to define the position and shape of the tumor. When minimally invasive surgery is an option, advanced endoscopic instruments are used to overcome the difficulty of visualizing and reaching embedded lesions.Case StudyMrs. G, a 32-year-old female expecting her first child, visited an ophthalmologist after noticing blurriness in her right eye that had gradually worsened over the last few years. An examination of her visual acuity and visual field was abnormal. She had optic disk pallor and limited light perception in the affected eye. An MRI scan revealed a small tumor (11mm in diameter) in the orbital apex of the right eye (Fig. 1). Mrs. G was then referred to the Department of Neurosurgery at Pennsylvania Hospital, where a neurosurgeon identified the lesion as a benign cavernous hemangioma and ordered a high-definition MRI, which defined its location in the inferior intraconal orbital compartment. When additional testing revealed continued deterioration of the vision in Mrs. G’s right eye, the neurosurgeon recommended that the lesion be removed. The options to remove the tumor included: 1) a formal craniotomy, accessing the orbital apex by lifting the brain; 2) oculoplasty to open the medial (and possibly lateral) wall of the orbit; and 3) minimally invasive endoscopic endonasal surgery. When these options were discussed with Mrs. G, she chose minimally invasive surgery. Because the endonasal approach was complicated by the position of the tumor and its proximity to the optic nerve, an oculoplastic surgeon and specialist in otorhinolaryngology-head and neck surgery were consulted prior to the procedure.Operative technique – Carefully avoiding the anterior and posterior ethmoid arteries, an endonasal drill was used under endoscopic visualization to cut through the lamina papyracea anterior to the optic canal. The medial portion of the orbital floor was then resected and a longitudinal incision made at the orbital periosteum adjacent to the tumor. Over the course of several hours, a purplish, berry-sized tumor was separated from the optic nerve, oculomotor nerve, medial rectus muscle and orbital fat. The tumor was removed en bloc and the orbit was then closed.Recovery – Mrs. G’s vision stabilized soon after surgery and she was discharged to home on postoperative day three. Her recovery was uneventful. Several months after her surgery she delivered a normal, full-term baby.Team of FacultyThe faculty of the Department of Neurosurgery is comprised of 13 neurosurgeons, all of whom have a particular subspecialty focus that covers the entire spectrum of surgically treated disorders of the nervous system. Together, these neurosurgeons perform more than 4,000 operations annually, and, when surgery involves tumors of the skull base, participate with a cross-disciplinary array of specialists within the Center for Cranial Base Surgery at Penn. The combination of experience, high volume and a multidisciplinary approach to treatment ensures that neurosurgery patients at Penn achieve the best possible result.Performing Endoscopic Endonasal Surgery for Cranial Base Tumors at Penn MedicineNeurosurgeryM. Sean Grady, MDCharles Harrison Frazier Professor of Neurosurgery Chairman, Department of NeurosurgeryPenn MedicineJohn Y.K. Lee, MDAssistant Professor of NeurosurgeryOculoplastics Roberta Gausas, MDAssociate Professor of OphthalmologyOtorhinolaryngology-Head and Neck SurgeryBert W. O’Malley, Jr., MDGabriel Tucker Professor and Chair,Department of Otorhinolaryngology-Head and Neck SurgeryJason G. Newman, MDAssistant Professor of Otorhinolaryngology-Head and Neck SurgeryJames Palmer, MDAssociate Professor of Otorhinolaryngology-Head and Neck SurgeryAccessHospital of the University of Pennsylvania3 Silverstein3400 Spruce StreetPhiladelphia, PA 19104Pennsylvania HospitalWashington Square West Building235 South 8th StreetPhiladelphia, PA 19106 To refer a patient and/or consult with a physician:Call 800.789.PENN (7366) or visithttp://PennMedicine.org/referralNeurosurgery Clinical Research DivisionThe Neurosurgery Clinical Research Division (NCRD) is dedicated to the development of research projects that focus on the neurosurgical interventions for surgical disorders of the nervous system and present and publish the results of those trials at completion.The NCRD is committed to conducting clinical research that protects the rights of human subjects through adherence to the standard operating procedures for good clinical practice established at the University of Pennsylvania to ensure the institutional culture of research excellence.Current Clinical TrialsDystonia• Humanitarian Device Exemption (HDE) for Medtronic Activa® Dystonia Therapy (HDE# H0200007)• Subthalamic Nucleus and Globus Pallidus Deep Brain Stimulation in Dystionia: A Prospective, Double-Blind Study of Safety and Efficacy (HDE# H0200007)Brain Tumors• Phase V GliaSite® Radiation Therapy System (RTS) Registry Protocol for the Treatment of Resectable Malignant Brain Tumors• Phase III Randomized Evaluation of Convection Enhanced Delivery of IL13-PE38QQR Compared to Gliadel® Wafer with Survival Endpoint in Glioblastoma Multiforme Patients at First Recurrence• NABTT# 9903: Interstitial Infusion of IL13-PE38QQR Cytotoxin in Recurrent Malignant Glioma: Phase I/II Study
