Showing papers by "Lenox Hill Hospital published in 1991"
TL;DR: Reflecting the background of profound immune deficiency, the AIDS-associated lymphomas were characterized by high aggressiveness, early tendency to generalization, frequent post-treatment relapse, and short periods of survival.
156 citations
TL;DR: Reversal of the normal palmar tilt of the distal radius in the sagittal plane was the most consistent and serious deformity of the bone, and in five patients it was associated with dorsal subluxation of the entire carpus.
Abstract: A malunited Colles' fracture causes distortion of three anatomic features of the distal radius: length of the bone and the angles of its articular surface in both frontal and sagittal planes. The relative importance of each of these factors was studied in a series of 14 patients with malunited Colles' fractures and severe disabilities. Reversal of the normal palmar tilt of the distal radius in the sagittal plane was the most consistent and serious deformity of the bone, and in five patients it was associated with dorsal subluxation of the entire carpus. Correction of the malunion was achieved with a biplanar closing wedge osteotomy without a bone graft. Resection of the ulna head and decompression of the median nerve within the carpal tunnel were done to reduce the likelihood that additional surgery would be required in the future.
76 citations
TL;DR: The patency of anastomoses joining the pancreas to either a Roux-Y loop of jejunum or the stomach was evaluated in 26 dogs and the eight dogs with duct-to-mucosa sutures clearly achieved superiorAnastomotic patency.
Abstract: The patency of anastomoses joining the pancreas to either a Roux-Y loop of jejunum or the stomach was evaluated in 26 dogs. At a preliminary operation, the head and uncinate process of the pancreas were resected while carefully preserving the duodenal blood supply. The remaining body and tail of the pancreas were totally obstructed. After obstruction for a mean of 22 (range: 6 to 42) days, one of three anastomoses was performed: (1) inversion pancreatogastrostomy with two layers of sutures; (2) a similar inversion pancreatojejunostomy to the side of a Roux-Y jejunal loop; or (3) pancreatojejunostomy in which the major duct was joined to the jejunal mucosa with interrupted sutures. Six animals were kept for controls. Anastomotic patency was assessed after 8 to 12 weeks by pancreatography, with minimal pressures to achieve anastomotic flow recorded. Weight trends were consistent with anastomotic status. The eight dogs with duct-to-mucosa sutures clearly achieved superior anastomotic patency.
73 citations
TL;DR: An investigation assessing the cost-effectiveness of nursing case management showed an overall decrease in length of stay, an increase in patient turnover, and a potential increase in patients' revenues generated for the hospital.
Abstract: Hospitals can realize substantial savings from nursing case management. The author describes an investigation assessing the cost-effectiveness of this mode of patient care delivery. The results showed an overall decrease in length of stay, an increase in patient turnover, and a potential increase in patient revenues generated for the hospital. The author provides several general and socioeconomic implications relating to the importance of nursing case management to patient care and institutions' profitability.
41 citations
TL;DR: In 17 patients, 7 with the recurrent gravel/colic syndrome and 10 with prior stones, this regimen abolished calculus formation during an average followup of 2 1/2 years, but further studies are needed before this regimen can be recommended as standard therapy for uric acid stone prophylaxis.
40 citations
TL;DR: Volar subluxation of the tendons of the first dorsal compartment of the wrist occurred in two patients after surgery for treatment of de Quervain's stenosing tenosynovitis, with both patients asymptomatic and free ofSubluxation one and five years after operation.
Abstract: Volar subluxation of the tendons of the first dorsal compartment of the wrist occurred in two patients after surgery for treatment of de Quervain's stenosing tenosynovitis. In both patients a painful tenosynovitis of the extensor pollicis brevis and abductor pollicis longus developed, which was unresponsive to conservative therapy as the tendons prolapsed over the prominence of the first dorsal compartment. A distally based flap of the brachioradialis tendon was used to prevent tendon prolapse, with both patients asymptomatic and free of subluxation one and five years after operation.
40 citations
Journal Article•
TL;DR: Clinicians should not fear using high dose ACTH/corticosteroids to treat severe Crohn's disease with an abdominal mass, if indicated, as it is both safe and effective whether an abscess cavity is present or not.
38 citations
TL;DR: Men had a higher systolic blood pressure in spite of the fact that they had similar sympathetic nervous system response as indicated by urinary norepinephrine excretion, and these differences were altered when adjusted for body weight, body surface area, and lean body mass.
28 citations
TL;DR: The first case to the authors' knowledge in which Caroli's disease was discovered on prenatal sonography, occurring in association with IPKD, is reported.
