Showing papers by "Lenox Hill Hospital published in 1993"
Journal Article•
TL;DR: 6-MP was once again demonstrated to be effective in achieving major therapeutic goals in two of three patients with severe Crohn's disease, and the need for surgical resection and subsequent extension of the disease is often postponed or eliminated.
152 citations
TL;DR: Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete’s safe return to sports and early recognition and treatment are vital to prevent associated morbidity of these rare butserious injuries.
Abstract: Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete's safe return to sports. Early, accurate anatomical diagnosis is essential. Nerve lesions may be due to acute injury (e.g. from a direct blow) or chronic injury secondary to repetitive microtrauma (entrapment). Accurate diagnosis is based upon physical examination and a knowledge of the relative anatomy. Palpation, neurological testing and provocative manoeuvres are mainstays of physical diagnosis. Diagnostic suspicion can be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. Proper equipment, technique and conditioning are the keys to prevention. Rest, anti-inflammatories, physical therapy and appropriate splinting are the mainstays of treatment. In the shoulder, spinal accessory nerve injury is caused by a blow to the neck and results in trapezius paralysis with sparing of the sternocleidomastoid muscle. Scapular winging results from paralysis of the serratus anterior because of long thoracic nerve palsy. A lesion of the suprascapular nerve may mimic a rotator cuff tear with pain a weakness of the rotator cuff. Axillary nerve injury often follows anterior shoulder dislocation. In the elbow region, musculocutaneous nerve palsy is seen in weightlifters with weakness of the elbow flexors and dysesthesias of the lateral forearm. Pronator syndrome is a median nerve lesion occurring in the proximal forearm which is diagnosed by several provocative manoeuvres. Posterior interosseous nerve entrapment is common among tennis players and occurs at the Arcade of Froshe--it results in weakness of the wrist and metacarpophalangeal extensors. Ulnar neuritis at the elbow is common amongst baseball pitchers. Carpal tunnel syndrome is a common neuropathy seen in sport and is caused by median nerve compression in the carpal tunnel. Paralysis of the ulnar nerve at the wrist is seen among bicyclists resulting in weakness of grip and numbness of the ulnar 1.5 digits. Thigh injuries include lateral femoral cutaneous nerve palsy resulting in loss of sensation over the anterior thigh without power deficit. Femoral nerve injury occurs secondary to an iliopsoas haematoma from high energy sports. A lesion of the sciatic nerve may indicate a concomitant dislocated hip. Common peroneal nerve injury may be due to a direct blow or a traction injury and results in a foot drop and numbness of the dorsum of the foot. Deep and superficial peroneal nerve palsies could be secondary to an exertional compartment syndrome. Tarsal tunnel syndrome is a compressive lesion of the posterior tibial nerve caused by repetitive dorsiflexion of the ankle--it is common among runners and mountain climbers.(ABSTRACT TRUNCATED AT 400 WORDS)
144 citations
TL;DR: The OCD population is expanded, adding patients from a second site, and the existence of two clusters of patients within a clinically homogeneous group of patients who met DSM-III-R criteria for OCD is replicated, which were characterized by excess relative power in theta, especially in the frontal and frontotemporal regions.
Abstract: Current neuropsychological, electrophysiological, and other imaging data strongly suggest the existence of a neurobiological basis for obsessive-compulsive disorder (OCD), which was long considered to be exclusively of psychogenic origin. The positive response of some OCD patients to neurosurgery, as well as the efficacy of agents that selectively block serotonin reuptake, lends further support to a biological involvement. However, a survey of the treatment literature reveals that only 45-62% of OCD patients improve with these specific medications. In a pilot study using a quantitative electroencephalographic (QEEG) method known as neurometrics, in which QEEG data from OCD patients were compared statistically with those from an age-appropriate normative population, we previously reported the existence of two subtypes of OCD patients within a clinically homogeneous group of patients who met DSM-III-R criteria for OCD. Following pharmacological treatment, a clear relationship was found between treatment response and neurometric cluster membership. In this study, we have expanded the OCD population, adding patients from a second site, and have replicated the existence of two clusters of patients in an enlarged, statistically more robust population. Cluster 1 was characterized by excess relative power in theta, especially in the frontal and frontotemporal regions; cluster 2 was characterized by increased relative power in alpha. Further, 80.0% of the members of cluster 1 were found to be nonresponders to drug treatment, while 82.4% of the members of cluster 2 were found to be treatment responders.(ABSTRACT TRUNCATED AT 250 WORDS)
123 citations
TL;DR: A retrospective study was done on 64 patients who underwent superficial or subtotal parotidectomy for a primary benign tumor of theParotid gland, and the marginal mandibular branch was affected in nine of 10 cases.
