Lebanon Hospital Research Articles

Endoscopic Test for Helicobacter pylori Infection in Patients without Alarm Symptoms: A Study in a Minority Population

Purpose: In addition to detecting common lesions in the upper gastrointestinal (UGI) tract, upper endoscopy is commonly used for diagnosis of H. pylori. In this study we would like to evaluate the yield of endoscopic test in detecting H. pylori infection, premalignant or malignant UGI lesions in patients with dyspepsia who did not have alarm symptoms or use NSAIDs chronically in our minority population. Methods: All men and women between 18-55 years of age with chronic abdominal pain who underwent EGD at the GI division of Bronx Lebanon Hospital Center (BLHC) between July 1, 2008 - December 31, 2009 were included in this retrospective study. Exclusion criteria were the presence of alarm symptoms and chronic NSAIDs use. Results: There were 205 patients who fulfilled the inclusion and exclusion criteria with median age of 43 years old. Of these patients, 59% were women, 66% hispanics, 24% African Americans and 9% other race. Most of the patients (92%) had upper abdominal pain. The endoscopic findings of these patients were esophagitis (12%), hiatus hernia (14%), erythema of gastric mucosa (49%), gastric ulcers (14%), erosion of gastric mucosa (23%), gastric polyp (5.9%), erythema of duodenal mucosa (4%) and erosion of duodenal mucosa (1%). Tissue biopsy from gastric mucosa revealed 22% (45/205) of positive urea based test and 17% (35/205) of positive H. pylori bacteria on histologic assessment. The yield of tissue biopsy for H. pylori was significantly higher among patients with gastric ulcers compared to those without gastric ulcers (12/30 in patients with gastric ulcers versus 35/175 in patients without gastric ulcers, p=0.02). Other findings from the tissue biopsy were esophageal inflammatory changes (7%), esophageal intestinal metaplasia (0.5%), gastric inflammatory changes (40%), hyperplastic gastric mucosa (1%), gastric foveolar hyperplasia (2%) and duodenal inflammatory changes (5%). None of the patients was diagnosed for upper gastrointestinal malignancy. Conclusion: Among patients with dyspepsia who did not have alarm symptoms or use NSAIDs chronically, endoscopic test revealed 22% of H. pylori infection. None of the patients were found to have premalignant or malignant lesions. Similar to previous studies in other communities, study in our minority population may indicate that the use of nonendoscopic test is an appropriate initial approach for detection of H. pylori infection in patients with dyspepsia who do not have have alarm symptoms or use NSAIDs chronically.

Admissions for diabetic ketoacidosis in ethnic minority groups in a city hospital

Hospitalization for diabetic ketoacidosis (DKA) is increasing, perhaps due to the rising incidence of DKA in patients with type 2 diabetes mellitus (T2DM). Ethnic minority groups are at increased risk for T2DM. This study aimed at elucidating the characteristics of patients with ketosis-prone diabetes in a predominantly ethnic minority population. We performed a retrospective analysis of adults admitted with DKA at the Bronx Lebanon Hospital Center, Bronx, NY over 3 years. The patients were divided into cohorts based on type of diabetes and ethnicity. The cohorts were described and compared using statistical methods. We recorded 219 cases of DKA in 168 patients, 97% of whom were African American or Hispanic. Fifty-three (32%) patients had T2DM. New-onset diabetes, which was more common in T2DM ( P < .0001), and African Americans ( P = .008), occurred in 42 patients (25%). Readmission with DKA was more common in the Hispanic patients with type 1 diabetes mellitus (T1DM) ( P = .0001). Type 2 diabetes mellitus was more prevalent in the African Americans ( P = .04). Patients with T1DM had more severe acidosis than patients with T2DM (lower pH and bicarbonate and larger anion gap; P = .03, .02, and .005, respectively). Creatinine level was higher in patients with T2DM ( P = .04) who were also less likely to have identifiable precipitating causes ( P = .02). Hemoglobin A 1c level was higher in patients with new-onset diabetes ( P < .05), but did not differ between those with T1DM and T2DM. Mortality, which was 2%, occurred only in the African Americans with T2DM. We conclude that DKA is an important mode of initial presentation of T2DM, with new-onset T2DM accounting for about 60% of all new cases of DKA. African American patients with T2DM, in comparison with the Hispanic patients, are more susceptible to developing DKA. Diabetic ketoacidosis could occur in T2DM without any identifiable precipitant. The rising incidence of DKA may be attributable to its increasing occurrence in T2DM; therefore, measures aimed at primary prevention of T2DM are worthwhile.