Abstract: We report the first case to our knowledge in which Caroli's disease was discovered on prenatal sonography, occurring in association with IPKD. Pathological correlation is presented
27 citations
TL;DR: Risk factors for vocal cord hemorrhages were reviewed in 44 professional voice users and it is stressed that such abnormalities should be ruled out by history and appropriate tests when necessary, to prevent the occasional crippling sequelae of vocal cords hemorrhages.
26 citations
TL;DR: Transesophageal echocardiography allows evaluation of cardiac, valvular and vascular structure and function in a relatively noninvasive manner and identifies patients who had dysphagia postoperatively.
Abstract: Transesophageal echocardiography (TEE) allows evaluation of cardiac, valvular and vascular structure and function in a relatively noninvasive manner. Although sustained esophageal pressure during intraoperative monitoring might possibly cause injury to the mucosa or deeper layers, reports of complications related to the technique are rare. Cucciara et al1 reported laryngeal injury after TEE monitoring in the sitting position. Urbanowicz et al2 found no histologic esophageal damage in dogs after maximum surface contact pressure between the esophagus and a fully flexed TEE probe. After several patients complained of dysphagia after cardiac surgery, we identified by prospective interviews 20 patients who had dysphagia postoperatively.
TL;DR: Thallium-exercise testing following angioplasty showed no evidence of inducible ischemia and no arrhythmia was seen, supporting the idea that exercise-related heart block may occur secondary to myocardial ischemIA.
TL;DR: The clinical results were encouraging and the high rate of dislocation may be related to a compromise of acetabular position to obtain bony fixation in acetabula early in the series.
Abstract: Seventy-five uncemented porous-coated total hip prostheses were implanted in 64 patients. The results were reviewed after a mean follow-up period of 47 months (range, 40-64 months). The mean preoperative rating was fair, and the mean postoperative rating was excellent. There were six dislocations. Ten patients had mild thigh pain at one year; by two years, the pain had resolved in six patients. Neither moderate nor severe limp nor significant loosening of beads was observed. Only one patient had progressive radiolucent lines. The high rate of dislocation may be related to a compromise of acetabular position to obtain bony fixation in acetabula early in the series. The clinical results were encouraging.
TL;DR: Results that indicate the normal voice contains significant amounts of very high-frequency energy above 10 kHz are presented, which varies significantly among different individuals.
TL;DR: A one month old infant presented with an abdominal mass that included a large heterogeneous mass but also revealed what appeared to be normal splenic tissue below the left hemidiaphragm, steering the patient away from the diagnosis of wandering spleen or splenic infarction.
Abstract: Torsion of a wandering spleen is an uncommon diagnosis and rare in children. The entity is commonly misdiagnosed. In our case, a one month old infant presented with an abdominal mass. Ultrasound identified a large heterogeneous mass but also revealed what appeared to be normal splenic tissue below the left hemidiaphragm. The ultrasound findings steered us away from the diagnosis of wandering spleen or splenic infarction. Differential diagnosis of the mass included twisted hemorrhagic ovarian cyst, neoplastic mass, or inflammatory abscess. Postoperative histologic analysis demonstrated splenic infarction.
TL;DR: It is important for patients with sickle cell disease to have periodic examinations by ophthalmologists, because the early identification of peripheral retinal disease can be adequately treated, with preservation of vision.
Abstract: Ophthalmologic complications in hemoglobinopathies are largely due to sickle cell disease. A wide spectrum of ophthalmic manifestations are associated with the sickle cell hemoglobinopathies. These ocular findings take on many different forms, which are present in the conjunctiva, iris, retina, and optic nerve. The eye offers an unique opportunity to study and better understand the pathologic changes secondary to the anemia and occlusive vasculopathy in sickle cell disease.
TL;DR: The data suggests that drug therapy may now be the most frequent factor associated with hyperkalemia, and patients with advanced age and HIV positivity are now major groups at risk.
Abstract: Since there has been an increase in the use of medications known to change renal potassium handling, we reassessed the prevalence of and factors associated with hyperkalemia (potassium ≧ 5.1 mmol L−1) in 100 hospitalized patients. The prevalence of hyperkalemia was 10.4%. Fifty-three patients were receiving one or more medications associated with changes in potassium homeostasis. The medications were potassium supplements (22 patients), converting enzyme inhibitors (12 patients), heparin (12 patients), beta-blocking drugs (9 patients), nonsteroidal anti-inflammatory drugs (3 patients), and potassium-sparing diuretics (2 patients). Beta-blocking drugs, or nonsteroidal antiinflammatory drugs were never the sole associated factor. After medications, the second most important factor associated with hyperkalemia (47 patients) was increased age (≧ 70 yr). Other factors included diabetes mellitus (26 patients), and chronic renal failure (15 patients). Eleven patients were HIV antibody positive. Sixty-seven patients had two or more risk factors. The data suggests that drug therapy may now be the most frequent factor associated with hyperkalemia. Also, patients with advanced age and HIV positivity are now major groups at risk.
