Anwar A. Jebran, MD

We presented a qualitative analysis that was conducted to evaluate the willingness of clinicians to participate in this program and the willingness of patients to enroll in this new care delivery model. We also presented our progress so far in terms of pre-implementation processes.

Mediastinal pancreatic pseudocyst (MPP) is one of the rare complications of acute or chronic pancreatitis. We present a rare case of a large MPP causing recurrent admissions due to chest heaviness & dysphagia.

An audio recording of a group of residents at Weiss Memorial Hospital talking about violence and ways to prevent it as part of the Art in Medicine project, "Violence as a preventable disease".

Situs Inversus Totalis (SIT) is an autosomal recessive congenital disorder. With an incidence rate of one in 5000 to 10,000 live birth, Situs Inversus considered a rare disorder. It presents as a complete inversion of the thoracic and intra-abdominal organ from one side to another. Standard surgical procedures in these patients are considered technically challenging, therefore, well preparation and an in-depth knowledge of the patient is warranted. To our knowledge, less than 10 cases have been… Show more

Situs Inversus Totalis (SIT) is an autosomal recessive congenital disorder. With an incidence rate of one in 5000 to 10,000 live birth, Situs Inversus considered a rare disorder. It presents as a complete inversion of the thoracic and intra-abdominal organ from one side to another. Standard surgical procedures in these patients are considered technically challenging, therefore, well preparation and an in-depth knowledge of the patient is warranted. To our knowledge, less than 10 cases have been reported about patients with colorectal cancer associated with SIT that were successfully treated with laparoscopic colorectal surgery.
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Diverticulosis is a very common bowel disease and the prevalence is increasing. Complications
like diverticulitis and diverticular bleeding appear in 10-15% of patients with diverticular
disease. Genetics predispositions and medications such as nonsteroidal anti-inflammatory
drugs (NSAIDs) remain a potential risk factor of developing diverticular disease. Foreign body
(FB) digestion might also be one of the uncommon causes of diverticulitis. Most people who
accidentally inges… Show more

Diverticulosis is a very common bowel disease and the prevalence is increasing. Complications
like diverticulitis and diverticular bleeding appear in 10-15% of patients with diverticular
disease. Genetics predispositions and medications such as nonsteroidal anti-inflammatory
drugs (NSAIDs) remain a potential risk factor of developing diverticular disease. Foreign body
(FB) digestion might also be one of the uncommon causes of diverticulitis. Most people who
accidentally ingest FBs are unaware of the incident. It is also associated with alcohol and drug
abuse, mental illness and retardation and denture-wearing elderly. Show less

Dyssynergic defecation (DD) is the discoordination of pelvic floor muscles, leading to an ineffective evacuation of stool and constipation. Three components are required to diagnose DD: constipation symptoms, a dyssynergic pattern on anorectal manometry (ARM) (paradoxical increase/lack of adequate relaxation of inter-sphincter muscles), and an abnormal balloon expulsion test (BET). Although the BET is used in conjunction with ARM to diagnose DD, the results do not always agree and as a result… Show more

Dyssynergic defecation (DD) is the discoordination of pelvic floor muscles, leading to an ineffective evacuation of stool and constipation. Three components are required to diagnose DD: constipation symptoms, a dyssynergic pattern on anorectal manometry (ARM) (paradoxical increase/lack of adequate relaxation of inter-sphincter muscles), and an abnormal balloon expulsion test (BET). Although the BET is used in conjunction with ARM to diagnose DD, the results do not always agree and as a result, the utility of ARM with BET has been scrutinized for reliability in diagnosing DD. The aims of this study were: 1) to define the prevalence of abnormal BET in our cohort of patients with constipation, and 2) to identify an ARM metric that predicts an abnormal BET. Show less

Pelvic floor dyssynergia (PFD), a functional constipation subtype, is defined by paradoxical movement or relaxation failure of the pelvic floor muscles. In some countries, squatting posture is the predominant method for bowel evacuation. This position allows an increase in both hip flexion and obtuse anorectal angle facilitating stool evacuation. The aims were to determine if use of a foot stool will aid in balloon expulsion in patients with abnormal balloon expulsion test (BET) and if there is… Show more

Pelvic floor dyssynergia (PFD), a functional constipation subtype, is defined by paradoxical movement or relaxation failure of the pelvic floor muscles. In some countries, squatting posture is the predominant method for bowel evacuation. This position allows an increase in both hip flexion and obtuse anorectal angle facilitating stool evacuation. The aims were to determine if use of a foot stool will aid in balloon expulsion in patients with abnormal balloon expulsion test (BET) and if there is an anorectal manometry (ARM) metric which predicts successful evacuation with position change. We hypothesize that use of a stool will open the anorectal angle, facilitate balloon expulsion and can be used for treatment of dyssynergia. Show less

Introduction: Chronic mesenteric ischemia (CMI) presents with post prandial abdominal pain. It is related to an occlusive disease involving celiac (CA), superior mesenteric (SMA), and inferior mesenteric arteries (IMA). Reporting a case of CMI due to chronic total occlusion (CTO) of only the CA.

Conclusion: CMI can occur in a single mesenteric artery occlusion. Percutaneous re-vasculariztion remains the preferred treatment approach.

BACKGROUND: Phyllodes tumor (PT) is a rare neoplasm of the breast. Concomitant PT with invasive ductal carcinoma (IDC) is an even rarer occurrence. When ductal carcinoma in situ (DCIS) or IDC are detected within the specimen, the management changes from wide local excision to further staging work-up, including sentinel node biopsy and radiation.
CASE REPORT: We report the case of a 70-year-old presented with right breast mass whose pathology showed benign PT with concomitant IDC and DCIS… Show more

BACKGROUND: Phyllodes tumor (PT) is a rare neoplasm of the breast. Concomitant PT with invasive ductal carcinoma (IDC) is an even rarer occurrence. When ductal carcinoma in situ (DCIS) or IDC are detected within the specimen, the management changes from wide local excision to further staging work-up, including sentinel node biopsy and radiation.
CASE REPORT: We report the case of a 70-year-old presented with right breast mass whose pathology showed benign PT with concomitant IDC and DCIS. The patient elected for a wide excision of the mass with sentinel lymph node biopsy, which did not show any involvement. The patient was started on appropriate therapy. She is currently doing well.
CONCLUSIONS: This case highlights the importance of wide local excision for PT as well as prudent histologic examination to rule out other malignant components, as the presence of IDC distinctly changes management. Show less

Meckel’s diverticulum is a true congenital diverticulum confined of all three layers of the intestine. It is described as a vestigial remnant of the omphalomesenteric duct. In the overwhelming majority of the cases, this diverticulum is asymptomatic and is incidentally diagnosed. However, when Meckel’s harbors ectopic gastric mucosa, the aberrant acidic secretions result in ulceration of the intestinal mucosa, and a subsequent lower GI. In our case, a 22-year old male who presented to the ER… Show more

Meckel’s diverticulum is a true congenital diverticulum confined of all three layers of the intestine. It is described as a vestigial remnant of the omphalomesenteric duct. In the overwhelming majority of the cases, this diverticulum is asymptomatic and is incidentally diagnosed. However, when Meckel’s harbors ectopic gastric mucosa, the aberrant acidic secretions result in ulceration of the intestinal mucosa, and a subsequent lower GI. In our case, a 22-year old male who presented to the ER with lower GI bleed of unknown source. Meckel’s diverticulum was suspected after negative upper & lower endoscopies and the proper scan was performed with negative findings. Subsequently, a CT angiography was performed in attempt to locate the bleeding source, and revealed the diverticulum. Show less