Zauber A.G.,Sloan Kettering Cancer Center |
Winawer S.J.,Sloan Kettering Cancer Center |
O'Brien M.J.,Boston University |
Lansdorp-Vogelaar I.,Erasmus Medical Center |
And 8 more authors.
New England Journal of Medicine | Year: 2012
BACKGROUND: In the National Polyp Study (NPS), colorectal cancer was prevented by colonoscopic removal of adenomatous polyps. We evaluated the long-term effect of colonoscopic polypectomy in a study on mortality from colorectal cancer. METHODS: We included in this analysis all patients prospectively referred for initial colonoscopy (between 1980 and 1990) at NPS clinical centers who had polyps (adenomas and nonadenomas). The National Death Index was used to identify deaths and to determine the cause of death; follow-up time was as long as 23 years. Mortality from colorectal cancer among patients with adenomas removed was compared with the expected incidence-based mortality from colorectal cancer in the general population, as estimated from the Surveillance Epidemiology and End Results (SEER) Program, and with the observed mortality from colorectal cancer among patients with nonadenomatous polyps (internal control group). RESULTS: Among 2602 patients who had adenomas removed during participation in the study, after a median of 15.8 years, 1246 patients had died from any cause and 12 had died from colorectal cancer. Given an estimated 25.4 expected deaths from colorectal cancer in the general population, the standardized incidence-based mortality ratio was 0.47 (95% confidence interval [CI], 0.26 to 0.80) with colonoscopic polypectomy, suggesting a 53% reduction in mortality. Mortality from colorectal cancer was similar among patients with adenomas and those with nonadenomatous polyps during the first 10 years after polypectomy (relative risk, 1.2; 95% CI, 0.1 to 10.6). CONCLUSIONS: These findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer. (Funded by the National Cancer Institute and others.) Copyright © 2012 Massachusetts Medical Society. All rights reserved.
Liss Y.,Mt Sinai Medical Center |
Frishman W.H.,New York Medical College
Cardiology in Review | Year: 2012
Vitamin D is a fat-soluble vitamin that is naturally found in very few foods, is added to others, and is available as a dietary supplement. It is produced endogenously when ultraviolet light strikes the skin. Recent epidemiologic and experimental evidence has suggested that low vitamin D levels may play a role in various cardiovascular conditions, including coronary artery disease, congestive heart failure, valvular calcification, stroke, hypertension, and cognitive decline. Low vitamin D may lead to vascular smooth muscle cell proliferation, endothelial cell dysfunction, vascular and myocardial cell calcification, and increased inflammation. However, the data supporting a cardioprotective effect of vitamin D supplementation are very weak, and the large, controlled clinical trials now in progress should resolve this issue. © 2011 by Lippincott Williams & Wilkins.
Hartman J.,Mt Sinai Medical Center |
Frishman W.H.,New York Medical College
Cardiology in Review | Year: 2014
It has recently been appreciated that atherosclerosis is predominantly an inflammatory process. Atherosclerosis begins with a fatty streak, which is made up almost entirely of monocyte-derived macrophages. The development of an atheroma continues as T-cells, mast cells, and other inflammatory cells are recruited to the intima. This collection of inflammatory cells promotes smooth muscle cell replication and extracellular matrix elaboration, thereby increasing the lesion size. Various studies have highlighted that interleukin-6 (IL-6) is an upstream inflammatory cytokine that plays a central role in propagating the downstream inflammatory response responsible for atherosclerosis. IL-6 release is stimulated by acute infections, chronic inflammatory conditions, obesity, and physiologic stress. The high level of IL-6 found in such conditions has a myriad of functions, including hepatic synthesis of acute-phase reactants, activation of endothelial cells, increased coagulation, activation of the hypothalamic-pituitary-adrenal axis, and promotion of lymphocyte proliferation and differentiation. Considering the importance of IL-6 in the development of coronary artery disease, targeting its actions could prove to be beneficial. Individuals with a variant in the IL-6 receptor that impairs classic IL-6 signaling were found to have a decreased risk for coronary heart disease. Tocilizumab is a monoclonal antibody that targets the IL-6 receptor and has been show to alleviate symptoms in patients with rheumatoid arthritis, a disease largely driven by the proinflammatory actions of IL-6. Therefore, further studies are needed to determine the role of tocilizumab and other IL-6 receptor blockers in decreasing the inflammatory response key in the development of atherosclerosis. © 2014 Lippincott Williams & Wilkins.
