Showing papers by "Lenox Hill Hospital published in 1989"
TL;DR: The data, showing a low incidence of toxicity in 396 patients, coupled with the previously demonstrated efficacy of 6-mercaptopurine in the treatment ofinflammatory bowel disease, indicate that the drug is a reasonable alternative in the management of patients with intractable inflammatory bowel disease.
Abstract: We assess toxicity related to 6-mercaptopurine in the treatment of inflammatory bowel disease by reporting our experience with 396 patients (120 patients with ulcerative colitis, 276 with Crohn disease) observed over 18 years. Follow-up data for a mean period of 60.3 months were obtained for 90% of the patients. Toxicity directly induced by 6-mercaptopurine included pancreatitis in 13 patients (3.3%), bone marrow depression in 8 (2%), allergic reactions in 8 (2%), and drug hepatitis in 1 (0.3%). These complications were reversible in all cases with no mortality. Most cases of marrow depression occurred earlier in our experience, when the initial drug doses used were higher. Infectious complications were seen in 29 patients (7.4%), of which 7 (1.8%) were severe, including one instance of herpes zoster encephalitis. All infections were reversible with no deaths. Twelve neoplasms (3.1%) were observed, but only 1 (0.3%), a diffuse histiocytic lymphoma of the brain, had a probable association with the use of 6-mercaptopurine. Our data, showing a low incidence of toxicity in 396 patients, coupled with the previously demonstrated efficacy of 6-mercaptopurine in the treatment of inflammatory bowel disease, indicate that the drug is a reasonable alternative in the management of patients with intractable inflammatory bowel disease.
710Â citations
TL;DR: Steady-state fluorescence spectra and excitation spectra from native human normal and malignant tumor breast tissues have been measured and analyzed as mentioned in this paper, and the statistics of the fluorescence results are given, and the reasons for false negative, false positive, and equivocal results are presented.
Abstract: Steady-state fluorescence spectra and excitation spectra from native human normal and malignant tumor breast tissues have been measured and analyzed. Two types of spectra from normal tissues have been found and discussed. The statistics of the fluorescence results are given, and the reasons for false negative, false positive, and equivocal results are presented.
161Â citations
TL;DR: It is believed that magnetic resonance imaging, when combined with clinical and roentgenographic examination, provides the most accurate non-invasive source of information that is currently available for pathological findings in the menisci and in the anterior cruciate ligament.
Abstract: A prospective double-blind study was undertaken to evaluate the usefulness of magnetic resonance imaging in the accurate interpretation of pathological intra-articular changes in the knee. Forty-seven patients who were scheduled to have arthroscopy and three patients who wer to have arthrotomy volunteered for magnetic resonance imaging preoperatively. The radiologists had no clinical or roentgenographic information about the patients before the evaluation of the magnetic resonance images, and the radiologists' interpretations were unknown to the surgeon before the arthroscopy or arthrotomy was done. Our important observations were limited to the findings in the menisci and in the anterior cruciate ligament. Magnetic resonance imaging had a positive predictive value of 75 per cent, a negative predictive value of 90 per cent, a sensitivity of 83 per cent, and a specificity of 84 per cent for pathological findings in the menisci. For complete tears of the anterior cruciate ligament, the positive predictive value was 74 per cent; the negative predictive value, 70 per cent; the sensitivity, 61 per cent; and the specificity, 82 per cent. We believe that magnetic resonance imaging, when combined with clinical and roentgenographic examination, provides the most accurate non-invasive source of information that is currently available for pathological findings in the menisci and in the anterior cruciate ligament.
135Â citations
TL;DR: The pulsed fluorescence spectra photoexcited by the second and third harmonic of a 10-ps pulse from Nd:glass laser are reported for normal and cancerous tissues of breast and lung.
Abstract: The origin of the differences in the fluorescence spectra obtained from cancerous and normal human breast and lung tissues is explored experimentally. The fluorescence spectra from chemically treated normal tissues were measured to give information on the source of the spectral differences. The pulsed fluorescence spectra photoexcited by the second and third harmonic of a 10-ps pulse from Nd:glass laser are reported for normal and cancerous tissues of breast and lung.
