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.

IL-1 Trap rilonacept in refractory adult onset Still's disease

Abstract: Adult onset Still's disease (AOSD) is a seronegative polyarthritis associated with rash and fever.1 The innate immune system has been implicated in its pathogenesis and hypersecretion of interleukin 1 (IL-1) has been associated with increased disease activity.2 We report the first successful use of rilonacept, a long-acting IL-1 Trap, in the management of three patients with refractory AOSD. Rilonacept is a soluble dimeric fusion protein (IL-1 receptor extracellular domain +hIgG1-Fc) administered as a weekly subcutaneous injection (220 mg loading dose and 160 mg maintenance dose).3 Patient 1 was a 41 year-old woman who presented with spiking fevers, sore throat, urticaria, arthritis and splenomegaly accompanied by leucocytosis, elevated erythrocyte sedimentation rate (>100 mm/h), increased lung function tests and hyperferritinaemia (8442 ng/ml). She …

Management of penetrating laryngotracheal injuries

Abstract: Background. Penetrating laryngotracheal injuries are uncommon; however, these injuries are associated with significant morbidity and mortality. In an attempt to define the management of penetrating laryngotracheal injuries, we reviewed our experience with these injuries. Methods. We retrospectively analyzed the records of all patients admitted to a Level I trauma center who required operative management for penetrating laryngotracheal injuries. During the period of this study all patients with penetrating neck injuries were managed according to a protocol of selective exploration. Results. Of fifty-seven patients with penetrating laryngotracheal injury 32 patients sustained gunshot wounds and 25 had stab wounds. The injuries were to the larynx in 24 (42%) and trachea in 33 (58%). Forty-six (81%) had isolated airway injuries and 11 (19%) had combined airway and digestive-tract injuries. Emergent airway management in 32 (56%) patients included : tracheostomy (15), endotracheal intubation (14), and cricothyroidotomy (3). Respiratory distress and subcutaneous crepitus were the commonest clinical findings. Diagnostic evaluation included : laryngoscopy/tracheoscopy (17), esophagoscopy (12), contrast esophagography (9), angiography (8), and bronchoscopy (3). Repair of laryngotracheal and esophageal injury was performed in the majority of patients. Selected patients with milder laryngotracheal injury did not have tracheostomy performed, with no increase in morbidity or mortality. There were 2 (3.5%) early deaths from associated major vascular injury. Conclusion. Mortality can be minimized by aggressive airway control. Endotracheal intubation can be accomplished safely in selected patients with penetrating laryngotracheal injuries. Digestive-tract injuries can often clinically occult and contribute significantly to morbidity and mortality ; therefore, early evaluation of the esophagus is vital. Simple repair of laryngotracheal and digestive-tract injuries can be performed safely with good results. In patients with minor injuries, tracheostomy does not appear to be mandatory.

A preliminary evaluation of emergency ultrasound in the setting of an emergency medicine training program.

Abstract: In this article we seek to evaluate the diagnostic accuracy of emergency physicians performing emergency ultrasonography in the setting of an emergency medicine training program. A prospective observational study was performed at an inner city Level I trauma center with an emergency medicine residency training program. From July 1994 to December 1996 a convenience sample of ultrasound exams was recorded. The diagnostic quality (“acceptable or technically limited”) was determined by a board-certified cardiologist or radiologist with fellowship training in ultrasonography. The emergency department interpretations were then compared to those of the blinded cardiologist or radiologist. Four hundred and fifty-six ultrasound examinations were videotaped and entered into the study; 408 (89%) of the studies performed were determined to be “acceptable.” The diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of these studies were as follows: cardiac, to rule out effusion (n = 67; 0.83, 0.98, 0.88, 0.98); transbdominal, to rule out abdominal aortic aneurysms (AAA), cholelithiasis, or free peritoneal fluid (n = 263; 0.91, 0.89, 0.88, 0.92); renal, to rule out hydronephrosis (n = 45; 0.94, 0.96, 0.94, 0.96); pelvic, to rule in intrauterine pregnancy (n = 33; 1.0, 0.90, 0.96, 1.0). The 48 “technically limited studies” included: 39 transabdominal (33 gallbladder, 1 abdominal aortic aneurysm, 5 free peritoneal fluid), 6 cardiac, 2 renal, and 1 pelvic ultrasound. This study suggests that emergency physicians with a minimal amount of training display acceptable technical skill and interpretive acumen in their approach to emergency ultrasonography.

A Critical Reappraisal of Indications for Fasciotomy After Extremity Vascular Trauma

Abstract: Objective: To critically reevaluate the indications for fasciotomy in vascular trauma of the extremities Design: Case-control study Setting: Level I trauma center Materials and Methods: One hundred sixty-three vascular injuries to the extremeties were analyzed Fasciotomy as an adjunct to vascular repair was performed in 45 limbs (28%), based either on the nature of injury or measured compartment pressure of greater than 35 mm Hg Main Outcome Measures: Need for fasciotomy or limb amputation Results: Fasciotomy was performed for 295% of isolated arterial injuries, 152% of isolated venous injuries, and 316% of combined arterial and venous injuries, and was not related to venous repair or ligation Seven delayed fasciotomies were performed either for vascular repair failure (5 patients) or compartment syndrome (2 patients) The highest incidence was for popliteal vessel injury (arterial 57%, combined 61%) Of the 33 lower-extremity fasciotomies, 58% were for popliteal vessel injury In 51 combined injuries of the lower extremity, only 7 (19%) of 38 patients with injury above the knee required fasciotomy, as compared with 8 (62%) of 13 with injury to the popliteal vessels (P<001), with or without venous repair There were 3 amputations, all resulting from vascular repair failure Conclusions: The presence of a combined vascular injury or the need for venous ligation does not necessitate routine fasciotomy The need for fasciotomy may be maximal for injuries to popliteal vessels