Kings County Hospital Research Articles

Incidence of cytogenetic (CG) abnormalities in acute myeloid leukemia (AML) in African American (AA) population.

6622 Background: CG characteristics play a critical role in outcome and therapy of AML. The incidence of normal CG in general population is estimated at 40%. The incidence of abnormal CG in AA population is not known. CG abnormalities help define the pathogenesis of AML subtypes and are prognostically significant; they occur in 40% of all AML cases, but their incidence in African Americans is not known. Methods: Records of adult patients with acute leukemia at Kings County Hospital and Downstate Medical Center from 2004 through 2010 were reviewed. The CG data were stratified into three prognostic groups: good; inv (16), t (8:21) and t (15:17); intermediate: normal CG, +8, t (9:11); poor: ≥ 3 CG abnormalities, including: -5, 5q-, -7, 7q-, inv (3), t (6:9), t (9:22). Results: Of the 52 patients with acute leukemia, 46 had AML; 29 were male and 17 female. Forty-three (93%) of these patients were AA. Ages ranged from 20-82 years (median 53), 15 (33%) having been over 65. Seven (15%) patients had a prior hematological malignancy (HM). CD34 was over-expressed in 23 of 46 (48%) patients with AML. CG data was available in 41 patients, 26 men and 15 women; and was normal in 13 (31%) and abnormal in 28 (69%). Of patients with de-novo AML and known CG; 21 (62%) were abnormal; and 13 (38%) were normal. The distribution of patients in risk stratified groups were: good: 8 (20%); intermediate: 19 (46%); and poor: 14 (34%). In patients with prior HM five (71%) had abnormal CG. The median age of patients with good, intermediate and poor risk CG was 57, 53 and 57 years respectively. Intermediate or poor risk AML occurred in 22 of 26 men (85%) and 11 of 15 women (73%). Conclusions: Our data suggest that CG in AA AML patients are more often abnormal, and of intermediate or poor risk than in the general population.

Incidence of cytogenetic (CG) abnormalities in multiple myeloma (MM) in a minority population.

e18568 Background: Genomic aberrations are associated with MM survival and disease evolution. The combination of cytogenetics and Fluorescence in situ hybridization (FISH) reveals more anomalies than CG alone. The incidence of CG abnormalities in African American MM patients (AA) is not known. Methods: Records of patients with MM seen at Kings County Hospital and Downstate Medical Center from 2004 through 2010 were reviewed. Results: Of the 185 records reviewed, 181 (98%) patients had MM; 3 had plasma cell leukemia. Their age ranged from 36-89 years (median 66). There were 84 men (46%) and 97 women. CG analysis was done in 86 patients, 41 (48%) female and 45 (52%) male; of whom 82 were AA. CG was abnormal in 14 male and 6 female patients. Aneuploidy was present in 15 of 20 (75%); 11 of the 15 (73%) were hyperdiploid and 4 (26%) hypodiploid. Hyperdiploid chromosome number ranged from 49 to 67 (median 53). The most frequently aberrant chromosomes were 1, 4, 5 and 15. FISH was done in 42 patients for abnormal chromosomes 13, 14 and 17. One of 37 chromosomes 13 (2.6%), 3 of 28 (11%) chromosomes 14, and 1 of 14 (7.1%) chromosomes 17 displayed molecular abnormalities. In no case was more than one abnormality found. FISH on 28 patients with normal CG yielded only 1 (3.6%) abnormality. Conclusions: Abnormal CG was not more frequent in this AA population than in MM patients from other ethnic groups, but was in male AA patients. Fewer molecular abnormalities were found in this population.

(P1-50) Pilot Study: The Challenges of Full Scale Radiation Decontamination Drills with Special Needs Populations

