Fourth Annual Scholarship Day

David Geffen School of Medicine at UCLA

and

Drew University of Medicine and Science

Friday, March 16, 2007

UCLA Faculty Center

Conference Moderator:

Wendy Coates, MD Chair, Acute Care College Director, Medical Education

Harbor-UCLA Department of EM

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Table of Contents

Schedule...............................................................................................3

California Room....................................................................................4 SURGERY I ...................................................................................................4 SURGERY II ..................................................................................................4 MEDICINE ....................................................................................................4 HEMATOLOGY/ONCOLOGY ..............................................................................5 INFECTIOUS DISEASES ..................................................................................5 MEDICAL EDUCATION ....................................................................................6 HEALTH DISPARITY........................................................................................6

Sequoia Room.......................................................................................7 HEALTH POLICY.............................................................................................7 OB/GYN & WOMEN’S HEALTH ..........................................................................7 RADIOLOGY/IMAGING....................................................................................7 HEAD & NECK/ENT.........................................................................................8 DERMATOLOGY .............................................................................................8

Sierra Room..........................................................................................9 OPHTHALMOLOGY..........................................................................................9 PEDIATRICS..................................................................................................9 MENTAL HEALTH............................................................................................9

Concurrent Plenary Sessions ..............................................................10

Abstracts ............................................................................................11 Ashwini Sagar .............................................................................................11 Michael Burgess ..........................................................................................11 Timothy Smith ............................................................................................11 Amy Swerdlin..............................................................................................12 Stephen Doane ...........................................................................................12 Olga Fedin ..................................................................................................13 Namita Singh ..............................................................................................13 Jessica Low.................................................................................................13 Osita Onugha..............................................................................................14 Stephen Beckham........................................................................................14 Rondeep Brar..............................................................................................14

Schedule

8:00 – 9:00 am Check-In Faculty Center Lobby

Continental Breakfast Buffet California Room Patio

Poster Set-up California, Sequoia & Sierra Rooms

9:00 – 11:00 am Concurrent Poster Sessions Group A – California Room Group B – Sequoia Room Group C – Sierra Room

10:40 – 10:55 Students remove posters no later than 10:55

11:00 – 12:00 noon Concurrent Plenary Oral Sessions Group A – Hacienda Room Group B – Downstairs Lounge

Noon Raffle Drawing

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Concurrent Poster Session Schedule California Room

9:30 & 9:45 am SURGERY I

Moderator: Alan Lefor, MD, MPH 9:30 am

Poster Student Topic 1 Rambhatla,

Amarnath Long Term Sildenafil Treatment Ameliorates Corporal Veno-Occlusive Dysfunction (CVOD) Induced by Cavernosal Nerve Resection in Rats

2 Stepanian, Sevan Positive Margins In Laparoscopic Partial Nephrectomy In 855 Cases: A Multi-Institutional Survey from USA and Europe

3 Vaca, Luis Advanced Age as a Risk Factor for Free Tissue Transfer Breast Reconstructions Using TRAM and DIEP Flaps: A Review of 372 Operations

4 Wu, Jeffrey Correlation of Clinical and Radiological Outcome of Renal Cell Carcinoma Brain Metastases Treated with SRS

5 Gainsbury, Melanie Congenital Diaphragmatic Hernia: Are We Making a Difference? 6 Patel, Vishal Management of Symptomatic Clavicle Non-Unions with Plate

Osteosynthesis and Local Bone Grafting

SURGERY II Moderator: Chris DeVirgilio, MD

9:45 am 7 Andacheh, Iden Cocaine-Induced Aortic Dissection 8 Zimmer, Raymond Establishment of a Patient Database for Analysis of Outcomes of

Percutaneous Coronary Intervention with Drug-Eluting Stents 9 Roth, Kevin Symptomatic Osteonecrosis of the Hip and Knee After Cardiac

Transplantation 10 Jones, Trishena The Role of Emergency Thoracotomy in Thoracic Trauma: Case Report

and Literature Review 11 Aquino, Glen Cricothyrotomy in Head and Neck Trauma: A Population at Risk 12 Suckow, Bjoern Increasing Number of Rib Fractures Predicts Mortality in Multi-Injury

Blunt Trauma Victims 13 Selassie, Sirach Colorectal Cancer Screening Rates in the African American Population