Active use of Cocaine: An Independent Risk Factor for Recurrent Diabetic Ketoacidosis in a City Hospital

To identify the risk factors for recurrent diabetic ketoacidosis (DKA) in a city hospital. We performed a retrospective analysis of sequential adult admissions for DKA at Bronx Lebanon Hospital Center in New York between July 1, 2001, and June 30, 2004. The patients were divided into cohorts, which were compared with use of analysis of variance and X2 tests. Multivariate logistic regression analysis was performed where indicated. In 168 patients (96 men and 72 women), 219 episodes of DKA occurred. The mean age (+/- SD) of the overall study group was 38.6 +/- 14.8 years. Fifty-four patients (32%) had type 2 diabetes, and 44 patients (26%) had new-onset diabetes. The recurrence rate of DKA was 169% in cocaine users and 39% in nonusers (P<0.0001). Active use of cocaine, noncompliance, and Hispanic ethnicity emerged as independent risk factors for recurrent DKA-odds ratio (OR) = 4.38, P = 0.001; OR = 1.96, P = 0.05; and OR = 0.40, P = 0.005, respectively. The commonest precipitants of DKA were noncompliance (44%) and infection (26%). Noncompliance was associated with use of cocaine, use of cannabis, and cigarette smoking (P = 0.008, 0.04, and 0.01, respectively). In 91 of the hospital admissions for DKA (42%), the patients were active smokers. Active use of cocaine is an independent risk factor for recurrent DKA, as are noncompliance and Hispanic ethnicity. Of these 3 factors, cocaine showed the strongest association with DKA. Therefore, toxicology screening in patients with recurrent DKA may be prudent and worthwhile.

Psychiatric Symptoms among Postpartum Women in an Urban Hospital Setting

The object of this study was to evaluate postpartum women for psychiatric symptomatology including cognitive disturbances, anxiety, depression, and anger to better meet their needs for support and involve them in the care of their infants. We interviewed 52 postpartum mothers at the Bronx Lebanon Hospital Center within 5 days of delivery and determined the presence of psychiatric symptoms using the 29-item Psychiatric Symptom Index. Despite the fact that adult mothers were happier they were pregnant (71.4% versus 29.4%; P = 0.010) and less likely to be worried about their baby's health (25.7% versus 52.9%; P = 0.003), adult mothers demonstrated higher depressive symptomatology ( P = 0.009), higher amounts of anger ( P = 0.004), and greater overall psychiatric symptomatology ( P = 0.005) than adolescent mothers. Mothers whose infants were in the neonatal intensive care unit did not report significantly higher psychiatric symptomatology than mothers whose infants were healthy. Physicians need to be aware of the high levels of depression and anger present among postpartum women so appropriate support can be given.

The Pulmonary Artery Catheter in Anesthesia Practice

Pressures in the right side of the heart and pulmonary capillary wedge can be obtained by cardiac catheterization without the aid of fluoroscopy. A No. 5 French double-lumen catheter with a balloon just proximal to the tip is inserted into the right atrium under pressure monitoring. The balloon is then inflated with 0.8 ml of air. The balloon is carried by blood flow through the right side of the heart into the smaller radicles of the pulmonary artery. In this position when the balloon is inflated wedge pressure is obtained. The average time for passage of the catheter from the right atrium to the pulmonary artery was 35 s in the first 100 passages. The frequency of premature beats was minimal, and no other arrhythmias occurred.

