Cornell Medical Center Research Articles

The currency of mythology.

*Assistant Clinical Professor of Psychiatry, Dept. of Child Psychiatry, Mount Sinai Medical School; and Adjunct Assistant Clinical Professor of Psychiatry, Cornell Medical Center. Versions of this paper were originally given at the William Alanson White Institute on January 19, 2000 and at the American Academy of Psychoanalysis conference in Chicago on May 14, 2000. I would like to express my gratitude to John Kirsch for sharing his knowledge of classics and to Heidi Lefer for help in preparation of this paper.

Commentary on Drs Patz, Black, and Goodman’s Viewpoint

HomeRadiologyVol. 221, No. 3 PreviousNext ViewpointCommentary on Drs Patz, Black, and Goodman’s ViewpointOlli S. Miettinen, Claudia I. HenschkeOlli S. Miettinen, Claudia I. HenschkeAuthor Affiliations1From the Department of Medicine, Weill Medical College of Cornell University, New York, NY, the Department of Epidemiology and Biostatistics, and the Department of Medicine, McGill University, Montreal, Quebec, Canada (O.S.M.); and the Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10021 (C.I.H.). Received October 12, 2000; revision requested October 24; revision received December 29; accepted January 17, 2001. Address correspondence to C.I.H. (e-mail: [email protected]).Olli S. MiettinenClaudia I. HenschkePublished Online:Dec 1 2001https://doi.org/10.1148/radiol.2213010617MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References 1 Patz EF, Black WC, Goodman PC. CT screening for lung cancer: not ready for routine practice. Radiology 2001; 221:587-591. Link, Google Scholar2 Miettinen OS. Screening for lung cancer: can it be cost-effective? Can Med Assoc J 2000; 162:1431-1436. Google Scholar3 Miettinen OS, Henschke CI. CT screening for lung cancer: coping with nihilistic recommendations. Radiology 2001; 221:592-596. Link, Google Scholar4 Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999; 354:99-105. Crossref, Medline, Google Scholar5 Flehinger BJ, Kimmel M, Melamed MR. The effect of surgical treatment on survival from early lung cancer: implications for screening. Chest 1992; 101:101-103. Google Scholar6 Sobue T, Suzuki T, Matsura M, et al. Survival for clinical stage I lung cancer not surgically treated: comparison between screen-detected and symptom-detected cases. Cancer 1992; 69:685-692. Crossref, Medline, Google Scholar7 Henschke CI, Naidich DP, Yankelevitz DF, et al. Early Lung Cancer Action project: initial findings from annual repeat screening. Cancer 2001; 92:153-159. Crossref, Medline, Google Scholar8 International Collaboration to Screen for Lung Cancer. Proceedings of the First, Second, Third, Fourth, and Fifth International Conferences on Screening for Lung Cancer. Available at: ICScreen.med.cornell.edu. Accessed October 1, 2001. Google ScholarArticle HistoryPublished in print: Dec 2001 FiguresReferencesRelatedDetailsCited ByJournal of Thoracic Imaging, Vol. 36, No. 1Orvosi Hetilap, Vol. 148, No. 34Screening for Lung Cancer: Been There and Done ThatFerris M. Hall, , 1 September 2002 | Radiology, Vol. 224, No. 3A Patient’s Viewpoint on a Current ControversyWilliam J. Casarella, 1 September 2002 | Radiology, Vol. 224, No. 3Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 221, No. 3 Metrics Downloaded 66 times Altmetric Score PDF download

Treatment of nonlaparotomized (clinical) stage I and II Hodgkin’s disease patients by extended field and splenic irradiation

