York Hospital-Cornell Medical Center Research Articles

Cachectin: a hormone that triggers acute shock and chronic cachexia.

Septic shock and invasive infection are diseases caused by humoral mediators of both exogenous and endogenous origin. The search for and identification of these factors has led to the discovery and molecular cloning of cachectin. This pyrogenic cytokine is identical to tumor necrosis factor (TNF) and, when released into the circulation, causes profound shock and multiple organ injury. Cachectin antibodies protect against the lethal effects of mice given endotoxin and baboons given E. coli, a result suggesting that this mediator is both necessary and sufficient to provoke septic shock. Cachectin is produced in humans after endotoxin infusion; the infusion of small doses of TNF is associated with fever, rigors, headache, and hypotension. Septicemic patients also produce cachectin, and during meningococcal infection, patients with the highest serum levels of cachectin die. Chronic cachectin production causes a potentially lethal syndrome of cachexia, anemia, and protein and lipid wasting. Future investigation is being directed toward the development of cachectin antibodies for use in treating the humorally mediated systemic complications of infectious disease.

Development and validation of a multivariate predictor of mortality in very low birth weight

Accurate prognosis is critical to the design of all prospective research aimed at improving survival. Predictions based on birth weight, gestational age, or any other single variable, fail to take into account the potentially important contribution of other factors. In order to develop a practical and accurate multivariate model, we studied all singleton pregnancies resulting in viable liveborn infants who weighed ⩽ 1500 g at birth during 1984 and 1985 at the New York Hospital-Cornell Medical Center. When gestational age, birth weight, and/or crown-heel length were considered, no maternal characteristics were significant predictors of mortality. The model with the maximal predictive accuracy (84.5%) used birth weight and 5-minute Apgar score to calculate a probability of mortality. This prognostic model was then validated in a separate cohort of singletons born in 1986. We conclude that clinical trials should require stratification before randomization, using the calculated probability of mortality, rather than birth weight or gestational age alone. Given the ability of models, such as the one presented here, to generate reasonable estimates of mortality, this information might also be used in the clinical setting to assist parents and physicians in individualized decision-making processes for a given infant.

Sex differences in factors affecting the daily variation of blood pressure

The purpose of this study was to examine whether the life experiences described by postural, situational, and emotional changes during the day have similar effects on the blood pressure of men and women. The subjects of the study were 137 men and 67 women from the clinical population of the Hypertension Center at The New York Hospital-Cornell Medical Center. There were 3023 individual pressure measurements available for study, 2072 from the men, and 951 from the women, which were taken using noninvasive ambulatory blood pressure monitoring techniques. Pressures were transformed to z-scores using the subject's daily mean pressure and standard deviation to assess the relative elevation during the various effects. Separate but identical ANOVA models were run for each sex. The results show that there were differences between men and women in the parameters associated with the level of systolic and diastolic pressure. Men's systolic pressure varied by situation of measurement ( P <0.0001) and emotional state ( P <0.0001), while that of women varied by posture ( P <0.0005) and situation of measurement ( P <0.0001). The diastolic pressure of men varied by emotional state as did that of women, except that men's diastolic pressure tended to be highest during reported anger while that of women tended to be highest during reported anxiety. Differences in occupation or environment, hormones, or in behavioral patterns related to the socialization process may all contribute to the differences between the sexes. While there are limitations with regard to the interpretation of the data, the findings are consistent with the concept that both the factors which influence blood pressure variation and the degree of variation associated with these factors are different between the sexes.

A Supportive Approach: Psychodynamically Oriented Supportive Therapy–Treatment of Borderline Patients who Self–Mutilate