61Â citations
TL;DR: The case presented here has not been previously described and is that of a "horseshoe" appendix in a 33-year-old man with sigmoid diverticulitis, which cannot be classified into any of the existing categories of appendiceal anomalies.
48Â citations
TL;DR: The case history of a patient with NF and conjunctival malignant melanoma which developed in an eye with primary acquired melanosis is yet another example of a neural crest malignancy developing in a NF patient.
45Â citations
TL;DR: Eight dorsal capsular ruptures are described in six patients who had closed direct trauma to either the knuckle of their index or long fingers and most of the injuries occurred in professional boxers.
Abstract: An injury to the dorsal aspect of the metacarpophalangeal joint of a finger usually damages the sagittal fibers of the extensor tendon mechanism. Rupture of the underlying joint capsule, a far more serious injury, has received scant attention in the medical literature. The problem is often unrecognized because the extensor tendon may remain in its normal midline position. Eight dorsal capsular ruptures are described in six patients who had closed direct trauma to either the knuckle of their index or long fingers. Most of the injuries occurred in professional boxers.
40Â citations
TL;DR: An enterovesical fistula in Crohn's disease rarely leads to serious complications and can often be treated successfully with medical therapy alone: by itself, it need not serve as an indication for surgery.
Abstract: We reviewed the course of 500 patients with Crohn's disease to document the incidence, the nature, and the results of management of fistulas to the bladder. Seventeen patients (14 men and three women) had developed enterovesical fistulas; 16 had pneumaturia. The barium radiographs demonstrated the fistula in only 37%. All had received sulfasalazine, and most were treated with corti-costeroids and antibiotics intermittently; two had successful control of their urinary symptoms on this regimen. Eight patients who received 6-mercaptopurine (6-MP) in addition tolerated the urinary fistula well, so that we encourage a trial of 6-MP for this complication of Crohn's disease. Six patients continue on medical therapy alone after a mean of 5.3 years. There were no instances of pyelonephritis during 60 patient years. Eleven patients eventually underwent bowel resection, but in only two was persistence of the enterovesical fistula the primary indication for elective surgery, and in both, it was the patient's choice. Visualization of the fistula on barium enema radiograph or presence of a connection between the sigmoid and the bladder were not associated with adverse outcome. An enterovesical fistula in Crohn's disease rarely leads to serious complications and can often be treated successfully with medical therapy alone; by itself, it need not serve as an indication for surgery.
37Â citations
TL;DR: A group of 75 outpatients suffering from obsessive-compulsive disorder began treatment with the bicyclic antidepressant fluoxetine in an open clinical setting and showed significant improvement on all measures, progressive over a 5-month period.
Abstract: A group of 75 outpatients suffering from obsessive-compulsive disorder began treatment with the bicyclic antidepressant fluoxetine in an open clinical setting. Their progress was evaluated using the Hamilton Depression Scale, the Hamilton Anxiety Scale, and a global scale of severity of obsessive-compulsive symptoms. The group showed significant improvement on all measures. This improvement continued and was progressive over a 5-month period. Weight loss was present but not significant by the end of the 5-month period.
35Â citations
TL;DR: S sustained exercise slightly ALT resulted in a significant potassium flux and very elevated catecholamine levels, and avoiding these metabolic stresses by exercising BLT may decrease chances for exercise-related arrhythmia or other cardiac dysfunction in susceptible patients.
33Â citations
Journal Article•
TL;DR: Oral TMP-SMX appears effective at preventing recurrent Pneumocystis pneumonia in patients with AIDS and may not be a contraindication to continuation of therapy and subsequent oral prophylaxis.
