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.

Natural history of incidental pulmonary nodules in children

Abstract: SummaryRATIONALE As there are no evidence based guidelines for the diagnosis and/or management of pulmonary nodules in children, there is an over reliance on the adult based algorithms when dealing with pulmonary nodules in children. We present our experience of pediatric patients evaluated for incidentally found pulmonary nodules. METHODS Retrospective chart review of patients diagnosed with a pulmonary nodule and evaluated at Goryeb Children's Hospital between January 2000 and December 2012. Primary outcome: change in the size of the pulmonary nodule between the initial and follow-up imaging. RESULTS Thirty six patients with pulmonary nodule (21 male/15 female; Median [range] age 15 [5–20] years.) were included in the study. Chest CT was obtained for respiratory symptoms and/or abnormal chest radiograph in 19 (52%). Nine pulmonary nodules (25%) were identified on abdominal CT obtained for abdominal symptoms. A total of 46 nodules were identified in 36 patients. Nine of the pulmonary nodules (9 patients) were ≤4 mm in size, 37 of the pulmonary nodules (27 patients) were >4 mm in size. Twenty-two of the 27 (81%) patients with nodule size >4 mm had follow-up CT: 14 nodules (54%) remained unchanged in size, 5 nodules (19%) decreased in size, and 7 nodules (27%) were not detected. CONCLUSION Our review of 36 patients with pulmonary nodules shows no obvious growth of the nodules over the study period, suggesting low risk of malignancy. Routine follow-up chest computer tomography using ACCP/Fleischner Society guidelines may not apply in children without known malignancy. Pediatr Pulmonol. 2015; 50:456–459. © 2014 Wiley Periodicals, Inc.

Subjective and objective outcomes 1 year after robotic-assisted laparoscopic sacrocolpopexy.

Abstract: We aimed to assess the subjective and objective outcomes 1 year after robotic sacrocolpopexy using a type I polypropylene mesh. This was a case series of 64 patients who underwent a robotic-assisted laparoscopic sacrocolpopexy using a type I monofilament polypropylene mesh coated with hydrophilic porcine collagen. Objective and subjective outcomes were assessed using the pelvic organ prolapse quantification (POP-Q), the short forms of the Pelvic Floor Impact Questionnaire (PFIQ 7) and the Pelvic Floor Distress Inventory (PFDI-20). Outcome measures were collected pre-operatively and 1 year post-operatively on all but one patient, who was lost to follow-up. Paired comparisons between pre- and post-operative outcomes were performed using the Wilcoxon signed rank test. At 1 year, POP-Q stage II or greater and loss of follow-up were considered to be surgical failure. The “surgical cure” rate was 89%. We observed three distal anterior failures, two distal posterior failures and one apical failure, and one patient was lost to follow-up. We found significant differences between pre- and post-operative POP-Q measurements (p < 0.001) and PFDI-20/PFIQ-7 total scores (p < 0.001). Robotic sacrocolpopexy using this polypropylene mesh resulted in significant improvements in subjective and objective outcome measures at 1 year.

Oxygen for the Preterm Newborn: One Infant at a Time

Abstract: The randomized trial by Wang et al1 compares short-term outcomes of infants who were 23 to 32 weeks' gestation and initially were given 1 of 2 fraction of inspired oxygen (Fio2) extremes (0.21 or 1.0) for delivery room resuscitation. “Too much” oxygen in the blood is a health hazard,2,3 and health care providers are the only known cause of neonatal hyperoxemia. Wang et al show that 100% O2 is not needed for most preterm infants during the transition period. Within 2 minutes, pulse oxygen saturation (Spo2) may reach values that are associated with high Pao24 and release “dastardly chemicals.”5 Likewise, infants can be made hyperoxemic without “pure O2.” If after the transition period … Address correspondence to Augusto Sola, MD, Mid Atlantic Neonatology Associates and Atlantic Neonatal Research Institute, Atlantic Health System, 100 Madison Ave, Morristown, NJ 07960. E-mail: augustosolaneo{at}gmail.com

Leptomeningeal Disease in Glioblastoma: Endgame or Opportunity?

Abstract: Glioblastoma is an aggressive cancer with a notoriously poor prognosis. Recent advances in treatment have increased overall survival, though this may be accompanied by an increased incidence of leptomeningeal disease (LMD). LMD carries a particularly severe prognosis and remains a late stage manifestation of glioblastoma without satisfactory treatment. The objective of this review is to survey the literature on treatment of LMD in glioblastoma and to more fully characterize the current therapeutic strategies. The authors performed a systematic review following PRISMA criteria on PubMed and OVID databases. Articles that included adult patients with LMD from glioblastoma were retrieved and reviewed. LMD in glioblastoma patients is increasing in incidence, with reports of up to 21%. The overall survival without treatment is alarmingly brief, with patients surviving between 1.6–3.8 months. All studies showed that treatment does improve overall survival significantly, increasing to 11.7 months in one study. However, no one adjuvant or surgical therapy has been shown to improve survival in LMD significantly over another. Direct treatment methods include chemotherapy (standard, anti-angiogenic, intrathecal, immunotherapy), and radiation. Hydrocephalus is a complication in LMD that can be treated with ventriculoperitoneal shunt placement, however treating hydrocephalus and delivering intrathecal chemotherapy is a challenge. Though evidence remains lacking and there is no consensus, treatments show a trend towards improving survival and should be considered on a case-by-case basis. Further studies are necessary in the pursuit of a standard of care.