Lenox Hill Research Articles

Metal allergy response to femoral head-neck corrosion after total hip replacement

aHospital for Special Surgery, Weill Cornell Medical College, New York, NY bDepartment of Pathology, Lenox Hill Hospital, New York, NY cDepartment of Orthopaedics, Lenox Hill Hospital, New York, NY Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Dr Jose A. Rodriguez is a consultant for Wright Medical Technology. Correspondence to Morteza Meftah, MD, Ranawat Orthopaedic Center, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, 6th Floor, New York, NY 10021 Tel: +646 797 8716; fax: +646 797 8777; e-mail: [email protected]; [email protected]

Somatostatin Receptor Scintigraphy as a Potential Diagnostic and Treatment Modality for Thyroid Follicular-Cell-Derived Cancers

ThyroidVol. 20, No. 6 Letters to the EditorSomatostatin Receptor Scintigraphy as a Potential Diagnostic and Treatment Modality for Thyroid Follicular-Cell-Derived CancersDebra J. Margulies and Manfred BlumDebra J. MarguliesDivision of Endocrinology, Department of Medicine, Lenox Hill Hospital, New York, New York.Search for more papers by this author and Manfred BlumDivision of Endocrinology, Department of Medicine, New York University, New York, New York.Search for more papers by this authorPublished Online:16 Jun 2010https://doi.org/10.1089/thy.2009.0453AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Somatostatin Receptor Scintigraphy as a Potential Diagnostic and Treatment Modality for Thyroid Follicular-Cell-Derived Cancers." , 20(6), pp. 671–672FiguresReferencesRelatedDetailsCited byAlternative Thyroid Imaging20 September 2016Management of the Patients with Negative Radioiodine Scan and Elevated Serum Thyroglobulin20 September 2016The Truncated Isoform of Somatostatin Receptor5 (sst5TMD4) Is Associated with Poorly Differentiated Thyroid Cancer21 January 2014 | PLoS ONE, Vol. 9, No. 1 Volume 20Issue 6Jun 2010 InformationCopyright 2010, Mary Ann Liebert, Inc.To cite this article:Debra J. Margulies and Manfred Blum.Somatostatin Receptor Scintigraphy as a Potential Diagnostic and Treatment Modality for Thyroid Follicular-Cell-Derived Cancers.Thyroid.Jun 2010.671-672.http://doi.org/10.1089/thy.2009.0453Published in Volume: 20 Issue 6: June 16, 2010PDF download

Scapulothoracic Fusion

From the Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY (Dr. DeFranco), and Shoulder & Elbow Reconstruction, Rush University Medical Center, Chicago, IL (Dr. Nho and Dr. Romeo). Dr. Nho or an immediate family member has received research or institutional support from Arthrex, DJ Orthopaedics, ConMed Linvatec, Ossur, Smith & Nephew, Athletico, and Miomed. Dr. Romeo or an immediate family member has received royalties from Arthrex; is a member of a speakers' bureau or has made paid presentations on behalf of Arthrex and DJ Orthopaedics; serves as a paid consultant to or is an employee of Arthrex; has received research or institutional support from Arthrex, DJ Orthopaedics, Smith & Nephew, Ossur, and ConMed Linvatec; and has received other nonincome support (such as equipment or services), commercially derived honoraria, or other nonresearch -related funding (such as paid travel) from Arthrex. Neither Dr. DeFranco nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article. The video that accompanies this article is “Scapulothoracic Fusion for Fascioscapulohumeral Muscular Dystrophy,” available on the Orthopaedic Knowledge Online website, at http://www5.aaos.org/oko/jaaos/surgical.cfm

Anal Skin Tags: An Overlooked Indicator of Crohn's Disease

Clinical Research in Gastroenterology, Department of Medicine, Lenox Hill Hospital, New York, NY There are no outside sources of support. There are no conflicts of interest.

