Roosevelt Hospital Research Articles

Effect of proactive MFM care on the incidence of stillbirth

ODED LANGER, ANDREJZ LYSIKIEWICZ, BARAK ROSENN, NICOLE GELLER, St. Luke’s Roosevelt Hospital Center, Obstetrics & Gynecology, New York, New York, St. Luke’s Roosevelt Hospital Center, Obstetrics and Gynecology, New York, New York, St. Luke’s Roosevelt Hospital Center, Obstetrics & MFM, New York, New York, St. Luke’s-Roosevelt Hospital Center, Obstetrics and Gynecology, New York, New York OBJECTIVE: To determine the rate of potentially avoidable stillbirths. STUDY DESIGN: All consecutive stillbirths were identified over a 5yr period (2000-2005) from a computerized database at an inner city, Obstetric and Gynecology Department. All cases were evaluated by the Quality Assurance Committee and independent assessment by two Maternal-Fetal Medicine Specialists. Stillbirths were stratified into 3 groups: 1) Nonavoidable: when all evaluators when all evaluators agreed that the cause of stillbirth could not be modified; 2) Avoidable: All evaluators identified risk factors that could be modified thereby changing the outcome; 3) Undetermined: There was not a general consensus of cause. RESULTS: The overall stillbirth rate was 4.2/1000 (112/26,385). Of the 112 stillbirths, 17.4% were deemed avoidable, 54% unavoidable and 28% cause undetermined. Overall, 48% of the stillbirths were clinic and 52% were private patients. The rate of avoidable stillbirths, was 22% in the clinic population and 17% in the private population (P=.56). Of the avoidable stillbirths, 69% were due to patient factor (i.e. noncompliance with fetal testing, inadequate prenatal care), 25% were physician error (i.e. delayed delivery, misdiagnosis), and 6% were both the patient and the physicians fault. Maternal-Fetal Specialists were involved in 47% of the avoidable, 31% of the unavoidable and 24% of the undetermined groups of stillbirths (P=NS). Stratified by risk factors, the rate of avoidable cases in each diagnosis group was: Postdates 6%, Fetal Growth Restriction 13%, Maternal Chorioamnionitis 7%, Decreased Fetal Movement 50%, Pregestational Diabetes 13%, GDM 13%, Preeclampsia 28% (all ‘‘mild’’ cases), Chronic Hypertension 13%. CONCLUSION: The stillbirth rate has been reduced significantly due to advances in obstetrics. However, it appears from our data that there is still room for improvement by early identification of at-risk patients, more intensive patient evaluation and patient education.

Glycemic control and birth percentile: Targeted thresholds that minimize shoulder dystocia in diabetes in pregnancy

MINIMIZE SHOULDER DYSTOCIA IN DIABETES IN PREGNANCY ODED LANGER, BARAK ROSENN, LOIS BRUSTMAN, St. Luke’s Roosevelt Hospital Center, Obstetrics and Gynecology, New York, New York, St. Luke’s Roosevelt Hospital Center, Obstetrics & MFM, New York, New York, St. Luke’s Roosevelt Hospital Center, Obstetrics & Gynecology, New York, New York OBJECTIVE: If the factors contributing to shoulder dystocia could be modified, it could result in decreased rate and prevention. We sought to investigate the relationship between levels of glycemia, birth percentiles and the occurrence of shoulder dystocia. STUDY DESIGN: Diabetic subjects using memory-based self monitoring blood glucose were treated with diet or insulin. The rate of SHD in each mean blood glucose and birth percentile categories was calculated. Mean blood glucose categories: low-90, 91-100, 101-110, 111-high mg/dl; birth percentiles: low-49, 50-69, 70-89, 90-high. Variables identified in the univariant analysis as being significant or borderline significant were included in multiple variable logistic regression analysis. RESULTS: The overall incidence of SD was 6.7% in the GDM group (82/1215) and PGDM 6.0% (35/545). For GDM subjects: (1.) a continuous increase in the rate of SHD for the first 3 categories of mean blood glucose (1.9, 4.7, 7.8 percent, p=0.05) and similar rate between the third and fourth glucose categories (7.8 vs. 8.7%) (2.) SHD in the low-49 birth percentile was 0.5%; 50-69, 70-89 and 90-high categories was 1.3, 3.9 and 14%, respectively, p=0.0000). In PGDM: (1.) a 4-fold higher rate of SHD was found above the first 2 glucose categories (3.0 vs. 12%). (2.) No SHD in the low-49 birth percentile; in the 50-69, 1.7% and in the 70-89, 8.7%, and in the 90-high, 18.2%, p=0.0000). For GDM and PGDM, logistic regression with adjustment for confounding effects found mean blood glucose, parity, birth percentile and instrumental delivery significant contributors to SHD. Obesity, previous GDM, previous macrosomia, weight at delivery and ethnicity were noncontributing variables. CONCLUSION: When mean blood glucose levels are targeted to !90mg/dl and the estimated birth percentile O70 is included in determining method of delivery, it may be possible to decrease the rate of SHD in diabetic patients.