Suh G.D.,St Johns Riverside Hospital |
Suh G.D.,Mt Sinai Medical Center |
Suh G.D.,Long Island Jewish Medical Center
Otolaryngology - Head and Neck Surgery (United States) | Year: 2013
Objective. To analyze the overall success rate of open midline glossectomy with lingual tonsillectomy in the surgical management of obstructive sleep apnea syndrome (OSAS) as well as a subset analysis to determine whether certain patient factors influence clinical outcome. Study Design. Case series with retrospective data collection. Setting. Private practice with surgeries performed at a single community hospital (St Johns-Riverside Hospital). Subjects and Methods. Fifty consecutive patients who had moderate to severe OSAS with Friedman tongue position III or IV and underwent midline glossectomy with lingual tonsillectomy as part of multilevel sleep apnea surgery and had pre- and postsurgery in-laboratory sleep studies performed. Results. The overall success rate was 56.0% using success defined as a postoperative apnea-hypopnea index (AHI) less than 20 and a decrease of greater than 50%. Median AHI decreased from 52.0 to 18.3 with a median change of -26.1 (interquartile range, -41.6 and -17.1). Of significance on subset analysis, patients with a preoperative AHI >60 had a 68.8% success rate (P = .02), and patients with Friedman tongue position III had a 75.9% success rate (P = .0009). Conclusion. The findings of this case series would suggest that multilevel sleep apnea surgery, incorporating midline glossectomy with lingual tonsillectomy, is a valid alternative for managing moderate to severe OSAS in patients who do not respond or are resistant to continuous positive airway pressure therapy. In patients with a preoperative AHI >60 or Friedman tongue position III, surgical success rate is significantly improved. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2013.
Swaminath A.,Columbia University |
Legnani P.,Mt Sinai Medical Center |
Kornbluth A.,Mt Sinai Medical Center
Inflammatory Bowel Diseases | Year: 2010
Over the last 8 years, capsule endoscopy (CE) has revolutionized the visualization of the small bowel. In 2004 this journal published "Capsule endoscopy in IBD: past, present and future" Kornbluth et al  Inflamm Bowel Dis 10:278-285). In this article we review advances since that time and discuss whether CE has achieved its potential and what remaining goals it can and should hope to achieve. In the 2004 article we listed a series of clinical questions to be answered with regard to the use of capsule endoscopy We review those questions that have been addressed in the intervening 5 years, and also update those topics for which information was available at the time of the initial article. Copyright © 2010 Crohn's & Colitis Foundation of America, Inc.
Neviaser A.S.,Mt Sinai Medical Center
Instructional course lectures | Year: 2012
Arthroscopic instability and rotator cuff repair techniques have rapidly evolved over the past decade with expanding indications; however, there has been a corresponding increase in complications. Careful attention to detail and patient selection will result in satisfactory outcomes for most patients.
Beasley M.B.,Mt Sinai Medical Center
Advances in Anatomic Pathology | Year: 2010
The term "small airway disease" has been used in reference to abnormalities occurring secondary to cigarette smoking in the context of chronic obstructive pulmonary disease (COPD), and the small airways are the major site of obstruction in patients with COPD. The histologic features associated with smoking-related small airway disease are largely nonspecific and overlap with those of other bronchiolitides. The pathogenesis of smoking-related small airway disease is poorly understood; however, insights into the development of airway remodeling and matrix production continue to evolve. The aim of this article will be to review the histologic findings and pathogenesis of smoking-related small airway disease in the context of COPD, and review other small airway disorders affecting cigarette smokers, namely respiratory bronchiolitis and Langerhans cell histiocytosis, and a newly described entity of respiratory bronchiolitis with fibrosis and associated issues with this entity. © 2010 by Lippincott Williams & Wilkins.