Journal Article•
TL;DR: The expanding areas of research in cancer are starting to dispel the doom and gloom of the last three decades with a spirit of optimism for the diagnosis and treatment of ovarian cancer, as the new century approaches.
Abstract: Ovarian carcinoma is now the leading cause of death among women. Surgery has reached its limits, and further aggressive surgery will result in an inordinate morbidity and mortality. Ovarian carcinoma is ideally treated by complete surgical removal of the cancer, followed by anti-cancer chemotherapy. Since it is often impossible to remove all of the cancer, adjunctive chemotherapy is playing an increasingly important role in the management of the cancer. New anti-cancer drugs must be found or synthesized, and new combinations of current anti-cancer drugs with mechanisms to protect the bone marrow must be explored. The field of genetics and the identification of the patient at high risk because of a familial history of ovarian cancer must be expanded. The role of tumor markers and oncogenes requires more in-depth study so that these signs can play a greater role in monitoring and identifying the patient with early ovarian cancer. The emerging fields of genetic engineering and biologic response modifiers are opening up new avenues for additional modalities of therapy. The expanding areas of research in cancer are starting to dispel the doom and gloom of the last three decades with a spirit of optimism for the diagnosis and treatment of ovarian cancer, as the new century approaches.
TL;DR: Uric acid stones are more common in older patients and their formation usually requires a persistently acid urine and can be dissolved and their re-formation prevented by the use of alkaline salt therapy.
Abstract: Uric acid stones are more common in older patients. Their formation usually requires a persistently acid urine. Conversely, they can be dissolved and their re-formation prevented by the use of alkaline salt therapy. This paper discusses the spectrum of uric acid stone disease including the frequent presentation as a recurrent gravel/colic syndrome. It reviews the clinical situations in which uric acid stones often form and outlines an approach to dissolution of stones using either oral therapy or urinary tract irrigation. Prophylaxis of further stone formation is often possible with only alternate day, single dose treatment with alkaline potassium salts.
Journal Article•
TL;DR: Bilateral neovascularization of the optic disc developed in a 16-year-old Hispanic girl with retinitis pigmentosa and regressed in both eyes over 1 year without treatment.
Abstract: Bilateral neovascularization of the optic disc developed in a 16-year-old Hispanic girl with retinitis pigmentosa. The neovascularization regressed in both eyes over 1 year without treatment. Ocular and systemic evaluation failed to reveal a recognized cause for the neovascularization. To our knowledge this is only the third case reported of this unusual association.
Journal Article•
TL;DR: Four unusual soft tissue tumors of the head and neck are discussed: osteosarcoma of the mandible, biphasic synovial cell sarcomA of the hypopharynx, soft part sarcomas of the maxillary sinus/alveolus, and adult rhabdomyoma of the larynx.
Abstract: Classifying soft tissue tumors of the head and neck is often difficult for both surgeon and pathologist because of the potential similarities in appearance of metastatic lesions, epithelial tumors, lymphomas, and inflammatory processes. This paper discusses four unusual soft tissue tumors of the head and neck: osteosarcoma of the mandible, biphasic synovial cell sarcoma of the hypopharynx, soft part sarcoma of the maxillary sinus/alveolus, and adult rhabdomyoma of the larynx. Precise diagnosis of these lesions requires adequate tissue sampling, immunocytochemical staining, and electron microscopy. The clinical and pathological features of these tumors, as well as a practical approach to the diagnosis, is presented.
Journal Article•
TL;DR: It is indicated that aerosolized pentamidine, while efficient against the pulmonary infection, may not produce fungicidal blood levels sufficient for the prevention of disseminated pneumocystosis.
Abstract: Pneumocystosis, the most common opportunistic infection associated with the acquired immunodeficiency syndrome, is usually restricted to the lungs and results in severe bilateral pneumonia, which is fatal unless vigorously treated. Rare cases have been reported in which involvement of other organs or disseminated disease occurred in addition to the pulmonary lesions. Pentamidine, an efficient drug used intravenously for the treatment of pulmonary pneumocystosis, has also recently been used in aerosolized form for the prevention of Pneumocystis infection in patients with the acquired immunodeficiency syndrome. In the present case, widely disseminated, though symptomless, pneumocystosis developed in a human immunodeficiency virus-positive individual treated prophylactically with aerosolized pentamidine. Despite heavy multiorgan infection with Pneumocystis carinii, the lungs revealed no microorganisms or characteristic inflammatory lesions. This case indicates that aerosolized pentamidine, while efficient against the pulmonary infection, may not produce fungicidal blood levels sufficient for the prevention of disseminated pneumocystosis.