Epidemiology of Chronic Hepatitis B Infection in South Bronx Community Hospital

Purpose: Prior study reported that prevalence of hepatocellular carcinoma (HCC) and portal hypertension from chronic hepatitis B virus (HBV) infection was 44% among Hispanics and 28% among Blacks. Since our institution predominantly serves these populations therefore we retrospectively studied the epidemiology of HBV infection in our community. Methods: We reviewed medical records all patients age ≥18 years with chronic HBV infection who had been evaluated at the clinics affiliated with Bronx Lebanon Hospital Center between January 1, 2002 and December 31, 2004. Results: 167 patients with chronic HBV infection were identified with mean age of 40 years (range 18–81). Of these, 82 (49%) patients were males. 103 (62%) were African-Americans, 60 (36%) Hispanics and 4 (2%) others. Majority of the patients were covered by health insurance (127, 76%). Co-morbidities included HIV (23, 14%), HCV (8, 5%), HIV and HCV (4, 2%). Of the 16 patients with liver cirrhosis, 9 (56%) were found to be decompensated and 1 (6%) had HCC. Among 68 patients who had HBeAg status known, 23 (34%) had positive HBeAg. Of 78 patients with alpha-fetoprotein (AFP) known, 69 (88%) had AFP level less than 10 ng/mL. Liver imaging study for HCC screening was performed in 80 (48%) patients. 12 (7%) patients underwent HBV treatment. Among 155 patients who were not treated, 107 (69%) had alanine aminotransferase (ALT) level less than upper limit of normal (ULN) without evidence of liver cirrhosis. 48 patients were not eligible for HBV treatment for the following reasons: 20 (42%) were active injection drug or heavy alcohol users, 17 (35%) were non-compliant with visits during the evaluation period and 11 (23%) did not have health insurance coverage. Conclusions: In the South Bronx, nearly half of our patients underwent HCC screening. More than half of patients with liver cirrhosis were decompensated. Most of our patients were not considered to be candidates for treatment because of normal ALT levels and potentially modifiable social factors. Recognition and management of the identified factors may increase rate of HCC screening and HBV treatment.

Building the Minority Faculty Development Pipeline

The shortage of faculty in dental education is well documented, but the data also show a shortage of minorities in postgraduate programs, which develop future faculty. In the last ten years, ADEA's effort to address minority issues in dental education has made some progress. In addition, examples of pipelines for minority faculty development that have shown some success include: a partnership between Harlem Hospital and Columbia University School of Dentistry and Oral Surgery in which the school dedicates one position in its postgraduate training programs to an individual participating in the Harlem Hospital General Practice Residency program; a partnership between the National Dental Association Foundation and Colgate-Palmolive Company, which provides scholarships for advanced dental education study; and the Bronx Lebanon Hospital Center Department of Dentistry, which enrolls underrepresented minorities in its General Practice Residency Program, a new Pediatric Dentistry Residency Program, and a unique program providing hands-on experience in HIV/AIDS health care policy and AIDS development management. Critical elements in the relative success of these programs are environment, selection criteria, mentoring, networking, and finance. The true measure of the outcomes is still to be seen.

Winston S Churchill's (1874-1965) inguinal hernia repair by Thomas P Dunhill (1876-1957).

* Department of Surgery, Bronx Lebanon Hospital Center, Bronx, NY, USA(Schein) † Department of Surgery, Gartnavel General Hospital, Glasgow, Scotland, USA(Rogers) **Correspondence address: Moshe Schein, MD, FACS, Department of Surgery, Bronx Lebanon Hospital Center, 1650 Selwyn Ave, Bronx, NY, USA 10457. Received July 22, 2002; accepted August 13, 2002. ☆No competing interests declared.