Diagnosis and Management of Interstitial Lung Disease
noreply@blogger.com (Penn Medicine) Mon, 09 Aug 2010 05:57:00 -0700
The Insterstitial Lung Disease program at Penn is a regional referral center for the evaluation, diagnosis and treatment of patients with ILD. The program is strongly complemented by its investment in research. A broad category of diseases characterized by scarring or fibrosis of the lungs, interstitial lung disease (ILD) includes idiopathic pulmonary fibrosis (IPF), collagen vascular associated ILD, chronic hypersensitivity pneumonitis and sarcoidosis and a host of other conditions. The clinical,physiologic and radiologic findings for the ILDs are similar. Some are more amenable to treatment than others; all are progressive and irreversible in their later stages. These facets of ILD place a critical value on accurate diagnosis and effective preventative treatment, when possible. In addition to epidemiologic studies, genetic studies and clinical trials, Penn was recently named a center for the IPF-Net, an NIH sponsored consortium of centers dedicated to research in IPF. The program is also actively involved in industry-sponsored clinical studies.The diagnosis of ILD at Penn features the interdisciplinarycoordination of expert lung pathologists and radiologists with cardiothoracic surgeons. Treatment includes both traditional and experimental therapies.Case Study 1Mr. L, a 58-year-old gentleman with a history of hypertension and hypercholesterolemia presented for evaluation. He noted increasing shortness of breath with exertion over the prior year, and had a dry persistent cough at evaluation.Mr. L first saw a cardiologist, who, finding no cardiovascular source for his dyspnea, referred him to a pulmonologist in his community. The pulmonologist performed PFTs and an HRCT, and suspecting ILD from their results, ordered a surgical lung biopsy at a local hospital.Mr. L was then referred to the ILD program at Penn Medicine, where his PFTs and the following HRCT were reviewed. These demonstrated mild restriction and moderate diffusion defect. An evaluation of his lung biopsy slides by a pathologist in the lung pathology division found changes typical of Usual Interstitial Pneumonitis (UIP), the pathology of IPF.After reviewing potential therapies with Mr. L, he chose to enroll in a clinical trial at Penn. He has just completed the first year of the study, and has now entered the open-label phase. His PFTs and symptoms have remained stable, and he is doing well on his study regimen.Case Study 2Mrs. D, a 61-year-old woman with a history of hypertension, was referred to the ILD program following several months of worsening dyspnea, fatigue, dry cough, rash and weakness. Following a PFT and HRCT, Mrs. D was found to have isolated DLCO. After serologic testing in consultation with a dermatologist at Penn, Mrs. D was diagnosed with dermatomyositis and ILD. A prednisone regimen was prescribed with dramatic improvement in Mrs. D’s symptoms. Eventually CellCept (mycophenolate mofetil) was added to her regimen and she was weaned from steroids. Today Mrs. D is maintained on low dose CellCept and remains symptom free.Our Team of FacultyThe Penn Interstitial Lung Disease Program was the first in the greater Philadelphia area specifically dedicated to the care of patients with this group of disorders. The program,which offers a multi-disciplinary approach to the diagnosis and treatment of patients with interstitial lung disease, includes experts in the fields of pulmonary medicine, thoracic surgery, radiology, pathology, nutrition, and rehabilitation medicine.Milton D. Rossman, MDDirector, Interstitial Lung Disease ProgramMaryl Kreider, MD, MSCECo-Director, Interstitial Lung Disease ProgramSeth A. Hoffman, MDPulmonary and Critical Care MedicineGregory Tino, MDChief, Pulmonary Clinical ServiceAccessPenn Lung CenterPerelman Center for Advanced MedicineWest Pavilion, 1st Floor3400 Civic Center BoulevardPhiladelphia, PA 19104To refer a patient and/or consult with a doctor:Call 800-789-PENN (7366) orvisit PennMedicine.org/referral Or PennMedicine.org/lung.