MEDICINE Moderator: Aravind Mani, MD

9:30 am 14 Buell, Catherine Using Glycated Hemoglobin (HbA1c) to Screen for Undiagnosed

Diabetes (NHANES 1999-2004) 15 Cottrell, Mi’quael The Relationship of 25-Vitamin D (25-D) Levels and Glomerular

Filtration Rate (GFR) by Race and Ethnicity: Data from the Third National Health & Nutrition Examination Survey (NHANES III)

16 Ho, Mailinh Effects of Wearing Front-Elevated Shoes on Oxygen Consumption and Weight Control

17 Kim, Woojae Evaluation of Acupuncture on Stroke Rehabilitation 18 Navarro, Geraldine Beliefs about Diabetic Medications among African American and Latino

Patients and its Impact on Diabetes Outcome 19 Trimble, Keila A Case Report of Lambert Eaton-Myasthenic Syndrome in a Patient with

Small Cell Lung Carcinoma 20 Zhu, Amy Gastric Acid and Bicarbonate Secretion in TRPV1 Knockout Mice

Concurrent Poster Sessions - Continued California Room

9:30 – 9:45 am HEMATOLOGY/ONCOLOGY Moderator: Gary Schiller, MD

9:45 am Poster Student Topic

21 Bruhn, Aron Variation in the Use of Gross and Frozen Section Pathological Consultations During Kidney Cancer Surgery

22 Chang, Pauline Hospital Reporting of Maternal Complications 23 Khan, Omer Small Papillary Thyroid Carcinoma: Analysis by US Guided

Nonaspiration Fine Needle Biopsy 24 Laury, Anna Lung Pathology Following Stem Cell Transplant 25 Lemus, Miguel Recurrent Cervical Cancer in the Emergency Department 26 Leung, Thomas Achieving Stability of LPS-Induced NF-KB Activation 27 Martinez, Kevin Are Students Prepared to Care for Cancer Survivors after Medical

School? 28 Winge, Goldie Urological Complications of Sickle Cell Disease among Children and

Adults in Spa 6

INFECTIOUS DISEASES Moderator: Matthew Liebowitz, MD

9:30 am 29 Abelson, Jonathan Fungemia in Children 30 Hernandez, Joseph Galectin-1 Binds Different CD43 Glycoforms to Cluster CD43 and

Regulate T Cell Death 31 Liang, Juliana Acinetobacter Bacteremia Following a Hamster Bite 32 Lopez, Jose Luis Cerebral Infection by Mycobacterium Avium Complex in Patients with

Acquired Immunodeficiency Syndrome 33 Miniel, Nicholas Evaluation of Outreach Program Targeting HIV Positive Individuals in

South Los Angeles 34 Oganesyan, Gagik Critical Role of TRAF3 in the Toll-Like Receptor-Dependent and -

Independent Antiviral Response 35 Ratanasen, Milin West Nile Virus Meningitis/Encephalitis: A Case Report

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Concurrent Poster Sessions - Continued California Room

9:30 – 9:45 am MEDICAL EDUCATION

Moderator: Sebastian Uijtdehaage, MD 9:45 am

Poster Student Topic 36 Desylvia, Dawn The Knowledge, Attitudes, and Usage of Complementary and

Alternative Medicine of Medical Students 37 Nguyen, Annie Healthier Fast Food Choices 38 Osaseri, Uyi Family Medicine Residents’ Perception of Communication Skills 39 Viernes, Darwin Improving Situational Awareness in the Acute Care Setting: A Method

of Teaching Students to Think Like Instrument Pilots 40 Constantinescu,

Octav Developing OASIS - Online Anesthesiology Sub-Intern Information Storehouse: A Roadmap for Sub-Internships, Research, Residency, and a Career in Anesthesiology

41 Hosseini, Puya Anesthesia Website 42 Nasseri-Noori, Kevin Acute Care College Anesthesiology Website 43 Umstot, Amber ANGEL Anesthesiology Website

HEALTH DISPARITY Moderator: Dora Weiner, MD

9:30 am 44 Bastian, Lakisha Was the Geographic Distribution of Mortality Attributed to Hurricane

Katrina Due to Elevation Alone? 45 Brambila, Maxamino Beliefs About Diabetic Medications among African American and Latino