Maternal serum α-fetoprotein and human chorionic gonadotropin levels in women with human immunodeficiency virus

Objective: The purpose of this study was to establish whether there is a correlation between maternal serum genetic screen analyte results in pregnant women with human immunodeficiency virus and corresponding human immunodeficiency virus index values. Study Design: Medical records of all pregnant women with human immunodeficiency virus who were delivered at Bronx Lebanon Hospital Center from January 2000 through December 2001 were reviewed for maternal serum screen results, viral load, CD4 counts and percent, antiretroviral therapy, opportunistic infections, substance abuse, and other demographic data. Statistical analysis was accomplished with the χ2 test, Mann-Whitney U test, and Spearman rank correlation test, with a probability value of <.05 considered significant. Results: Of the 98 women with human immunodeficiency virus who were delivered, 49 women (50%) had a maternal serum genetic screen available. Screened and unscreened women had similar severity of human immunodeficiency virus disease, CD4 count and percentage, and viral loads. Serum screen results showed elevations in maternal serum human chorionic gonadotropin (1.43 ± 1.04 multiples of the median [MoM]; range, 0.2-5.2 MoM) and maternal serum α-fetoprotein (1.29 ± 0.9 MoM; range, 0.5-3.3 MoM) compared with expected values in the general obstetric population. Maternal serum human chorionic gonadotropin was correlated inversely with CD4 count (P =.002) and CD4 percent (P <.0001). Maternal serum α-fetoprotein varied directly with viral load (P <.0001). Conclusion: Increasing maternal serum human chorionic gonadotropin and maternal serum α-fetoprotein levels in patients with human immunodeficiency virus are correlated with increasing viral load and decreasing CD4 counts. (Am J Obstet Gynecol 2003;188:1052-6.)

Psychiatric Symptoms In Postpartum Adolescent and Adult Women 68

The object of this study was to evaluate post-partum women for psychiatric symptomatology, including cognitive disturbances, anxiety, depression, and anger in order to better meet their needs for support and involve them in the care of their infants. We interviewed 52 post-partum women at The Bronx Lebanon Hospital Center, 17 adolescents (age≤19 yrs, mean age 17.5 yrs.) and 35 adults (mean age 26.6 yrs.). The presence of psychiatric symptoms were measured by using the 29-item Psychiatric Symptom Index (Ilfeld 1976) on mothers within 5 days of delivery. There were no significant differences between the adolescents and the adults for maternal race, prenatal complications, type of delivery, cigarette smoking, drug use, current employment status, or infant health. Adults were more likely to have planned the pregnancy(41.2% vs. 11.8%, p=.003), received prenatal care (100% vs. 87.5%, p=.033), and report feeling happy upon learning they were pregnant(71.4% vs 29.4%, p=.010). Despite the fact that adult mothers were less likely to be worried about the health of their babies (25.7% vs. 52.9%, p=.003) and more likely to report that they would be better off a year from now (90.0% vs. 62.5%, p=.025), they demonstrated higher depressive symptomatology, higher amounts of anger, and greater overall psychiatric symptomatology than adolescent mothers. Physicians need to be aware of the high levels of depression and anger among adult mothers to provide appropriate support. Adolescent mothers may not realize the gravity of their situation and may not seek adequate intervention. Table

Cocaine Attenuates Neonatal Withdrawal in Methadone-Maintained Mothers† 1226

There is conflicting data about the effect of cocaine on the withdrawal of newborns from methadone. We reviewed 85 consecutive cases of newborns born at Bronx Lebanon Hospital Center from January 1993 till February 1996 to mothers in methadone maintenance programs. The age range of the mothers was 18-41 years (mean 30.4± 5.1) with 75% Latino and 22% African-American. Sixty-four women (91%) had prenatal care during the pregnancy and 7% had extramural deliveries. The overall prevalence of illicit drug use within one month prior to delivery was 55%. This was determined by history or a positive infant urine toxicology screen. The mothers were divided into 4 groups: 1. methadone alone (methadone) 38 mothers (45%), 2. cocaine + methadone (cocaine) 13 (15%), 3. opiates + methadone (opiates) 13 (15%), 4. methadone +cocaine+opiates (poly-drug) 21 (25%). There were no significant differences between the groups in birth weight, gestational age, length, head circumference, neonatal morbidity, blood pressure, and exposure to smoking or alcohol. There were several important differences between the groups. The daily dose of methadone was significantly higher in the cocaine group than in the methadone group (76 vs 56 mg, p=0.0036) or the opiate group (55mg, p=0.0050). In addition, mothers using cocaine were enrolled in a methadone program significantly longer than the methadone users (60 vs 25 months, p=0.0015) or opiate users (13 months, p=0.0011). However, the peak total withdrawal score(modified Finnegan 1975) was significantly lower in the cocaine-exposed group than the methadone-exposed group (12 vs 16, p=0.0111) or the opiate-exposed group (16, p=0.0220). The number of hospital days spent withdrawing was also significantly lower with cocaine than methadone (22 vs 34, p=0.0235) or opiate(39, p=0.042). Despite the use of illicit drugs, 44% (20/45) of these newborns were discharged home to their mothers. We conclude that while methadone maintenance programs are hailed as an effective method of preventing illicit drug use, concomitant drug use is still very high and continues to place the newborn at risk both in the immediate neonatal period as well upon discharge home. Cocaine use attenuates the neonatal withdrawal syndrome from methadone, whereas opiate use does not.