Special needs populations are often excluded from emergency preparedness plans, despite their vulnerability. As defined by the CDC one aspect of special needs is physical disabilities which include mobility issues. In 2009 the CDC reported 16% of the US non-institutionalized population as having a physical disability. The literature is limited and empirical evidence on addressing the needs of disabled individuals in disaster preparedness is sparse. This demonstrates the need for guidelines on how to plan for the needs of individuals with physical disabilities during disasters. In July 2010 a coalition of hospitals in Central Brooklyn, NY, University Hospital Brooklyn, Kings County Hospital Center, and Kingsbrook Jewish Hospital Center conducted full scale radiological decontamination exercises which incorporated people with physical disabilities. The exercises utilized the same set of drill participants; 17 total victims and 4 victims with physical disabilities that included 2 wheelchair bound nonmobile victims. The exercise required the HAZMAT teams to address in their decontamination plan the use of accessible equipment for nonmobile individuals. As a pilot study, we hypothesized that the hospitals would be unprepared to decontaminate special needs victims, especially the nonmobile victims based on guidelines published by the US Department of Health and Human Services. By conducting this exercise we found that the hospitals were unprepared to effectively decontaminate special needs victims. We also had a secondary finding that showed that the exercise failed to reach the primary goal also because of the artificiality of the drill. By utilizing healthy actors to assume the role of special needs victims, we found that many of the challenges of special needs victims were bypassed. We share the lessons learned in this drill in both the decontamination of special needs victims and how to prevent the short cuts that can occur in drills that simulate real life scenarios.

Jeffrey S. Klein, MD, Named Editor ofRadioGraphics

The Board of Directors of the Radiological Society of North America (RSNA) is pleased to announce that Jeffrey S. Klein, MD, will become RadioGraphics editor in January 2012. He will succeed William W. Olmsted, MD, who has continuously raised the bar for the RSNA’s education journal since taking the helm in 1990. Dr Olmsted will retire as editor at the end of this year. Dr Klein is the A. Bradley Soule and John P. Tampas Green and Gold Professor of Radiology and Associate Dean for Continuing Medical Education in the University of Vermont College of Medicine and chief of thoracic radiology at Fletcher Allen Health Care in Burlington, Vt. In addition to his expertise in lung cancer staging and detection, Dr Klein brings vast experience in radiologic education—with an emphasis on continuing medical education—that makes him a superior choice as the next RadioGraphics editor. After receiving his bachelor’s degree from Brooklyn College, Dr Klein earned his MD degree at the State University of New York Health Science Center at Brooklyn. He completed an internship at the Staten Island University Hospital, a residency at the State University of New York Kings County Hospital Center in Brooklyn, and a fellowship at the University of California, San Francisco, Medical Center. Dr Klein is certified by the American Board of Radiology and is a fellow of the American College of Radiology (ACR). Dr Klein began his academic radiology career in 1988 as a clinical instructor of radiology and assistant professor in residence at the University of California, San Francisco, School of Medicine. In 1990, he became an assistant professor in residence at San Francisco General Hospital, where he currently maintains an appointment as a clinical assistant professor of radiology. From 1993 to 1995, Dr Klein was a clinical associate professor, chief of thoracic imaging, and associate director of the residency training program in the Department of Radiology at St Joseph’s Hospital and Medical Center in Phoenix, Ariz. He then joined the University of Vermont College of Medicine, serving as an associate professor of radiology and chief of thoracic imaging until 2000, when he was named a professor of radiology. Dr Klein was vice-chair of the Department of Radiology at the University of Vermont College of Medicine from 1998 to 2000 and was named to the endowed professorship in 2006. Sarah S. Donaldson, MD—Chairman, RSNA Board of Directors William T. Thorwarth, Jr, MD—Liaison for Publications and Communications, RSNA Board of Directors