Multislice coronary computed tomographic angiography in emergency department presentations of unsuspected acute myocardial infarction

Coronary computed tomographic angiography (CCTA) is not indicated in the setting of acute myocardial infarction in the emergency department (ED). Nonetheless, acute coronary syndromes may have atypical presentations, and CCTA may be inadvertently performed in this setting. This study was designed to determine the frequency and characteristics of CCTA imaging of unsuspected acute myocardial infarction in the ED. All CCTAs performed in the ED at Lenox Hill Hospital were reviewed for clinical indications and subsequent course; patients with documented acute myocardial infarction were identified. Of the 500 CCTAs performed on ED patients in the Lenox Hill laboratory, 5 patients (1%) were imaged during the initial phase of an unsuspected acute myocardial infarction; in all cases the CCTAs were key to the diagnosis. The imaging characteristics were (1) total or subtotal occlusion and (2) transmural hypodensity in the infarct area. Although acute myocardial infarction on CCTA in ED patients is an infrequent event, proper and prompt recognition is critical for appropriate patient care, particularly as applications to the ED increase.

AJR Teaching File: Right Atrial Mass in a Woman with Uterine Fibroids

Received February 28, 2008; accepted after revision April 7, 2008. 1All authors: Department of Radiology, Lenox Hill Hospital, 100 E 77th St., New York, NY 10075. Address correspondence to E. H. Dillon (evandillonmd@gmail.com). AJR 2009;192:S53–S56 0361–803X/09/1923–S53 © American Roentgen Ray Society Case History A 48-year-old woman with a history of hypertension who had undergone dilatation and curettage for vaginal bleeding related to uterine fibroids presents with palpitations and chest pain. A heart murmur is detected on physical examination. Echocardiography performed elsewhere depicted a possible right atrial myxoma with inferior vena caval involvement. She was then referred to our institution for further evaluation and treatment.

Retrospective Cost Analysis of Testing for HIT Antibodies in a Community Hospital

Background: Heparin-Induced Thrombocytopenia is a serious, immune-mediated complication of heparin therapy. At Lenox Hill Hospital when HIT is suspected, a test for heparin associated antibodies is ordered. Like many community hospitals, Lenox Hill Hospital does not perform this test “in house”, so it is sent to a reference lab. We use the Mayo Clinic Laboratory as our reference lab. It takes about 7 days for results to come back to Lenox Hill Hospital from the Mayo Clinic Lab. Meanwhile, patients are started on Argatroban or Lepirudin infusions in order to avoid thrombosis. We performed a retrospective review of all patients suspected of having HIT in a one year period, in order to assess the cost effectiveness of sending out these tests and treating these patients with alternative anticoagulants while waiting for the test results.Methods: We performed a retrospective review of all patients who were tested for HIT Antibodies. We obtained a list of patient specimens sent to Mayo Clinic for heparin associated antibodies from January 2007 to January 2008. A list of patients placed on either Argatroban or Lepirudin infusions was also obtained for the same time frame from our Pharmacy Department. We then recorded the results for the ELISA test for the HIT antibodies from our computer system.Results: There were 150 patient samples sent for heparin associated antibody tests to the Mayo Clinic Laboratory during these 12 months. Only 12 out of 150 patient samples tested positive for HIT by ELISA. Four out of 150 tested equivocal for HIT. All the remaining reports were negative. The hospital was charged $300 for each ELISA test, so our community hospital spent $ 45,000 in one year on heparin associated antibody testing. 15 of these patients were placed on Argatroban infusion while awaiting lab results. All fifteen patients who were placed on Argatroban ultimately tested negative for HIT. Four patients were started on Lepuridin infusions. Only one of the patients on Lepuridin tested positive for HIT. In total, there were 19 patients treated with either Argatroban or Lepuridin during this 12 months period. Only one patient, out of the 19 treated patients tested positive for HIT.The 12 months cost analysis showed that 100 vials of Lepirudin were used at a cost of $158.80/vial, for a total of $15,880. The 12 months cost analysis for Argatroban showed that 15 vials were ordered each month at a cost of $985/vial for a total of $177,300.The total amount spent including testing and expectant came to $238,180.00. Only one patient truly needed to be treated with an alternative anticoagulant.Discussion: Lepirudin and argatroban are two accepted drugs for treatment of HIT. These are direct thrombin inhibitors that are given intravenously. Argatroban binds to the catalytic site of thrombin. It gets metabolized by the liver and should be dose adjusted with careful monitoring in patients with hepatic impairment. No dose adjustment is necessary in patients with renal dysfunction. Lepirudin binds to both catalytic and a fibrinogen-binding site of thrombin. It gets excreted in the urine and should be carefully monitored in patients with renal insufficiency. Both drugs can lead to bleeding complications. These drugs should be used with great caution when there is an increased risk of a hemorrhagic event. The cost of Argatroban and Lepirudin infusions was obtained from the pharmacy purchase orders. The cost of HIT antibody testing was obtained from our main labarotory. The cost of the machine at the Mayo Labarotory that is used in the Special Coagulation laboratory (DSX ELISA processing system) was $52,000. The machine was purchased prior to 2004. We concluded that our community hospital spends a total of $238,000 per year in the evaluation and expected management of heparin-induced thrombocytopenia.Conclusion: In this retrospective review of 150 patients who have had HIT antibodies testing and 19 who were started on anticoagulation therapy and have had their HIT antibodies tests sent out for HIT confirmation, only 1 had a positive result. We concluded that our community hospital spends a total of $238,000 per year in the evaluation and expectant management of heparin-induced thrombocytopenia. The hospital would save money and improve patient care if it purchased the laboratory equipment and ran the tests in-house, providing faster turn around and more accurate assessment of risk.