Journal Article•
TL;DR: The litigation milieu has not only paralyzed the health care industry but it has had a devastating effect across the board on the way Americans live and do business.
Abstract: The malpractice ripoff began when the no-fault automobile accident law was passed. Many lawyers were in a panic at this time and turned to medical malpractice litigation to make a living. It became the conduit to quick wealth. The patient was the loser, the lawyer the winner, and the physician often devastated by the patient's ingratitude. For a patient-plaintiff to maintain a successful lawsuit for medical negligence against a physician, four elements must be alleged and proved in a court of law: duty, breach of duty, causation, and damages. Each must be proved by a patient to prevail against a physician. Since this is very difficult to do, the lawyers have subtly brought in a new approach called maloccurrence. This is defined as a bad outcome unrelated to the quality of care provided. The lawyers need not prove the four elements to win a malpractice case; many are won on deceit and in violation of the law by introducing the concept of maloccurrence. Not only are tort reforms needed but out of court alternatives must be mandated by law or our health care delivery system will be destroyed. Government interference and the malpractice ripoff has had a devastating effect on the talent attracted to medical school, and the number of applicants is falling rapidly. The medical malpractice crisis could soon be translated into a health delivery service crisis. Concerned citizens must join together with the medical profession and leaders of the legal profession to halt this monstrous injustice. The litigation milieu has not only paralyzed the health care industry but it has had a devastating effect across the board on the way Americans live and do business. It must be solved now for justice delayed is justice denied.
TL;DR: The passage of mandatory seat belt legislation has markedly decreased the incidence of head and neck trauma to passengers in private automobiles, however, taxicabs are exempt from seat belt laws in many states.
Abstract: • The passage of mandatory seat belt legislation has markedly decreased the incidence of head and neck trauma to passengers in private automobiles. However, taxicabs are exempt from seat belt laws in many states. Seat belts, which are included as standard equipment by automobile manufacturers, are often made inaccessible by taxicab operators. We present five cases of head and neck trauma sustained by passengers in taxicabs in which seat belts were not accessible. Injuries included laryngeal fractures, maxillofacial trauma, and severe trauma to the cervical spine. All injuries could have been avoided by the use of an accessible safety belt. The nationwide scope of this problem and strategies for modification of existing laws for better protection of passengers in cars for hire are presented. (Arch Otolaryngol Head Neck Surg. 1991; 117:442-445)
TL;DR: In conclusion, propafenone is an effective therapy to convert AF to sinus rhythm in about 50% of cases and has a low incidence of side effects.
TL;DR: A 40-year-old man who had a DeBakey Type I aortic dissection initially underwent replacement of the aorta with a pulmonary homograft, and has a functioning gastrointestinal tract and no vascular insufficiency of the lower extremities and no evidence of degeneration of the homografted.
TL;DR: The article by Phero et al.
Abstract: The article by Phero et al. [3] was fascinating on a number of accounts. The authors chose to discuss only the ‘side effect’ of a ‘psychotic’ reaction to intravenous 2-chloroprocaine (2-CP). In part, the reaction appeared to be a traumatic flashback or abreactive reliving of an episode of sexual abuse that the patient had suffered at the age of seven and had completely repressed. The patient had atypical facial pain for 7 years and had seen 10 health professionals. Following the ‘psychotic reaction’ the patient had no pain. This very dramatic material was mentioned as a ‘side effect’ and as a ‘complication’ but its potential value as a powerful and active ingredient in the treatment process and outcome was not discussed. A number of studies [1,4] have found a significant percentage of patients with chronic intractable pain to have histories of sexual abuse. Pain has been noted to be a somatic presentation of underlying psychiatric distress by a number of authors, and indeed many of us working in pain treatment centers [2,5] have observed the diminution of a pain complaint with the uncovering of repressed affectively uncomfortable memories. For these reasons, Phero et al.‘s [3] brief clinical note becomes an important observation to be considered, not only for its strictly pharmacologic observations (i.e., as a ‘side effect? but also for its possible implications in the ‘treatment and cure.’ The patient’s chronic facial pain had resisted treatment attempts by 10 health care professionals over a 7 year period. She reported complete relief of pain following the flash-