Bories C.,Service des Maladies du Sang |
Jagannath S.,Mt Sinai Medical Center
Clinical Lymphoma, Myeloma and Leukemia | Year: 2014
Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) represent the earlier phases of plasma cell dyscrasias. Their definition is based on absence of end-organ damage with presence of a malignant clone that grows in the bone marrow. They share, as a common feature, the risk of progression to a symptomatic disease. MGUS progression risk is approximately 1% per year, and SMM has a risk of progression of 10% for the first 5 years which tapers off over time. The main purpose of identification of these earlier phases of the plasma cell dyscrasia was to identify patients who do not warrant treatment with chemotherapy, in whom the risk of treatment outweighs the benefit. Over the years, the definitions have not been modified to incorporate developments in imaging (magnetic resonance or positron emission and computed tomography), or genomics to identify patients at highest risk of progression within 2 years, where wait and watch might not be an appropriate option. In the absence of such definition, patients who have only a 50% chance of progression within 2 years are being offered therapy, which might also not be an optimal approach. In this review, we provide an overview of the definition, current prognostic factors, and risk stratifications in asymptomatic gammopathies, and discuss clinical trial outcomes in high-risk SMM. © 2014 Elsevier Inc.
Levy L.,Mt Sinai Medical Center |
Zeichner J.A.,Mt Sinai Medical Center
Journal of Diabetes | Year: 2012
With the rising incidence of diabetes mellitus (DM) in the US, it is of paramount importance that practitioners understand the complications of DM and how best to manage them. Diabetes affects every organ system and the skin is no exception. There are numerous cutaneous manifestations of DM that have similar etiologies and result from the same pathologic mechanisms as the internal complications of this disease state. In addition, skin manifestations may precede the diagnosis of diabetes. The present article reviews both the common and less common cutaneous manifestations of DM, including presenting lesions, pathogenesis, and management. © 2011 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.
Zeichner J.A.,Mt Sinai Medical Center
Journal of Drugs in Dermatology | Year: 2013
Acne vulgaris is a common disease of the pilosebacous unit that affects an estimated 40-50 million Americans. Greater than 95% of teenage boys and between 83% and 85% of teenage girls suffer from acne. The condition frequently continues into adulthood. While boys more commonly suffer from acne in the teenage years, greater numbers of women suffer into adulthood. It is unclear if the number of post-adolescent women with acne is rising as compared to the past, or whether women are now seeking out treatment more than in the past. 4 Post-adolescent acne is a significant problem for women. One survey-based United States study found that approximately 50% of women continue to suffer from acne in their twenties, 35% in their thirties, 26% in their forties, and 15% in their fifties. The prevalence of acne was shown to be higher in women than in men in each of these age groups.7 A similar study from Europe showed that beyond the age of 23, acne is more prevalent in women than men. In their forties and fifties, 5% and 8% of women suffered from acne, respectively. Several other studies have provided similar data, showing that larger numbers of adult women suffer from acne as compared to age matched men. Acne is the number one reason that patients visit a dermatologist. While the mean age at which patients are seen for acne is 24 years old, 10% of visits occur in patients in their mid-thirties and forties. Approximately two thirds of dermatology visits for acne are made by women, and one-third of total acne office visits are made by women over 25 years old. Acne patients suffer from a significant psychological burden, which has been compared to that of patients with systemic diseases like diabetes, asthma, arthritis, or epilepsy. Up to 50% of adolescents with acne experience disturbances to their psyche, including issues with body image, anxiety, depression, poor self-esteem, social impairment, and thoughts of suicide. Moreover, acne treatment is expensive. The average total cost of care related to an acne patient's visit to the dermatologist is estimated to be $689.14 Copyright © 2013 Journal of Drugs in Dermatology.