Restrictive dermopathy: two‐ and three‐dimensional sonographic features

Restrictive dermopathy is a rare lethal genetic disorder characterized by tight and rigid skin, skin erosions and prominent superficial vasculature with epidermal hyperkeratosis. In addition, one may find microstomia, a small pinched nose, micrognathia and sparse/absent eyelashes and eyebrows, as well as mineralization defects of the skull, thin dysplastic clavicles and humeri, multiple joint contractures, intrauterine growth restriction and polyhydramnios. Associated anomalies of the viscera may include hepatosplenomegaly, ureteral duplication and pulmonary hypoplasia. Liveborn infants usually die within the first week of postnatal life1-6. It is caused by either autosomal dominant or autosomal recessive mutations of a gene that encodes a metalloprotease essential for the post-translational processing of prelamin A to mature lamin A, an important step in collagen synthesis6, 7. Approximately 47 cases of restrictive dermopathy have been reported worldwide8. Antenatal diagnosis has been reported in only three cases following a high index of suspicion based on family history2-4. We report a case in which typical features of restrictive dermopathy were seen antenatally in a pregnancy with no positive family history. A 35-year-old primigravid woman was seen at our center for maternal fetal medicine. She was a healthy Caucasian, and was not consanguineous with her husband. Her pregnancy course had been unremarkable; she had had a normal nuchal translucency scan. Karyotyping at 16 weeks' gestation showed a normal 46,XX. The anatomical survey at 20 weeks' gestation was normal. At 30 weeks' gestation a routine ultrasound examination revealed multiple fetal anomalies, including abnormal facial profile with a beak-like nose, micrognathia and microstomia, abnormal calvarium, hypertelorism and frontal bossing of the forehead (Figure 1a). In addition, the upper arms were permanently flexed and the hands remained open with the fingers spread out (Figure 2a). Sandal gap toes, ambiguous genitalia, moderate-to-severe fetal ascites and mild polyhydramnios were also documented. Even though a precise diagnosis was not provided antenatally, the patient was told that a severe and complex fetal malformation had been detected. After discussing the management options, the patient elected to terminate the pregnancy at 31 weeks. (a) Three-dimensional ultrasound image at 31 weeks' gestation showing a pinched nose, micrognathia and microstomia, abnormal calvarium, hypertelorism and frontal bossing of the forehead. (b) Profile of the fetus following termination at 31 weeks demonstrating the same features as those in (a). (a) Two-dimensional ultrasound image at 31 weeks' gestation showing a hand spread open. (b) Postmortem image showing hands open, with the fingers spread out. A female fetus weighing 1300 g was delivered. Autopsy revealed a thin, extremely taut and stretched-out skin, with total alopecia. Histological examination of the skin was consistent with restrictive dermopathy. All of the features identified on prenatal sonographic examination were confirmed on macroscopic examination (Figures 1b and 2b). No abnormalities of the internal organs were identified. Restrictive dermopathy was the final diagnosis. The differential diagnosis of restrictive dermopathy includes Rubinstein–Taybi syndrome and congenital skin disorders such as epidermolysis bullosa, aplasia cutis congenita, the lethal ichthyosis variant of arthrogryposis, and other severe congenital skin defects5, 9. It is known that the specific sonographic manifestations of restrictive dermopathy become evident only at the beginning of the third trimester2, 4. Hamel et al. performed skin biopsies at 20 weeks on several cases of restrictive dermopathy and could not demonstrate any skin abnormalities. They concluded that these abnormalities develop only later in fetal life10. The present case illustrates the prenatal appearance of restrictive dermopathy by providing two- and three-dimensional sonographic images of several malformations described in this syndrome. In our case the ability to produce a three-dimensional image of the face allowed us to demonstrate typical features including the small pointed nose, micrognathia, open fixed mouth and frontal bossing of the head. Once this syndrome is suspected, specific genetic testing and a definitive diagnosis are possible before delivery. N. Feldman-Leidner*, K. Delaney*, M. Malikina*, P. Segarra*, G. R. Tiller , T. Singer*, M. Y. Divon*, * Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA, Women's Health Care Services, Wichita, KS, USA