Patients and its Impact on Diabetes Outcome 46 Harris, James The Multi-Ethnic Study of Atherosclerosis: Racial Differences in the

Inflammatory Markers Interleukin-6 and C Reactive Protein 47 Imamura, Susan Perception of Mental Illness and Utilization of Mental Health Services

among Asian and Asian American Undergraduates 48 Kirolos, Henry Establishing a Clinic for the Underserved of Santa Ana, CA 49 Lemus, Jesus Assessing Cultural Competency in the Latino and Somali populations of

Metro-Atlanta 50 Espejo, Jay Faith, Religiosity, and Pain Tolerance

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Concurrent Poster Session Sequoia Room

9:30 & 9:45 am HEALTH POLICY

Moderator: David Schriger, MD 9:45 am

Poster Student Topic 51 Bahl, Nupur Medical Errors and Their Prevention 52 Deng, Holly Attempting near universal health care coverage: a comparison of the

plans in Maine, Massachusetts, Vermont, and Hawaii with the new California proposal

53 Lowen, Stacey Role of Alcohol and Drugs in Exposure to Violence among a sample of American Indians

54 Luke, Janiene Dietary Habits of African Americans in Los Angeles 55 Morairty, Zachary UCLA Healthcare Advocacy Group 56 Solomon, Matthew Cost-sharing and the initiation of antihypertensive medication 57 Zaghi, Daniel Pain in America: A Survey of the Prevalence, Barriers Behind, Costs

and Consequences of Inadequate Pain Coverage in America

OB/GYN & WOMEN’S HEALTH Moderator: Dotun Ogunyemi, MD

9:30 am 58 Aguilera, Lucy Documented Short-Term Continuation Rates for Combined Hormonal

Contraceptives 59 Benalt, Wendi A case of Bartter syndrome complicated by acute renal failure in the

setting of severe pre-eclampsia 60 Nguyen, Phuong Protracted first stage of labor and postpartum hemorrhage 61 Hecht, Danielle Protracted Second Stage of Labor and Postpartum Hemorrhage 62 Nnoli, Aisha Confined placental mosaicism and intrauterine growth restriction in

assisted reproductive technologies 63 Shapiro, Kimberly Recurrent Breast Cancer or New Primary? : Case Report of an Unclear

Presentation 64 Thorne, Diana Looking deeper in advanced paternal age 65 Truong, Christina Resistance to Lapatinib, a dual kinase inhibitor in HER-2 Positive Breast

Cancer

RADIOLOGY/IMAGING Moderator: Kathy Brown, MD

9:45 am 66 Alemozaffar,

Mehrdad Intraoperative Infrared Imaging for Detection of Organ Ischemia and Identification of Anatomic Structures

67 Allen, Jared Innovations in Quantitative Image Analysis of High Resolution Computed Tomography: Heterogeneous Patterns of Airway Reactivity in Asthma

68 Lee, Nicolas Dynamic Magnetic Resonance Imaging of the Lumbar Spine 69 Lee, Deborah Pancreatic Phase Multidetector CT Angiography: Performance in

assessment of surgical resectability of pancreatic adenocarcinoma in 45 consecutive patients

70 Roybal, Donna Mapping the Effects of Gender and APOE e4 Allele in a Longitudinal MRI Study of Normal Aging

71 Woodhouse, Kimberley

Atypical Presentation of Discitis and Epidural Abscess in DISH Syndrome

Concurrent Poster Session - Continued Sequoia Room

9:30 & 9:45 am HEAD & NECK/ENT

Moderator: Ken Wolf, MD 9:30 am

Poster Student Topic 72 Basseri, Benjamin Current National Incidence, Trends, and Health Care Resource

Utilization of Cleft Lip and Palate 73 Golshan, Ali Clinical and Angiographic Outcomes of Coil Embolization of Posterior

Communicating Artery Aneurysms 74 Gomes, Esteban Cleft Palate 75 Kim, Alyn Salvage Surgery with Free Flap Reconstruction 76 Jackson, Eric Evaluation and Management of Macrocephaly 77 Mansour, Masood Gastroesophageal Reflux Protects Against Periodontal Disease While

Worsening Dental Erosions 78 Vyas, Raj Defining Optimal Patient Selection for Mandibular Distraction

