scispace - formally typeset
Search or ask a question

Showing papers by "Lenox Hill Hospital published in 1985"


Journal ArticleDOI
TL;DR: The site of intestinal involvement with Crohn's disease did not appear to play a significant role in the frequency or degree of response to 6-MP, but patients without prior resection and fistulae did better than those with fists occurring after surgery.
Abstract: Fistulae are distressing chronic complications of Crohn's disease which have served as one of the most common indications for surgical resection. While steroids and sulfasalazine have not been successful in closing fistulae, in a previous double-blind study 6-mercaptopurine (6-MP) was more effective than placebo in accomplishing this goal (31% vs 6%). Thirty-four patients with Crohn's disease fistulae were treated with 6-MP for a minimum period of 6 months. In 13 patients (39%) the fistulae closed completely, and in another 9 (26%) there was obvious improvement. All types of fistulae responded to 6-MP with the most impressive closures occurring in patients with fistulae of the abdominal wall and enteroenteric fistulae. The mean time to respond was 3.1 months, with 23% of patients taking longer than 4 months to show any response. Response was not related to other drugs (steroids, sulfasalazine) used in conjunction with the 6-MP. The site of intestinal involvement with Crohn's disease did not appear to play a significant role in the frequency or degree of response to 6-MP, but patients without prior resection and fistulae did better than those with fistulae occurring after surgery. The long-term response to fistulae was good if 6-MP was maintained, whereas exacerbation eventually followed discontinuation of 6-MP. 6-Mercaptopurine is an effective and useful drug in the treatment of fistulae, as it is in other manifestations of chronic unrelenting Crohn's disease.

243 citations


Journal ArticleDOI
15 Dec 1985-Cancer
TL;DR: Twenty‐one cases of lymphoma in men at high risk for Acquired Immune Deficiency Syndrome (AIDS) were diagnosed in one community hospital in New York City within the last 2 years.
Abstract: An increased incidence of lymphoid neoplasias is associated with the states of immune deficiency, both congenital and acquired. Twenty-one cases of lymphoma in men at high risk for Acquired Immune Deficiency Syndrome (AIDS) were diagnosed in one community hospital in New York City within the last 2 years. The mean age of these patients was 39.6 years, 20 were homosexual, and 1 was an intravenous drug abuser. There were 3 Hodgkin's and 18 non-Hodgkin's lymphomas of various histologic types, but almost all of high-grade categories. The proportion of extranodal lymphomas, the involvement of the gastrointestinal tract, central nervous system, bone marrow, and myocardium were significantly higher than in the lymphomas of the general population. The phenotypes were B-cell and non-B-non-T-cell types without any T-cell lymphomas. All patients had reversed helper-suppressor T-cell ratios and all those tested had circulating HTLV-III antibodies. Seven patients have had previous lymph node biopsies performed, showing the lesions of AIDS-related lymphadenopathies that often were directly associated with lymphoma. A variety of severe opportunistic infections and Kaposi's sarcoma affected these patients. All lymphomas in this group were highly aggressive, involved multiple organs, and responded poorly to treatment, resulting in early deaths.

220 citations


Journal ArticleDOI
TL;DR: The results of these studies indicate that patients with AIDS and AIDS-related complex have circulating antibodies capable of reacting selectively with a population of T cells that is predominantly composed of helper cells and does not include suppressor cells.

118 citations


Journal ArticleDOI
TL;DR: The central corneal flattening obtained by radial diamond knife incisions has been duplicated by radial laser incisions in 18 enucleated human eyes and Histopathology revealed the remarkably smooth edges of the laser incision.

95 citations


Journal ArticleDOI
TL;DR: The course of 16 consecutive patients with Crohn's disease in whom sigmoidoscopy showed normal mucosa at the time of diversion and who underwent an ileostomy or colostomy was reviewed, it is suspected that the disorder of nonspecific "diversion colitis" might account for this phenomenon entirely.
Abstract: Diverting the fecal stream has been considered to benefit the course of Crohn's disease. Clinical signs and symptoms have not, however, been distinguished previously from the objective inflammatory changes in the distal segment. We reviewed the course of 16 consecutive patients with Crohn's disease in whom sigmoidoscopy showed normal mucosa at the time of diversion and who underwent an ileostomy or colostomy, the rectal segment being left in place. As early as 3 months after diversion, all 16 patients showed progressive friability, ulceration, and exudation in the retained rectum. Stricture occurred in four and lead to abdominoperineal resection in three. Four of eight patients with only moderate inflammation on sigmoidoscopy underwent reanastomosis which was followed by a return to a normal-appearing rectal mucosa. The rectal segment inflammed after diversion rarely shows the histological characteristics of Crohn's disease when resected. This leads us to suspect that the disorder of nonspecific "diversion colitis" might account for this phenomenon entirely, or at least it may accelerate the Crohn's disease process. Continuity of the intestinal tract should be maintained in the course of Crohn's disease surgery if feasible. If a diversion is clinically warranted, reanastomosis should be considered as early as possible despite progressive inflammation of the rectal mucosa.