Waiting-to-Death, or Security and Asylum-Seeking in a Hospital ER

Whom am I to tell my private nightmares to if I cant tell them to you? - Estragon, Waiting for Godot Waiting To wait, according to Oxford English Dictionary (OED), is to do nothing for a period of time in expectation or hope that something will happen. A is an antechamber for people who are obliged to wait (OED). Detention is compulsory delay, confinement, restraint, custody, from Latin for hold back (OED). Those being detained are made to wait. Clarkson Avenue. Building G. Early Morning. Kings County Hospital in Brooklyn is one of largest municipal hospitals in United States.1 The hospital is a sprawling complex on Clarkson Avenue that has more than six hundred beds and sees half a million patients a year. The hospital hosted New York States first open-heart surgery. The first human image from an MRI machine was made in this facility, and its doctors invented hemodialysis machine for treatment of kidney failure. Its centers for diabetes, Parkinson s disease, stroke, and pediatric trauma have achieved recognition. It boasts having cuttingedge of technology and providing the most modern procedures with state-of-the-art equipment (Kings County Hospital Center n.d.). It is, then, a place of vitality, where our biological capacities to live are managed and extended (Rose 2006). For a number of years, however, psychiatry ward of Kings County Hospital, housed in Building G, was focus of a civil rights lawsuit for a record of patient neglect. In this building, in waiting room of psychiatry ER, a patient named Esmin Green died of an untreated blood clot while waiting for care. Esmin Green was an undocumented immigrant to Brooklyn from Jamaica who had been living in neighborhood surrounding Kings County Hospital for several years. In June 2008, at age of forty-nine, she was brought by friends to psychiatry ER because she was experiencing psychosis. This was not her first visit; she had a history of psychotic episodes. Upon arrival, she refused medical review and then was involuntarily admitted, a common practice for psychiatric patients who are deemed unable to consent to medical treatment. She was given a tranquilizer and put in a hospital gown. Because of a scarcity of beds in ward, Esmin Green was left in waiting room in company of a few other patients. She waited there for twenty-four hours while hospital staff and security guards ignored her. One of local newspapers, New York Daily News, offered this account of her final minutes: Green, 49, a native of island of Jamaica, was brought to Kings County because of agitation. At end of her waiting room stay, she keels over face down, legs splayed, in plain view. No one does anything. She lies there for 20 minutes. A security guard comes by, looks at her and leaves. Roughly 10 minutes pass. Green thrashes her legs. Roughly 5 more minutes pass. Green rolls over and shortly stops moving. A security guard checks Green out and leaves her. A patient summons help. A nurse checks for signs of life - by nudging Green with her foot. Too late; resuscitation is futile. (The Snake Pit 2008) Such a detailed description was made possible because Esmin Greens death was videotaped. The security cameras, tracking from four different angles, watched and recorded every move of patient and staff. Death, Watched The local and national media circulated security tapes of Esmin Greens death and replayed them for weeks, instigating a public outcry. The images of Esmin Green collapsed on floor, and of nurse poking Greens body with her foot, went viral on Internet. Journalists and bloggers highlighted case as evidence of discrimination against poor, black, immigrant, and mentally ill persons. Others also pointed to a systemwide crisis in psychiatric care in United States. …

Jeffrey S. Klein, MD, Named Editor ofRadioGraphics

HomeRadioGraphicsVol. 31, No. 2 PreviousNext Special CommunicationsJeffrey S. Klein, MD, Named Editor of RadioGraphicsSarah S. Donaldson, William T. Thorwarth, JrSarah S. Donaldson, William T. Thorwarth, JrSarah S. DonaldsonWilliam T. Thorwarth, JrPublished Online:Mar 7 2011https://doi.org/10.1148/rg.312105245MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished online: Mar 7 2011Published in print: Mar 2011 FiguresReferencesRelatedDetailsRecommended Articles Low-Dose Chest CT to Predict Disease-Free Survival for Early-Stage Node-Negative Centrally Located Lung AdenocarcinomaRadiology2021Volume: 299Issue: 2pp. 448-449Pulmonary Fibrosis: A Guide for the PerplexedRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 1Time to Start Describing Fibrotic Interstitial Lung Abnormalities in the Chest CT ReportRadiology2022Volume: 306Issue: 22017 RSNA Outstanding ResearcherRadiology2017Volume: 285Issue: 3pp. 712Should “Mature” Radiologists Be Put Out to Pasture?: Practice CornerRadioGraphics2016Volume: 36Issue: 3pp. 937-938See More RSNA Education Exhibits Case-based Learning during Anatomy Block as a Modality for Preclinical Interventional Radiology Education: Successes and ChallengesDigital Posters2019Management of Solitary Pulmonary Nodules: Pushing the Limits Beyond the GuidelinesDigital Posters2019Introduction to Artificial Intelligence and Big Data Research in Chest RadiologyDigital Posters2019 RSNA Case Collection Pulmonary SequestrationRSNA Case Collection2022Small cell lung carcinomaRSNA Case Collection2020Superior Vena Cava SyndromeRSNA Case Collection2020 Vol. 31, No. 2 Metrics Altmetric Score PDF download

What Caused My ‘Meltdown’ in Face of Disaster Drill?

What Caused My ‘Meltdown’ in Face of Disaster Drill?

