Lincoln Hospital

About: Lincoln Hospital is a healthcare organization based out in New York, New York, United States. It is known for research contribution in the topics: Population & Emergency department. The organization has 1033 authors who have published 929 publications receiving 14486 citations. The organization is also known as: Lincoln Medical and Mental Health Center & Lincoln Hospital.

A Rare Case of β-hCG Production by a Solitary Fibrous Tumor of the Pleura

Abstract: Background Solitary fibrous tumors are rare tumors of mesenchymal origins, most commonly seen arising from the pleural lining of the lungs. These are generally benign tumors, which in rare cases have been identified to be associated with multiple para-neoplastic syndromes. Case report This is a case of a solitary fibrous tumor of the pleura in a 49 year old female which was found to be associated with elevated levels of serum beta human chorionic gonadotropin β-hCG). Due to the lack of plausible causes for elevated β-hCG in the patient, immune-histochemical staining of the tumor specimen for β-hCG was obtained. This confirmed the patient's solitary fibrous tumor as the source of the β-hCG. The patient was also found to have a possible paraneoplastic syndrome with irregular menstruation and hot flushes from the secreted β-hCG. Conclusions This is the first reported case of solitary fibrous tumors of the pleura producing {b-hCG. Multiple types of lung tumors have been associated with production of β-subunit of human chorionic gonadotropin. Production of β-hCG by these tumors has been associated with a poor prognosis. In this case, we find an aggressive form of solitary fibrous tumor associated with production of β-hCG and associated paraneoplastic syndrome secondary to the β-hCG. Further study is required to identify the frequency of this phenomenon and the implications of β-hCG production in the prognosis of the solitary fibrous tumors.

Neonatal Abstinence Syndrome

Abstract: During pregnancy, substance abuse is on the rise, especially opioids, both prescribed and illicit, resulting in a hidden epidemic of neonatal abstinence syndrome (NAS). NAS is diagnosed every 25 minutes in the United States. It is a multisystemic disorder resulting from chronic in-utero exposure and its abrupt cessation at birth. The predominant symptoms include central nervous system (CNS), gastrointestinal (GI), and autonomic manifestations. The pathophysiology of this condition remains unknown. Multiple neonatal and maternal factors affect the expression of symptoms, including gestational age, sex, genetics, and maternal polysubstance abuse or smoking. The diagnosis is made based on an accurate maternal history and neonatal clinical features, with or without biological testing. Multiple assessment tools exist, but the traditional Finnegan scoring system is the most commonly used to evaluate neonates and make management decisions. Non-pharmacological care, like rooming-in and control of environmental factors, is the first clinical management strategy and should continue even after discharge from the hospital. Breastfeeding should be strongly encouraged unless there is maternal polysubstance abuse or maternal medical contraindication. When withdrawal signs are severe, pharmacotherapy is initiated. Although no clear consensus exists on which medication is best, morphine remains the most commonly used first-line agent.More recent evidence supports methadone or buprenorphine to treat NAS as their use is associated with shorter hospital stays and decreased pharmacologically treated days. Phenobarbital and clonidine are useful as second-line agents with variable effects. A standardized approach to both non-pharmacological and pharmacological treatment is essential. A new management approach called "eat, sleep, and console" is based on the basic functioning of the infant, standardized non-pharmacological care, and an increase in the family's involvement in the care of the baby. This approach is showing promising results. Management of NAS must also address maternal issues such as co-existing mental illness, intimate partner violence, and limited health care access to maintain the mother-infant relationship necessary for the infant's normal development. NAS is associated with long-term consequences, including but not limited to neurodevelopmental delays, behavioral problems, and, when untreated, death. Adequate data still lacks long-term outcomes attributed to NAS because of the existence of multiple uncontrollable confounding factors. A public health approach is necessary to reduce the incidence of NAS and the resultant economic burden.

Hemophagocytic Lymphohistiocytosis Associated With Parvovirus B19 in a Patient With Acquired Immunodeficiency Syndrome

Abstract: Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening condition characterized by widespread inflammation due to massive immune activation and cytokine release. It is of 2 types, primary or familial and secondary or acquired. Diagnosis is made by fulfilling 5 of 8 criteria as determined by the Histiocyte Society. Treatment includes etoposide, dexamethasone, with or without intrathecal methotrexate in the presence of neurologic involvement as well as treating the underlying cause in secondary HLH. We present a case of a 23-year-old female with congenital human immunodeficiency virus (HIV) infection who presents with nonspecific signs and symptoms of cough, fever, leukopenia, and anemia, and a high-serum parvovirus B19 DNA, later diagnosed with HLH and treated with etoposide and dexamethasone. She made clinical improvements and was successfully discharged to home after 26 days of admission.

Research opportunities in the management of acute exacerbations of chronic obstructive pulmonary disease

Abstract: Acute exacerbations of chronic obstructive pulmonary disease are a common problem in the emergency department. Despite considerable research involving the management of this disease over the past decade, much remains unclear from an emergency medicine perspective. Increased research would better guide the management of these complex patients from the perspectives of the patient, the caregiver, and society. The major areas of research can be divided into diagnosis, therapy, and education. The reliability and validity of different definitions of acute exacerbations of chronic obstructive pulmonary disease need to be assessed. The utility and performance characteristics of diagnostic testing need to be determined for this difficult patient population. Specific diagnostic tests include measures of dyspnea, spirometry and exercise tolerance, measures of gas exchange, airway inflammation, and chest imaging. It remains unclear which patient-specific therapies (oxygen, bronchodilators, corticosteroids, antibiotics, noninvasive positive pressure ventilation, and methylxanthines) should be used and monitored. Finally, the utility of education of both health care providers and patients and how it may be applied to the acute setting need to be addressed.

Opiate Withdrawal Complicated by Tetany and Cardiac Arrest

Abstract: Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status.