What are the rules when treatment with 6-MP/AZA is started?

The most important rule is assurance that the patient realizes that Crohn’s disease (CD) is a lifetime pathological process and that the gastroenterologist has explained the specific indications for using 6-mercaptopurine/azathioprine (6-MP/AZA) for their particular case, that 6-MP/AZA may result in a prolonged and possibly permanent remission, and that the risks of adverse reactions in using the drug, although infrequent, are mostly reversible and understood. While ulcerative colitis (UC) is theoretically curable by colectomy, 6-MP/AZA are effective just as much as in CD and the possibility of postoperative complications such as pouchitis, risk of mucosal cancer, impotence, or permanent ileostomy warrant a fair trial of immunosuppressives. Since the metabolism of the drug varies, the initial dose is low (I start at 50 mg/d) but an increase may be anticipated pending inadequate response, and stopped or decreased pending a fall in the white blood cell count (WBC) or platelets or development of abnormal liver function tests. The patient must be compliant with having blood drawn for complete blood count (CBC) weekly usually for the first 3 weeks and subsequently no matter how much the interval is increased. This is managed in my own center by request that reports be faxed by the laboratory and then the patients call for directions on the dose and the interval. Compliance is better achieved by monitoring the results of the blood work, and the phone call from the patient to receive directions, than by the results of serological tests that also require the patients’ cooperation and motivation but a longer lag period. While measurement of the enzyme thiopurine methyltransferase (TPMT) is of value, its measurement is rarely essential since its complete absence (potentially leading to bone marrow depression) occurs in only 1 out of 300 patients. Meanwhile, the CBC is monitored very carefully in all. Most patients are still on steroids at the time when 6-MP/AZA are introduced, which serves to increase the WBC, and the use of granulocyte stimulating factor offers further protection, although rarely needed. Whenever fever occurs, regardless of cause, 6-MP/AZA should be temporarily stopped and the CBC measured. Since early on it has been my own conviction that the initial dose of 6-MP/AZA should not be based on the patient’s weight; both experience and the pursuit of measuring levels of serological metabolites have supported these early observations. While the standard of dose introduction at 1.5 mg/kg for 6-MP and 2.5 mg/kg of AZA date back to the early placebo-controlled crossover trial conducted via the private offices of Korelitz and Present, and the National Cooperative Crohn’s Disease Study conducted at 14 centers, it soon became clear that efficacy in some patients tolerating only one-half a tablet of 6-MP every 2–3 weeks fared equally well as another patient requiring 5–6 tablets daily. This is best explained serologically by the preferential shunting via a metabolic pathway to the effective moiety 6TG rather than 6MMP, which is far less if at all effective and proportionally leads to hepatic toxicity. Therefore, in those cases when efficacy is clinically not achieved, measurement of 6TG and 6PPT may lead to increasing the dose of 6-MP/6TG much sooner. Until now this goal has been accomplished without serological measurements by reintroducing steroids (or raising the dose back to original levels), always accompanied by raising the dose of 6-MP/AZA by 25–50 mg/day at the same time. The reintroduction or raising the dose of steroids should be brief, not permitting either steroid-dependence or steroidresistance to occur. Despite the fact that 6-MP/AZA has proven to be the most effective drug for maintenance in moderate to severe UC and CD to date, its disadvantage has been the delayed time to effectiveness (3–12 months), requiring corticosteroids or infliximab to buy time until doses are raised and efficacy becomes evident. What then can be done to try to enable 6-MP/AZA to work faster? Administering the drug intravenously has not yet been shown to accomplish this purpose. There is some evidence that the use of 5-aminosalicylic acid (5-ASA) products will speed up the action of 6-MP/AZA, presumably by switching more of its metabolites to 6TG, but practically speaking almost all patients started on immunosuppressives are already taking 5-ASA products without any evident clinical counterpart. There is currently some hope that continuous use of Allopurinol, which until now has been recognized as risking severe leukopenia in those who require the drug along with the 6-MP/AZA will From the Lenox Hill Hospital, New York University School of Medicine, New York, USA. Copyright © 2008 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1002/ibd.20705 Published online in Wiley InterScience (www.interscience.wiley.com).