Detection and Management of Beryllium-Induced Disease
noreply@blogger.com (Penn Medicine) Mon, 09 Aug 2010 05:50:00 -0700
Today, the Penn Lung Center is one of six institutions nationwide and the only center in the Mid-Atlantic and Northeast Region offering diagnosis and treatment for beryllium-induced disease.An occupational granulomatous lung disorder caused by inhalation of beryllium dust or fumes, beryllium-induced disease has both acute and chronic pathologies. The acute form is now extremely rare. Chronic beryllium disease (CBD), by contrast, may affect as many as 16,000 individuals in the United States. Insidious and slow to progress, CBD is virtually identical pathophysiologically to chronic pulmonary sarcoidosis.Differentiating chronic pulmonary sarcoidosis from chronic beryllium disease is one of the specialties of the Penn Lung Center. For patients with chronic beryllium disease, early detection, treatment and removal from further exposure are paramount concerns.“A suspicion of beryllium exposure must be considered in all patients with histological evidence of pulmonary granulomata given the 50 year history of beryllium manufacturing in the US and the increasing use of the metal in a variety of industries worldwide.” Milton Rossman, MDDirector, Interstitial Lung Disease ProgramThe Penn Lung CenterCase StudyMr. W, a 56-year-old man, worked for five years in the early-1980s as a machinist in a factory manufacturing beryllium copper alloy pipe. His health was good until late 2001, when he began to experience occasional dyspnea and cough. An X-ray at this time was negative for lesions or opacifications. When a high-resolution CT in 2005 revealed confluent apical infiltrates in both lungs and evidence of mid-zone granularity, Mr. W’s pulmonologist diagnosed pulmonary sarcoidosis and referred him to the Penn Lung Center for treatment.At Penn, pulmonary function tests confirmed marked reduction of total lung capacity, vital capacity and diffusion capacity. A cardiopulmonary exercise test revealed exercise induced oxygen desaturation.Suspecting CBD from Mr. W’s work history, Penn pulmonologists performed a fiberoptic bronchoscopy and transbronchial biopsy, revealing non-caseating granuloma. Beryllium lymphocyte proliferation testing (BeLPT) was performed on blood and bronchoalveolar lavage cells . These tests proved sensitization to beryllium and Mr. W was diagnosed with chronic beryllium disease.He began prednisone, 40 mg, on alternate days, with almost immediate improvement of his dyspnea. The prednisone was titrated over 6 months to a maintenance dose.Our Team of FacultyThe Penn Lung Center is a destination center for the evaluation, diagnosis and treatment of patients with chronic beryllium disease. In addition to treatment and diagnosis, the Lung Center’s faculty is available to assist industry in the development of cost-effective screening programs for beryllium disease, as well as programs for the evaluation and treatment of symptomatic workers.Medical PathologyLeslie A. Litzky, MDAssociate Professor of Pathology and Laboratory MedicinePulmonary MedicineMaryl Kreider, MD, MSCEAssistant Professor of MedicineMilton Rossman, MDProfessor of MedicineRadiologyWallace T. Miller, Jr., MDAssociate Professor of RadiologyAccessPenn Lung CenterPerelman Center for Advanced MedicineWest Pavilion, First Floor3400 Civic Center BoulevardPhiladelphia, PA 19104To refer a patient and/or consult with a doctor:Call 800-789-PENN (7366) or visitpennmedicine.org/referral or http://PennMedicine.org/lung.