Metabolic consequences of body size and body composition in hemodialysis patients

Small body mass index is associated with increased mortality in chronic hemodialysis patients. The reasons for this observation are unclear but may be related to body composition. This study aimed to investigate the body composition in chronic hemodialysis patients. The difference between body mass and the sum of muscle, bone, subcutaneous, and visceral adipose tissue masses, measured by whole body magnetic resonance imaging, was defined as the high metabolic rate compartment representing the visceral mass. Protein catabolic rate was calculated from urea kinetics. Forty chronic hemodialysis patients (mean age 54.7 years; 87.5% African Americans; 45% females) were studied. High metabolic rate compartment expressed in percent of body weight was inversely related to body weight (r=-0.475; P=0.002) and body mass index (r=-0.530; P<0.001). In a multiple linear regression model, protein catabolic rate was significantly correlated only with high metabolic rate compartment (r=0.616; P<0.001). Assuming that protein catabolic rate in addition to protein intake reflects urea and uremic toxin generation, it follows that high metabolic rate compartment is the major compartment involved in their generation. Consequently, uremic toxin production rate may be relatively higher in patients with low body weight and low body mass index as compared to their heavier counterparts. The poorer survival observed in smaller dialysis patients may be related to these relative differences.

Effects of Growth Hormone on Visceral Adipose Tissue and Dyslipidemia in HIV, an Erratum

Effects of Growth Hormone on Visceral Adipose Tissue and Dyslipidemia in HIV, an Erratum

Amlodipine Better Than Lisinopril?

The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) compared in >30 000 high-risk hypertensive patients the effects on coronary heart disease of 3 treatment strategies: (1) based on the diuretic chlorthalidone, (2) the calcium-channel blocker (CCB) amlodipine, and (3) the angiotensin converting-enzyme (ACE) inhibitor lisinopril, respectively.1 Sponsored by the National Heart, Lung, and Blood Institute, ALLHAT stands out because no differences occurred in the incidence of the primary end point that consisted of the combination of fatal coronary heart disease and acute myocardial infarction.1 Not surprisingly, the attention of the ALLHAT consortium shifted to secondary end points, such as stroke, or to loosely defined2 components of secondary end points, such as heart failure. At the end of the line, the ALLHAT investigators based their main conclusions on events that, at the initiation of the trial, they regarded as “soft data that will at best confirm or supplement the primary endpoint.”3 More importantly, what was not identical in the 3 treatment groups was the on-treatment blood pressure despite vigorous attempts to titrate and combine the study medications to achieve a blood pressure of <140 mm Hg systolic and 90 mm Hg diastolic.1 These salient features of ALLHAT should be kept in mind whenever one attempts to interpret the findings of this landmark trial. In this issue of Hypertension , Leenen et al4 published a post hoc analysis, in which they made a direct comparison of cardiovascular and other outcomes among the 18 102 ALLHAT participants randomly assigned to amlodipine or lisinopril. In line with previous reports,1 the incidence of the primary coronary end point and total and cardiovascular mortality were similar in both groups. However, the patients randomly assigned to lisinopril experienced higher risks of stroke, combined cardiovascular disease, gastrointestinal bleeding, …