Spike-timing-dependent plasticity and subcortical waves enhance alpha oscillations in a computer model of neocortex

Event Abstract Back to Event Spike-timing-dependent plasticity and subcortical waves enhance alpha oscillations in a computer model of neocortex Samuel Neymotin1*, Cliff Kerr2, George Chadderdon3, Christopher Fietkiewicz3 and William Lytton4 1 NYU-Poly, United States 2 U Sydney, Australia 3 SUNY Downstate, United States 4 Kings County Hospital, United States A prominent alpha oscillation is a salient part of neocortical activity that emerges over the first several years of life. In retina and other tissues slow oscillations are generated during development. We hypothesized that such waves in lower centers could train the cortex to produce alpha. We here show that frequencies of this range could emerge in the network via a process of spike-timing-dependent plasticity (STDP). We used a previously published model consisting of 470 event-based integrate-and-fire cells (Neymotin et al., 2011). Excitatory and inhibitory cells were arranged in 13 types to reflect the laminar structure of sensory cortex. Each cell received external driving Poisson inputs, as well as inputs from other cells in the model, via AMPA, NMDA, and GABAA synapses. STDP was implemented at AMPA synapses, with a maximal spike-time difference of 40 ms and a decay time constant of 10 ms. After learning, we evaluated the spectral power in the network with application of white noise, to see if it had learned to produce activity in the trained bands, effectively retaining a memory of the training. The waves from lower centers were simulated by rhythmic inputs to layer 4 excitatory cells to simulate inputs via thalamus. At baseline, prior to STDP, the excitatory cell multiunit activity vector (MUA) power spectrum had a low-amplitude peak near 7 Hz and gradual attenuation towards higher frequencies (Fig. 1, orange). When STDP was implemented only at synapses on excitatory cells, the network was prone to epileptic activity, including high-frequency oscillations and pathologically high firing rates. To provide balanced inhibition in the network, we subsequently implemented STDP for excitatory synapses on inhibitory cells. STDP caused a shift in the distribution of synaptic weights, with the strength of AMPA synapses on inhibitory cells increasing more than those on excitatory cells, preventing epileptic activity from emerging. After applying STDP with no training signal, the spectral peak was reduced (Fig. 1, black) due to the added inhibition in the network. In order to train the network, we provided a subcortical training input consisting of shocks applied at several different frequencies. When a training signal of 7 Hz was applied, the activity of layer 4 excitatory cells increased, causing an increase in the spectral power. The post-training spectral peak in response to white noise was broad (7 - 22 Hz) and changed little from baseline (Fig. 1, red). A small increase in training signal rate to 8 Hz (Fig. 1, blue) produced a large increase in resultant overall spectral power. In this case, a sharp spectral peak emerged near 12.5 Hz, considerably higher than the training frequency. A smaller peak was produced at 8 Hz. Applying a 10 Hz training signal enhanced the amplitude of the spectral peak further and pushed the resultant peak upwards to form a broad profile that peaked at approximately 15 Hz (Fig. 1, green). The greater response to 8 and 10 Hz appeared to be associated with far greater spread of excitation throughout the initial, untrained network, suggesting that a resonant response can occur at these higher frequencies due to the continuation of activations for these time periods. Our model suggests that learning rates should be properly balanced between excitatory to excitatory and excitatory to inhibitory synapses in order to avoid a transition to epileptic dynamics. Alterations in excitatory weights are necessary for learned dynamics, but learning must be modulated by interneurons. Finally, we predict that alpha/beta oscillations could emerge via STDP learning of training signals projected from subcortical areas. Supported by: DARPA grant N66001-10-C-2008

Innovation in Our Nation's Public Hospitals: Three-Year Follow-Up Interview with Five CEOs and Medical Directors—Part 2

Tom Janisse, MD Summer 2011 - Volume 15 Number 3 This is Part 2 of a two-part conversation with leaders (Table 1) from four hospitals and systems who participated and attended the 2010 annual meeting of the National Association of Public Hospitals i

Outcome of Patients With Adult T Cell Lymphoma/Leukemia Admitted to the Medical Intensive Care Unit

PURPOSE: Adult T cell leukemia/lymphoma (ATLL) is one manifestation of infection by the HTLV-I retrovirus endemic in Asia and the Caribbean. Kings County Hospital Center (KCHC) is an inner city hospital in Brooklyn, NY, that serves a large Caribbean population. Standard combination chemotherapy induces a short lived response followed by rapidly fatal systemic relapse. The median survival with therapy is approximately 6 months. In our experience, the relentless course of ATLL is not altered by MICU care.