Comprehensive Care at Every Stage of Heart Failure
noreply@blogger.com (Penn Medicine) Mon, 09 Aug 2010 05:20:00 -0700
The Heart Failure and Transplantation Program at the Hospital of the University of Pennsylvania (HUP) has developed a multidisciplinary algorithm for heart failure management that reflects the chronic, progressive nature of the disease. Thus, the program provides a seamless continuum of care to address heart failure, its effects and comorbidities from its earliest stages onward."In designing a heart failure management program, it’s vitally important to embrace continuity of care, ideally beginning well before the first symptoms appear, to ensure consistent, appropriate treatment throughout the natural course of the disease.”Mariell Jessup, MD,Medical Director,Penn Heart and Vascular CenterCase StudyMr. W, a 58-year-old male with a two-year history of non-ischemic cardiomyopathy, was referred to the Penn Heart and Vascular Center. At presentation, his medications included carvedilol 25 mg BID, lasix 40 mg BID, enalapril 20 mg BID, and spironolactone 25 mg QD. Despite good compliance with this regimen, Mr. W was increasingly symptomatic, requiring an increase in his daily diuretic dose.After consultation at Penn, Mr. W was electively scheduled for right heart catheterization, which revealed a markedly abnormal cardiac performance, with a cardiac index of only 1.4L/min/m2 and an elevated pulmonary capillary wedge pressure (35mmHg) with normal systemic vascular resistance. Milrinone was initiated following admission to the inpatient heart failure unit, with improvement in cardiac index.An inpatient heart transplant evaluation was begun with the transplant team, including the nurse coordinator for transplant assessment and education, a social worker to address potential psycho-social concerns pre- and post-transplant, and a financial counselor to verify insurance and prescription coverage. A battery of lab tests was performed to more accurately determine Mr. W’s risk at the time of transplant and to aid in individualization of his post-transplant immunosuppression.Mr. W felt much better on inotropic support, although he developed significant ventricular dysrhythmias. At the weekly multidisciplinary transplant meeting, the cardiac surgeons decided to evaluate Mr. W for a ventricular assist device (VAD) as a bridge to transplant. Subsequently, he underwent successful implantation of the HeartMate® II. His recovery was uneventful.To ensure that he would be in optimal condition for his transplant, he was followed closely by the nutritionists and physical therapists on the transplant team. After successfully completing 6 weekly outpatient appointments with the VAD coordinators and HUP transplant cardiologists, Mr. W underwent heart transplant surgery. He has done remarkably well post-transplant. He eagerly talks about his experience and serves as an inspiration to those who are waiting on the list. He now comes in on a routine basis for his cardiac biopsies and is scheduled to start cardiac rehabilitation soon.Our Team of FacultyThe Penn Heart and Vascular Center is comprised of a multidisciplinary team of specialists and clinicians whose experience spans the breadth and depth of heart failure care. The team includes some of the nation's finest cardiologists, cardiovascular surgeons, nurses, transplant and VAD coordinators, as well as social workers and specialists in cardiac imaging, arrhythmia management, cardiac anesthesia, infectious disease, immunology and rehabilitation medicine. Together, this team is dedicated to the management of patients with complex heart failure.Heart FailureSusan C. Brozena, MDAssociate Professor of MedicineThomas C. Cappola, MD, ScMAssistant Professor of MedicineStephen M. Chrzanowski, MDBrian M. Drachman, MDClinical Assistant Professor of MedicineDaniel L. Dries, MDAssociate Professor of MedicinePaul R. Forfia, MDAssistant Professor of MedicineLee R. Goldberg, MD, MPHAssociate Professor of