Purpose: At the New York Presbyterian Hospital–Cornell Medical Center, patients with unequivocal clinical stage I and IIA Hodgkin’s disease (HD) have been treated with mantle, splenic, and extended field radiation therapy (EFRT) (without surgical staging). A 24-year retrospective review was conducted to determine the effectiveness of our patient selection on the outcome of patients treated with this modality. Methods and Materials: During the period 1971 to 1994, 94 patients with clinically staged HD, with favorable prognostic factors, were retrospectively reviewed. Patients with pathological or equivocal staging, “B” symptoms, bulk disease, history of previous chemotherapy, and/or Stage III or IV disease were excluded from our analysis. There were 27 Stage IA and 67 Stage IIA patients. All patients were treated to 3600 cGy with a 400 cGy boost to the involved field. The median follow-up was 52 months, mean of 62.1 months. Results: Ten of 94 patients (10.5%) relapsed. Seven of the relapses were in the pelvis, one submandibularily, one in the tonsil, and one in the axilla. Nine of the relapses had nodular sclerosis histology, one had lymphocyte predominance, and none had mixed cellularity. The median time to relapse was 38 months; mean time 42.3 months. All patients are alive, well and free of disease, including nine who received subsequent chemotherapy and one who underwent autotransplantation. Conclusions: Careful clinical staging of early, asymptomatic HD patients treated with mantle, splenic, and EFRT may obviate the need for exploratory laparotomy.

DEPARTMENTS: Letters to the Editor

Department of Urology New York Hospital—Cornell Medical Center and Population Council Center for Biomedical Research New York, New York Ronald Schondorf, MD, PhD Department of Neurology The Sir Mortimer B. Davis Jewish General Hospital and McGill University Montreal, Canada Gerald B. Brock, MD Department of Urology University of Western Ontario London, Ontario, Canada

Critical pathways : a review. Committee on Acute Cardiac Care, Council on Clinical Cardiology, American Heart Association.

Critical pathways, also known as critical paths, clinical pathways, or care paths, are management plans that display goals for patients and provide the sequence and timing of actions necessary to achieve these goals with optimal efficiency.1 As competition in the healthcare industry has increased, managers have embraced critical pathways as a method to reduce variation in care, decrease resource utilization, and potentially improve healthcare quality. Cardiovascular medicine in particular is an area in which critical pathways have been embraced. This is due in part to the high volume and high cost associated with cardiovascular diseases and procedures. In addition, the relatively mature guideline process has also contributed to the growth in use of critical pathways in cardiology. Although anchored in clinical guidelines, the critical pathway is a distinct tool that details processes of care and highlights inefficiencies regardless of whether there is evidence to warrant changes in those processes. Clinical guidelines, on the other hand, are consensus statements that are systematically developed to assist practitioners in making patient management decisions related to specific clinical circumstances.2 Although clinical guidelines can and should be used in pathway development, the majority of processes included in a pathway have not been rigorously tested and are generally not addressed in guidelines. Another term that should also be distinguished from critical pathways is clinical protocols. Protocols are treatment recommendations that are often based on guidelines. Like the critical pathway, the goal of the clinical protocol may be to decrease treatment variation. However, protocols are most often focused on guideline compliance rather than the identification of rate-limiting steps in the patient care process. In further contrast to critical pathways, protocols may or may not include a continuous monitoring and data-evaluation component. Critical pathway techniques were first developed for use in industry as a tool to …