PREDICTORS OF TOXICOLOGY TESTS POSITIVE FOR COCAINE IN AN URBAN POPULATION.102

At a time of declining resources, toxicologies screens of newborn infants become an expensive proposition. We therefore, designed a study to try to predict which newborns would have a positive screen for cocaine or other drugs. 444 consecutive women who delivered at the Bronx Lebanon Hospital Center were evaluated. Detailed histories including drug use were obtained by structured interview on the post-partum floor. Concurrently, maternal urine and infant urine and meconium samples were obtained, numerically coded and matched to interview data to insure anonymity. Reported cocaine drug use during pregnancy by history was 34, (7.7%), total drug use by history was 39(8.8%) and drugs + marijuana was 48 (10.8%). This differed significantly with the number identified by toxicology screens, cocaine 93 (20.9%, p=.000), drug 117 (26.3%, p=000) and drug + marijuana 140 (31.5%, p=.000). Drug using mothers were more likely to be born in the US (60% vs 50%, p=.042), be a US citizen (81% vs 70%, p=.017), have spent more years in the US (21.3±9.0 vs 16.2±10.1, p=.000), be on public assistance (71% vs 59%, p=.017), smoke (56% vs 22%, p=.000), drink alcohol during the pregnancy (37% vs 4% p=.000), be African-American (51% vs 41%, p=.039), have a higher number of pregnancies (4.2±2.8 vs 3.1±2.3, p=.001), have a positive RPR(14% vs 2% p=.000), and have a newborn with a lower gestational age(38.8±2.7 vs 39.5±1.8, p=.006), lower birth weight(2940±699 vs 3208±560, p=.000), smaller length (48.2±4.4 vs 49.5±5.0, p=.017) and smaller head circumference (33.0±13.4 vs 34.1±2.5, p=.001). After reviewing the data we identified 3 criteria to predict those with a positive toxicology for drugs: a past history (prior to the pregnancy) for cocaine or marijuana, inadequate prenatal care defined as a first visit starting from 7 months of gestation or later or 2 prenatal visits or less, or a newborn who required admission to our neonatal ICU. These criteria correctly identified 72% of those with a positive toxicology for cocaine and 69% those with a positive toxicology for any drug or marijuana, while exposing only 20% of our drug free population to toxicology tests. These findings suggest a more cost-effective method to decide who requires toxicology screens.