MedicineDonald C. Haas, MD, MPH, FACCClinical Associate of MedicineMariell L. Jessup, MDProfessor of MedicineKenneth B. Margulies, MDProfessor of MedicineJ. Eduardo Rame, MDAssistant Professor of Medicine Joyce W. Wald, DOAssistant Professor of Clinical MedicineRoss. R. Zimmer, MDClinical Assistant Professor of MedicineCardiovascular SurgeryMichael A. Acker, MDWilliam Maul Measey Professor of SurgeryRohinton J. Morris, MDClinical Associate Professor of SurgeryAlberto Pochettino, MDAssociate Professor of SurgeryWilson Y. Szeto, MDAssistant Professor of SurgeryY. Joseph Woo, MDAssistant Professor of SurgeryHeart Failure Nurse SpecialistsPatrice Schneider, RN, BSNJudy Marble, RN, BSNSarah Fontana, RN, MSNBonne Farberow, RN, BSNJudie Shilling, RNJoann Treacy, RN, BSNLinda Wells, RN, BSNAdam Greenberg, RN, BSNAmy Marzolf, RN, BSNNora Brennan, RN, BSNMechanical Circulatory Support Device (MSD) CoordinatorsMary Lou O’Hara, MSN, RN, CCRNKim Brewer, RN, BSNJudy Marble, RN, BSNHeart Transplant Clinical PractitionersSusan Chambers, MSN, CRNPWilhelmina Maslanek, MSN, CRNPMaria Molina, MSN, CRNPBridget Vincent, MSN, CRNPMary Williams, MSN, CRNPWilliam Wynne, RN, BSNPre-Transplant CoordinatorNicole Hornsby, MSN, CRNPSocial WorkersDeborah L. Gordon, MSS, LCSWSallie Blair Smith, MSWJulia Bruno, MSW, LSWFinancial CoordinatorCammy McCaskillClinical Operations DirectorDonna Chojnowski, MSN, CRNPFor more information on Heart Failure, Mechanical Assist Device and Transplantation programs and services.To refer a patient and/or consult with a doctor: Call 800-789-PENN (7366) or visithttp://PennMedicine.org/referral or http://PennMedicine.org/heart.
Distraction Osteogenesis
noreply@blogger.com (Penn Medicine) Wed, 23 Jun 2010 05:43:00 -0700
Oral and maxillofacial surgeons at Penn were among the first to apply distraction osteogenesis to the treatment of surgical, genetic, age-related and traumatic defects of the jaws.1 Originally developed to treat patients with orthopaedic trauma or disease, distraction osteogenesis involves the use of a distraction device to gradually (1 mm per day) separate existing bone segments, creating gaps where new bone forms.This process continues until the desired bone height or length is achieved, at which point a final consolidation, or healing, phase occurs. During this time, the immature osteoid matrix matures into bone. One advantage of distraction osteogenesis is that it precludes harvest bone grafting, a procedure with many potential complications.At Penn, distraction osteogenesis is used to produce bone growth in a wide range of conditions including alveolar atrophy of edentulous areas requiring endosseous implant-supported dental restoration; reconstruction following segmental resection of the jaw; alveolar defects due to traumatic injury and congenital alveolar deformity.Case StudyRW was referred to Penn Oral and Maxillofacial Surgery at age 13, when a lump was discovered in his left jaw. On examination, RW was noted to have a painless expansion of the left buccal cortex of the mandible and decreased light touch sensation of the left lower lip.Panorex and CT evaluation revealed a radiolucent lesion of the left mandible extending from the first premolar to the angle of the mandible. Histologic examination of an incisional biopsy of the lesion was consistent with desmoplastic fibroma. Rather than surgical management of the lesion, RW and his family opted for a course of chemotherapy at this time.When the lesion began to enlarge a year later despite this treatment, RW had a mandibular resection with free fibular bone graft reconstruction (Figure 1), a treatment judged successful. A year later, the neomandible was evaluated for possible dental rehabilitation. Because RW’s ridge height would not support endosseous implants and his bone graft was poorly positioned in relation to the adjacent dentition, augmentation of the neomandible was deemed necessary.RW had distraction osteogenesis to improve his alveolar height. Following