State University of New York, Downstate Medical Center College of Medicine

State University of New York, Downstate Medical Center College of Medicine

Triage Hyperglycemia as a Prognostic Indicator of Major Trauma

To test the diagnostic utility of the triage serum glucose in differentiating major from minor injuries. Prospective database at Kings County Hospital, a Level I trauma center, from August 2005 to August 2008. trauma patients 13+ years. diabetes or obvious life-threatening injuries requiring immediate surgery, isolated head trauma, or transferred or dead on arrival. We recorded age, sex, injury mechanism, base deficit (BD), lactate (LAC), and serum glucose and calculated Injury Severity Scores. Major injury: a change in hematocrit >10, blood transfused within 24 hours, or Injury Severity Score >15. Data were reported as mean differences (95% confidence interval [CI]). Groups were compared by Student's t test; receiver operator characteristic curves were compared by Wilcoxon test (two-tailed, [alpha] = 0.05). One thousand six hundred forty-nine patients with an average age of 35.5 years (13-95 years), 79.5% male, and 50% blunt trauma were studied. Patients with major (n = 278) compared with minor injury (n = 1371) had significantly (p < 0.0001) lower BD and higher LACs (p < 0.0001). Major injury patients had significantly (p < 0.0001) higher serum glucose levels (8.33 mMol/L, 95% CI: 7.94-8.69 mMol/L) compared with patients with minor injuries (6.49 mMol/L, 95% CI: 6.39-6.66 mMol/L). Areas under the curve for glucose (0.73, 95% CI: 0.70-0.76) are similar to BD (0.72, 95% CI: 0.68-0.76) and LAC (0.71, 95% CI: 0.67-0.75). Serum glucose was as discriminating as BD or LAC in differentiating minor from major injury. An initial glucose >/=11.1 mMol/L had a low sensitivity (15%) but a high specificity (94%) for major injury.

Role of fine needle aspiration (FNA) cytology in assessment of cervical lymphadenopathy

e19525 Background: The ability of FNA specimens to provide a definitive lymphoma diagnosis is controversial. Otolaryngolists routinely employ FNA for cervical lymph nodes which may have arisen from head and neck carcinomas, since incisional procedures may interfere with potentially curative surgery. Methods: The charts of 176 patients referred to the Kings County Hospital Center since 1996 for confirmed lymphoma were reviewed. All patients with cervical adenopathy are initially referred to the Otolaryngology service for biopsy, which is routinely FNA. Results: Of the 123 patients for whom pathological data was available, 37 had initial FNAs; 10 more FNAs (total 47) were done when the first was not diagnostic. Cervical adenopathy was the presentation in 27 of 37 patients (73%), 6 of whom also had disseminated adenopathy. Upper aerodigestive tract (UAT) fiberoscopy had been negative in 16 and not performed in 7. The FNA specimens contained interpretable material in 42 of 47 cases (89%). Five FNA specimens were diagnostic of lymphoma (11%), but the type was classifiable in only one. Thus, 32 initial FNA specimens were not diagnostic, nor were 10 repeat FNA's on the same patients. Of the 32 patients who initially had non-diagnostic FNAs, a lymphoma diagnosis and classification was ultimately established by a single excisional lymph node biopsy. Lymphoma diagnosis was delayed in 19 patients because of FNA by 10–941 days; median 38, mean 68 days. Conclusions: Though 90% were not diagnostic, FNA was routinely, and sometimes repeatedly performed in patients with cervical adenopathy, most of whom had no evidence of UAT neoplasms, and some of whom had disseminated adenopathy. Significant delays in diagnosis were the result. Decisions concerning biopsy technique in patients with cervical adenopathy should be made in the context of clinical presentation. No significant financial relationships to disclose.