Abstract: Thirty-four homosexual patients with AIDS were treated for Pneumocystis carinii pneumonia between April 1984 and November 1985. All 31 survivors were treated with oral trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis immediately upon completion of intravenous therapy, despite the prior occurrence of hypersensitivity reactions to intravenous TMP-SMX in 21 of these patients. Only four patients had subsequent reactions to oral TMP-SMX requiring the drug's discontinuation. None of the patients remaining on prophylaxis developed recurrent Pneumocystis pneumonia. Oral TMP-SMX appears effective at preventing recurrent Pneumocystis pneumonia in patients with AIDS. Hypersensitivity reactions during therapy with TMP-SMX may not be a contraindication to continuation of therapy and subsequent oral prophylaxis.
TL;DR: Inadequate sampling may be responsible for lack of correlation between histological criteria and tumor progression, and six other gross and microscopic attributes analyzed, including mitotic counts, did not provide equally useful prognostic indications.
Abstract: Metastatic and lethal gastric leiomyosarcoma in 12 of 30 surgically treated cases was found most closely correlated with larger size tumors. A highly statistically significant correlation (p less than 0.0001) between tumor diameter and success or failure of surgical extirpation was demonstrated for the total of 241 gastric leiomyosarcomas in the present series and collected from the literature. Six other gross and microscopic attributes analyzed, including mitotic counts, did not provide equally useful prognostic indications. Inadequate sampling may be responsible for lack of correlation between histological criteria and tumor progression.
TL;DR: A patient who, while being treated with phenytoin and corticosteroids, developed panhypogammaglobulinemia, recurrent pneumonia, eosinophilia, and a transient rash is described, prompting a careful evaluation of the patient's immunologic status.
Abstract: Phenytoin-induced panhypogammaglobulinemia mimicking the common variable immunodeficiency syndrome is rare. We describe a patient who, while being treated with phenytoin and corticosteroids, developed panhypogammaglobulinemia, recurrent pneumonia, eosinophilia, and a transient rash. Immunoglobulin levels, which had been normal prior to phenytoin therapy, returned to normal over a period of several months after the drug therapy was stopped. Levels of IgG subclasses and numbers of B cells, T cells, and T-cell subsets were determined during the recovery period. In a review of the reported cases, eosinophilia and rashes were frequently noted. These findings, along with recurrent infections in a patient receiving phenytoin therapy, should prompt a careful evaluation of the patient's immunologic status.
TL;DR: There is a consistent increase of the fourth formant frequency in all vowels after the subject has had a tonsillectomy, and the meaning of this finding is yet to be dertermined.
Journal Article•
TL;DR: Endostreptosin (ESS) is probably the pathogenetic antigen of glomerulonephritis and is deposited on the subendothelial side of the basement membrane in the first few days of the disease and is rapidly covered by newly-formed and specific antibody and complement with resultant immune injury.
Abstract: It is now generally accepted that acute post-streptococcal glomerulonephritis (PSGN) is the consequence of the formation of antigen-antibody-complement complexes on the basement membrane of the glomerulus and that the antigen is of streptococcal origin In cases of acute PSGN a high titre of specific antibodies to a streptococcal cytoplasmic extract can be found at the very beginning of the disease This cytoplasmic antigen which we called endostreptosin (ESS) is probably the pathogenetic antigen of glomerulonephritis It is deposited on the subendothelial side of the basement membrane in the first few days of the disease and is rapidly covered by newly-formed and specific antibody and complement with resultant immune injury causing signs and symptoms of symptomatic but also frequently asymptomatic acute glomerulonephritis To further characterize and isolate ESS we used immunoaffinity chromatography and Western blotting techniques PAGE analysis of the affinity-isolated ESS revealed the major component to have a molecular weight of approximately 45 kD Sera from patients with PSGN or sera of rabbits immunized with affinity-isolated ESS reacted by Western blotting with at least one antigenic component with a molecular weight of approximately 45 kD Normal human sera or the sera of non-immunized rabbits failed to demonstrate activity against this antigen The basement membranes of the glomeruli of patients with very early PSGN stain with fluorescein-labelled gammaglobulin of patients with glomerulonephritis This staining can be prevented when these sera are pre-absorbed with ESS but not by pre-absorption with intact cells or cytoplasmic extracts of other bacteria
TL;DR: There was enough tissue damage from the relatively mild formulation used to suggest no EDTA solution yet formulated is safe for clinical use and indicates the same calcium chelating property which makes this chemical effective also makes it toxic.