removal of the reconstruction bone plate, the fibula graft was osteotomized to create a mobile segment at the superior aspect. Two alveolar distraction devices were then placed in parallel (Figure 2). Five days later, RW began activating the distraction devices at a rate of 1mm per day. After the device maximum of 1.5cm was achieved (Figure 3), RW entered the three-to-four month consolidation phase, then returned for removal of the distractors. Examination at this time revealed adequate height of bone to support dental implants. Subsequently, RW underwent placement of eight dental implants (Figure 4) followed by fabrication of an implant-supported dental restoration. His appearance restored, RW has returned to school and has had no complications.1. Havlik RJ, Bartlett SP. J Craniofac Surg. 1994;5:305-310.Our Team of FacultyThe Penn Department of Oral and Maxillofacial Surgery is composed of a multidisciplinary team of dental/ medical specialists whose expertise encompasses non-surgical and surgical treatment of oral and maxillofacial disorders, traumatic injuries, congenital defects, oral lesions and temporomandibular joint dysfunction.Lawrence M. Levin, DMD, MDChair, Department of Oral and Maxillofacial SurgeryLee R. Carrasco, DDS, MDAssistant Professor of Oral and Maxillofacial SurgeryJoli C. Chou, DMD, MDInstructor, Oral and Maxillofacial SurgeryHelen Giannakopoulos, DDS, MDAssistant Professor of Oral and Maxillofacial SurgeryBarry H. Handler, DDS, MDAssociate Professor of Oral and Maxillofacial SurgeryPeter D. Quinn, DMD, MDProfessor of Oral and Maxillofacial Surgery and Pharmacology-Clinician EducatorDavid C. Stanton, DMD, MD, FACSAssociate Professor of Oral and Maxillofacial SurgeryAccessPatient appointments are available at:Department of Oral and Maxillofacial SurgeryHospital of the University of Pennsylvania5 White3400 Spruce StreetPhiladelphia, PA 19104Penn Presbyterian Medical Center38th and Market Streets235 Myrin PavilionPhiladelphia, PA 19104Penn Medicine at Radnor250 King of Prussia RoadRadnor, PA 19087To refer a patient and/or consult with a physician: Call 800.789.PENN (7366) or visit PennMedicine.org/referral.
Focus: Penn’s Neuro­-Ophthalmology Service
noreply@blogger.com (Penn Medicine) Mon, 21 Jun 2010 11:50:00 -0700
The Penn Neuro-Ophthalmology Service bridges the fields of ophthalmology and neurology to provide diagnosis and treatment for patients with neurological and systemic diseases that affect vision and eye movements. A part of the renowned Scheie Eye and Penn Neurological Institutes, the Penn Neuro-Ophthalmology Service is the largest of its kind in the nation. Penn’s fellowship-trained neuro-ophthalmologists work in concert with specialists in ophthalmology, neurology, neurosurgery, otorhinolaryngology and neuro-radiology to achieve a comprehensive approach to disease evaluation, diagnosis, and treatment. The team has extensive experience with all forms of neuro-ophthalmic disease, including double vision, optic neuropathy, pupillary abnormalities, visual field defects, nystagmus, and visual defects related to neoplastic disease.Case StudyMrs. V,, a 36-year-old woman, was evaluated for acute visual loss and abduction deficits. Between the ages of 20 and 24, she had eight lumboperitoneal shunt revisions for treatment of pseudotumor cerebri. Three months prior to presentation she experienced headaches, blurred vision, and nausea. One month prior to presentation her vision and optic nerve appearance was normal.She then developed a constant severe headache and neck pain and vision loss that worsened over several days. Upon examination, she had no light perception vision in the right eye, 20/70 visual acuity and a large nasal visual field defect in the left eye.In addition, bilateral sixth nerve palsies, and severe pallid papilledema with peripapillary hemorrhages and venous distension were evident. Magnetic resonance imaging (MRI) of the brain was normal. Lumbar puncture opening pressure was markedly