Anal skin tags in inflammatory bowel disease: New observations and a clinical review

The association between intestinal Crohn's disease (CD) and specific perianal abnormalities called anal skin tags (AST) has been recognized but not well defined. Skin tags have been classified into 2 types: 1) raised, broad, or narrow, single or multiple, soft or firm, and painless, often referred to as "elephant ears"; or 2) edematous, hard, often cyanotic, tender or not, and typically arising from a healed anal fissure, ulcer, or hemorrhoid. The aims of this study were to i) better characterize those skin tags identified by the term "elephant ears" and differentiate them from other types of AST; ii) compare their prevalence in patients with CD and ulcerative colitis (UC); iii) observe the relationship of the skin tags to the location of the primary bowel disease; and iv) to discuss the value of these typical AST in making an early diagnosis of CD. Photographs of all AST were taken when present at lower endoscopy in 170 consecutive patients with inflammatory bowel disease (IBD) seen in the private office of the senior investigator and Lenox Hill Hospital. Data was gathered with respect to major differences between the 2 types of AST. The location of the primary bowel disease for these patients was obtained from an extensive IBD computer database and review of details from charts. Specific features of AST were described and served to favor type 1 versus type 2. AST were found more frequently in patients with CD (75.4%) as compared to patients with UC (24.6%), confirming previous observations that they are more diagnostic of CD (P = 0.005). Subset analysis revealed a trend with a greater incidence of AST in patients with colitis (46.9%) as compared to patients with ileitis (36.7%) and ileocolitis (16.3%) (P = 0.067). We provide photographs with the most characteristic features of AST and attempt to separate elephant ears (type 1) from less typical AST (type 2) in CD. Our study confirms previous reports that AST are more commonly found in association with CD as compared with UC and more so in the presence of disease limited to the colon as compared to disease elsewhere in the bowel. Our observations support the diagnostic significance of AST heralding the diagnosis of CD when they are discovered on physical exam, especially in young people with diarrhea, abdominal pain, and/or growth retardation.

Franz John A. Torek

Franz John A. Torek (1861 to 1938) is one of the pioneering surgeons in thoracic surgery. The son of German immigrants, he worked in the German (now Lenox Hill) Hospital in New York City. In 1913 he performed the first thoracic esophagectomy for cancer, and the patient survived for 12 years. We describe the surgical work and private life of Torek and recall the details of the groundbreaking operation.