Abstract: A retrospective study was done on 64 patients who underwent superficial or subtotal parotidectomy for a primary benign tumor of the parotid gland. Factors, such as age, sex, smoking, alcohol consumption, type of surgery, duration of surgery, pathology of lesion, and size of lesion, were reviewed in a multivariate statistical analysis to determine if any factor alone or in combination contributed to the development of functional facial nerve weakness postoperatively. Only the age of the patient was found to have a statistically significant causal relation using the Pearson chi-square method (p = 0.015). The marginal mandibular branch was affected in nine of 10 cases. Different surgical approaches cited in the literature are discussed, along with the possible role of ischemic injury to the facial nerve during parotidectomy.
65 citations
TL;DR: An enlarged iliopsoas bursa should be considered in the differential diagnosis of hip pain or extremity swelling after total hip arthroplasty.
Abstract: The authors report an unusual complication of total hip arthroplasty. A patient developed significant swelling and discomfort in the left lower extremity 4 1 2 years following a left total hip arthroplasty. Magnetic resonance imaging and venography demonstrated a large intrapelvic mass compressing the external iliac vein. An arthrogram revealed a cystic cavity consistent with an iliopsoas bursa in communication with the hip pseudocapsule. Two aspirations of the bursa led to resolution of the cystic enlargement and symptoms. An enlarged iliopsoas bursa should be considered in the differential diagnosis of hip pain or extremity swelling after total hip arthroplasty.
31 citations
TL;DR: Eudragit-S-coated mesalamine appears to be effective in the treatment and maintenance of remission of UC in 82% of those patients allergic or intolerant to the parent drug, sulfasalazine, and in a much larger percentage of patients with Crohn's disease than the parentDrug.
Abstract: We reviewed the courses of 63 patients with inflammatory bowel disease (IBD) treated in a private gastroenterology practice. All were allergic, unresponsive, or in some way intolerant of sulfasalazine and therefore were treated with Eudragit-S-coated mesalamine (Asacol). Thirty-eight patients had ulcerative colitis (UC) and 25 had Crohn's disease. In 22 and 14, respectively, mesalamine was used to treat active disease; in 16 and 11, respectively, it was introduced to maintain remission. In some patients, mesalamine was used along with other medications. Symptomatic and endoscopic response was seen in seven of nine (77%) with active UC treated with measalamine alone; remission was maintained in seven of eight (94%) when mesalamine was used alone. Therapeutic success was noted in eight of 10 (80%) with active Crohn's disease, and remission was maintained in seven of nine (78%) when mesalamine was used alone. Adverse reactions of varying severity occurred in 21 of 63 (33%), but the drug had to be terminated in only 9 of 63 (14%). Eudragit-S-coated mesalamine appears to be effective in the treatment and maintenance of remission of UC in 82% of those patients allergic or intolerant to the parent drug, sulfasalazine. Furthermore, contrary to what was expected, we found it effective in a much larger percentage of patients with Crohn's disease (79%) than the parent drug.
20 citations
TL;DR: A previously healthy 39-year-old woman was admitted with complaints of diffuse abdominal pain for one week, hematochezia for four days, and diarrhea with tenesmus for one day, and low-grade fever for several days.
Abstract: A previously healthy 39-year-old woman was admitted with complaints of diffuse abdominal pain for one week, hematochezia for four days, and diarrhea with tenesmus for one day. She also reported low-grade fever for several days. Prior menstrual history was unremarkable. Last menstrual period was one week prior to admission. Vital signs were within normal limits. Physical examination revealed hyperactive bowel sounds with right lower quadrant and periumbilical tenderness. The remainder of the examination was normal. Significant laboratory findings were confined to anemia (Hgb 11.2 g/dl; Hct 33.1%). Colonoscopy revealed a smooth, thick, cigar-shaped polypoid mass within the cecum measuring 10 x 2 cm. A right hemicolectomy was performed. The postoperative course was uneventful. On gross pathologic examination, the surgical specimen consisted of 35 cm. of distal ileum and ascending colon. The vermiform appendix was not readily visualized. Instead, a deep umbilication was noted at the junction of the colonic teniae. Upon opening the cecum, the inverted appendix was recognized. The appendiceal mucosa was hemorrhagic and partly eroded (Figure 1). Microscopically, the vermiform appendix demonstrated a congested, focally eroded, everted colonic type mucosa (Figure 2). Noted within the mesoappendix were
17 citations
TL;DR: The time has come to reevaluate the clinical approach to ovarian pathology and conclude that a pelvic mass found during a pelvic examination is the only practical and consistent clinical method available to detect an ovarian tumor.
