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.

Surgical Treatment for Hepatocellular Carcinoma

Abstract: The treatment of hepatocellular carcinoma (HCC) has undergone evolution and refinement over the past three decades. Changes in the understanding of HCC with respect to tumor size, number and location, underlying liver function and portal pressure, and hepatic anatomy, in combination with refinement of surgical techniques and technologies, have greatly influenced the approach to surgical management. Surgery is considered the mainstay of curative HCC treatment with resection and transplantation achieving the best outcomes in well-selected candidates (5-year survival of 60–80 %). Surgical resection of HCC, especially within the Milano/Mazzaferro criteria (i.e., solitary tumor ≤ 5 cm or up to three tumors all ≤ 3 cm) in patients with well-preserved liver function (Child-Pugh A and selectively B patients), offers the greatest chances for survival. Liver transplantation is considered the treatment of choice for patients with compromised liver function (Child-Pugh B/C). The clinical parameters identified in this Chapter will be used to generate Digital Patient Models (DPMs) to facilitate diagnosis, prognosis, and treatment selection, i.e. Model Guided Therapy (MGT). The following have been identified as key issues relating to Predictive, Preventive, and Personalized Medicine (PPPM) and surgical treatment for HCC: tumor characterization, such as size, number, and vascular invasion; the patientʼs clinical status, particularly the presence of cirrhosis, the degree of portal hypertension, and liver functional reserve; pre-operative management, such as patient selection for resection or transplantation, choice of donor, down-staging and bridging therapies; and, surgical techniques, including techniques to minimize blood loss and to ensure an adequate liver remnant.

Minimally Invasive Therapies for Hepatocellular Cancer: Ablation Technologies

Abstract: Ablation therapy is proving to be a major tool in the anti-cancer armamentarium. The superb diagnostic capabilities of CT, US, and MRI, along with IR techniques, have combined to allow percutaneous tumor ablation to become fairly widespread in availability at major centers. The fundamental concept of ablation is that the extremes of temperature kill cancer. Thus both heating and freezing methods are effectively tumoricidal. Heating options are via radiofrequency, laser, and microwave. The former is utilized most frequently, laser least, and microwave is in its early clinical experience. Other primary methods of percutaneous tumor ablation include cryotherapy (CRYO) and direct chemical injection. While various agents have been injected for direct percutaneous injection into tumors, alcohol ablation is most effective, and has been utilized most frequently. The efficacy of radiofrequency ablation (RFA) is related to the size of the liver tumor. It is accepted that the lesion should not exceed 2.5–3.0 cm to obtain complete necrosis. It has been reported that certain microwave ablation (MWA) devices may allow successful treatment of lesions as large as 5 cm with an acceptable margin of safety. Notwithstanding, RFA commonly is utilized for lesions greater than 3 cm in diameter, occasionally for palliative debulking rather than cure. Guidelines may assist in the selection and use of the more widely used thermal technologies to provide optimal Predictive, Preventive and Personalized Medicine (PPPM). To achieve maximal effectiveness for cure, basic treatment precepts must be understood and adhered to, including: (1) proper patient selection; (2) treatment of the entire lesion; (3) providing adequate tumor margins.

Graves' Disease-Induced Coronary Vasospasm.

Abstract: A 51-year-old woman presented to the emergency department with a 3-week history of intermittent palpitations, dyspnea, and substernal chest pain lasting 5 to 10 min with spontaneous resolution. She remained hemodynamically stable, and an electrocardiogram showed a 1.5-mm ST-segment elevation in lead

Management Setting of Obstructive Sleep Apnea

Abstract: Management Setting of Obstructive Sleep Apnea To the Editor Dr Chai-Coetzer and colleagues1 compared management models of obstructive sleep apnea (OSA) and found that primary care physicians and advanced practice nurses did not provide inferior screening and diagnosis of OSA vs physicians with specialized training in sleep medicine. I believe that several relevant issues suggest this conclusion is premature. First, more than twice as many patients in the primary care group than in the sleep specialist group withdrew from the study. Second, the primary care pathway included a telephone call to the patient 2 weeks after starting continuous positive airway pressure (CPAP) and a total of 5 follow-up appointments. The follow-up with the sleep specialist group was unclear, which suggests the study methods may have been biased. Third, at 6 months, there was a nonsignificant trend showing 0.6 hours greater use of CPAP per night in the specialist group, a difference meaningful in clinical practice. In addition, not everyone who seeks sleep medicine services is a patient with moderate to severe OSA. This is evident in the data in this study showing that 39% of referred cases were excluded for not meeting eligibility criteria. Specialized training and comprehensive patient evaluation is the only way to ensure that all patients seeking sleep medicine services are well treated, and not just select cases as included in this trial. Both in-laboratory polysomnography and out-of-center sleep testing require the interpretation of a sleep specialist who has the training and expertise to make an accurate diagnosis of OSA, rule out common comorbid sleep disorders, and determine the most appropriate treatment plan. Studies have shown that both American Academy of Sleep Medicine accreditation and board certification in sleep medicine are associated with improved patient care, including increased CPAP adherence.2,3 Concerns about waiting lists are not valid in the United States where the number of accredited sleep disorders centers and certified sleep physicians is sufficient. The authors’ attempt to generalize the results from Australia to the United States is misleading. The calculations for sleep center management only took into account in-laboratory polysomnography. However, an increasing number of centers are using portable monitors and autotitrating CPAP to evaluate and treat select patients, significantly reducing costs.4 I believe that it is unrealistic to expect an overburdened primary care system to take on the additional demands of OSA patients, and it is unnecessary when an extensive system of sleep centers is sufficiently meeting this need.