A Supportive Approach: Psychodynamically Oriented Supportive Therapy–Treatment of Borderline Patients who Self–MutilateLawrence H. RocklandLawrence H. RocklandAddress reprint requests to the author at The New York Hospital-Cornell Medical Center, 21 Bloomingdale Road. White Plains. NY 10605.Search for more papers by this authorPublished Online:February 2011https://doi.org/10.1521/pedi.1987.1.4.350PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. Supervised case experience in supportive psychotherapy: suggestions for trainersOnline publication date: 2 January 2018. Go to citation Crossref Google Scholar2. The outcome of psychodynamic psychotherapy for psychological disordersOnline publication date: Go to citation Crossref Google ScholarPeter Fonagy, Anthony Roth and Anna Higgitt3. Psychodynamic psychotherapies: Evidence-based practice and clinical wisdomOnline publication date: 5 July 2005. Go to citation Crossref Google Scholar4. Online publication date: Go to citation Crossref Google Scholar5. Adapting Supportive Psychotherapy for Individuals with Borderline Personality Disorder Who Self-Injure or Attempt SuicideOnline publication date: Go to citation Crossref Google Scholar6. Shifting Conversations on Girls' and Women's Self-Injury: An Analysis of the Clinical Literature in Historical ContextOnline publication date: 25 July 2016. Go to citation Crossref Google Scholar7. The Coming of Age of Self-MutilationOnline publication date: Go to citation Crossref Google Scholar8. Patient Self-Mutilation: When Nursing Becomes a NightmareOnline publication date: Go to citation Crossref Google Scholar9. Supportive Psychotherapy the Search for Positive MeaningsOnline publication date: 2 January 2018. Go to citation Crossref Google Scholar10. Psychotherapy in Borderline and Narcissistic Personality DisorderOnline publication date: 2 January 2018. Go to citation Crossref Google Scholar Volume 1Issue 4Dec 1987 Information© 1987 The Guilford PressPDF download

Hirsutism, Polycystic Ovarian Disease, and Ovarian 17-Ketosteroid Reductase Deficiency

Division of Pediatric Endocrinology, Department of Pediatrics, and Department of Obstetrics and Gynecology, New York Hospital-Cornell Medical Center, New York, New York

Neuroscience, AIDS Head Agenda at AMA-NY Hospital-Cornell Conference

DURING THE PAST year, two topics have monopolized much of medicine's fair share of media attention. The United States is now more than 23 000 dead and six years into the acquired immunodeficiency syndrome (AIDS) epidemic. Efforts by scores of researchers are producing a more precise understanding of the disease, and a prodigious medical literature. Much of it was, and is, news. No surprise, then, that AIDS was a major topic of discussion at the American Medical Association's (AMA) Sixth Science Reporters Conference. Six of the eight presentations planned for the first day of the two-day conference held at and cosponsored by New York Hospital-Cornell Medical Center were about AIDS. Neurology and neuroscience were second. Those news stories told of promising drugs for Alzheimer's and Parkinson's diseases, adrenal glandbrain transplants, the possibility of fetal-brain-cell transplants, new theories of memory, and animal studies of spinaltissue regeneration. Fernando Nottebohm, PhD, and Ira

Hepatic-portal infusions of bombesin reduces food intake in rats : D. Greenberg, P.A. Foelsch, P.M. Perez, G.P. Smith, and J. Gibbs. Dept. of Psychiatry, Eating Disorders Institute and Bourne Behavioral Research Laboratory, New York Hospital-Cornell Medical Center, White Plains, NY 10605, USA

Hepatic-portal infusions of bombesin reduces food intake in rats : D. Greenberg, P.A. Foelsch, P.M. Perez, G.P. Smith, and J. Gibbs. Dept. of Psychiatry, Eating Disorders Institute and Bourne Behavioral Research Laboratory, New York Hospital-Cornell Medical Center, White Plains, NY 10605, USA

Submaximal exercise as an adjunct to intravenous refeeding : [formula omitted], K.J. Tracey, D.G. Hesse, J.D. Albert, A. Legaspi, S.F. Lowry, Department of Surgery, New York Hospital-Cornell Medical Center, New York City, USA

Submaximal exercise as an adjunct to intravenous refeeding : [formula omitted], K.J. Tracey, D.G. Hesse, J.D. Albert, A. Legaspi, S.F. Lowry, Department of Surgery, New York Hospital-Cornell Medical Center, New York City, USA

The role of endotoxin and nutritional support on peripheral tissue amino acid metabolism during critical illness : [formula omitted], K.J. Tracey, Y. Fong, J.D. Albert, A. Legaspi, P.S. Barie, S.F. Lowry, Department of Surgery, The New York Hospital-Cornell Medical Center, New York City, USA

The role of endotoxin and nutritional support on peripheral tissue amino acid metabolism during critical illness : [formula omitted], K.J. Tracey, Y. Fong, J.D. Albert, A. Legaspi, P.S. Barie, S.F. Lowry, Department of Surgery, The New York Hospital-Cornell Medical Center, New York City, USA

Effect of daily submaximal exercise on cellular membrane function during intravenous refeeding in normal man : [formula omitted], G.A. Fantini, Y. Fong, J.D. Albert, D.G. Hesse, K.J. Tracey, S.F. Lowry and G.T. Shires. Department of Surgery and Clinical Research Center, New York Hospital-Cornell Medical Center, New York City, U.S.A.