573: The impact of single vs multiple abnormal genetic screening tests in the detection of trisomy 21

THE DETECTION OF TRISOMY 21 ERAN BORNSTEIN, EREZ LENCHNER, ALAN DONNENFELD, YONI BARNHARD, DAVID SEUBERT, TOMER SINGER, MICHAEL DIVON, New York University, Maternal Fetal Medicine, New York, New York, New York University Statistics and Mapping laboratory, New York, Genzyme Genetics, Pennsylvania, Lenox Hill Hospital, Obstetrics & Gynecology, New York, New York OBJECTIVE: To determine the Odds Ratios of an abnormal first trimester screen (Ab1st), abnormal second trimester screen (Ab2nd) and abnormal genetic ultrasound (AbGU), either alone or in combination, in the detection of trisomy 21 (T21). STUDY DESIGN: A retrospective review of a Genzyme Genetics amniocentesis and CVS database (2006 to 2007) was performed. Specimens obtained following the detection of an Ab1st, Ab2nd and/or AbGU comprised the study group. Women who underwent amniocentesis solely for maternal anxiety or advanced maternal age served as controls. The prevalence of T21 in study cases and controls was compared with the use of Pearson Chi-Square testing. RESULTS: 98,338 specimens were analyzed. Odds ratio (O.R.) for the detection of T21 are presented in the table. CONCLUSION: Based on a very large amniocentesis and CVS database, our results indicate that Ab1ST is the single best predictor of T21. Furthermore, the presence of multiple abnormal screening tests significantly increases the risk of T21.

Scrotal Reconstruction Using Rapid Intraoperative Tissue Expansion: A Preliminary Report

Extensive scrotal skin loss can pose a difficult management problem. In most cases delayed scrotal approximation is feasible due to the redundancy of scrotal skin. However, large defects usually require reconstruction using flaps or grafts. We present a novel technique of scrotal closure using rapid intraoperative tissue expansion to manage select extensive partial scrotal defects. Between January 1996 and April 2006, 3 patients underwent delayed closure using rapid intraoperative tissue expansion for approximately 75% scrotal skin loss. Intraoperatively the residual lateral scrotal and medial thigh skin, and subcutaneous tissues were dissected, creating bilateral cavities for the placement of round 300 cc tissue expanders. Gradual inflation for a total of 20 minutes allowed adequate tissue expansion of the 2 thigh flaps, enabling tension-free scrotal closure. Each patient was followed for 12 months. The resulting reconstruction provided a tension-free, cosmetically appealing scrotum with complete testicular coverage. There were no perioperative or postoperative complications. Although rapid intraoperative tissue expansion has been successfully used for the closure of facial and extremity defects, to our knowledge it has not been described for genital skin loss. Our experience suggests that this relatively simple method is a viable addition to the reconstructive armamentarium in a select group of patients with extensive scrotal skin defects that are not amenable to scrotal approximation alone.

Maternal consequences of delivery for prolonged pregnancy

MICHAEL DIVON, ASAF FERBER, PETRA OTTERBLAT OLAUSSON, MAGNUS WESTGREN, Lenox Hill Hospital, NewYork, NewYork, Huddinge University Hospital, Obstetrics and Gynecology, Stockholm, Sweden OBJECTIVE: Current definitions of prolonged pregnancy (PP) are based solely on perinatal mortality. To date, no consideration has been given to maternal consequences related to these definitions. We set forth to calculate maternal mortality rates associated with elective delivery as they relate to the definition of PP. STUDY DESIGN: The National Swedish Database was used to derive fetal and maternal mortality rates. Assuming that the fetus benefits from being delivered when the pregnancy becomes ‘‘prolonged’’, maternal deaths (MDs) were calculated using two delivery options: all remaining pregnancies would be delivered by either elective CS or induction of labor. Two definitions for PP were tested: 41 and 42 wks. RESULTS: 656,134 pregnancies formed the study population. If all undelivered pregnancies would be delivered at 41 or at 42 wks, 250 and 78 fetuses would be saved from dying, respectively, p!0.001. As gestational age advances, a significant decrease in MDs/1000 saved fetuses (SF) was noticed, p!0.05 (see table). Elective CS was associated with significantly more MDs than induction of labor for both 41 and 42 wks, p!0.01. CONCLUSION: This is the first study to indicate that an inverse relationship exists between fetal and maternal deaths as GA at delivery advances beyond term. Such a conflict of interest between fetus and mother presents a great challenge to obstetricians and their patients as well as to our profession in general.