56 citations


Journal ArticleDOI
TL;DR: This series delineates those anatomic and clinical exceptions wherein percutaneous transluminal coronary angioplasty may be utilized as the primary therapy for left main stem coronary stenosis.

56 citations



Journal ArticleDOI
TL;DR: Visceral Kaposi's sarcoma and malignant lymphomas were the principal malignancies recognized, and their occurrence in young men should alert clinicians to the possibility of AIDS.

31 citations


Journal ArticleDOI
TL;DR: Evidence is presented, using technetium 99‐labeled thrombi in two rabbit aortas and one human cadaver coronary artery, that distal embolization does not occur after argon laser recanalization.
Abstract: The primary concerns in the development of a laser catheter for intravascular use are the potential hazards of vessel wall perforation and distal embolization. We present evidence, using technetium 99-labeled thrombi in two rabbit aortas and one human cadaver coronary artery, that distal embolization does not occur after argon laser recanalization. Also, no vessel wall perforation was observed during recanalization of 15 thrombosed rabbit aortas and 1 inferior vena cava, used because of their extremely thin walls. Laser recanalization of three peripheral arteries with atherosclerotic plaque obstruction, in amputated human legs, snowed no evidence of vessel wall perforation. The incidence of vessel wall perforation can be minimized by preferential use of the argon laser, strict maintainence of a coaxial relationship between the laser catheter and the vessel, and exercising care during the actual lasing process. Distal embolization does not appear to be an important consideration.

15 citations


Journal ArticleDOI
TL;DR: The applicability of the Coronary Artery Surgery Study (CASS) to clinical practice is seriously hampered by the following findings.

14 citations


Journal ArticleDOI
TL;DR: The following case involves an unusual instance of the tissue effects of thorium in a clinical setting that was quite difficult to understand, since there was no history of injection or ingestion of Thorotrast.

Journal Article
TL;DR: Employing a rim of tissue created from the supra-annular left atrium imbricated to the edge of the posterior mitral leaflet, a substitute "annulus" for prosthetic valve fixation is created.
Abstract: Severe calcification of the mitral annulus presents a technical challenge in valve replacement, and in the case reported here, we replaced the valve with a new technique. Employing a rim of tissue created from the supra-annular left atrium imbricated to the edge of the posterior mitral leaflet, we created a substitute “annulus” for prosthetic valve fixation.

Journal ArticleDOI
TL;DR: The time interval between the release and beginning of vocal cord vibration in word-initial /p/ and /b/ was measured and it is suggested that such a test of vocal initiation could provide a useful measure for the evaluation of laryngeal dysfunction.
Abstract: The time interval between the release and beginning of vocal cord vibration in word-initial /p/ and /b/ was measured. The data from subjects with laryngeal pathology are described. /b/ showed larger values compared with the data from normals. It is suggested that such a test of vocal initiation could provide a useful measure for the evaluation of laryngeal dysfunction.

Book ChapterDOI
01 Jan 1985
TL;DR: The correlations obtained between these tests and clinical diagnoses indicate their potential usefulness in the detection and monitoring of AIDS and ARC patients.
Abstract: The number of surface immunoglobulins (SIg)-positive lymphocytes was found to increase when normal lymphocytes were incubated with sera of AIDS or ARC patients. These circulating antilymphocyte antibodies were selectively reactive with 0KT4- but not with 0KT8-staining T-cells. In the present study, AIDS, ARC and control patients were evaluated for antilymphocyte antibodies, anti HTLV-III antibodies and helper/suppressor (h/s) T-cell ratios. In the AIDS group, 23 of 24 patients had circulating HTLV-III antibodies, 24 of 24 showed markedly decreased h/s T-cell ratios and 19 of 21 patients showed marked elevation of anti-lymphocyte antibodies. In contrast, in control patients, none of 14 had HTLV-III antibodies, 13 of 14 had normal h/s T-cell ratios and 3 of 11 showed small increases in antilymphocyte antibodies. In the ARC group, 16 of 16 had circulating anti HTLV-III antibodies. 11 of 15 had decreased h/s T-cell ratios and 6 of 11 showed elevated anti T-cell antibodies. The correlations obtained between these tests and clinical diagnoses indicate their potential usefulness in the detection and monitoring of AIDS and ARC patients.