The Mayo Clinic World War II Short Course and Its Effect on Anesthesiology

The Mayo Clinic World War II Short Course and Its Effect on Anesthesiology

`Harm Reduction' Controversial in Alcohol Treatment

Back to table of contents Previous article Next article Professional NewsFull Access`Harm Reduction' Controversial in Alcohol TreatmentJim RosackJim RosackSearch for more papers by this authorPublished Online:20 Jan 2006https://doi.org/10.1176/pn.41.2.0006aSeemingly one of the most significant issues facing addiction specialists is the debate between those who favor complete abstinence as a treatment goal and those who favor “harm reduction” as a valid treatment target.During last month's annual meeting of the American Academy of Addiction Psychiatry (AAAP), several sessions explored the apparent disconnect between traditional addiction treatment trials and clinicians' real-world experience with their patients. Clinical trials for addiction treatments have commonly used dichotomous outcome measures such as “drinking alcohol” versus “not drinking alcohol.” Few patients in these trials were able to achieve complete abstinence, and the medications being studied were deemed not very effective.Yet in the “real world” many addiction specialists clinically use a more continuous outcome measure: they simply aim to help patients reduce the amount they drink on any given day and/or reduce the number of days a month when the patient does drink. If the traditional clinical trials had used more continuous outcomes measures, the available medications would have looked significantly better, some researchers say.“Requiring complete abstinence isn't realistic,” said Richard Rosenthal, M.D., who chaired a symposium at the AAAP meeting on emerging concepts in the pharmacotherapy of alcoholism. Rosenthal is a professor of psychiatry at Columbia University and St. Luke's Roosevelt Hospital Center in New York City and former president of AAAP.“Using a continuous model of treatment outcomes opens up new potential targets for therapy,” Rosenthal explained. “You can target reducing heavy drinking days, for example, or you could target reducing alcohol intake—from heavy down to moderate. Might these outcomes, which result in a reduction in harm, have clinical value?”Recently, Rosenthal detailed, clinical trials have been published using outcomes such as the reduction of heavy drinking compared with traditional abstinence measures. These trials, he added, may impact treatment planning and patient selection. In addition, he said, recent data using the continuous model “suggest potential targets for pharmacological intervention beyond categorical alcohol dependence.”In the future, Rosenthal said, “as new medications for alcoholism become available and new research opens broader opportunities to document positive treatment effects, clinicians may need to adjust their therapeutic approach and consideration of what is a successful intervention.”“The big question, though,” added Henry Kranzler, M.D., a professor of psychiatry at the University of Connecticut School of Medicine,“ is how do you differentiate folks who need total abstinence versus those who could be appropriate for a goal of reduced number of heavy drinking days?”Clinically that is a difficult question, Kranzler said, but a look at the three currently approved medications for the treatment of alcohol abuse may help clinicians decide on which drug treatment to use to promote which treatment goal.Disulfiram (Antabuse) is approved “for the prevention of any alcohol intake,” Kranzler explained. “When taken in combination with alcohol, the drug reacts violently and makes the patient very ill.”In clinical trials disulfiram has been effective at cutting in half the number of heavy drinking days when the 250 mg dose was compared with placebo, said Kranzler. Yet disulfiram was not statistically significantly better than placebo at promoting complete abstinence.Acamprosate (Campral), also approved for the maintenance of abstinence from alcohol, has been effective in clinical trials at promoting abstinence. After one year of treatment, clinical trial data suggest abstinence is doubled in those taking acamprosate compared with those taking placebo. The effect, Kranzler added, appears to persist for as long as one year after acamprosate treatment was stopped. In addition, for those taking acamprosate who did not achieve complete abstinence, there was a noted significant effect on harm reduction through reduced alcohol intake.The third approved medication for alcohol abuse and dependence is naltrexone (ReVia). In 14 clinical trials with more than 2,000 patients, Kranzler said, the drug has been shown to have a “clear effect on reducing risk of relapse in those patients who are abstinent when they start naltrexone. However, naltrexone has a negligible effect on increasing abstinence.”The FDA recently issued an approvable letter for a monthly injectable formulation of naltrexone (Vivitrol) (see MedCheck on Original article: page 30). Researchers hope the once-a-month injection may help increase compliance in patients with alcohol dependence who do not regularly take their daily medication.“Clearly, all of the approved medications reduce drinking,” Kranzler concluded, but the data on increasing abstinence are not clear.“ We need to develop and determine predictors for the reduced harm versus abstinence treatment pathways.” ▪ ISSUES NewArchived

