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Hodgman M.J.,SUNY Upstate Medical University | Hodgman M.J.,Bassett Medical Center | Garrard A.R.,SUNY Upstate Medical University
Critical Care Clinics | Year: 2012

Acetaminophen poisoning remains one of the more common drugs taken in overdose with potentially fatal consequences. Early recognition and prompt treatment with N-acetylcysteine can prevent hepatic injury. With acute overdose, the Rumack-Matthew nomogram is a useful tool to assess risk and guide management. Equally common to acute overdose is the repeated use of excessive amounts of acetaminophen. Simultaneous ingestion of several different acetaminophen-containing products may result in excessive dosage. These patients also benefit from N-acetylcysteine. Standard courses of N-acetylcysteine may need to be extended in patients with persistently elevated plasma concentrations of acetaminophen or with signs of hepatic injury. © 2012 Elsevier Inc.

Buppajarntham S.,Albert Einstein Medical Center | Junpaparp P.,Albert Einstein Medical Center | Kue-A-Pai P.,Bassett Medical Center
American Journal of Emergency Medicine | Year: 2013

Warburg effect is a rare metabolic complication in hematologic malignancies, commonly presented with lactic acidosis and hypoglycemia. Mechanism explained by abnormality of mitochondrial oxidative phosphorylation in cancer cells and energy production is mostly dependent on anaerobic respiration or glycolysis pathway to meet large tumor demand. We present a case with history of lymphoplasmacytic lymphoma and Waldenstörm macroglobulinemia, partial response to chemotherapy. Lymphoplasmacytic lymphoma transformed to diffuse large B-cell lymphoma, which is aggressive and rapid progression, leading to Warburg effect. Patient developed more than 10-cm retroperitoneal mass less than 1 year, and his symptoms were progressively worsening within 3 weeks. Warburg effect represents poor prognosis no matter with or without hypoglycemia. Treatment of choice is cytoreduction with early chemotherapy. Our patient died 2 days after Warburg effect occurred. © 2013 Elsevier Inc.

Oba Y.,University of Missouri | Lone N.A.,Bassett Medical Center
Therapeutic Advances in Respiratory Disease | Year: 2015

Background: We hypothesized a class effect of currently available long-acting muscarinic antagonists (LAMAs; i.e. tiotropium as a dry powder inhaler or a soft mist inhaler, aclidinium bromide, and glycopyrronium) in preventing chronic obstructive pulmonary disease (COPD) exacerbations. The hypothesis was tested with a network meta-analysis. Methods: Several databases and manufacturer's websites were searched for relevant clinical trials. Randomized, controlled trials, of at least 12 weeks duration, comparing a LAMA with placebo or another LAMA were included. Moderate-to-severe and severe exacerbations were chosen as the outcome assessment criteria. The data were pooled using network metaanalysis. Results: A total of 27 studies with 48,140 subjects were included. All LAMAs reduced moderate-to-severe exacerbations compared with placebo. However, there were no statistically significant differences in preventing moderate-to-severe or severe exacerbations among LABAs. In a subgroup analysis restricting studies to those that had a minimum of 6 months of treatment, glycopyrronium was associated with the least-effective strategy and aclidinium was associated with the greatest probability of being the best therapy in preventing severe exacerbations. Our meta-regression analysis suggested that the prevention of COPD exacerbations were less effective in studies which allowed concomitant use of a long-acting beta agonist (LABA). Conclusion: All LAMAs were equally effective in preventing moderate-to-severe exacerbations. Aclidinium was associated with the lowest risk for severe exacerbations when treatment duration was 6 months or longer. The concomitant use of LABA may not enhance the efficacy of LAMAs in preventing COPD exacerbations. More studies are needed to further examine above findings. © The Author(s), 2015.

Lancey R.A.,Bassett Medical Center
Journal of Cardiac Surgery | Year: 2010

Numerous analyses have identified an inverse relationship between case volume in coronary artery bypass graft (CABG) surgery and mortality, and have led some to call for the consideration of minimum-volume standards for open-heart surgery programs. These findings, however, have been questioned by studies that demonstrate a weak or absent association, and by the availability of risk-adjusted mortality data. There is also growing evidence that clinical care processes have greater impact on mortality than sheer numbers alone. Policy decisions that may address this issue in the future need to consider the impact of mandating referrals away from low-volume programs, including the negative financial and programmatic effect on hospitals and both the clinical and social ramifications for patients and families, particularly in rural regions of the country. © 2010 Wiley Periodicals, Inc.

Calore B.L.,Bassett Medical Center | Cheung R.C.,Stanford University | Giori N.J.,Stanford University
Journal of Arthroplasty | Year: 2012

Many orthopedic surgeons train or are employed at the Department of Veterans Affairs (VA) hospitals. We sought to determine the prevalence of hepatitis C antibody-positive and hepatitis C-viremic patients in the VA population undergoing total joint arthroplasty. In this prospective cohort study, 381 of 408 patients undergoing primary total joint arthroplasty for 22 consecutive months were tested for hepatitis C virus (HCV) infection preoperatively. Thirty-two (8.4%) of 381 patients were positive for hepatitis C virus antibody. Seventeen were actually viremic at the time of total joint arthroplasty (4.5%). The prevalence of detectable hepatitis C antibody in VA patients undergoing total joint arthroplasty is about 6 times the general population (1.3%). Surgeons practicing on populations with a high prevalence of hepatitis C such as this should do all they can to minimize the risk of sharps injury. © 2012.

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