Osteogenesis in Management of Neonatal Upper Airway Obstruction

DERMATOLOGY Moderator: Lorraine Young, MD

9:45 am 79 Acree, Sara Severe Atopic Dermatitis: A Pediatric Case Report 80 Crittenden, Daria Sweet's syndrome in association with systemic lupus erythematosus 81 Paravar, Taraneh Combination therapy using topical corticosteroids and

immunomodulators in the treatment of vitiligo: a retrospective analysis 82 Thai, Hao Detection of Braf mutation in melanoma 83 Jalian, Hrak All-trans retinoic acid shifts propionibacterium acnes induced matrix 84 Nguyen, Alain Relative Efficacy of Psoriasis Treatment Options

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Concurrent Poster Session - Continued Sierra Room 9:30 & 9:45 am

OPHTHALMOLOGY Moderator: Lynn Gordon, MD

9:30 am Poster Student Topic

85 Chang, Vicky Etanercept associated optic neuropathy 86 Freeman, Breanna Meta-analysis on the recurrence of pterygium after primary pterygium

excision by bare sclera resection with mitomycin, conjunctival autograft, or amniotic membrane transplant

87 Huang, Jennifer Digital infrared thermography in the assessment of treatment response in thyroid associated orbitopathy: A pilot study

88 Huang, Lynn Supplement Use of Selenium is Associated with a Decreased Risk of Cataract Surgery among Older Women

89 Momi, Rominder Exclusion of Coding Mutations at the 1p36 Locus for Schnyder Crystalline

90 Nguyen, Anne Central vision snuff-out in advanced glaucoma patients undergoing trabeculectomy

91 Wangu, Zoon Patient JH: Case Report in Pediatric Noninfectious Uveitis

PEDIATRICS Moderator: Daphne Calmes, MD

9:45 am 92 LaCaze, Courtney Costa Rica 93 Lee, Tiffany Prenatal Programming of Childhood Overweight and Obesity 94 Ly, Lisa Improving Long Term Follow-up Care for Childhood Cancer Survivors 95 Ramirez, Rey Pediatric Desmoid tumor 96 Ruiz, Maritza What factors contribute to seeking long-term follow-up care amongst

Hispanic pediatric cancer survivors and their non-Hispanic white counterparts?

97 White, Natasha Examining Trends in Blood Component Usage and Donor Exposures Among Neonates Undergoing Extracorporeal Membrane Oxygenation: A Comparative Analysis of the Literature

98 Unruh, Brandon Henry Beecher and the Distorted Legacy of the Willowbrook Hepatitis Studies

MENTAL HEALTH Moderator: Margi Stuber, MD

9:30 am 99 Chan, Molina A 29-year-old female with Munchausen syndrome 100 Garcia-Toledo, Sergio Hippocampal Changes in Adolescents with Psychosis Prodrome and

Early Psychosis 101 Antelo, Fernando Correlates of readiness to change drinking behaviors among a sample

of inner-city Emergency Department patients with alcohol problem 102 Kaldas, Marian Prevalence And Correlates Of Depression In A National Sample Of

Medical Students 103 Kayman, Joshua Discussing Religion and Spirituality with Hispanic Patients 104 Moccia, Robert A Role for Active Nuclear Import During Long-Term Plasticity of Aplysia

Synapses 105 Rasyidi, Ernest Prevalence of Problem Gambling in Local Asian Americans 106 Villanueva, Monissa Do Parental Psychosocial Factors Have An Impact On Hospital

Utilization Of Pediatric Post-Transplant Patients?

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Concurrent Plenary Sessions Hacienda Room and Downstairs Lounge

11:00 – 12:00 noon Student presentations are 6 minutes in length

followed by a 3-minute question and answer period.