Charles Heber McBurney (1845 - 1913)

Charles Heber McBurney (1845 - 1913)

J. William Littler, MD, 1915–2005

J. William Littler, MD, one of the founders of the specialty of hand surgery, former director of the hand surgery service of the St. Luke’s-Roosevelt Hospital Center, and mentor to several generations of American and international hand surgeons, died on February 27, 2005, in Providence, Rhode Island. He had sustained a head injury in a fall in late October 2004. He was 89 years old and he lived a major part of his life in New York City. Dr. Littler was a legend in the field of hand surgery—a true renaissance man who aptly applied a rich background in the classics, mathematics, and engineering with the keen eye of an accomplished artist, to teaching and innovation in upper-extremity surgery. He edited several classic textbooks in hand reconstruction and published over 70 original articles, many of which defined the basic principles in hand surgery: sensory neurovascular island transfers, reconstruction for the absent thumb, and tendon transfers for nerve-damaged arms and hands. His contributions to hand surgery are so fundamental and so fully assimilated into the basic principles of structure and function of the hand, that little thought is given to who originally described them. Dr. Littler was born in Manlius in upstate New York, October 7, 1915, the son of James H. and Adelaide Littler. At age 8 he attended weekend art classes at Syracuse University College of Fine Arts and at 16 he built and flew his own glider. He attended Duke University Medical School, graduating with honors in 1942. His internship was at Johns Hopkins Hospital, where he was awarded the William Halstead Fellowship; however, his formal training was interrupted by World War II. He joined the U.S. Army and was eventually stationed at Cushing Army Hospital outside Boston. He was assigned to the orthopedic service, which was subsequently designated as one of several centers for the late care and reconstruction of upper-extremity injuries. At war’s end he volunteered to complete many complex hand reconstruction procedures on Valley Forge Army Hospital patients. While there, he developed many of the reconstruction principles and techniques that are still in use today. After the war Dr. Littler, although a recognized authority on upper-extremity reconstruction, completed a plastic surgery residency under Jerome Webster, MD, at Columbia University. In 1952 he set up practice at Roosevelt Hospital in New York City and founded a hand surgery fellowship program that continues to this day. Many of the more than 100 graduates have presided over national hand, orthopedic, and plastic societies and have chaired academic departments in these specialties throughout the United States and abroad. The Professor, as he was affectionately known by his students, had a remarkable ability to make rapid, clear sketches as he spoke, making his subject clear and easily remembered. The hallmark of his numerous prestigious national and international lectureships were his remarkable illustrations. His drawings appear in all major hand, plastic, and orthopedic texts and are regarded as classics in hand reconstruction. His sketches have also graced the napkins and tablecloths of many restaurants here and abroad. Dr. Littler was one of the last surviving founding members of the American Society for Surgery of the Hand. He was also a founding member of the Group d’Etude de la Main (GEM) and Sociedad de Cirugia de la Mano del Caribe. Dr. Littler was also a member of the American College of Surgeons, the American Association of Plastic Surgeons, the British Society for Surgery of the Hand, and the Societe International de Chirurgie Orthopedique et de Traumatologie. He was Emeritus Professor of Surgery (Plastic) at Columbia College of Physicians and Surgeons in New York City. Dr. Littler is survived by his daughter, Anne, of Paradise Valley, Nevada; a brother, Ted, in Providence, Rhode Island; his long-time secretary, Joyce Jones Wells; and the Members of the Littler-Eaton Society. At his request there are to be no memorial funds or services in his name.

