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Multinodular plaque on the penis [Case Report]

Nickerson, Derek W; Dowling, Jessica R; O'Connor, Heather; Lopez, Daniel; Elston, Dirk M
PMID: 32352444
ISSN: 2326-6929
CID: 5505472

Update on Current Treatment Recommendations for Primary Cutaneous Melanoma

Dowling, Jessica; McGregor, Sean P; Williford, Philip
Primary cutaneous melanoma describes any primary melanoma lesion of the skin that does not have evidence of metastatic disease. This article reviews the current workup, treatment, and follow-up recommendations for primary cutaneous melanoma (stages 0, I, and II). Specific attention is focused on recent updates with regard to staging, sentinel lymph node biopsy, and surgical modalities.
PMID: 31466581
ISSN: 1558-0520
CID: 5505462

Asboe-Hansen sign in toxic epidermal necrolysis [Letter]

Dowling, Jessica R; Anderson, Kathryn L; Huang, William W
PMID: 31116821
ISSN: 2326-6929
CID: 5505452

Pharmacotherapeutic strategies for standard treatment-resistant psoriasis

Heath, Michael S; Kolli, Sree S; Dowling, Jessica R; Cline, Abigail; Feldman, Steven R
INTRODUCTION:Psoriasis management includes a variety of treatments including localized therapies and systemic treatments; however, many patients report inadequate clinical response and resistance to therapy. Currently there is no treatment algorithm that incorporates effective strategies to tackle the various barriers leading to resistance. AREAS COVERED:The authors evaluate the scope of resistance, the reasons it occurs, and provide the reader with strategies for overcoming resistance in both localized and systemic therapies for psoriasis. EXPERT OPINION:Refractory psoriasis involves modifiable and non-modifiable factors that warrant different approaches to maximize clinical response. Treatment-resistance to topical therapies may be due to poor adherence. Improving adherence involves incorporating patients' treatment preferences, improving the physician-patient relationship, and simplifying treatment regimens. Treatment-resistance to systemic therapies can be due to non-adherence but can also be due to ineffective dosing, development of anti-drug antibodies, and severe disease that necessitates multiple drugs. After addressing non-adherence, strategies to maximize systemic therapies include increasing the dosage, combining treatments, drug switching and incorporating pharmacogenetics.
PMID: 30589362
ISSN: 1744-7666
CID: 5505442

Myopic shift in a pseudophakic eye with an accommodating IOL following vitrectomy with gas tamponade

Aker, Jonathan; Dowling, Jessica; Halperin, Lawrence
PURPOSE/OBJECTIVE:To report the case of a patient with Crystalens, an accommodating posterior-chamber intraocular lens (IOL), who experienced a myopic shift following subsequent vitrectomy with gas tamponade. We propose a hypothesis as to why this myopic shift occurred and analyze its validity based on current literature. OBSERVATIONS/METHODS:A patient had cataract surgery with implantation of a Crystalens AT-50AO +21D. Preoperative A-scan measured anterior chamber depth (ACD) to be 3.69 mm. The refraction was emmetropic following cataract surgery. Nine months later, the patient required pars plana vitrectomy with gas tamponade for a rhegmatogenous retinal detachment, followed by vitrectomy, membrane peel, and air/fluid exchange for epiretinal membrane. The retinal repair was anatomically successful, however, the patient experienced a -1.0 D myopic shift. ACD measurement following vitrectomy was 5.08 mm. CONCLUSIONS AND IMPORTANCE/CONCLUSIONS:Myopic shift following vitrectomy with gas tamponade in pseudophakic eyes is widely reported. This patient's myopic shift was assumed due to anterior movement of the Crystalens caused by a gas bubble placed during retinal detachment repair as this is the prevailing theory in the literature [1]. However, a comparison of the patient's ACD measurements does not support the above hypothesis. Further study is needed to determine the mechanism of myopic shift seen in pseudophakic patients following vitrectomy, specifically those with gas.
PMID: 29780961
ISSN: 2451-9936
CID: 5505692

A Rare Axonal Variant of Guillain-Barré Syndrome following Elective Spinal Surgery [Case Report]

Dowling, Jessica R; Dowling, Thomas J
Acute motor and sensory axonal neuropathy (AMSAN) is a rare axonal variant of Guillain-Barré syndrome. AMSAN is considered the most severe form of GBS, known for its rapid onset of severe symptoms, and often leading to quadriparesis within 7 days of initial symptom onset. We present a case of a middle-aged Caucasian female who developed AMSAN 2 weeks following an elective spinal surgery. Although rare, GBS has been reported as a complication of surgery. GBS classically presents as ascending motor weakness starting in the lower extremities following a gastrointestinal or upper respiratory tract infection. This patient's GBS manifested slightly differently, with both sensory and motor symptoms of her thoracic region and lower extremities, with no preceding history indicative of infection. To the authors' knowledge, this is the first reported case of AMSAN following spinal surgery. Because of its risk of significant morbidity and mortality, as well as similar presentation to more common spinal postoperative complications, GBS should always be included in the differential diagnosis whenever motor or sensory weakness is observed after spinal surgery.
PMID: 30159189
ISSN: 2090-6749
CID: 5151562

The David

Dowling, Jessica Rose
ISSN: 2334-5896
CID: 5505702