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Boffa D.J.,Yale University | Kosinski A.S.,Duke University | Paul S.,New York Presbyterian Weill Cornell | Mitchell J.D.,University of Colorado at Denver | Onaitis M.,Duke University
Annals of Thoracic Surgery | Year: 2012

Background: Unsuspected lymph node metastases are found in the surgical specimens of 10% to 25% clinical stage I lung cancers. Video-assisted thoracic surgery (VATS) is a minimally invasive alternative to thoracotomy. Because detection of clinically occult metastases is dependent on the completeness of surgical lymph node dissection, the influence of surgical approach on nodal evaluation is of interest. We determined the frequency of nodal metastases identified in clinically node-negative tumors by thoracotomy ("open") and VATS approaches to approximate the completeness of surgical nodal dissections. Methods: The Society of Thoracic Surgery database was queried for lobectomies and segmentectomies from 2001 to 2010. Results: A total of 11,531 (7,137 open and 4,394 VATS) clinical stage I primary lung cancers were resected. Nodal upstaging was seen in 14.3% (1,024) in the open group and 11.6% (508) in the VATS group (p < 0.001). Upstaging from N0 to N1 was more common in the open group (9.3% versus 6.7%; p < 0.001); however, upstaging from N0 to N2 was similar (5.0% open and 4.9% VATS; p = 0.52). Among 2,745 propensity-matched pairs, N0 to N1 upstaging remained less common with VATS (6.8% versus 9%; p = 0.002). Conclusions: During lobectomy or segmentectomy for clinical N0 lung cancer, mediastinal nodal evaluation by VATS and thoracotomy results in equivalent upstaging. In contrast, lower rates of N1 upstaging in the VATS group may indicate variability in the completeness of the peribronchial and hilar lymph node evaluation. Systematic hilar dissection is encouraged, particularly as more surgeons adopt the VATS approach. © 2012 The Society of Thoracic Surgeons.

PubMed | Beth Israel Deaconess Medical Center, New York Presbyterian Weill Cornell and Columbia University
Type: | Journal: Clinical imaging | Year: 2016

The purpose of this study is to compare diagnostic quality, inter-observer variability and agreement of non-contrast enhanced MRA (NC-MRA) with contrast-enhanced MRA (CE-MRA) in the evaluation of hepatic arterial anatomy. 20 potential liver donors were included in this retrospective study. NC-MRA, CE-MRA and combined data sets were randomized and reviewed by two readers. Reference standard was consensus by two senior radiologists using all data including CTA. There was no difference in IQ or diagnostic confidence between NC-MRA, CE-MRA or combined data for either reader but the arterial origin of segment IV was successfully identified on NC-MRA when CE-MRA was suboptimal.

DeFilippis E.M.,New York Presbyterian Weill Cornell | Arleo E.K.,New York Presbyterian Weill Cornell
Clinical Imaging | Year: 2013

A 63-year old female with right breast cancer underwent lumpectomy, with axillary lymph nodes negative for metastatic carcinoma but demonstrating noncaseating granulomatous lymphadenitis. These histopathologic findings, in conjunction with thoracic lymphadenopathy and diffuse splenic nodules on computed tomography, were consistent with sarcoidosis. This unusually novel case of concomitant diagnosis of breast cancer and sarcoidosis case reminds both the radiologist and pathologist to keep in mind the possibility of alternate or new diagnoses when reading their respective studies. © 2013 Elsevier Inc.

Arleo E.K.,New York Presbyterian Weill Cornell | DeFilippis E.M.,New York Presbyterian Weill Cornell
Clinical Imaging | Year: 2014

The terms "cornual," "interstitial," and "angular" pregnancies are used inconsistently in the literature. Some sources use "interstitial" and "cornual" synonymously, while others reserve "cornual" for gestations in bicornuate or septate uteri; others distinguish interstitial from angular pregnancy, while in practice, many physicians are unfamiliar with the latter designation. This article aims to clarify the terms and review the literature with respect to diagnosis and prognosis, with attention to the potential roles of 3D ultrasound and magnetic resonance imaging. © 2014 Elsevier Inc. All rights reserved.

