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Reddy K.,New York University | Lowenstein E.J.,New York University | Lowenstein E.J.,Brookdale University Hospital Medical Center
Journal of the American Academy of Dermatology | Year: 2011

The evaluation of skin findings is critical in identifying many types of injury, whether self- inflicted or accidentally or intentionally inflicted. Specific causes of injury include homicide, abuse, neglect, assault, self-inflicted injury, suicide, torture, poisoning, and bioterrorism. Forensic findings in hair and nails are also discussed. This overview of dermatologic findings in forensic pathology highlights the significance of the cutaneous manifestations of injury. © 2010 by the American Academy of Dermatology, Inc.

Tabrizian P.,Mount Sinai Medical Center | Shrager B.,Morristown Medical Center | Jibara G.,Brookdale University Hospital Medical Center | Yang M.-J.,Mount Sinai Medical Center | And 4 more authors.
Journal of Gastrointestinal Surgery | Year: 2014

Background: Cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) is an effective but morbid procedure in the treatment of peritoneal carcinomatosis. We report our outcomes at a single tertiary institution. Method: A total of 170 consecutive patients underwent CRS-HIPEC for peritoneal carcinomatosis between July 2007 and August 2012. The peritoneal cancer index (1-39) was used for peritoneal carcinomatosis (PC) staging. Mitomycin C (88.8 %) was administered intraperitoneally at 42 °C for 90 mins. Risk factors associated with major morbidities were analyzed. The Kaplan-Meier method was used for survival analyses. Results: The mean age was 55.1 (±11.3) years, and the majority (77.1 %) of patients had complete cytoreduction (CC0-1). Tumor types included colorectal (n = 51, 30.0 %), appendiceal (n = 50, 29.4 %), pseudomyxoma peritonei (n = 16, 9.4 %), and other (n = 53, 31.2 %). Factors associated with major complications were estimated blood loss (>400 ml), length of stay (>1 week), intraoperative blood transfusion, operative time (>6 h), and bowel anastomosis. Intraoperative blood transfusion was the only independent prognostic factor on multivariate analysis (p = 0.031). Median follow-up was 15.7 months (±1.2). The recurrence rates for colorectal and appendiceal carcinoma at 1 and 3 years were 40 %, 53.5 % and 68 %, 79.1 %, respectively. The 1- and 3-year overall survival for colorectal and appendiceal carcinomatosis was 74.0 %, 32.5 % and 89.4 %, 29.3 %, respectively. Intraoperative peritoneal cancer index (PCI) score (>16) and need for blood transfusion were factors independently associated with poor survival (p < 0.05). Conclusion: Our single institution experience of CRS/HIPEC procedures for peritoneal carcinomatosis demonstrates acceptable perioperative outcome and long-term survival. Optimal cytoreduction was achieved in the majority of cases. Intraoperative PCI > 16 was associated with poor survival. This series supports the safety of CRS-HIPEC in selected patients. © 2014 The Society for Surgery of the Alimentary Tract.

Goltser A.,Brookdale University Hospital Medical Center | Soleyman-Zomalan E.,Texas Health Resources | Kresch F.,Maimonides Medical Center | Motov S.,Maimonides Medical Center
American Journal of Emergency Medicine | Year: 2015

A convenience sample of 14 patients received an analgesic dose of ketamine infusion for acute pain in the emergency department (ED). Low-dose ketamine (LDK) was defined as the administration of 0.2 to 0.4 mg/kg of ketamine, and infusion was defined as a drip of ketamine diluted in 50 to 100 mL of normal saline piggyback administered over 10 to 15 minutes. Pain intensity was measured using validated numeric rating scale in 8 of the 14 cases, 5 were documented nonquantitatively, and 1 case was not documented. Fourteen cases in which patients received LDK infusion in the ED were identified. Doses ranged from 10 to 35 mg. Patients received opioids in the ED before LDK infusion in 12 of the 14 cases. Significant improvement in pain was observed in 11 of the 14 cases. None of the patients required rescue analgesia. Two patients reported mild adverse reactions. The administration of analgesic dose of ketamine infusion in the ED may be a safe and effective analgesic modality for ED patients with acute painful conditions who have a history of chronic opioid use or who are refractory to opioid pain medications. More prospective randomized controlled trials are needed before widespread use of LDK infusion for analgesia in the ED can be recommended.

Reddy K.,New York University | Lowenstein E.J.,New York University | Lowenstein E.J.,Brookdale University Hospital Medical Center
Journal of the American Academy of Dermatology | Year: 2011

Examination of the skin and adnexae is a critical part of the forensic examination. Little information on forensic sciences has been published in the dermatologic literature. Correct forensic terminology and documentation of dermatologic findings is of critical importance in forensic investigations. The skin may reveal clues to the identity of an individual and the time and method of death or injury. Normal postmortem changes in the skin are described along with pseudopathology and damage from postmortem animal activity. The forensic classification of types of injuries is introduced in this first of a two-part paper on forensics in dermatology. © 2010 by the American Academy of Dermatology, Inc.

Viswanathan K.,Brookdale University Hospital Medical Center | Swaminathan N.,Brookdale University Hospital Medical Center | Viswanathan R.,New York University | Lakkaraja M.,Brookdale University Hospital Medical Center
Journal of the National Medical Association | Year: 2015

Acknowledgements: The authors would like to thank Dr. Morisky for giving us permission to use the Morisky Medication Adherence Scale Purpose: To explore caregivers' Health Locus of Control's relationship to selfreported adherence to penicillin prophylaxis or hydroxyurea in children with sickle cell disease (SCD). Procedure: A questionnaire-based study was conducted of caregivers of children with SCD who visited a comprehensive sickle cell center in an inner city hospital, who were either on penicillin prophylaxis or hydroxyurea or both. Multidimensional Health Locus of Control Scale (MHLC) and the Morisky Medication Adherence Scale (MMAS-8) questionnaires were used for the study. Results: Caregivers of 43 children (27 on penicillin prophylaxis, 13 on hydroxyurea, and 3 on both) completed the MHLC and the MMAS-8. There was no significant difference in adherence between the penicillin and the hydroxyurea groups. The mean Powerful Others score of caregivers of the hydroxyurea only group (25.5+5.6) was higher than that of the penicillin only group (21.2+6.1, p=0.043). Regression analysis revealed an inverse relationship of Chance Locus of Control to adherence in the entire group (Beta =-0.306, R2=0.093, F[1,40]=4.12, p=0.049). Conclusion: Chance Locus of control may identify caregivers of children with SCD at risk for non-adherence to treatment.

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