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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. Source

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. Source

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. Source

Hannan E.L.,Albany State University | Cozzens K.,Albany State University | Samadashvili Z.,Albany State University | Walford G.,Johns Hopkins University | And 7 more authors.
Journal of the American College of Cardiology | Year: 2012

Objectives: The purpose of this study was to determine appropriateness of percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery performed in New York for patients without acute coronary syndrome (ACS) or previous CABG surgery. Background: The American College of Cardiology Foundation (ACCF) and 6 other societies recently published joint appropriateness criteria for coronary revascularization. Methods: Data from patients who underwent CABG surgery and PCI without acute coronary syndrome or previous CABG surgery in New York in 2009 and 2010 were used to assess appropriateness and to examine the variation across hospitals in inappropriateness ratings. Results: Of the 8,168 patients undergoing CABG surgery in New York without ACS/prior CABG who could be rated, 90.0% were appropriate for revascularization, 1.1% were inappropriate, and 8.6% were uncertain. Of the 33,970 PCI patients eligible for rating, 28% lacked sufficient information to be rated. Of the patients who could be rated, 36.1% were appropriate, 14.3% were inappropriate, and 49.6% were uncertain. A total of 91% of the patients undergoing PCI who were classified as inappropriate had 1- or 2-vessel disease without proximal left anterior descending artery disease and had no or minimal anti-ischemic medical therapy. Conclusions: For patients without ACS/prior CABG, only 1% of patients undergoing CABG surgery who could be rated were found to be inappropriate for the procedure according to the ACCF appropriateness criteria, but 14% of the PCI patients who could be rated were found to be inappropriate, and 28% lacked enough noninvasive test information to be rated. © 2012 American College of Cardiology Foundation. Source

Verghese J.,Yeshiva University | Mahoney J.,Yeshiva University | Ambrose A.F.,Mt Sinai Medical Center | Wang C.,Yeshiva University | Holtzer R.,Yeshiva University
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2010

Background. Attention and executive functions show strong associations with slow gait and falls in seniors and have been shown to be amenable to cognitive remediation. However, cognitive remediation as a strategy to improve mobility has not been investigated. Methods. Using a randomized single-blind control design, 24 sedentary older adults (exercise less than or equal to once weekly and gait velocity <1 m/s) were randomly assigned to an 8-week computerized cognitive remediation program or wait-list. Primary outcome was change in gait velocity during normal pace and "walking while talking" conditions. We also compared the proportion of improvers (velocity change ≥4 cm/s) in each group. Results. The 10 participants who completed cognitive remediation improved gait velocity from baseline during normal walking (68.2 ± 20.0 vs 76.5 ± 17.9 cm/s, p =. 05) and walking while talking (36.7 ± 13.5 vs 56.7 ± 20.4 cm/s, p =. 002). The 10 intervention participants improved gait velocity over the 8-week intervention both during normal walking (change: 8.2 ± 11.4-1.3 ± 6.8 cm/s, p =. 10) and walking while talking (change: 19.9 ± 14.9-2.5 ± 20.1 cm/s, p =. 05) compared with the 10 control participants. Six intervention participants were improvers on normal pace walking compared with three controls (odds ratio = 3.0, 95% confidence interval = 0.5-19.6). All 10 intervention participants improved on walking while talking compared with 3 controls (odds ratio = 3.5, 95% confidence interval = 1.5-8.0). Conclusions. The findings of this pilot trial are promising and suggest that cognitive remediation may improve mobility in sedentary seniors. This approach should be validated in larger scale trials. © The Author 2010. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. Source

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