TL;DR: If the clinical course of IBD is downhill, the clinician is justified in starting steroids even if evaluation for amebiasis incomplete, if, however, the index of suspicion is high, concomitant treatment with Metronidazole would be reasonable.
Abstract: Amebic colitis can mimick Crohn's disease of the colon and ulcerative colitis. Inflammatory bowel disease (IBD) patients can also be carriers of amebae. Since steroids can provoke amebic activity and even cause a fulminating colitis, it is necessary to determine that amebae do or do not exist. Furthermore, amebae can be easily eliminated by drug therapy but it is hard to eradicate IBD. Despite the above, diagnostic modalities for IBD are as effective as those for amebiasis, particularly for Crohn's disease with ileal involvement. Problems in differential diagnosis arise with IBD grossly limited to the colon. In these cases, false negative stool studies are increased by diarrhea and preparation for examinations, and both stool studies and serologies are compromised by steroids. If the clinical course of IBD is downhill, the clinician is justified in starting steroids even if evaluation for amebiasis incomplete. If, however, the index of suspicion is high, concomitant treatment with Metronidazole would be reasonable.
TL;DR: The causes and management of malpositions of posterior chamber intraocular lenses, including pupil capture; sunset syndrome; sunrise syndrome; horizontal decentration; and the windshield wiper syndrome are explored.
Abstract: Decentration and malposition of posterior chamber intraocular lenses (PC IOL) accounts for one of the remaining and unresolved conditions associated with the implantation of these lenses. This condition assumes importance since in approximately 50% of cases where a PC IOL is removed there is an aspect of improper positioning. The common types of malpositions are: pupil capture; sunset syndrome; sunrise syndrome; horizontal decentration; and the windshield wiper syndrome. This paper will explore the causes and management of these conditions and discuss the virtues of capsular bag implantation.
TL;DR: Resistance-transference-countertransference exchanges reveal the child's or adolescent's efforts to move towards health while emerging from the internalized family.
Abstract: Countertransference brings to light the influence of both anxiety and family processes on the child's or adolescent's maturation and character development. The significance of developmental, dynamic, and family-interpersonal factors have all been stressed as part of the latent communication inherent in resistance. Family influences on resistance and countertransference have to be the subject of analytic scrutiny. The engagement of children and adolescents in the therapeutic process seriously threatens parents' defensive operations both as couples and as individuals. Countertransference responses afford the opportunity not only to clarify the meaning of resistances but also to pinpoint anxieties that have been reexperienced by the child or adolescent with the analyst at points of threat and disorganization. The twofold therapeutic task with children and adolescents consists of delineating and counteracting the family's negative impact on the child's development and self, in addition to addressing the children's contribution to their own pathological traits and immaturities. Countertransference anxiety confirms the dynamic and family implications of the analyst's participation with the patient. Countertransference resistance suggests the analyst's lack of openness in investigating how the treatment has evoked the child's anxiety, the parent's anxiety, and the analyst's anxiety. Resistance-transference-countertransference exchanges reveal the child's or adolescent's efforts to move towards health while emerging from the internalized family.
TL;DR: Antigenic differences represent the first known qualitative distinction between cancer cells and their normal counterparts, revealed by immunological techniques that take advantage of the extraordinary power of discrimination of the immune defense mechanism itself.
Abstract: The function of the immune system is to protect the body from damage caused by invading microorganisms, that is, bacteria, viruses, fungi, and parasites. The humoral mechanism functions through plasma cells producing antibodies that control bacterial infections. Viruses, fungi and parasites are controlled through the thymus dependent T lymphocytes. It is now clear that cancers also invoke immunologic reactions in their hosts. Cancer cells, like bacteria and viruses have their own characteristic antigens. An antigen is defined as a substance, usually a protein or polysaccharide, that the body recognizes as foreign, and to whose presence it reacts by forming antibodies. Antigenic differences represent the first known qualitative distinction between cancer cells and their normal counterparts. These qualitative differences between normal and cancer cells had escaped other methods of investigation, but were revealed by immunological techniques that take advantage of the extraordinary power of discrimination of the immune defense mechanism itself. This mechanism is capable of distinguishing even minute differences between protein molecules, probably one different amino acid in a chain of several thousand.