Moderator: Jonathan Hiatt, MD Hacienda Room – Group A

Time Student Mentor Presentation 11:00–11:09 Sagar, Ashwini Lawrence Maldonado,

MD The Evolution of Intensive Care Units: From the 1950’s to the 21st century

11:10–11:19 Burgess, Michael Charles L. Sawyers, MD Comparative Analysis of Two Clinically Active BCR-ABL Kinase Inhibitors Reveals the Role of Conformation-Specific Binding in Resistance

11:20–11:29 Smith, Timothy Shahrzad Bazargan-Hejazi, MD, Behrouz Salehian, MD, Richard Lindstrom, Sergio Infante, MD

Overweight & Obesity in US Medical Residents

11:30–11:39 Swerdlin, Amy Noah Craft MD, PhD, DTM&H

Cutaneous Signs of Child Abuse

11:40–11:49 Doane, Stephen Brant Putnam, MD The Ability of Emergency Medicine Physician-Performed Ultrasound to Predict Acute Gallbladder Disease Requiring Surgical Intervention

Moderator: Jodi Friedman, MD Downstairs Lounge – Group B

Time Student Mentor Presentation 11:00–11:09 Fedin, Olga Charles Niesen, MD Clinical Characterization of Children with

Complex Partial Epilepsy 11:10–11:19 Singh, Namita Nigel Bamford, MD Chronic Methamphetamine Induces Very

Long-Term Depression of Striatal Excitation

11:20–11:29 Low, Jessica David Sarraf, MD Comparison of Diabetic Retinopathy Phenotype Between Latinos and Blacks

11:30-11:39 Onugha, Osita Brant Putnam, MD Near-Infrared Spectroscopy-Derived Cerebral Oximetry Predicts Oxygen Delivery In A Controlled Model Of Altered Perfusion

11:40–11:49 Beckham, Stephen

John Williams, MD Chorionic Villus Sampling and Risk for Hypertensive Disorders of Pregnancy

11:50–11:59 Brar, Rondeep Peggy Miles, MD Acute Dapsone-Induced Methemoglobinemia in a 24 Year-Old Female with Ulcerative Colitis

12:00 noon Door Prize Drawings Hacienda Rooms and Downstairs Lounge

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Abstracts

Hacienda Room Group – A

Ashwini Sagar The Evolution of Intensive Care Units: From the 1950’s to the 21st century

Intensive care units (ICUs) are now a well-established part of healthcare systems around the world. The greatest strides in the evolution of critical care took place in the second half of the 20th century. Via a thorough analysis of primary sources, interviews with medical intensivists, and detailed evaluation of historical texts, this thesis examines the key developments in the past five decades that have led to our modern day notion of intensive care. The polio epidemic in Denmark demonstrates one of the initial patient care models that resembled that of our modern day ICU. The spread of tuberculosis in the 1950s led to the creation of sanitariums in Europe and the United States, and an appreciation for the value of specialized nursing care for critically ill patients. In the 1960s, the advent of mechanical ventilation led to a boon in the number of hospitals that housed ICUs. Even though the Society for Critical Care Medicine was established a decade later, it was not until 1986 that critical care was recognized by the American Board of Medical Specialties. In the 21st century, ICUs face many challenges brought on by managed care, the ageing population, and issues of medical ethics. A look back at the evolution of this unique specialty allows for a better understanding of the epidemics and innovations that have contributed to our current ICU system.

Michael Burgess Comparative Analysis of Two Clinically Active BCR-ABL Kinase Inhibitors Reveals the Role of

Conformation-Specific Binding in Resistance Structural studies suggest that most point mutations in the BCR-ABL kinase domain cause resistance to the ABL kinase inhibitor imatinib by impairing the flexibility of the kinase domain, restricting its ability to adopt the inactive conformation required for optimal imatinib binding, rather than by directly interfering with drug contact residues. Dasatinib, currently in clinical development for imatinib-resistant CML, is a dual SRC/ABL kinase inhibitor that binds ABL in both the active and inactive conformation. To examine the potential role of conformational binding properties in drug resistance, we mapped the mutations in BCR-ABL capable of conferring resistance to dasatinib. Through saturation mutagenesis, we identified 13 such BCR-ABL mutations, 9 of which occurred at drug contact residues accounting for over 95% of the isolates. Some mutants were unique to dasatinib whereas others also conferred imatinib resistance. Remarkably, the identity of the amino acid substitution at either of two contact residues differentially affects sensitivity to imatinib or dasatinib. The combination of imatinib plus dasatinib greatly reduced the recovery of drug resistant clones. Our findings provide further rationale for considering kinase conformation in the design of kinase inhibitors against cancer targets.