From Feeling Blue to Clinical Depression: Exploring the Pathogenicity of Depressive Symptoms and Their Management in Cardiac Practice

From the Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Malcom Randall VA Medical Center, Gainesville, Florida D.S.S.); and the Division of Cardiology, St. Luke's–Roosevelt Hospital Center, and the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY (A.R.). Address correspondence and reprint requests to David S. Sheps, MD, MSPH, Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Malcom Randall VA Medical Center, Gainesville, FL 32610-0277. E-mail: [email protected] Accepted for publication March 18, 2005. In accordance with CME accreditation guidelines, author David S. Sheps disclosed that he has served on the speakers' bureau for Pfizer. Alan Rozanski disclosed no real or potential conflicts of interest.

Cell transplantation after hepatic preconditioning using radiation corrects liver disease in the LEC rat model of Wilson's disease: H Malhi, I Volenberg, Ml Schilsky, S Gupta, Liver Research Center, Albert Einstein College of Medicine, Bronx, NY, The National Center for the Study of Wilson's Disease, Inc, St Luke's/Roosevelt Hospital, and Division of Liver Diseases and Transplant Institute, Mount Sinai School

Cell transplantation after hepatic preconditioning using radiation corrects liver disease in the LEC rat model of Wilson's disease: H Malhi, I Volenberg, Ml Schilsky, S Gupta, Liver Research Center, Albert Einstein College of Medicine, Bronx, NY, The National Center for the Study of Wilson's Disease, Inc, St Luke's/Roosevelt Hospital, and Division of Liver Diseases and Transplant Institute, Mount Sinai School

Association among TNF-alpha polymorphisms, insulin resistance and liver disease in morbidly obese subjects: Pierre M Gholam, St Luke's-Roosevelt Hospital Center, Columbia P&S, New York, NY; Safak R Reka, SUNY Health Sciences Center at Brooklyn, New York, NY; Douglas A Charney, Louis J Flancbaum, Donald P Kotler, St Luke's-Roosevelt Hospital Center, Columbia P&S, New York, NY

Association among TNF-alpha polymorphisms, insulin resistance and liver disease in morbidly obese subjects: Pierre M Gholam, St Luke's-Roosevelt Hospital Center, Columbia P&S, New York, NY; Safak R Reka, SUNY Health Sciences Center at Brooklyn, New York, NY; Douglas A Charney, Louis J Flancbaum, Donald P Kotler, St Luke's-Roosevelt Hospital Center, Columbia P&S, New York, NY

The effects of a non-selective and cyclooxygenase II selective inhibitor on prostacyclin and thromboxane production by placental arteries