Congenital adrenal hyperplasia: update on prenatal diagnosis and treatment

The diagnostic term congenital adrenal hyperplasia (CAH) applies to a family of inherited disorders of steroidogenesis caused by an abnormality in one of the five enzymatic steps necessary in the conversion of cholesterol to cortisol. The enzyme defects are translated as autosomal recessive traits, with the enzyme deficient in more than 90% of CAH cases being 21-hydroxylase. In the classical forms of CAH (simple virilizing and salt wasting), owing to 21-hydroxylase deficiency (21-OHD), androgen excess causes external genital ambiguity in newborn females and progressive postnatal virilization in males and females. Non-classical 21-OHD (NC21OHD) refers to the condition in which partial deficiencies of 21-hydroxylation produce less extreme hyperandrogenemia and milder symptoms. Females do not demonstrate genital ambiguity at birth. The gene for adrenal 21-hydroxylase, CYP21, is located on chromosome 6p in the area of HLA genes. Specific mutations may be correlated with a given degree of enzymatic compromise and the clinical form of 21-OHD. NC21OHD patients are predicted to have mild mutations on both alleles or one severe and one mild mutation of the 21-OH locus (compound heterozygote). In most cases the mutation groups represent one diagnosis (e.g., Del/Del with SW CAH), however we have found several non-correlations of genotype to phenotype. Non-classical and classical patients were found within the same mutation group. Phenotypic variability within each mutation group has important implications for prenatal diagnosis and treatment. Prenatal treatment of 21-OHD with dexamethasone has been utilized for a decade. An algorithm has been developed for prenatal diagnosis and treatment, which, when followed closely, has been safe for both the mother and the fetus, and has been effective in preventing ambiguous genitalia in the affected female newborn. This is an instance of an inborn metabolic error successfully treated prenatally. Since 1986, prenatal diagnosis and treatment of congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21-OHD) has been carried out in 403 pregnancies in The New York Hospital–Cornell Medical Center. In 280, diagnoses were made by amniocentesis, while 123 were diagnosed using chorionic villus sampling. Of the 403 pregnancies evaluated, 84 babies were affected with classical 21-OHD. Of these, 52 were females, 36 of whom were treated prenatally with dexamethasone. Dexamethasone administered at or before 10 weeks of gestation (23 affected female fetuses) was effective in reducing virilization. Thirteen cases had affected female sibs (Prader stages 1–4); 6 of these fetuses were born with entirely normal female genitalia, while 6 were significantly less virilized (Prader stages 1–2) than their sibs, and one was Prader stage 3. Eight newborns had male sibs; 4 were born with normal genitalia, 3 were Prader stages 1–2, and 3 were born Prader stages 3–4. No significant or enduring side effects were noted in either the mothers or the fetuses, indicating that dexamethasone treatment is safe. Prenatally treated newborns did not differ in weight, length, or head circumference from untreated, unaffected newborns. Based on our experience, proper prenatal diagnosis and treatment of 21-OHD is effective in significantly reducing or eliminating virilization in the newborn female. This spares the affected female the consequences of genital ambiguity of genital surgery, sex misassignment, and gender confusion.

CDC Guidelines for the Prevention of Perinatal Group B Streptococcal Disease: Are They Appropriate?

Form the Department of Obstetrics and Cynecology, New York Hospital–Cornell Medical Center, New York

TRAUMATIC DISLOCATION OF THE LENS INTO POSTERIOR TENONʼS SPACE

From the * Department of Ophthalmology. The New York Hospital, Cornell Medical Center, New York, and the †Vitreous Retina Macula Consultants of New York, New York. Reprint requests: Yale L. Fisher. MD. Vitreous Retina Macula Consultants of New York. 519 E. 72nd Street. Suite 203. New York, NY 10021.

Measurement of the free radical-derived isoprostane, 8-EPI prostaglandin F2x, in acute stroke: Norman Delanty, Daniel MacGowan, Muredach Reilly, John Lawson, and Garret FitzGerald (Department of Neurology, Cornell Medical Center, University of Pennsylvania, Philadelphia, PA)

Measurement of the free radical-derived isoprostane, 8-EPI prostaglandin F2x, in acute stroke: Norman Delanty, Daniel MacGowan, Muredach Reilly, John Lawson, and Garret FitzGerald (Department of Neurology, Cornell Medical Center, University of Pennsylvania, Philadelphia, PA)

Detecting acute pulmonary emboli with TC-99m-P357: XL.Zhang, XJ.Liu, RF.Shi, ST.Li, YZ.Liu, BP.Chen, XS.Chen, and JS.Borer∗ Cardiovascular Institute Beijing, China; ∗New York Hospital, Cornell Medical Center

Detecting acute pulmonary emboli with TC-99m-P357: XL.Zhang, XJ.Liu, RF.Shi, ST.Li, YZ.Liu, BP.Chen, XS.Chen, and JS.Borer∗ Cardiovascular Institute Beijing, China; ∗New York Hospital, Cornell Medical Center