ARE NURSES HOME VISITS A SOLUTION TO THE PROBLEM OF EARLY DISCHARGES AMONG INNER CITY DELIVERIES? † 642

In order to contain medical costs many insurance companies have advocated 24 hour discharges of postpartum mothers and newborn infants followed by a nurses home visit within 48 hours of discharge. We hypothesized that such an approach would not work in our inner city population because many of the addresses given by our mothers are false and therefore, these mothers and babies may not be found. We were also concerned about the safety of such visits. In order to test that hypothesis we reviewed the records of all Maternal Child Health Referrals in 1995 to the Visiting Nurse Service of New York for Bronx, N.Y. A total of 8,419 patients were referred and 7,035 visits were successful (84%). Of the 1,384 unsuccessful visits, 480 (35%) were because the patient could not be found, 265 (19%) were because the patient/family refused care, 80 (6%) because the family moved, 3 were because the visit was thought not to be safe and 628 (45%) were because of other technical problems. To evaluate a poor inner city population we reviewed the records for Bronx Lebanon Hospital. Among 1958 patients referred, 1644 were successful (84%) and 314 unsuccessful. 160 (33%) could not be found, 71 (23%) were because of refusal of care, 14 (4%) because the family moved, and 2 because of safety. We conclude that nursing home visits are successful in at least 84% of newborn infants and therefore, early discharges may be possible in the majority of deliveries even in an inner city population. We hypothesize that a single antenatal nursing home visit would help to identify those families who could have a successful post-discharge home visit.

Guillain-Barr?? Syndrome Following Herpes Zoster in an HIV-1-Infected Patient

From the Department of Medicine, Bronx Lebanon Hospital Center; and the Albert Einstein College of Medicine, Bronx, New York

Community-Acquired Enterococcal Meningitis in an Adult

Journal Article Community-Acquired Enterococcal Meningitis in an Adult Get access Barkat A. Fazal, Barkat A. Fazal Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York Reprints or correspondence: Dr. Barkat A. Fazal, Division of Infectious Diseases, Bronx Lebanon Hospital Center, 1650 Grand Concourse, Bronx, New York 10457. Search for other works by this author on: Oxford Academic PubMed Google Scholar Glenn S. Turett, Glenn S. Turett Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York Search for other works by this author on: Oxford Academic PubMed Google Scholar Sridhar S. Chilimuri, Sridhar S. Chilimuri Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York Search for other works by this author on: Oxford Academic PubMed Google Scholar Conchita M. Mendoza, Conchita M. Mendoza Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York Search for other works by this author on: Oxford Academic PubMed Google Scholar Edward E. Telzak Edward E. Telzak Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York Search for other works by this author on: Oxford Academic PubMed Google Scholar Clinical Infectious Diseases, Volume 20, Issue 3, March 1995, Pages 725–726, https://doi.org/10.1093/clinids/20.3.725 Published: 01 March 1995

Human immunodeficiency virus seropositivity in critically ill neonates in the south Bronx.

Cord blood was anonymously screened to determine the prevalence of human immunodeficiency virus (HIV) seropositivity in neonates admitted to the neonatal intensive care unit (NICU) at the Bronx Lebanon Hospital Center, located in the South Bronx. We speculated that factors leading to admission to the NICU such as low birth weight, prematurity and being small for gestational age would also be associated with an increased prevalence of HIV seropositivity. During the study period the prevalence of HIV seropositivity was 11.6% in the NICU population. There was no significant difference in maternal age, gravidity, race and sex in HIV-seropositive vs. HIV-seronegative newborns. There was a significantly increased incidence of maternal drug use (P less than 0.01), babies small for gestational age (P less than 0.005) and microcephaly (P less than 0.02) in seropositive vs. seronegative NICU babies. The results of this study suggest that the NICU population may comprise a significant number of infants of HIV-infected mothers.

Antimicrobial agent susceptibility patterns of bacteria in hospitals from 1971 to 1982.

Bacterial susceptibility to 16 commonly used antibiotics was analyzed for a 12-year period (from 1971 to 1982, inclusive). Susceptibilities of 5,828,243 strains isolated from a mean of 242 hospitals nationwide and of 194,575 strains isolated at the Massachusetts General Hospital, Boston, Mass., and the Bronx Lebanon Hospital Center, New York, N.Y., were compared. Strains of Escherichia coli, Staphylococcus aureus, Haemophilus influenzae, and Pseudomonas aeruginosa showed virtually the same susceptibilities to antibiotics throughout the 12-year period, whereas Streptococcus faecalis and Staphylococcus epidermidis showed significant increases in resistance to most antibiotics. The close similarity between antibiotic susceptibilities shown at both the 242 hospitals and the 2 individual hospitals suggests that this analysis accurately reflects trends of bacterial resistance to antibiotics in U.S. hospitals. Since most of the species analyzed produce serious disease and high mortality, their susceptibility to antibiotics is relevant both to physicians treating infectious diseases and to epidemiologists.