THE FIRST TRIMESTER YARIV YOGEV, ODED LANGER, AVI BEN HAROUSH, ORLI MOST, RONY CHEN, MOSHE HOD, St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University, Obstetrics and Gynecology, NY, New York, Rabin Medical Center, Perinatal Division, Department of Obstetrics and Gynecology, Petach-Tikva, Israel, Israel OBJECTIVE: In diabetic women, hyperglycemia during the first trimester is associated with an increased rate of congenital malformations and spontaneous abortion. However, there is a lack of data concerning the ambulatory normal glycemic profile in non-diabetic subjects. Therefore, we investigated the glucose characteristics defining normoglycemia during the first trimester. STUDY DESIGN:Daily glycemic profile was evaluated during the first trimester in 42 non-diabetic non obese gravid patients using Continuous Glucose Monitoring System-CGMS. CGMS measures glucose levels every 5 minutes for 72 consecutive hours for a total of 288 measurements daily. All women were asked to refrain from any lifestyle modification or dietary restriction during the study period. RESULTS: (1) Overall, averages of 774 G 41glucose measurements were recorded for each woman. (2) Average gestational age was 8.1 G 2.4 weeks and mean BMI was 24.1 G 1.4 kg/m. (3) For the total 126 days (42 women ! 3 days) of continuous glucose monitoring glycemic characterization revealed a daily mean glucose level of 79.3 G 7 mg/dL, mean fasting glucose of 74.5 G 11 mg/dL, and a mean preprandial glucose level of 77.6 G 9 mg/dL. (4) Further analysis was performed in relation to meals. The 1-h postprandial glucose peak value was 108.7 G 16.9 mg/dL and the time interval required to reach this peak value was 65.4 G 28 minutes. (5) During study period, no hypoglycemic events (glucose !40 mg/dL) were identified. CONCLUSION: Our data provides a definition of normoglycemia in early pregnancy in non-obese, non-diabetic women. This in turn may be used as a measure in the first trimester to evaluate the degree of deviation from this standard that may be associated with adverse outcome in a diabetic pregnancy. 474 THE EFFECTS OF A NON-SELECTIVE AND CYCLOOXYGENASE II SELECTIVE INHIBITOR ON PROSTACYCLIN AND THROMBOXANE PRODUCTION BY PLACENTAL ARTERIES DAMIAN PAONESSA, ANDREA SHIELDS, JAMES WRIGHT, BOBBY HOWARD, PETER NAPOLITANO, Madigan Army Medical Center, tacoma, Washington, MAMC, Clinical Investigation, tacoma, Washington OBJECTIVE: To determine if there is a difference in the production of thromboxane and prostacyclin by placental arteries treated with a non-selective cyclooxygenase or a cyclooxygenase II selective inhibitor. STUDY DESIGN: Four arteries were obtained from each of 8 placentas collected from normal parturients. Specimens were incubated in Dulbecco’s modified eagle media containing one of the following: (1) ibuprofen, (2) celecoxib, (3) indomethacin at therapeutic serum concentrations, or (4) Dulbecco’s for control. Culture media samples were obtained at 2, 4, 6, 12, 24 and 48 hours. Serial samples were then assayed for thromboxane and prostacyclin by immunoassay of their stable metabolites. Statistical analysis was performed using analysis of variance, all values are reported as mean concentration (ng/mg tissue) G SD. RESULTS: Compared to controls, thromboxane production was decreased at 4 hours in the indomethacin arm (0.25 G 0.09 vs. 0.57 G 0.30) P ! .05, at 6 hours in the ibuprofen arm (0.27 G 0.19 vs. 0.63 G 0.35) P ! .05 and at 48 hours in the celecoxib arm (0.70 G 0.34 vs. 1.033 G 0.47) P ! .05. Compared to the celecoxib arm, thromboxane production was significantly lower in both the indomethacin (0.29 G 0.086 vs. 0.70 G 0.34) P ! .01 and ibuprofen arm (0.26 G 0.14 vs. 0.70 G 0.34) P ! .01 at 48 hours. Prostacyclin production was significantly decreased at 24 hours in the indomethacin (0.48 G 0.30 vs. control 1.89 G 1.28) P ! .05 and ibuprofen arm (0.51 G 0.47 vs. control 1.89 G 1.28) P ! .05 compared to controls. There was no difference in prostacyclin production in the celecoxib arm compared to controls. CONCLUSION: Exposure to indomethacin and ibuprofen rapidly and dramatically inhibits the production of thromboxane by placental arteries within 6 hours. Exposure to celecoxib decreases thromboxane production of placental arteries after 24 hours, but the effect is less than indomethacin and ibuprofen at 48 hours.