Effect of daily submaximal exercise on cellular membrane function during intravenous refeeding in normal man : [formula omitted], G.A. Fantini, Y. Fong, J.D. Albert, D.G. Hesse, K.J. Tracey, S.F. Lowry and G.T. Shires. Department of Surgery and Clinical Research Center, New York Hospital-Cornell Medical Center, New York City, U.S.A.

Whistleblowing

MARY A. KIELY, MSN, MPA, RN, CCRN, is the nursing care coordinator of the medical ICU at St. Vincent's Medical Center, New York, New York, and DEIRDRE C. KIELY, MSN, MPA, RN, CCRN, is a clinical specialist at New York Hospital-Cornell Medical Center, New York, New York.

Mitral valve prolapse and infective endocarditis

It is now more than 20 years since it was first suggested that mitral valve prolapse (MVP) was associated with an increased risk of infective endocarditis (IE).’ Support for the existence of this association was initially provided by case reports of IE in patients with preexisting MVP,2 series of IE patients in which persons with MVP appeared to be overrepresented,3.6 and small follow-up studies of patients with MVP documenting a relatively high incidence of IIL6eQ More recently, several casecontrol studies have been conducted in an effort to determine more accurately the magnitude of the association between MVP and IE.10-‘2 These studies have provided estimates of the relative risk of IE in persons with MVP in comparison with those without MVP. However, it is also possible to make some estimate of the absolute risk of IE (i.e., the actual probability of IE developing over a specific time intervaI) using the results of these studies together with data about the incidence of IE and prevalence of MVP in the general population. In an effort to produce the best estimates of the relative and absolute risks of IE in patients with MVP, we examine the published results of the relevant studies together with new data from a study conducted at the New York Hospital-Cornell Medical Center. We consider the risks in the total population of persons with MVP and the risks in certain subgroups identified by various characteristics postulated to be associated with a higher than average risk of IE. We consider the implications of our estimates of the risks of IE for decisions about strategies for antibiotic prophylaxis in persons with MVP.

Nonintervention in Premature Rupture of the Amniotic Membranes

Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical Center, New York, New York Surg. Gynecol. Obstet. 163: 5, 1986

Controlled, comparative study of moxalactam and cefazolin for prophylaxis of abdominal hysterectomy : Berkeley AS; Hayworth SD; Hirsch JC; et al. Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical Center, New York, NY 10021, USA

Moxalactam was compared with cefazolin and a control group to determine the efficacy and value of a third generation cephalosporin in abdominal hysterectomy antibiotic prophylaxis. One hundred patients were prospectively randomized in a double-blind manner between moxalactam and cefazolin. An additional 50 patients who were either allergic to penicillin or refused participation in this study were simultaneously observed to establish a base line level of infection on our service during this time period. Dosage for both antibiotic groups was 1 gram given intravenously or intramuscularly on call to the operating room followed by two 1 gram doses at six and 12 hours after the first dose. Standard febrile morbidity was 36, 30 and 42 per cent for moxalactam, cefazolin and control groups, respectively. Postoperative surgical infection requiring antibiotic treatment occurred in 8, 6 and 4 per cent, respectively; urinary tract infection or symptomatic findings, or both, requiring treatment occurred in 8, 10 and 10 per cent, respectively. No pelvic abscesses occurred in this series. In every statistical evaluation of postoperative morbidity, there were no differences noted among the three groups. Our results suggest no benefit from the use of prophylactic antibiotics in abdominal hysterectomy in terms of standard febrile or infectious morbidity or urinary tract pathologic findings. In addition, there was no difference between the two antibiotic groups.