Burnet's clonal selection theory has become the central dogma of immunology. It can be summarized by saying that lymphocytes have been destined from time immemorial to identify a specific antigen. When the lymphocyte encounters that antigen it becomes a sensitized lymphocyte, and on contact with similar antigens again produces an immune response including the production of very potent pharmacologic agents called lymphokines. Immunodeficiency diseases are identified by increased frequency of infections in patients. The impaired immunity decreases the patient's protection against developing a malignancy. Autoimmunity is the reaction of the immune system against the body's own tissue. Autoimmune disorders as well as autoimmune diseases often follow a malignancy or predispose to its development. Hypersensitivity is related to the immunopathology that occurs when there is an exaggerated or inappropriate immune response. There are five types of hypersensitivity; and the cell mediated immunity and delayed hypersensitivity reaction is related to the protection of the body against invasion by malignant cells. Tumor markers are providing a method for indentifying the type of cancer and at present have a particularly important part in monitoring the therapy for the treatment of malignancies. One of the recent areas of interest in the field of immunology is that of biologic response modifiers: The body's inherent biochemical capacity for killing cancer cells plus the new genetic technology of biologic response modification or biomodulation for short. It is a new wave in cancer treatment. Recombinant DNA technology, commonly referred to as genetic engineering or gene splicing, has provided scientists with the tool for the biosynthesis and subsequent mass production of a significant number of biologicals. It has added an entirely new armamentarium to the diagnosis and therapy of malignant diseases.
TL;DR: A variant of the Boerhaave syndrome is described in which only the outer longitudinal muscle layer of the esophagus was torn, and in this case most of the usual radiological findings were absent.
Abstract: The Boerhaave syndrome is classically considered a panmural perforation of the distal esophagus secondary to forced vomiting or retching. A variant of the syndrome is described in which only the outer longitudinal muscle layer of the esophagus was torn, and in this case most of the usual radiological findings were absent. The clinical, radiological, and surgical findings are discussed.
TL;DR: A case of post-traumatic renal hypertension secondary to unilateral hydronephrosis is presented and the patient remains normotensive two years after the procedure.
TL;DR: An unusual presentation of CMV retinitis which appeared initially only in the foveal region is discussed.
Abstract: Cytomegalovirus (CMV) retinitis is a common and one of the most serious ophthalmic manifestations of the acquired immunodeficiency syndrome (AIDS). Early recognition is essential in the proper management of this necrotizing and progressive infection. We discuss an unusual presentation of CMV retinitis which appeared initially only in the foveal region.
Journal Article•
TL;DR: Although this technique is easy to perform, well tolerated by patients, and accompanied by a low complication rate, it was found that the 16 F Russell introducer allowing placement of a 14 F Foley catheter was accompanied by an unacceptably high rate of tube clogging.
TL;DR: In this article, a cerebellopontine angle epidermoid lesion was identified in a noise-exposed patient as part of an occupational hearing conservation program, where the patient was a 24-year-old employee of a major national newspaper.
Abstract: A cerebellopontine angle epidermoid was identified in a noise-exposed patient as part of an occupational hearing conservation program. The patient is a 24-year-old employee of a major national newspaper who, because of workplace noise levels, was required to be part of a hearing conservation program. A shift in thresholds in 1 year was identified by the audiologic reviewer and referral for audiologic and otologic services was recommended and carried out. The steps leading from the initial air-conduction, pure-tone audiogram to final neurosurgical removal of the epidermoid CPA lesion was described. Such referral is essential if potentially health and life threatening conditions are to be identified and managed, although the primary objectives of the hearing conservation program remains the prevention of sensorineural hearing loss from workplace noise exposure.