Abstract: The time has come to reevaluate our clinical approach to ovarian pathology. Although carcinoma of the endometrium is still the most prevalent cancer of the female reproductive system, ovarian carcinoma has become the leading killer of women who die from gynecologic malignancy. With the present state of diagnostic development, diagnosis of an ovarian tumor is a matter of chance rather than a scientific discovery. By the time it is diagnosed, ovarian cancer in more than 70 to 80% of the patients has spread beyond the ovary. The hard fact remains that a pelvic mass found during a pelvic examination is the only practical and consistent clinical method available to us to detect an ovarian tumor. Certain functional or dysontogenetic tumors with hormone activity are the exception. However, there are only a few such tumors compared to the number of epithelial tumors, which comprise the main group of killers.
17 citations
TL;DR: The depressant effect of ethanol on PCBF may be the result of its direct action on pancreatic cells causing edema and capillary compression rather than on primary vascular control mechanisms that adjust blood flow.
Abstract: The effects of intravenous ethanol and ethanol plus furosemide on pancreatic capillary blood flow (PCBF) were investigated using a laser-Doppler flowmeter. Forty Sprague-Dawley male rats were divided into 4 groups: (1) control, (2) 80% ethanol, (3) 80% ethanol plus furosemide, and (4) furosemide. Mean arterial blood pressure and heart rate were monitored. Levels of serum amylase, calcium, electrolytes, ethanol, and furosemide (groups 3 and 4) were measured, and samples of pancreatic tissue were obtained. The ethanol and furosemide levels were statistically different (p 0.05) between groups 1 and 4. Histopathologic analysis revealed swollen acini in group 2 and sparse focal necrosis without acinar swelling in group 3. The depressant effect of ethanol on PCBF may be the result of its direct action on pancreatic cells causing edema and capillary compression rather than on primary vascular control mechanisms that adjust blood flow. Furosemide counters this effect.
15 citations
TL;DR: Administration of a luteinizing hormone-releasing hormone analogue has supplanted orchiectomy and estrogen therapy for the treatment of disseminated disease, as witnessed by a 4-fold increase in its use.
15 citations
01 Jan 1993
TL;DR: Cancer of the ovary raises many challenges during the preoperative, operative, and postoperative periods, and it is important to rule out the ovarian tumor as a metastatic lesion before exploratory laparotomy.
Abstract: Cancer of the ovary raises many challenges during the preoperative, operative, and postoperative periods. It is not only the site of origin of a variety of tumors but a target for metastases from many other organs (i.e., thyroid, breast, stomach, colon, and the opposite ovary). Therefore it is important to rule out the ovarian tumor as a metastatic lesion before exploratory laparotomy. To be forewarned is indeed to be forearmed. The diagnostic evaluation has been covered in Chapter 8.
01 Jan 1993
TL;DR: Sex steroid hormone receptors provide the means by which estrogen and progesterone influence their target tissues and their application to study of the ovary is currently undergoing intensive investigation.
Abstract: Sex steroid hormone receptors provide the means by which estrogen and progesterone influence their target tissues Receptor assays have proved clinically useful for the management of breast cancer Their application to study of the ovary is currently undergoing intensive investigation
TL;DR: In this paper, a posterior laminectomy was combined with an anterior neck exploration to remove four patients with dural extension of the cervical plexus, three of which were neurilemomas and one was a meningioma.
Abstract: Tumors of the cervical plexus are rare. Often these tumors are found on routine exam as asymptomatic masses. We present our experience in managing four patients with tumors with dural extension. Three of these lesions were neurilemomas and one was a meningioma. Symptoms and signs included weakness and hypoesthesia. Evaluation included complete neurologic examination with electromyography (EMG). Magnetic resonance imaging (MRI) was the best diagnostic tool to see tumor extent into the epidural and intradural space. Computed tomography (CT) or plain x-rays were used to evaluate the degree of destruction of the cervical spine. The surgical removal of these tumors was performed by a two-team approach. A posterior laminectomy was combined with an anterior neck exploration. Follow-up shows persistent upper extremity weakness in two patients, hypesthesia in three patients, and anesthesia of the anterior chest wall in two patients. Patients with these lesions should be informed of the potential neurologic consequences of removal.
TL;DR: The etiology, symptoms, and treatment of hyponatremic and hypernatremic syndromes are reviewed.