Immersion anesthesia for extracorporeal shock wave lithotripsy: Review of two hundred twenty treatments

Two hundred twenty extracorporeal shockwave lithotripsy (ESWL) treatments at the New York Hospital-Cornell Medical Center between September, 1984, and April, 1985, were reviewed with respect to anesthetic management. One hundred seventy-four treatments (79%) were performed under a regional anesthetic technique (RA), either with an indwelling epidural catheter (155 treatments), or with a single spinal injection (19 treatments). Forty-six treatments (21 %) were performed under general anesthesia (GA). Ninety per cent of the patients were classified as ASA 1 or II. Hypotension during treatment, defined as blood pressure falls greater than 20 per cent of baseline mean arterial pressure, was recorded with 19.5 per cent of the regional anesthetic treatments (18. 7 % of the epidurals and 26.3 % of the spinals) and 13. 0 per cent of the general anesthetic treatments. Blood pressure falls were larger in the regional group than in the general group. The average recovery room stay was longer for the bupivacaine (0.25–0.5 %) epidurals and the tetracaine (0.4 %) spinals (252 min and 212.1 min, respectively) than for the lidocaine (1.5–2.0%) epidurals and the general anesthetics (101.7 min and 102.1 min, respectively). General anesthesia, with controlled ventilation, was advantageous in minimizing renal excursion and stone movement during treatment. Yet, in appropriately selected and sedated patients, regional anesthesia with continuous lidocaine epidural techniques was found to provide acceptable anesthesia for patients undergoing ESWL.

AIDS, Blood Transfusions, and Directed Donations

Prince et al. (Feb. 6 issue) recently expressed concern that human T-cell lymphotropic virus Type III (HTLV-III) could be transmitted by intravenous immune globulin preparations. They suggested that conditions used to make intermediate Cohn-Oncley fractions did not inactivate spiked HTLV-III; however they did not study partitioning of HTLV-III into the various fractions. We recently reported the results of such studies. HTLV-III was spiked into the various Cohn-Oncley fractions and its partitioning between precipitates and supernatants as well as inactivation was studied by viral cultures and quantitative antigen measurements by antigen-capture enzyme-linked immunosorbent assay (ELISA). These studies showed that HTLV-III was partioned and inactivated at multiple steps in the Cohn-Oncley process. At the most efficient step HTLV-III was quantitatively (99.5%) partitioned into precipitate III a fraction discarded during the manufacturer of immune globulin. The cumulative effects of partitioning and inactivation resulted in a potential efficiency of virus removal of 10(15) infectious units per milliliter. This efficiency is many orders of magnitude greater than would be needed to eliminate the small amounts of virus that potentially could be present in plasma pools used for immune globulin manufacture. Thus the conjecture of Prince et al. that lyophilization of immune globulin would preserve HTLV-III infectivity is not relevant. In addition not all intravenous preparations are lyophilized as they implied. Surveillance studies of recipients of intravenous immune globulin suggested by Prince et al. have been under way since the autumn of 1985. The number of patients is limited because most recipients are immunodeficient and would not be expected to acquire antibodies even if they were infected with HTLV-III. Furthermore because immune globulin preparations may contain antibodies to HTLV-III patients receiving immune globulin on a long-term basis are unsuitable for study; antibody detected in serum samples from such patients could have been transferred passively. Despite these limitations 134 recipients (mostly patients with immune thrombocytopenia but a few with renal transplants or Kawasakis disease) of intravenous immune globulin made by various manufacturers (data provided by J. Bussel M.D. The New York Hospital-Cornell Medical Center The Massachusetts Public Health Biologic Laboratories Miles Laboratories Travenol Laboratories The Blood Transfusion Service of The Swiss Red Cross Immuno AG and Kabi Vitrum AB) have been followed for 2 to 24 months by means of ELISA and Western blotting of serum reactive by ELISA. 3 patients had passively transferred antibodies; none produced HTLV-III antibodies. Thus the results of laboratory studies of the fractionation process and surveillance of immune globulin recipients corroborate epidemiologic observations indicating that receipt of immune globulin is not associated with the risk of the development of AIDS. (full text)

Reproducibility of Quantitative Echocardiography: Factors Affecting Variability of Imaging and Doppler Measurements

