New York Methodist Hospital

About: New York Methodist Hospital is a healthcare organization based out in Brooklyn, New York, United States. It is known for research contribution in the topics: Myocardial infarction & Percutaneous coronary intervention. The organization has 948 authors who have published 936 publications receiving 29954 citations.

Specification and design of a Therapy Imaging and Model Management System (TIMMS)

Abstract: Appropriate use of Information and Communication Technology (ICT) and Mechatronic (MT) systems is considered by many experts as a significant contribution to improve workflow and quality of care in the Operating Room (OR) This will require a suitable IT infrastructure as well as communication and interface standards, such as DICOM and suitable extensions, to allow data interchange between surgical system components in the OR A conceptual design of such an infrastructure, ie a Therapy Imaging and Model Management System (TIMMS) will be introduced in this paper A TIMMS should support the essential functions that enable and advance image, and in particular, patient model guided therapy Within this concept, the image centric world view of the classical PACS technology is complemented by an IT model-centric world view Such a view is founded in the special modelling needs of an increasing number of modern surgical interventions as compared to the imaging intensive working mode of diagnostic radiology, for which PACS was originally conceptualised and developed A proper design of a TIMMS, taking into account modern software engineering principles, such as service oriented architecture, will clarify the right position of interfaces and relevant standards for a Surgical Assist System (SAS) in general and their components specifically Such a system needs to be designed to provide a highly modular structure Modules may be defined on different granulation levels A first list of components (eg high and low level modules) comprising engines and repositories of an SAS, which should be integrated by a TIMMS, will be introduced in this paper

Hepatic dysfunction and neurotoxicity in a patient receiving long-term low-dose amiodarone therapy.

Abstract: Background: Amiodarone is commonly used in the treatment of refractory paroxysmal atrial fibrillation. Much of the literature focuses on the toxic effects of this medication in the setting of rapid loading or long-term therapy with high maintenance doses. However, patients have been known to develop multi-organ toxicities with long-term low-dose therapy. Case Report: We present a 90-year-old man with paroxysmal atrial fibrillation undergoing low-dose amiodarone therapy for a period of 18 months without medical follow-up who developed signs and symptoms consistent with neurotoxicity and hepatotoxicity in association with hyperammonemia. Upon discontinuation of the medication and treatment of the hyperammonemia, the patient had a rapid decline in symptoms and a return to his baseline status. Conclusion: Identifying toxicity early and correcting it rapidly may prevent life-threatening sequelae associated with amiodarone toxicity.

Serial Cardiac Magnetic Resonance Imaging of a Rapidly Progressing Liquefaction Necrosis of Mitral Annulus Calcification Associated With Embolic Stroke

Abstract: Mitral annulus calcification (MAC) is a common finding in the elderly. A rare manifestation of MAC is liquefaction necrosis that can be mistaken for a tumor or an abscess. Because its course is most often benign, a correct diagnosis is imperative to avoid unnecessary workup or treatment. A 76-year-old woman with history of hypertension and dyslipidemia presented with chest pain and elevated cardiac enzymes. A coronary angiogram revealed no significant coronary artery disease. Echocardiogram (Figure 1) revealed a large, solid mass within the atrioventricular groove and the lateral wall of the left ventricle. There was moderate calcification of the mitral valve annulus. Computed tomography scan of the chest (Figure 2) revealed a soft tissue density inseparable from the region of the mitral valve and the left ventricular wall. Cardiac magnetic resonance (CMR) showed a large mass involving the basal lateral wall near the atrioventricular groove, extending into the left atrium (Figure 3A and 3B). The mass was slightly hyperintense on T1 (Figure 4) and hypointense on T2 imaging (Figure 5). The mass was homogenous on delayed enhancement with a bright ring (Figure 6), the characteristics were not changed with fat saturation, and it was avascular by perfusion (Figure 7). The patient was discharged from the hospital with a scheduled outpatient workup to continue. Figure 1. Echocardiography images before and after biopsy. A , 4-chamber view performed on presentation, reveals a soft tissue mass involving the atrio-ventricular groove, the left atrium, and left ventricle. There is moderate calcification of the mitral valve. B , 4-chamber view performed after biopsy. The mass has decreased in size and appears cystic. White arrows indicate the mass. Figure 2. Computed tomography image performed on first admission. This is a 5-chamber …

Performance of PCR/Electrospray Ionization-Mass Spectrometry on Whole Blood for Detection of Bloodstream Microorganisms in Patients with Suspected Sepsis

Abstract: Blood culture (BC) often fails to detect bloodstream microorganisms in sepsis. However, molecular diagnostics hold great potential. The molecular method PCR/electrospray ionization-mass spectrometry (PCR/ESI-MS) can detect DNA from hundreds of different microorganisms in whole blood. The aim of the present study was to evaluate the performance of this method in a multicenter study including 16 teaching hospitals in the United States (n = 13) and Europe (n = 3). First, on testing of 2,754 contrived whole blood samples, with or without spiked microorganisms, PCR/ESI-MS produced 99.1% true-positive and 97.2% true-negative results. Second, among 1,460 patients with suspected sepsis (sepsis-2 definition), BC and PCR/ESI-MS on whole blood were positive in 14.6% and 25.6% of cases, respectively, with the following result combinations: BC positive and PCR/ESI-MS negative, 4.3%; BC positive and PCR/ESI-MS positive, 10.3%; BC negative and PCR/ESI-MS positive, 15.3%; and BC negative and PCR/ESI-MS negative, 70.1%. Compared with BC, PCR/ESI-MS showed the following sensitivities (coagulase-negative staphylococci not included): Gram-positive bacteria, 58%; Gram-negative bacteria, 78%; and Candida species, 83%. The specificities were >94% for all individual species. Patients who had received prior antimicrobial medications (n = 603) had significantly higher PCR/ESI-MS positivity rates than patients without prior antimicrobial treatment—31% versus 22% (P