FDA OKs Nonprescription Defibrillators

over 14-week period, with 2 weeks of baseline, 8 weeks of medication, and 4 weeks of follow-up. Of more than two dozen medications assessed so far, Gorelick said, the most promising include disulfiram, currently used to treat alcohol abuse, and modafinil, a nonstimulant approved for the treatment of sleepiness associated with narcolepsy, shift work sleep disorder, and obstructive sleep apnea. A phase 3 trial of disulfiram for cocaine dependence is now in progress. In addition, a recent phase 1 trial found that a “cocaine vaccine” was well tolerated and produced detectable levels of anticocaine antibodies for up to 9 months after immunization (Drugs. 2004;64: 1547-1573). PSYCHIATRIC COMORBIDITY One quarter of the US population will meet criteria for lifetime substance use disorder, said Richard N. Rosenthal, MD, professor of clinical psychiatry, Columbia University, and chair of psychiatry, St Luke’s-Roosevelt Hospital Center, New York, NY. Comorbidity is the rule, he said, not the exception. Cocaine abusers’ risk for non–substancerelated mental disorders is 11 times that of the general population (JAMA. 1990; 264:2511-2518). Cocaine abusers also are 13 times more likely than the general population to have schizophrenia. Among individuals with schizophrenia, psychostimulant abuse is two to five times higher than in the general public. Such use probably has a self-medication aspect, Rosenthal said. Stimulants may provide some relief from negative symptoms, such as anhedonia and hypochondriasis. Cocaine use also decreases dysphoria and increases sociability. On the other hand, he cautioned, stimulants may induce psychosis; some users go on to have a psychotic disorder indistinguishable from schizophrenia. For patients with psychotic illnesses, Rosenthal said, a new approach to treatment is a “sufficient services” model rather than a comprehensive approach that such patients often find overwhelming. Its core is a supportive group focused on motivational enhancement, psychoeducation, and relapse prevention. Sobriety is a goal of treatment but not a requirement.

HCA efficiency

Diabetes, Obesity and MetabolismVolume 6, Issue 6 p. 458-459 HCA efficiency S. B. Heymsfield, Corresponding Author S. B. Heymsfield Obesity Research Center, St. Luke's-Roosevelt Hospital, Columbia University, New York, NY, USA *Steven B. Heymsfield MD, Professor of Medicine, Obesity Research Center, St. Luke's-Roosevelt Hospital, Columbia University, New York, NY, USA E-mail:[email protected] or [email protected]Search for more papers by this authorL. J. Aronne, L. J. Aronne Clinical Professor of Medicine, Weill-Cornell University, Medical College, New York Presbyterian Hospital, New York, NY, USASearch for more papers by this authorG. L. Blackburn, G. L. Blackburn Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USASearch for more papers by this author S. B. Heymsfield, Corresponding Author S. B. Heymsfield Obesity Research Center, St. Luke's-Roosevelt Hospital, Columbia University, New York, NY, USA *Steven B. Heymsfield MD, Professor of Medicine, Obesity Research Center, St. Luke's-Roosevelt Hospital, Columbia University, New York, NY, USA E-mail:[email protected] or [email protected]Search for more papers by this authorL. J. Aronne, L. J. Aronne Clinical Professor of Medicine, Weill-Cornell University, Medical College, New York Presbyterian Hospital, New York, NY, USASearch for more papers by this authorG. L. Blackburn, G. L. Blackburn Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USASearch for more papers by this author First published: 08 October 2004 https://doi.org/10.1111/j.1462-8902.2004.00423.xCitations: 1Read 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.Citing Literature Volume6, Issue6November 2004Pages 458-459 RelatedInformation

Human papillomavirus infections in children.