elevated at 550 mm H20 (nl A diagnosis of severe acute vision loss due to pseudotumor cerebri and lumboperitoneal shunt failure was made. Intravenous methylprednisolone and acetazolamide were administered immediately. Optic nerve sheath fenestration was then performed on the right optic nerve, and the lumboperitoneal shunt was externalized. A malfunctioning valve was discovered when the shunt was revised. Postoperatively, the steroids and azetazolamide were discontinued. The patient’s vision improved rapidly. Two weeks later the papilledema had almost resolved, and visual acuity was 20/20 in both eyes with residual infranasal constriction of the visual fields of each eye.Clinical TrialsMultiple Sclerosis – The Penn Division of Neuro­Ophthalmology is currently participating in a randomized clinical trial to determine whether combination interferon beta­1a (IFN) and glatiramer acetate (GA) is a measurably better therapy than either agent alone in patients with relapsing­remitting (RR) multiple sclerosis (MS).Our Team of Faculty The Scheie Eye Institute and Penn Neurological Institute offer complete diagnostic and treatment services in comprehensive and subspecialty ophthalmology and neurology. The breadth of expertise and experience in the Penn Division of Neuro­Ophthalmology provides a comprehensive network of care for patients with complex conditions that span both neurology and ophthalmology. Our team is also leading the development of novel therapies for neuro­ophthalmic diseases through cutting­edge clinical and basic science research studies, teaching, and residency and fellowship training.Steven L. Galetta, MDChief, Neuro-Ophthalmology DivisionVan Meter Professor of Neurology and OphthalmologyLaura J. Balcer, MD, MSCEAssociate Professor of Neurology and OphthalmologyDina Jacobs, MDAssistant Professor of NeurologyGrant T. Liu, MDProfessor of Neurology and OphthalmologyKenneth S. Shindler, Md, PhDAssistant Professor of OphthalmologyMadhura A. Tamhankar, MDAssistant Professor of OphthalmologyNicholas J. Volpe, MDAdele Niessen Professor of Neurology and OphthalmologyAccessPatient appointments are available at:Scheie Eye Institute atPenn Presbyterian Medical Center39th and Market StreetsPhiladelphia, PA 19104Penn Eye Care at theHospital of the University of PennsylvaniaDepartment of Ophthalmology2nd Floor, Gates Building3400 Spruce St.Philadelphia, PA 19104Department of NeurologyHospital of the University of Pennsylvania2nd Floor, Ravdin Building3400 Spruce St.Philadelphia, PA 19104Penn Eye Care at Radnor250 King of Prussia RoadRadnor, PA 19007To refer a patient and/or consult with a physician: Call 800.789.PENN (7366) or visit PennMedicine.org/referral.

KevinMD.com

We need a better way to share information to care for patients
Kevin Fri, 03 Sep 2010 08:00:47 -0700
by Edward Pullen, MD This evening I went to a meeting of many of the independent physicians in our community who came together to discuss ways we can help each other to remain viable as relatively small independent practices of medicine.  Two things about the meeting really hit home for me. First is [...]
The primary care specialist pay gap shouldn’t be squeezed too hard
Kevin Fri, 03 Sep 2010 06:00:54 -0700
by Colin Son, MD The primary care-specialist pay gap is a popular target for those eager for reform. The gap is hailed independently as an example of and a cause of the lack of focus on primary care and prevention in the United States. There is no doubt that the United States treats primary [...]
Most doctors don’t like prescribing pills
Kevin Fri, 03 Sep 2010 04:00:02 -0700
by Melanie Lane, MD I am a medical doctor.  I am also called an allopath, someone who practices “Western medicine.” We allopaths like data, proof, science, randomized, double-blind, placebo-controlled trials.  We want to know the “mechanism of action.”  We want someone to prove that yoga or medication or some procedure actually helps your [...]

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