A Technique for Preventing Post‐operative Scrotal Haematoma

International Journal of Clinical PracticeVolume 38, Issue 3 p. 93-94 Clinical Studies A Technique for Preventing Post-operative Scrotal Haematoma R. Shreedhar FRCS (Ed), R. Shreedhar FRCS (Ed) Registrar Present address Bronx Lebanon Hospital, New York.Search for more papers by this authorT. Duncan FRCS (Ed), T. Duncan FRCS (Ed) Consultant South Cleveland Hospital, MiddlesbroughSearch for more papers by this author R. Shreedhar FRCS (Ed), R. Shreedhar FRCS (Ed) Registrar Present address Bronx Lebanon Hospital, New York.Search for more papers by this authorT. Duncan FRCS (Ed), T. Duncan FRCS (Ed) Consultant South Cleveland Hospital, MiddlesbroughSearch for more papers by this author First published: 01 March 1984 https://doi.org/10.1111/j.1742-1241.1984.tb07259.x Read the full textAboutPDF 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 onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume38, Issue3March 1984Pages 93-94 RelatedInformation

Hypertension in pregnancy: Zoltan Zarday, Bronx Lebanon Hospital, Albert Einstein College of Medicine, Bronx, New York; George Kleiner

Hypertension in pregnancy: Zoltan Zarday, Bronx Lebanon Hospital, Albert Einstein College of Medicine, Bronx, New York; George Kleiner

The problems of dependency and the value of art therapy as a means of treating alcoholism

THIS study was made over a period of eleven months. I was at that time the head of, and the only member of the Art Therapy Department of the Bronx Lebanon Hospital in the South Bronx. I made my office in the Psychiatric Day Hospital, although my program was attended by the inpatients as well. This is a large city hospital, servicing a community made up primarily of Blacks and Puerto Ricans. I was the first art therapist to be employed, and as such was given a great deal of leeway as to how the program should be set up and run. None of the services or facilities and activities enjoyed by the other patients were available to the alcoholics. The new art room had been used for meetings and occasionally by an alcoholic patient in search of a way to pass the time. In among the many posters hanging on the wall, I noticed some poems and a painting. (Fig. 1) The painting caught my eye at once. It was unsigned, and depicted a head and torso with the left side of the face blacked out. The bright yellow on the right side was set off eerily by a single empty sightless eye. On closer inspection there seemed to be another less defined head to the right of this one, seemingly coming from the same body. It, too, was featureless and had an empty, red eye socket in place of an eye. There seemed to be a third black head as well to the far right. I was struck not only by the bizarreness of this painting and the anxiety, fear and anger that it expressed by means of the frag mented lines and angry looking colors, but also by the knowledge and skill in both the composition and in the use of color. Upon examining the other pieces of paper (Figs. 2, 3 and 4) hanging around it, I saw that they followed a pattern. Each poem had some small heads drawn on it. Each head was depicted with rather prominent ears, wore a hat and sported a beard. The right eyes were all sightless, while the left sockets, although not empty, were blacked out, negating vision. All of them were signed Harold. All had haunting melancholy themes reflecting hopelessness and long lost loves whose warmth he seemed never to have known. The eyeless heads on the poems were obviously related to feelings depicted in the painting, despite the fact that they were as dispassionate as the painting was passionate. All were pleading to be seen and understood. They verbally stated many of the observable emotions of the painting; longings for love and warmth, anger and self-pity and selfdenigration. The placement of the word “See” over his head indicated a feeling of being misunderstood and unappreciated, as well as unnoticed and futile. Alienation from people could also be perceived. “I was never deep into anything but wine.” Who was this sad, alienated, lonely person that drifted alone into the art room to pour out his heart to the empty spaces around him? In perusing his chart, I found that Harold was 26, black, and had been admitted three months before my arrival. He had been referred to the clinic by his married sister. At that time he had taken some pills which caused vomiting of blood. When admitted to Bronx