A novel presentation of a rare chromosome 21q22.2 deletion

aThe State University of New York Downstate Medical Center bKings County Hospital Center, Brooklyn, New York cThe University of Texas MD Anderson Cancer Center, Houston, Texas dThe Loyola University Health Sciences Center, Maywood, Illinois, USA Correspondence to Dr Andrew C. Miller, MD, State University of New York and Kings County Hospital Center, 450 Clarkson Ave, Box 1228, Brooklyn, NY, USA Tel: +1 347 405 8110; fax: +1 718 245 4799; e-mail: [email protected]; [email protected] Received 13 March 2008 Accepted 18 August 2008

A Short Course of Prednisone in the Management of Acute Chest Syndrome of Sickle Cell Disease.

Background: Acute chest syndrome is defined as the presence of acute pulmonary findings in an individual with sickle cell disease. A brief course of dexamethasone was shown to significantly attenuate the course of mild to moderate ACS, but treated patients appeared to have an increased risk of readmission, generally for pain episodes, as compared to controls (31.5% vs. 4.7%; p=0.09). In a more recent retrospective review of patients with ACS, the readmission rate was even more alarming, with 59% of patients who received steroids alone (without transfusion) readmitted, again primarily for vaso-occlusive pain episodes. Over the past several years low dose steroid therapy [1–2mg/kg (maximum 80mg) of prednisone for 3 – 7 days] has been embraced as routine care for ambulatory and hospitalized patients with status asthmaticus. Potentially deleterious effects of steroid therapy, namely immunosuppression, especially in patients with concurrent pneumonia, and rebound wheezing after discontinuation of therapy have not been problematic. We reasoned that such a regimen to treat ACS might be beneficial without a “rebound effect” potentially leading to pain episodes, and over the past several years have increasingly used an asthma regimen of steroid therapy in our ACS patients who showed worsening clinical severity.Methods: Admissions recorded in a Pediatric Hematology – Oncology inpatient register were reviewed from July 1, 2005 to June 30, 2007 to identify patients hospitalized at the University Hospital of Brooklyn and King's County Hospital Center with ACS; the register included children with ACS on admission and those who developed ACS during hospitalization for other complications. The clinical course of patients who received prednisone was compared to those who did not, particularly to assess the frequency of early (within two weeks) readmission after discharge.Results: Between July 2005 and June 2007, 63 patients were admitted for 78 episodes of ACS. Fifty-three patients received prednisone and 25 did not. Prednisone was used more frequently in patients with moderate or severe ACS (p<0.001). Eight patients (15.1%) who received prednisone were re-admitted within 2 weeks versus two (8.3%) who did not receive steroids (p=0.41). Overall the duration of hospital stay was similar in both groups, 3.1 days in patients who did not receive steroids and 3.8 days in patients who did (p=0.13). Seventeen patients (21.8%) received a simple blood transfusion, fifteen in the prednisone group and two in the non prednisone group. None had exchange transfusion. No patient required mechanical ventilation.Conclusion: In our retrospective chart analysis, we did see re-admissions after short course prednisone therapy; however, the re-admission rate was not significantly greater than that seen in children not receiving steroids and lower than that previously reported. Duration of stay and transfusion frequency were no different between steroidtreated and untreated patients, though the former had more severe disease at diagnosis; this may suggest clinical benefit. In summary, it may be possible to achieve the previously documented beneficial effects of steroid therapy for ACS without an unacceptable readmission rate by adjusting the treatment regimen. An asthma regimen similar to that used here would be reasonable to assess in a large prospective trial.