The human papillomavirus is a ubiquitous 55-nm DNA virus that causes a variety of clinical disease states in children, commonly referred to as warts. The natural history of warts is spontaneous regression through the development of a complex blend of cell-mediated and humoral immunity. Although spontaneous immunity can develop, as many as one third of children will have persistent human papillomavirus infection beyond 2 years. Therapeutic modalities are manifold, primarily because no therapy is universally effective. The purpose of this review is to update the reader with the latest information on the human papillomavirus and its therapeutics in children. Recently, encouraging research has been conducted in human papillomavirus, including destructive and immunologic therapies. Vaccines tailored to genital human papillomavirus strains are just coming into clinical use. Manipulation of the immune system through medications or vaccination will likely help contain human papillomavirus in the future and prevent secondary human papillomavirus oncogenesis of the skin and cervix.

In the footsteps of Abraham Jacobi, an early international medical graduate: contributions of a single South African medical school to US pediatrics.

Abraham Jacobi is generally recognized as the father of pediatrics in the United States. He was born in Germany and graduated from the University of Bonn in 1851 at a time of political turmoil. He was jailed for 2 years for high treason as a result of his activities as a member of a democratic revolutionary group. He was advised to leave the country to escape additional prosecution. After a brief, unsuccessful attempt to set up a practice in England, he made his way to the United States in 1853 during a period when immigrants from Europe were being welcomed with open arms. He established a practice in the Bowery in New York City, which, at the time, housed a quarter of a million German immigrants and hundreds of thousands of others seeking opportunities in the land of the free. His practice grew by leaps and bounds, and he began translating abstracts of articles from Germany dealing with diseases of children as well as publishing in US journals. In 1859, he co-authored the textbook Midwifery and Diseases of Women and Children. His 1860 appointment as Professor in Infantile Pathology and Therapeutics at New York Medical College was one of the first, if not the first, such academic appointment in pediatrics in the United States. In recognition of his clinical skills, his dynamic bedside teaching, and his contributions to the scientific literature, he was offered and accepted a professorial appointment at Columbia in 1870. However, he had to wait 18 years before he was granted faculty voting privileges. Jacobi’s Therapeutics of Infancy and Children was first published in 1895. He remained at Columbia until his death in 1919, having served as president of both the American Pediatric Society (APS) and the American Medical Association.1–3 As the first international … Reprint requests to (G.S.G.) Emeritus Staff Office, Plummer 10, Mayo Clinic, Rochester, MN 55905. E-mail: gilchrist-gerald{at}msn.com

Commentary on “The Hand that Rocks the Cradle Rocks the Boat: The Empowerment of Women” by Ann Ruth Turkel

Commentary on “The Hand that Rocks the Cradle Rocks the Boat: The Empowerment of Women” by Ann Ruth TurkelSharon SagemanSharon Sageman1. Columbia University College of Physicians and Surgeons, New York, NY; Assistant Professor of Psychiatry, New York University Medical School; Assistant Professor of Psychiatry, St. Luke's-Roosevelt Hospital Center; Medical Director, Women's Health Project.Search for more papers by this authorPublished Online:March 2011https://doi.org/10.1521/jaap.32.1.55.28322PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutReferencesEmerson , R. W.(2002), “What lies behind us . . .” http://[email protected] Google ScholarHass , N. (2002), Hey Dads, Thanks for the love and support (and the credit card), The New York Times, June 16, 2002. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 32Issue 1Mar 2004 Information© The American Academy of Psychoanalysis and Dynamic PsychiatryPDF download

Genetic architecture of ingestive behavior in humans

Myles S. Faith, PhD, and Kathleen L. Keller, PhDFrom the Weight and Eating Disorders Program, University of Pennsylvania School ofMedicine, Philadelphia, Pennsylvania, USA; and the NY Obesity Research Center,St. Luke’s–Roosevelt Hospital, Columbia University College of Physicians & Surgeons,New York, New York, USAINTRODUCTION

Loveless on wasp venom allergy and immunity- part 1

Loveless on wasp venom allergy and immunity- part 1