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.

Vulvar squamous cell carcinoma metastatic to skin of the forearm.

Abstract: THE PATIENT was a 77-year-old female who initially underwent radical vulvectomy with bilateral inguinal lymphadenectomy for classification of the International Federation of Gynaecologists and Obstetricians stage III squamous cell carcinoma of the vulva. At the time of the original treatment, there was no evidence of systemic spread of disease. Over the following 6 months, the patient developed a progressively enlarging, firm, rounded tumor on the anterior aspect of the right forearm (Figure 1). Incisional biopsy of the lesion documented poorly differentiated squamous cell carcinoma with infiltration of the adjacent connective tissue and skeletal muscle. The findings were consistent with cutaneous metastasis secondary to vulvar carcinoma. Computerized tomography (CT) of the abdomen and pelvis did not show any sign of distant metastasis, but there was evidence of lymphatic metastasis suggested by right inguinal lymphadenopathy. CT and scout films of the forearm showed a multiloculated intramuscular soft tissue mass invading the subcutaneous tissue and showing hemorrhage within the mass, without adjacent bone involvement. The patient then underwent excision of the forearm mass as palliative treatment. The pathologist’s examination of the tissue found a poorly differentiated high-grade carcinoma extending to the deep resection margin and consistent with metastatic squamous cell carcinoma of the vulva. After a 4-month disease-free interval, right axillary lymphatic metastasis developed, followed by metastasis to the lungs. The patient remained alive, however, for 1 year after excision of the forearm lesion, finally succumbing to her disease shortly thereafter. Cancer of the vulva represents 4% to 5% of all gynecologic malignancies and is the fourth most common. It is a slowly progressive tumor that advances locally and metastasizes via regional lymph nodes first to the inguinal then to the deep pelvic nodes. Hematogenous spread may occur in the late stages. In females, cutaneous metastasis occurs most commonly from breast carcinoma, followed by colorectal carcinoma, melanoma, and ovarian carcinoma. Cutaneous metastasis from vulvar carcinoma is extremely rare, and there are only five previous cases presented in the literature. In all of these cases, the cutaneous metastasis was to the skin of the thigh and the lower abdomen, with close proximity to the genitalia, and represented a preterminal event. All five reported patients expired within the ensuing year. Our report describes the first case of cutaneous metastasis of vulvar carcinoma to the upper extremity, remote from the genital tract, and associated with a survival of more than 1 year after the development of metastasis.

Iron Deficiency Anemia in Adult Onset Still's Disease with a Serum Ferritin of 26,387 μg/L.

Abstract: Serum ferritin rises in the anemia of chronic inflammation reflecting increased iron storage and other changes mediated by inflammation. When iron deficiency coexists, the ferritin may not always decline into the subnormal range. We describe the rare interaction of iron deficiency with the extreme hyperferritinemia characteristic of adult onset Still's disease. The combination has clinical relevance and allows deductions about the presence of serum ferritin at 26,387 μg/L despite obvious iron depletion. The diagnosis of iron deficiency anemia was delayed and became fully obvious when her Still's disease remitted and serum ferritin decreased to 6.5 μg/L. The coexistence of iron deficiency should be considered when evaluating a patient with anemia of chronic inflammation even when the ferritin level is elevated several hundredfold. Further insights on ferritin metabolism in Still's disease are suggested by the likelihood that the patient's massive hyperferritinemia in the acute phase of Still's disease was almost entirely of the iron-free apoferritin form.

Laparoscopic adrenalectomy for bilateral metachronous aldosteronomas

Abstract: Introduction Primary aldosteronism affects 5% to 13% of patients with hypertension. Idiopathic bilateral hyperplasia (IHA) and unilateral aldosterone-producing adenoma (APA) are the most common types of primary aldosteronism. Bilateral APA is a very rare entity with only a few reports in the literature. We present the case of a patient with metachronous bilateral APA treated with metachronous bilateral total and near total adrenalectomy. Case report A 66-year-old female was evaluated for hypokalemia and hypertension refractory to medical therapy 2 years after laparoscopic adrenalectomy for right APA. Follow-up abdominal CT scan revealed a new 1.1-cm left adrenal mass. The patient underwent a laparoscopic near total adrenalectomy for her new left adrenal mass. Pathology examination revealed a new APA. The operation and the patient's postoperative course were uneventful. Potassium levels were normalized and her hypertension became well controlled. Conclusion APA can present metachronously months to years after adrenalectomy for APA in the contralateral adrenal gland. Laparoscopic adrenalectomy remains the approach of choice for this pathology.

Coronary Artery Bypass Surgery Compared With Percutaneous Coronary Intervention for Proximal Left Anterior Descending Artery Treatment in Patients With Acute Coronary Syndrome: Analysis From the ACUITY Trial.

Abstract: BACKGROUND The optimal revascularization strategy in patients with acute coronary syndrome (ACS) and proximal left anterior descending (pLAD) coronary artery lesions is not well defined. The aim of this study was to compare the outcomes of ACS patients with pLAD culprit lesions receiving percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG). METHODS The ACUITY trial was a multicenter, prospective trial of patients with ACS treated with an early invasive strategy. Major adverse cardiac event (MACE; defined as death, myocardial infarction [MI], and repeat revascularization) and stroke were compared at 30 days and 1 year between PCI and CABG in patients with significant stenosis of the pLAD undergoing revascularization. Postprocedural major bleeding was evaluated at 30 days. RESULTS Among patients with a significant pLAD stenosis (n = 842), a total of 562 (66.7%) underwent PCI and 280 (33.3%) underwent CABG. Baseline characteristics, including age, sex, diabetes, and TIMI risk score, were well matched between groups; however, patients undergoing PCI were more likely to have had previous CABG (21.9% vs 6.4%; P<.001). Death, MI, MACE, and stroke rates did not differ between groups at 1 year. PCI patients had lower bleeding rates (8.1% vs 52.4%; P<.001) and blood product transfusion at 30 days (4.5% vs 41.3%; P<.001), but higher rates of unplanned revascularization at 1 year (12.7% vs 5.2%; P<.01). These results were consistent in patients with single vs multivessel disease and in diabetics vs non-diabetics. CONCLUSIONS Among ACS patients with pLAD culprit lesions, an initial revascularization strategy of PCI compared with CABG yields similar 1-year death, MI, and MACE rates, although unplanned revascularization is more common after PCI.

High-resolution chest tomography in idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia: utility and challenges.

Abstract: Purpose of review High-resolution computed tomography (HRCT) scan is regarded as the imaging modality of choice to evaluate patients with known or suspected interstitial lung disease. With current technology, HRCT allows for detailed assessment of interstitial compartments. We examine recent data on its role in the diagnostic evaluation, clinical decision-making, and prognosis of patients with interstitial lung disease, and we highlight the challenges related to its application in this field. Recent findings HRCT findings are either diagnostic or strongly suggestive of underlying pathologic patterns. By identifying the presence of certain characteristics, radiologists have developed a clearer understanding of HRCT patterns that coincide with underlying pathology. Challenges and controversies still remain, however. For example, recent studies indicate that the diagnostic accuracy and performance characteristics of HRCT depend predominantly on the study setting; intra-observer and inter-observer variability are less between academic radiologists than between community radiologists. Despite this, clinicians tend to rely primarily on HRCT when a radiologic pattern characteristic for histologic usual interstitial pneumonia is identified. Summary Specific HRCT patterns help to differentiate and prognosticate different interstitial lung diseases. It is important for clinicians to understand the utility and limitations of HRCT in managing their patients. A multidisciplinary approach remains the gold standard.