TL;DR: A teenage girl with Crohn's disease who developed an acute abdomen following ACTH therapy was reported, and CT revealed the mass to be a hemorrhagic adrenal gland; the opposite adrenal glands was hypertrophied but without signs of hemorrhage.
Abstract: Huge dose ACTH therapy is used in some severely ill patients with inflammatory bowel disease. We report a teenage girl with Crohn's disease who developed an acute abdomen following ACTH therapy. CT revealed the mass to be a hemorrhagic adrenal gland; the opposite adrenal gland was hypertrophied but without signs of hemorrhage.
Journal Article•
TL;DR: The only prophylaxis for ovarian cancer is oophorectomy, except in the very rare case when an ovarian cancer appears to arise from the mesothelial tissue of the abdominal cavity.
Abstract: The only prophylaxis for ovarian cancer is oophorectomy, except in the very rare case when an ovarian cancer appears to arise from the mesothelial tissue of the abdominal cavity It has been shown that women who have taken the oral contraceptive pill for 4 or 5 years decreases the incidence of ovarian cancer by approximately 40% It is estimated that the oral contraceptive pill can prevent approximately 1500 ovarian cancers each year, The postmenopausal palpable ovary syndrome is simply the palpation of what is interpreted as a normal-sized ovary in the premenopausal woman represents an ovarian tumor in the postmenopausal woman
TL;DR: A patient-specific protocol utilizing individually derived PET data provides an acceptable and easy to calculate initial treatment prescription for each patient that avoids the necessity for trial and error that has heretofore been employed.
Abstract: ObjectiveTo develop a formula that would permit a rapid and simple calculation of required dialysate volume needed to provide a predetermined daily creatinine clearance.DesignProspective study of p...
TL;DR: ALA excess may prove to be associated with the development of neuropathy in AIP, and the impact of ALA and PBG on human neuroblastoma and glioblastoma tumor cell survival as measured by the MTT assay.
Abstract: Acute intermittent porphyria (AIP) or precursor syndrome is a well described neuropathic clinical entity with incompletely known etiology. The most prominent biological abnormalities associated with this syndrome are elevations in serum and hepatic δ-aminolevulinic acid (ALA) and porphobilinogen (PBG). We determined the impact of ALA and PBG on human neuroblastoma and glioblastoma tumor cell survival as measured by the MTT assay. ALA proved to be cytotoxic in neuroblastoma cells, while PBG lacked cytotoxic effects. This cytotoxic effect of ALA could be enhanced by deferoxamine and diminished by heme, presumably through modulation of ALA synthesis. In conclusion, ALA excess may prove to be associated with the development of neuropathy in AIP.
TL;DR: An adult patient with intestinal lymphangiectasia is reported with an unusual presentation simulating an acute abdomen with protein-losing enteropathy, mal absorption, and ascites.
Abstract: Intestinal lymphangiectasia is a disorder of the lymphatics of the gastrointestinal system that usually manifests itself with protein-losing enteropathy, malabsorption, and ascites. We report an adult patient with this disorder with an unusual presentation simulating an acute abdomen.
TL;DR: There is a significant amount of morbidity associated with development of stone disease, and a comprehensive yet simple evaluation to determine the cause of the problem is warranted.
01 Jan 1993
TL;DR: Ultrasonography is employed to evaluate the position and volume of tumor; and if disease is identified with this technique, ultrasonography will be employed to monitor therapy.
Abstract: Early diagnosis of ovarian cancer is a matter of chance rather than scientific discovery. The same frustration confounds any attempt at detecting early recurrence of disease. Currently, laparoscopic examination and laparotomy are the only means available that have a predictable rate of accuracy. Periodic gynecologic examinations have not been helpful. Cul-de-sac aspiration, cytology, and serum enzyme studies have limited application in the initial diagnosis. Tumor markers, such as CA125, CA15-3, CA19-9, NB/70K, LASA-P, carcinoembryonic antigen, α-fetoprotein, human chorionic gonadotropin, acute phase reactive proteins, complement components, and complement inhibitors, if present, can serve to monitor response to treatment. Ultrasonography is employed to evaluate the position and volume of tumor; and if disease is identified with this technique, ultrasonography is employed to monitor therapy.
Journal Article•
TL;DR: A case of a patient who had documented ulcerative colitis as a child and later presented with isolated Crohn's jejunitis is presented, and a small bowel series is indicated.
01 Jan 1993
TL;DR: The term childhood or adolescent gynecologic tumor is used to indicate any new growth that develops between birth and age 16, which implies the growth of newly formed cells derived from normal body cells or that preceding the developmental cells of origin.