The Body Politic and the Politics of the Body

The Body Politic and the Politics of the Body Margaret Marsh (bio) Lisa Forman Cody. Birthing the Nation: Sex, Science, and the Conception of Eighteenth–Century Britons. Oxford: Oxford University Press, 2005. vii + 353 pp.; ill. ISBN 0–19–926864–9 (cl). Tom Davis. Sacred Work: Planned Parenthood and its Clergy Alliances. New Brunswick, NJ: Rutgers University Press, 2005. ix + 245 pp.; ill. ISBN 0–8135–3493–3 (cl). Judith A. Houck. Hot and Bothered: Women, Medicine, and Menopause in Modern America. Cambridge, MA: Harvard University Press, 2006. ix + 328 pp. ISBN 0–674–02740–X (cl). Jennifer Nelson. Women of Color and the Reproductive Rights Movement. New York: New York University Press, 2003. ix + 224 pp. ISBN 0–8147– 5821–5 (cl). Rickie Solinger. Pregnancy and Power: A Short History of Reproductive Politics in America. New York: New York University Press, 2005. vii + 301 pp. ISBN 0–8147–9827–6 (cl). Alexandra Minna Stern. Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America. Berkeley: University of California Press, 2005. vii + 247 pp.; ill. ISBN 0–520–24443–6 (cl). D. Kelly Weisberg. The Birth of Surrogacy in Israel. Gainesville: University of Florida Press, 2005. vii + 291 pp.; ill. ISBN 0–8130–2809–4 (cl). Consider the following six stories: Surrey, England, 1726: Farm worker Mary Toft finds herself pregnant. A few months later, she claims to have given birth to rabbits after having dreamed of them during her pregnancy, a claim verified by two reputable physicians. A credulous public provides her with a brief period of notoriety, but soon, she confesses to having abetted a hoax. Although the circumstances—the young woman was poor and passive, and had been manipulated by greedy acquaintances—were as sad as they were bizarre, she is vilified and jailed for having perpetrated a scandal. [End Page 181] Sacramento, California, 1909: Legislators enact the third sterilization bill to be passed in the United States, following Indiana by two years and the state of Washington by only a few weeks. The law authorizes the medical superintendents of asylums and prisons to “asexualize” inmates or patients if the superintendent believes that sterilization would improve their “physical, mental, or moral condition.” By 1921, more than two thousand Californians would be sterilized, amounting to about eighty percent of all sterilizations nationwide. Charlottesville, Virginia, 1920: Carrie Buck, the daughter of a single woman labeled as both a prostitute and “feebleminded,” becomes homeless when the state assigns her mother to the Colony of Epileptics and Feebleminded in 1920. Sent as a housekeeper to the home of a local citizen, Buck is raped and becomes pregnant in 1923. She herself is now declared feebleminded and the state rules that she should be sterilized. Buck sues, losing in the Supreme Court in 1927. A long era of legal involuntary sterilization in the United States ensues. Durham, North Carolina, 1949: Duke University endocrinologist Edwin Hamblen, in a popular book called The Change of Life, assures women that their postmenopausal years could be among their most productive. The end of a woman’s reproductive life, he tells them, would open up a new age of creativity. Menopause and its aftermath, he declares, provides women with the opportunity to realize their own hopes and dreams. Freed from burdensome reproductive functions, women could look forward to a time of freedom. Every woman could enjoy the prime of her life (and have the time of her life) in the postmenopausal years. New York City, 1958: A young married woman suffering from complications of diabetes is admitted to Kings County Hospital. While there, she asks to be fitted for a diaphragm, since she and her physicians agree that another pregnancy would endanger her life. Her physician makes the appointment with her, but then his superiors order him not to proceed. It is the policy of public hospitals in New York, the doctor learns, not to provide contraception to any woman, married or not, because of the opposition of the Catholic Church to birth control. Elected officials in New York are fearful of inflaming Catholic opinion by providing birth control to any users of public hospital services, no matter what their personal beliefs. Phoenix, Arizona, 1962: Twenty...

Omission of post-tumorectomy radiation (RT) for patients treated for invasive breast cancer in Caribbean nations

11506 Background: Breast Cancer (BC) is an increasing problem in West Indies, where access to chemotherapy and radiation is limited. The East Flatbush section of Brooklyn, NY, where the Kings County Hospital Breast Cancer Clinic is located, has many West Indian immigrants. Methods: Since 1996, 67 patients diagnosed with and treated for localized BC in the West Indies came to the Clinic for a second opinion or further treatment. Their charts were retrospectively reviewed. Results: Of the 67 patients, 27 had mastectomies and 35 tumorectomies; 30 of the latter had not received radiation (T-RT). The intervals (months) between the dates of primary surgery and that of their presentation at our clinic for all 67 patients were a median of 8 (range 1–156, mean 19); for the 30 T-RT patients the intervals were a median of 4 months (range 1–48; mean 7). Local recurrence was found in 17 of the 30 T-RT patients (57%), and in 8 of the 32 patients who had mastectomies, or tumorectomy with radiation (25%). We were able to determine why 20 of the 30 T-RT patients had not received radiation. Four were referred to other nations for RT. Twelve denied having been offered RT, though we lack statements from their physicians. Four refused RT. Access to RT in these patients’ nations is known to have been limited or unavailable. That less time elapsed (≤4 months in most) between primary surgery and presentation at our clinic for the 30 T-RT patients than for those who had received complete local treatment, suggests that the former were aware of the need for further therapy, and came to our clinic as soon as travel arrangements were made. Conclusions: Eighty-five per cent of patients treated with tumorectomy for breast cancer in Caribbean nations had not received RT there. RT was therefore delayed for a median of 4 months after surgery, and 57% of these patients presented to our clinic with local recurrences. Tumorectomy for breast conservation in patients with invasive carcinoma may not be safe and practicable in regions lacking ready access to RT. No significant financial relationships to disclose.