Timothy Smith Overweight & Obesity in US Medical Residents

Objectives: Two-thirds of Americans are either overweight or obese, leading to calls from the NIH, the US Surgeon General, and the WHO to consider and deal with excess weight as a serious public health threat. While there is some data regarding the prevalence of this epidemic among medical students and practicing physicians, there is little that deals with medical residents. Methods: To determine the body mass index (BMI) and health behaviors that impact weight gain in medical residents, a cross-sectional, 50-question online survey compiled from previously validated surveys for exercise, diet, and weight loss/gain was provided to 113 randomly selected ACGME accredited US residency programs (representing approximately 3500 residents within seven specialties: family medicine, general surgery, psychiatry, obstetrics and gynecology, internal medicine, pediatrics, and neurology). All statistical analysis was performed using SPSS software 12.0. Results: Approximately 38% of the programs contacted responded to the survey (60% female, average age = 30 yrs). The average resident BMI increased from 25 to 26 (p<.01) across all residents throughout an average residency duration of 2.5 years. This represented an average weight gain of 2.3 lbs/year (p<.01). After beginning residency, 60% of respondents reported exercising less, 80% reported not having enough time to exercise, 46% think changing their diet is a high priority, 42% are eating worse, and approximately 65% want to lose weight. Conclusion: These data suggest that regardless of specialty, the BMI of many residents increases during graduate medical education.

Amy Swerdlin Cutaneous Signs of Child Abuse

Maltreatment of children is a major public health crisis and it is estimated that each year over 3 million children are victims of abuse. 2,000 children die from abuse each year and the numbers are increasing. Safeguarding the welfare of children is a priority and it is the moral and ethical responsibility of healthcare professionals to detect cases of abuse and intervene appropriately to prevent further harm. Physical abuse is the most frequently reported form of child abuse, with skin injury being the most common manifestation. Clinicians are often challenged to differentiate signs of child abuse from skin conditions that mimic maltreatment. This determination is critical in protecting the safety of children since there is a 50% chance of recurrent abuse and a 10% chance of death if maltreatment is not detected at the initial presentation. Although the detection of child abuse is of critical importance, a misdiagnosis can also be traumatizing to the child, family, and those who are suspected of abuse. Therefore, it is essential for dermatologists and other healthcare providers to be able to correctly identity and capture child abuse while avoiding inappropriate diagnosis. Currently, few resources specific to dermatological signs of abuse exist to aid in diagnosis. This scholarly project will entail the development of a CME review article to be used as an educational resource to assist dermatologists and other clinicians in differentiating cutaneous signs of physical and sexual child abuse from mimickers of inflicted injury. In addition, the project will also involve the development of pediatric anogenital and physical abuse computer-based modules to ultimately be used in primary care clinics and emergency rooms to guide clinicians in the visual diagnosis of abuse. The goals of the project will be to increase awareness of this prevalent problem, improve diagnosis of abuse and help clinicians understand the appropriate steps in management and reporting.

Stephen Doane The Ability of Emergency Medicine Physician-Performed Ultrasound to Predict Acute Gallbladder

Disease Requiring Surgical Intervention A retrospective study was done to evaluate the ability of gallbladder ultrasonography performed by emergency medicine (EM) physicians to predict the need for cholecystectomy. 1161 patients with a history and physical exam consistent with acute gallbladder disease underwent bedside ultrasonography by an EM physician to look for cholelithiasis and sonographic signs of cholecystitis. Of these, 325 patients had subsequent cholecystectomy within three weeks of admission for suspected cholecystitis. Surgical pathology results were reviewed as a reference standard for comparison with ultrasound findings. The finding of cholelithiasis on EM physician-performed ultrasonography had a sensitivity of 92.4% for acute cholecystitis and 93.8% for either acute or chronic cholecystitis. In patients who received cholecystectomy, the finding of cholelithiasis on EM physician-performed ultrasonography, combined with a high clinical suspicion for acute gallbladder disease, had a positive predictive value of 99.7% for either acute or chronic cholecystitis. Ultrasonography performed by a radiologist was found to have a sensitivity and positive predictive value similar to that performed by an EM physician in a subset of 104 patients who received cholecystectomy. Bedside ultrasonography performed by an EM physician is a sensitive and efficient method to identify patients with acute gallbladder disease requiring surgical evaluation and treatment.