The HBV and HCV Pandemics: Health, Political, and Security Challenges

Political Science QuarterlyVolume 120, Issue 2 p. 243-251 The HBV and HCV Pandemics: Health, Political, and Security Challenges ALBERT B. KNAPP, ALBERT B. KNAPP ALBERT B. KNAPP is an associate clinical professor of Medicine (Gastroenterology & Hepatology) at the New York University Medical School as well as an attending physician at both the Lenox Hill Hospital and the NYU Hospitals Center. He is the author of over 15 peer-reviewed research publications as well as a textbook on Gastroenterology and Hepatology.Search for more papers by this author ALBERT B. KNAPP, ALBERT B. KNAPP ALBERT B. KNAPP is an associate clinical professor of Medicine (Gastroenterology & Hepatology) at the New York University Medical School as well as an attending physician at both the Lenox Hill Hospital and the NYU Hospitals Center. He is the author of over 15 peer-reviewed research publications as well as a textbook on Gastroenterology and Hepatology.Search for more papers by this author First published: 15 February 2013 https://doi.org/10.1002/j.1538-165X.2005.tb00546.xCitations: 1 AboutPDF ToolsExport 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 Volume120, Issue2Summer 2005Pages 243-251 RelatedInformation

Emergency conversion to cardiopulmonary bypass during attempted off-pump revascularization results in increased morbidity and mortality

We sought to evaluate outcomes and predictors of emergency conversion to cardiopulmonary bypass during attempted off-pump coronary bypass surgery. From January 1999 through July 2002, 1678 consecutive isolated coronary artery bypass operations were performed at Lenox Hill Hospital, with the intention to treat all patients with off-pump coronary bypass surgery. Fifty (2.97%) patients required urgent conversion to cardiopulmonary bypass. All the preoperative, intraoperative, and postoperative variables were collected and analyzed in accordance with the New York State Cardiac Surgery Reporting System. Multivariate regression analysis was performed to determine predictors for conversion. In-hospital mortality and major morbidity were significantly lower in the nonconverted group compared with the converted patients (mortality: 1.47% [n = 24] vs 12% [n = 6], P = .001; stroke: 1.1% [n = 18] vs 6% [n = 3], P = .02; renal failure: 1.23% [n = 20] vs 6% [n = 3], P = .02; deep sternal wound infection: 1.54% [n = 25] vs 8% [n = 4], P = .009; respiratory failure: 3.75% [n = 61] vs 28% [n = 14], P < .0001; nonconverted vs converted patients, respectively). The annual incidence of conversion decreased during the study period. There was a significant reduction in the incidence of conversion after routine use of a cardiac positioning device to performing lateral and inferior wall grafts (4.2% [n = 27] vs 2.3% [n = 23], P = .04). None of the preoperative variables were independent predictors of conversion on multivariate regression analysis. Because emergency conversion to cardiopulmonary bypass during attempted off-pump coronary bypass surgery results in significantly higher morbidity and mortality, studies comparing off-pump coronary bypass surgery with conventional coronary artery surgery should include converted patients in the off-pump group. In our experience, emergency conversion is an unpredictable event. The incidence of conversion decreases with increasing experience of surgeons in performing off-pump coronary surgery and use of a cardiac positioning device.

Unknown primary.