Abstract: The term childhood or adolescent gynecologic tumor is used to indicate any new growth (benign or malignant) that develops between birth and age 16. It implies the growth of newly formed cells derived from normal body cells or that preceding the developmental cells of origin. Benign neoplasm indicates a tumor that does not itself destroy the host, whereas a malignant neoplasm, if left untreated, does destroy the host.
TL;DR: The extent of hazing-related injuries and deaths is still unknown because of concealment of the activity by student participants and lack of recognition by professionals who treat students for a variety of injuries of undetermined origin.
Abstract: IN 1985, Leslie et al1described a series of 168 cases of injuries and deaths related to fraternity hazing activities occurring in the United States between 1923 and 1982. This was the first article in the literature to address the medical hazards of fraternity hazing. Hazing has reportedly existed on the campuses of American universities since the mid-19th century, but documentation of a specific incident was unavailable at the time of the original research. The extent of hazing-related injuries and deaths is still unknown because of concealment of the activity by student participants and lack of recognition by professionals who treat students for a variety of injuries of undetermined origin. The types of injuries previously reported included those from blunt force (beatings, paddling, motor vehicle crashes, pedestrian accidents, and falls from height), burns (including chemical burns, branding, and immolation), cold exposure, heat exhaustion, acute ethanol intoxication, food and laxative
01 Jan 1993
TL;DR: The word common has been used to describe certain epithelial ovarian tumors because approximately 75 to 80% of ovarian tumors belong in this general category.
Abstract: The word common has been used to describe certain epithelial ovarian tumors because approximately 75 to 80% of ovarian tumors belong in this general category. They arise from the basic germinal epithelium or mesothelium on the surface of the ovary and can be designated mesotheliomas with varying amounts and activities of the gonadal mesenchyme. The latter is known as the ovarian stroma and contains two elements: the potentially functioning element, or theca, and the supporting connective tissue. Thus all ovarian tumors are potentially hormone producing.
01 Jan 1993
TL;DR: The ovary is unique in that it not only gives rise to a great variety of malignancies but itself is a favorite site for metastases from many other organs.
Abstract: Ovarian cancer is becoming a common malignancy. It has been considered a family of malignancies arising within the ovary rather than a single entity. The ovary is complex in its embryology, histology, steroidogenesis, and potential for malignancy. It is made up of germ cells, gonadal stromal cells, and cells of the mesenchymal tissue, each with its own potential to form a tumor. Although sex is determined genetically at fertilization, the ovary passes through its early phases as an indifferent organ with parallel development that could allow it to become an ovary or a testis. Alterations or imbalances during these steps of development may provide the setting for the later cellular malfunctioning that produces endocrine imbalances as well as malignancy. The ovary is unique in that it not only gives rise to a great variety of malignancies but itself is a favorite site for metastases from many other organs.
01 Jan 1993
TL;DR: It is commonly stated that ovarian malignancies are frequently asymptomatic; subjective complaints occur only after complications arise or, in the case of carcinoma, after dissemination is widespread.
Abstract: It is commonly stated that ovarian malignancies are frequently asymptomatic; subjective complaints occur only after complications arise or, in the case of carcinoma, after dissemination is widespread. Therefore it is accepted that of all aspects of ovarian cancer the symptomatology is the least satisfactory. If there are no early symptoms of malignant ovarian tumors, this fact is partly responsible for the poor results achieved, because one of the important factors in prognosis in ovarian cancer is the extent of disease at the time of treatment. Specific symptoms depend on the size, location, and type of tumor, as well as on such complicating factors as torsion, hemorrhage, infection, or rupture. Among the germ cell or gonadal stromal tumors, symptoms may relate to the hormone secreted by the tumor.
01 Jan 1993
TL;DR: The response of the common epithelial ovarian cancer and its type of superficial spread over the liver and diaphragm interfered with optimal treatment and chemotherapy was selected as the treatment of choice.
Abstract: Controversy has developed over the role of external x-ray therapy for the management of patients with common epithelial ovarian cancer. Although it is accepted that external x-ray therapy has a place in the treatment of the gonadal stromal tumors and germ cell tumors exclusive of the extraembryonal tumors, its role in the therapy of the common epithelial ovarian cancers has diminished in prominence. There are several reasons: (1) A study carried out at the M.D. Anderson Hospital compared melphalan (Alkeran) to radiation therapy as postoperative therapy. The radiation therapy was associated with more serious toxicity and a greater economic cost to the patient but did not improve the surgical rate; therefore chemotherapy was selected as the treatment of choice. (2) The response of the common epithelial ovarian cancer and its type of superficial spread over the liver and diaphragm interfered with optimal treatment.