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Downstairs Lounge Group – B

Olga Fedin Clinical Characterization of Children with Complex Partial Epilepsy

The majority of children with complex partial epilepsy have no identified cause, i.e. no family history of epilepsy and normal neuroimaging studies. In the past, these children with idiopathic (non-lesional) childhood epilepsies have been treated as a homogenous group despite the fact that their seizures manifest themselves in a variety of ways. The purpose of this study was to examine whether this group could be clinically subdivided into subgroups and to determine whether this subgroup classification would lead to information on prognosis and outcome of the seizure disorder. METHODS: Children with complex partial epilepsy (ages 6 months to 18 years of age) were included in the study if their neuroimaging studies were normal and if there was no family history of epilepsy. RESULTS: From epilepsy population of greater than 300 patients at Cedars Sinai Medical Center, 85 children with idiopathic complex partial epilepsy were identified. Patients were subdivided by age of seizure onset and by EEG localization of seizures. Approximately equal numbers of patients with frontal and temporal lobe epilepsies were found, with ages of onset spanning the full pediatric range. An interesting subgroup of patients with primary nocturnal epilepsy was uncovered. CONCLUSION: Details of seizure localization and age of onset are important factors that determine seizure disorder duration and prognosis. Patients with nocturnal epilepsy often require more medications than those with daytime seizures and may indicate an important subgroup for further analysis and genetic study.

Namita Singh Chronic Methamphetamine Induces Very Long-Term Depression of Striatal Excitation

Background: Behavioral sensitization to psychostimulants and other drugs of abuse reflects complex alterations in striatal neurotransmitters including dopamine and glutamate. Study Design and Methods: To determine the effect of chronic psychostimulant exposure on glutamate release from cortical terminals in the dorsal striatum, we used the endocytic tracer FM1-43, in combination with multiphoton confocal microscopy in slice preparations from methamphetamine (METH)-exposed adult and neonatal C57B1/6 mice. The activity-dependent release of FM1-43 out of corticostriatal terminals allows a measure of terminal kinetics quantified by the halftime decay of fluorescence intensity. Results: Mice treated with METH for 10 days demonstrated a long-lasting, dose-dependent reduction in corticostriatal release with a �paradoxical' increase in release following drug reinstatement in vivo. During withdrawal, the combination of amphetamine and the dopamine D2 receptor antagonist sulpiride normalized release. Similarly, corticostriatal release was depressed following METH-exposure in utero and returned to control halftimes following exposure to amphetamine and sulpiride. Treated mice demonstrated no increase in striatal apoptosis. The muscarinic antagonist atropine increased release in a dose-dependent manner, whereas nicotine and acetylcholine accelerated release. Conclusion: These data suggest that chronic exposure to psychostimulants results in a very long-term depression of vesicular glutamate release, reflecting alterations in cholinergic receptor sensitivity. As drug withdrawal depresses the release of acetylcholine from cholinergic interneurons, psychostimulants may tilt the balance between acetylcholine and dopamine, mediating long-lasting changes in striatal function.

Jessica Low Comparison of Diabetic Retinopathy Phenotype between Latinos and Blacks

Purpose: The objective of this study is to delineate the difference in the phenotype of diabetic retinopathy (DR) between Blacks and Latinos using characteristics shown on fundus photography (FP) and fluorescein angiography (FA). This may help to determine the prognosis of DR and tailor management according to racial profile Methods: This is a retrospective study of medical charts of Black and Latino diabetics from the KDMC Eye Clinic from 1/1998 to 3/2005. Systemic data such as Hemoglobin A1C (HbA1C) were collected. FP and FA were analyzed and graded according to ETDRS criteria. Statistical analysis was performed to determine whether a given lesion type was more characteristic of a particular racial group. Results: 367 eyes of 203 patients were included, 80% Latino and 20% Black. Gender, age, and average HbA1C values were not significantly different between groups. The presence of clinically significant macular edema (CSME), focal or diffuse, was very high in both groups, 44% in the Latinos and 46% in the Blacks, and the overall grade of DR was similar. However, upon individual lesion analysis, the Latinos were noted to have more prevalent intraretinal hemorrhages involving a greater area of the retina (p=0.046). Conclusions: Although Latinos and Blacks of comparable age and glycemic control are equally at risk of CSME and proliferative retinopathy, Latinos may be at greater risk of a specific phenotype of DR characterized by extravasation of intraretinal hemorrhages, which is associated with a poor prognosis. Further prospective studies may uncover racial differences which may have implications for prognosis and therapy.