Journal of Surgical OncologyVolume 87, Issue 4 p. 191-203 Review Article Unknown primary† Mitchell I. Chorost MD, Mitchell I. Chorost MD Department of Surgery, Lenox Hill Hospital, New York and State University of New York, Downstate Medical Center Brooklyn, New YorkSearch for more papers by this authorM. Catherine Lee MD, M. Catherine Lee MD Department of Surgery, Lenox Hill Hospital, New York and State University of New York, Downstate Medical Center Brooklyn, New YorkSearch for more papers by this authorCindy B. Yeoh MD, Cindy B. Yeoh MD Department of Surgery, Lenox Hill Hospital, New York and State University of New York, Downstate Medical Center Brooklyn, New YorkSearch for more papers by this authorManuel Molina MD, Manuel Molina MD Department of Surgery, Lenox Hill Hospital, New York and State University of New York, Downstate Medical Center Brooklyn, New YorkSearch for more papers by this authorBimal C. Ghosh MD, FACS, Corresponding Author Bimal C. Ghosh MD, FACS [email protected] Department of Surgery, Lenox Hill Hospital, New York and State University of New York, Downstate Medical Center Brooklyn, New YorkProfessor and Vice Chairman of Surgery, Downstate Medical Center and Surgeon-in-Chief, Department of Surgery, New York Healthcare System Brooklyn Campus 800 Poly Place Brooklyn, New York 11209.Search for more papers by this author Mitchell I. Chorost MD, Mitchell I. Chorost MD Department of Surgery, Lenox Hill Hospital, New York and State University of New York, Downstate Medical Center Brooklyn, New YorkSearch for more papers by this authorM. Catherine Lee MD, M. Catherine Lee MD Department of Surgery, Lenox Hill Hospital, New York and State University of New York, Downstate Medical Center Brooklyn, New YorkSearch for more papers by this authorCindy B. Yeoh MD, Cindy B. Yeoh MD Department of Surgery, Lenox Hill Hospital, New York and State University of New York, Downstate Medical Center Brooklyn, New YorkSearch for more papers by this authorManuel Molina MD, Manuel Molina MD Department of Surgery, Lenox Hill Hospital, New York and State University of New York, Downstate Medical Center Brooklyn, New YorkSearch for more papers by this authorBimal C. Ghosh MD, FACS, Corresponding Author Bimal C. Ghosh MD, FACS [email protected] Department of Surgery, Lenox Hill Hospital, New York and State University of New York, Downstate Medical Center Brooklyn, New YorkProfessor and Vice Chairman of Surgery, Downstate Medical Center and Surgeon-in-Chief, Department of Surgery, New York Healthcare System Brooklyn Campus 800 Poly Place Brooklyn, New York 11209.Search for more papers by this author First published: 23 August 2004 https://doi.org/10.1002/jso.20099Citations: 31 † The opinion expressed herein are those of the authors and do not necessarily reflect the views of the New York Healthcare System, Brooklyn Campus. AboutPDF 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 Citing Literature Volume87, Issue415 September 2004Pages 191-203 RelatedInformation

Sternal wound reconstruction: 252 consecutive cases. The Lenox Hill experience.

The authors report on a personal experience of 252 consecutive secondary sternal wound closures resulting from a series of 11,601 median sternotomies at a single institution performed over a 14-year period. Protocols for treatment are described from the time of initial consultation with the plastic surgeon through the period of postoperative care. The patients and wounds were diverse and complex, with each factor requiring careful analysis before a treatment course was selected. Complete and thorough wound débridement with the elimination of dead space ensured by the placement of healthy tissue and the maintenance of active suction at the operative site were the common elements of success.

Melvin David Yahr, MD (1917-2004).

Dr. Melvin David Yahr died of lung cancer on January 1, 2004 and left the world of neurology without one of its giants. Dr. Yahr was a world-renowned expert in Parkinson disease (PD) and Chairman Emeritus of the Department of Neurology at the Mount Sinai School of Medicine in New York City. He had served as President of the American Neurologic Association and American Board of Psychiatry and Neurology, was Chairman of the Board of Trustees of the Association for Research in Nervous and Mental Disease, and was Founder and Chairman of the World Federation of Neurology Research Committee on Extrapyramidal Disorders. ⇓ Melvin David Yahr Dr. Yahr was born in New York City and attended New York University for undergraduate and medical studies. He interned and studied neuropsychiatry at the Lenox Hill Hospital between 1943 and 1945 and completed a residency in neurology under the direction of H. Houston Merritt at the Montefiore Hospital in 1948. After a year as a National Research Council Fellow, Dr. Yahr joined the faculty of the College of Physicians and Surgeons at Columbia University, where he rose to become the first H. …

Is sodium restriction important to hypertension? The argument for.

Is sodium restriction important to hypertension? The argument for.