Food-induced Anaphylaxis and Oral Allergy Syndrome

1. Priyamvada Tatachar, MBBS* 2. Smita Kumar, MD† 1. *Resident, Department of Pediatrics 2. †Clinical Assistant Professor of Pediatrics, Division of Allergy and Immunology, Kings County Hospital Center and SUNY Downstate Medical Center, Brooklyn, NY After completing this article, readers should be able to: 1. Recognize symptoms of food-induced allergy in general and oral allergy syndrome and anaphylaxis in particular. 2. Know when to refer those who have these problems to an allergist. 3. Discuss how to educate parents about food allergy. A 16-year-old boy presents to the allergy clinic with complaints of perioral itching and tingling after handling apples at his father's fruit stall. He had experienced such symptoms on previous occasions, but this time he has developed mild lip swelling and tongue itching, as well. He has a history of seasonal allergic rhinitis that is controlled by nasal steroid spray. His father is concerned that the reaction might be due to pesticides. A skin prick test with fresh apples gives a positive response that confirms the clinical diagnosis of oral allergy syndrome (OAS). Food allergies are an increasingly common problem faced by pediatricians. Food allergy is defined as an immune-mediated adverse reaction to foods causing symptoms affecting the skin, gastrointestinal (GI) tract, or respiratory system. The reactions can be immune globulin E (IgE)-mediated and nonIgE-mediated processes. Currently, food allergies affect 2% of the general population and 6% to 8% of children. They are most prevalent in the first few postnatal years. Although many children outgrow their food allergies by adulthood, most allergies to peanuts, tree nuts, and seafood are not outgrown. About 35% of children who have moderate-to-severe atopic dermatitis have IgE-mediated food allergies, and about 6% of children who have asthma have food-induced wheezing. The most common food allergens in the pediatric population include cow milk, eggs, peanuts, tree nuts, soy, and wheat; peanuts, tree nuts, fish, and shellfish are implicated most commonly in adults. The human GI tract presents many barriers to ingested immunogenic food proteins. Mucosal-associated secretory IgA, gut-associated lymphoid tissue, gastric acidity, …

Innovative approaches to increase deep vein thrombosis prophylaxis rate resulting in a decrease in hospital‐acquired deep vein thrombosis at a tertiary‐care teaching hospital

Hospital-acquired venous thromboembolic events (VTEs) in medically ill patients account for a significant percentage of in-hospital mortality. Unfractionated heparin and low-molecular-weight heparin have been shown to be effective in the prevention of VTEs. However, use of these medications for thromboprophylaxis remains suboptimal. The objective of this article is to report the impact of a continuous quality improvement project on adherence with DVT prophylaxis guidelines and on the subsequent incidence of hospital-acquired DVT in medical patients at a teaching hospital between 2002 and 2005. In November 2002, Kings County Hospital Center Department of Medicine embarked on a project to increase the rate of thromboprophylaxis use. Quality improvement strategies included an active, multifaceted, layered combination of provider education, provider reminders with decision support, and audit with feedback. The DVT prophylaxis rate on the general medicine house-staff service increased from a baseline of 63% in 2002 to 96% in 2005. The number of hospital-acquired DVTs decreased from a baseline of 14 in 2002 to 1 in 2005. The hospital-acquired DVT rate fell significantly, from 2.6 per 1000 discharges in 2002 (95% CI 1.5-4.4) to 0.2 per 1000 discharges in 2005 (95% CI 0.0-1.1), P = .007. A layered combination of provider education, provider reminders with decision support, and audit with feedback increased the DVT prophylaxis rate and decreased the rate of hospital-acquired DVTs in the medicine department at a tertiary-care hospital center.

Personal Accounts: More Magic Bullets?

Personal Accounts: More Magic Bullets?