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Osita Onugha Near-Infrared Spectroscopy-Derived Cerebral Oximetry Predicts Oxygen Delivery in a Controlled

Model of Altered Perfusion Transcranial near-infrared spectroscopy (NIRS) provides a continuous, non-invasive method of monitoring regional oxygen saturation (rSO2) in the cerebral cortex. This prospective observational study compared continuous cerebral oximetry monitoring to calculated oxygen delivery (DO2) in patients undergoing cardiopulmonary bypass (CPB). Forty patients were monitored using NIRS-derived rSO2 during cardiothoracic surgical procedures. Cardiac output (CO), mean arterial pressure (MAP), arterial blood gases and serum hemoglobin were recorded, and DO2 was calculated at key stages in the procedure. Median rSO2 decreased from 79% (IQR, 62 � 81) at baseline, to 62% (IQR, 54 � 71) at the start of CPB (p < 0.0001). During maintenance of CPB, there was no significant change in rSO2. After termination of CPB, cerebral perfusion showed signs of recovery, as rSO2 increased from 63% (IQR, 56 - 69) during re-warming, to 71% (IQR, 66 � 75) by the time of closure (p < 0.0017). Calculated DO2 decreased from 754 ml/min (IQR, 560 - 950) at baseline, to 472 ml/min (IQR, 396 - 600) with the initiation of CPB (p < 0.0002). No change in DO2 was observed during maintenance of CPB, however there was a significant increase from 566 ml/min (IQR, 504 - 734) during re-warming, to 773 ml/min (IQR, 718 - 997) at the time of closure (p < 0.001). There was moderate correlation between rSO2 and DO2 across all stages of the procedure (Spearman r = +0.55). Linear regression revealed cerebral rSO2 significantly predicted calculated oxygen delivery [R2adj = 0.32, F (1, 147) = 68.05, p < 0.0001)]. For patients undergoing CPB, NIRS-derived cerebral rSO2 is a non-invasive, reliable predictor of calculated oxygen delivery. Near-infrared spectroscopy remains a promising technology for the assessment of critically ill and injured patients.

Stephen Beckham Chorionic Villus Sampling and Risk for Hypertensive Disorders of Pregnancy

Objective: To evaluate the relationship between CVS at 10-13 weeks' GA and hypertensive disorders of pregnancy. Study Design: The prevalence of gestational hypertension (HTN) and preeclampsia in women with singleton gestations, undergoing transcervical or transabdominal CVS between 10 weeks 0 days and 13 weeks 6 days GA was compared with that of control women with singleton gestations having 1st-trimester screening with nuchal translucency (NT) and biochemistry between 11 weeks 0 days and 13 weeks 6 days GA. Patients having invasive prenatal diagnosis (CVS or amniocentesis) were excluded from the control group. All patients delivered at Cedars-Sinai Medical Center. Results: There were 1540 women who had CVS and 840 controls. Hypertensive disorders of pregnancy were diagnosed in 76 (4.9%) patients in the CVS group and in 37 (4.4%) of the controls (χ2 = 0.34, p= 0.31). Conclusion: CVS at 10 to 13 weeks GA does not appear to increase the overall risk for hypertensive disorders of pregnancy. However, there appears to be an association between CVS and severe hypertensive disorders including severe preeclampsia, eclampsia, and HELLP syndrome.

Rondeep Brar Acute Dapsone-Induced Methemoglobinemia in a 24 Year-Old Female with Ulcerative Colitis

Methemoglobin, a unique form of hemoglobin with diminished oxygen affinity, is normally formed and metabolized at roughly equivalent rates under physiologic conditions. However, when methemoglobin generation supersedes compensatory physiologic reductive capacity, pathologic methemoglobinemia may result. Potential etiologies include a variety of heritable metabolic defects and acquired insults, with the latter commonly a consequence of exposure to exogenous oxidizing agents. The following report reviews the case of a 24 year-old female who acutely developed methemoglobinemia while being treated with dapsone during an ulcerative colitis (UC) exacerbation. A discussion of hemoglobin physiology, as well as the pathogenesis, diagnosis, and treatment of methemoglobinemia is included as well.