Personality Disorders in the Elderly

International Journal of Geriatric PsychiatryVolume 11, Issue 9 p. 759-763 Research Article Personality Disorders in the Elderly ROBERT C. ABRAMS, ROBERT C. ABRAMS The New York Hospital – Cornell Medical Center, Payne Whitney Clinic and Westchester Division, New York, USASearch for more papers by this author ROBERT C. ABRAMS, ROBERT C. ABRAMS The New York Hospital – Cornell Medical Center, Payne Whitney Clinic and Westchester Division, New York, USASearch for more papers by this author First published: September 1996 https://doi.org/10.1002/(SICI)1099-1166(199609)11:9<759::AID-GPS497>3.0.CO;2-TCitations: 11AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume11, Issue9September 1996Pages 759-763 RelatedInformation

Evaluation of Repeat Administration of a Replication Deficient, Recombinant Adenovirus Containing the Normal Cystic Fibrosis Transmembrane Conductance Regulator cDNA to the Airways of Individuals with Cystic Fibrosis. New York Hospital–Cornell Medical Center, New York, New York

Evaluation of Repeat Administration of a Replication Deficient, Recombinant Adenovirus Containing the Normal Cystic Fibrosis Transmembrane Conductance Regulator cDNA to the Airways of Individuals with Cystic Fibrosis. New York Hospital–Cornell Medical Center, New York, New York

Management of gastroesophageal reflux disease - a personal viewpoint

Management of gastroesophageal reflux disease - a personal viewpoint Get access D. B. Skinner, M.D. D. B. Skinner, M.D. 1President of the ISDE The New York Hospital, Cornell Medical Center, New York, USA 2D. B. Skinner MD, Professor of Surgery, The New York Hospital, Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA Search for other works by this author on: Oxford Academic Google Scholar Diseases of the Esophagus, Volume 8, Issue 3, 1 January 1995, Pages 155–158, https://doi.org/10.1093/dote/8.3.155 Published: 01 January 1995

A clinical and ethical evaluation of routine obstetric ultrasound

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The New York Hospital, Cornell Medical Center, New York, New York, USA

A Team Approach—Quality of Care in Special Care Units

Assistant Director of Nursing Practice and Quality Assurance Department of Critical Care Nursing The New York Hospital–Cornell Medical Center New York, New York

Calcium antagonists in the management of systemic hypertension

From the Departments of Medicine, The Albert Einstein College of Medicine, Bronx, New York and *Cornell Medical Center, New York, New York, USA.

Age at Onset or Late‐Life Depression: A Research Agenda Report of a MacArthur Foundation‐NIMH Workshop

A workshop titled "Age of Onset in Late-Life Depression" was cosponsored by the MacArthur Foundation Research Network on the Psychobiology of Depression and NIMH in November 1992. The purpose was to better define the relevant methodological and conceptual issues regarding age-at-onset research and to address the ways in which age at onset might more fruitfully inform progress in understanding and treating late-life depression. This paper summarizes the workshop and includes consensus recommendations for future investigation.

171 Assessment of intracellular potassium and sodium in hypertension and diabetes by nuclear magnetic resonance spectroscopy

(Cardiovascular Center, Cornell Medical Center, New York, New York, and Department of Physiology, Albert Einstein College of Medicine, Bronx, New York, USA)

Hemodynamic Changes Associated with Tourniquet Use Under Epidural Anesthesia for Total Knee Arthroplasty

Department of Anesthesiology, The Hospital for Special Surgery, Cornell Medical Center, New York, New York

The rationing of health care: a doctor's dilemma.

Physicians are currently presented with very difficult ethical issues regarding who receives what level of medical care and for how long. A meaningful response to these perplexing issues necessitates a collaboration of doctors with others steeped in religious and ethical traditions. This paper addresses the complicated issue of the rationing of health care, and this issue is then addressed by responses from representatives of the religious community. This symposium took place at the New York Hospital—Cornell Medical Center in March 1991.