EchocardiographyVolume 3, Issue 3 p. 219-235 Reproducibility of Quantitative Echocardiography: Factors Affecting Variability of Imaging and Doppler Measurements DONALD C. WALLERSON M.D., DONALD C. WALLERSON M.D. Division of Cardiology, Department of Medicine, The New York Hospital-Cornell Medical Center, New York, New York.Search for more papers by this authorRICHARD B. DEVEREUX M.D., Corresponding Author RICHARD B. DEVEREUX M.D. Division of Cardiology, Department of Medicine, The New York Hospital-Cornell Medical Center, New York, New York.Address for correspondence: Richard B. Devereux, M.D., Division of Cardiology, Box 222, The New York Hospital-Cornell Medical Center, 525 East 68th Street, New York, 10021.Search for more papers by this author DONALD C. WALLERSON M.D., DONALD C. WALLERSON M.D. Division of Cardiology, Department of Medicine, The New York Hospital-Cornell Medical Center, New York, New York.Search for more papers by this authorRICHARD B. DEVEREUX M.D., Corresponding Author RICHARD B. DEVEREUX M.D. Division of Cardiology, Department of Medicine, The New York Hospital-Cornell Medical Center, New York, New York.Address for correspondence: Richard B. Devereux, M.D., Division of Cardiology, Box 222, The New York Hospital-Cornell Medical Center, 525 East 68th Street, New York, 10021.Search for more papers by this author First published: May 1986 https://doi.org/10.1111/j.1540-8175.1986.tb00199.xCitations: 29AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume3, Issue3May 1986Pages 219-235 RelatedInformation

Extracorporeal Shock-Wave Lithotripsy for Upper Urinary Tract Calculi

Four hundred sixty-seven patients with symptomatic upper urinary tract calculi underwent extracorporeal shock-wave lithotripsy (ESWL) at The New York Hospital-Cornell Medical Center during the first year. Ninety-five percent of stones were completely treated with one ESWL session. An analysis of 300 treatments revealed that the overall stone-free rate (success) three months after treatment was 75%. The stone-free rate for patients with renal pelvic calculi less than or equal to 20 mm in diameter was 91%. Individual patient stone-free rates depended on stone size (burden), position, composition, and quality of disintegration. Two percent of treatments failed to disintegrate the targeted stone. Complications were minimal. Seven percent of treatments were followed by a secondary endoscopic procedure to facilitate complete stone passage, and 23% of treatments were preceded by cystoscopy with ureteral stent placement of manipulation of stones. Combined therapy utilizing percutaneous surgery or multiple sequential ESWL treatments is necessary for complex stones, and ureteroscopy or basket extraction remains the treatment of choice for distal ureteral calculi.

Resuscitation: How Do We Decide?

Physicians have to address the question of the measures to be employed in the event that a patient's condition deteriorates after admission to the hospital. To identify the information that physicians use in making such decisions, all 604 patients admitted to the medical service during a one-month period were studied. The patient's age and residents' estimates of the patient's long-term prognosis and ability to function were the three primary factors that correlated with intervention preferences. When illness severity, the reason for admission, comorbidity, and poor function were taken into account, mortality and morbidity rates did not differ between patients for whom full vs not-full intervention was favored. Apart from differential rates of admission to critical care units, there were no important differences in the care, course, or mortality of patients for whom less than full intervention was initially favored. Suggestions that physicians should discuss resuscitation with all or most patients who may die are unrealistic. A more prudent strategy is to discuss the issue with patients whose hospital course is marked by a steady deterioration.A study was undertaken to identify the determinants of physicians' decisions about the treatment status of all patients admitted to the medical service of the New York Hospital-Cornell Medical Center during a one-month period. It was found that the patient's age, prognosis, and functional status were the main factors considered in assigning "full" vs. "not-full" intervention. Within prognostically similar groups, there was no significant difference in mortality rates between "full" and "not-full" intervention patients. Except for admission to intensive care units the level of care was not lower for "not-full" intervention patients. The investigators conclude that, because most severely ill patients survive and patient participation in resuscitation decisions is psychologically stressful, the optimal strategy is to limit initiation of such discussions to those patients whose hospital course is marked by a steady deterioration.

Incisions of the Pregnant Uterus and Delivery of Low-Birth Weight Infants

Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical Center, New York, New York