McArthur H.L.,Sloan Kettering Cancer Center | Mahoney K.M.,New York Presbyterian Weill Cornell | Morris P.G.,Sloan Kettering Cancer Center | Patil S.,Sloan Kettering Cancer Center | And 4 more authors.
Cancer | Year: 2011

BACKGROUND: Several large, randomized trials established the benefits of adjuvant trastuzumab with chemotherapy. However, the benefit for women with small, node-negative HER2-positive (HER2+) disease is unknown, as these patients were largely excluded from these trials. Therefore, a retrospective, single-institution, sequential cohort study of women with small, node-negative, HER2+ breast cancer who did or did not receive adjuvant trastuzumab was conducted. METHODS: Women with ≤2 cm, node-negative, HER2+ (immunohistochemistry 3+ or fluorescence in situ hybridization ≥2) breast cancer were identified through an institutional database. A " cohort of 106 trastuzumab-untreated women diagnosed between January 1, 2002 and May 14, 2004 and a " cohort of 155 trastuzumab-treated women diagnosed between May 16, 2005 and December 31, 2008 were described. Survival and recurrence outcomes were estimated by Kaplan-Meier methods. RESULTS: The cohorts were similar in age, median tumor size, histology, hormone receptor status, hormone therapy, and locoregional therapy. Chemotherapy was administered in 66% and 100% of the "no trastuzumab" and " cohorts, respectively. The median recurrence-free and survival follow-up was: 6.5 years (0.7-8.5) and 6.8 years (0.7-8.5), respectively, for the "no trastuzumab" cohort and 3.0 years (0.5-5.2) and 3.0 years (0.6-5.2), respectively, for the " cohort. The 3-year locoregional invasive recurrence-free, distant recurrence-free, invasive disease-free, and overall survival were 92% versus 98% (P =.0137), 95% versus 100% (P =.0072), 82% versus 97% (P <.0001), and 97% versus 99% (P =.18) for the "no trastuzumab" and " cohorts, respectively. CONCLUSIONS: Women with small, node-negative, HER2+ primary breast cancers likely derive significant benefit from adjuvant trastuzumab with chemotherapy. Copyright © 2011 American Cancer Society.

Schlegel P.N.,New York Presbyterian Weill Cornell
Fertility and Sterility | Year: 2012

Some men with severely defective sperm production commonly have excess aromatase activity, reflected by low serum testosterone and relatively elevated estradiol levels. Aromatase inhibitors can increase endogenous testosterone production and serum testosterone levels. Treatment of infertile males with the aromatase inhibitors testolactone, anastrazole, and letrozole has been associated with increased sperm production and return of sperm to the ejaculate in men with non-obstructive azoospermia. Use of the aromatase inhibitors anastrazole (1 mg/day) and letrozole (2.5 mg/day) represent off-label use of these agents for impaired spermatogenesis in men with excess aromatase activity (abnormal testosterone/estradiol [T/E] ratios). Side effects have rarely been reported. Randomized controlled trials are needed to define the magnitude of benefit of aromatase inhibitor treatment for infertile men. © 2012 by American Society for Reproductive Medicine.

Arleo E.K.,New York Presbyterian Weill Cornell | Reichman M.,New York Presbyterian Weill Cornell | Dashevsky B.Z.,New York Presbyterian Weill Cornell | Babagbemi K.,New York Presbyterian Weill Cornell | Drotman M.,New York Presbyterian Weill Cornell
Breast Disease | Year: 2015

Due to an increasing number of breast cancer diagnoses in younger women anecdotally noted at our institution, we conceived of this study %was to retrospectively review the records of women diagnosed with breast cancer under the age of 40 for potentially alterable versus unalterable risk factors in their history. Between 2007 and 2013, there were 52 patients less than 40 years of age with breast cancer at our institution: 79% (41/52) presented with a clinical abnormality (palpable mass, nipple discharge or inversion) and 21% (11/52) were asymptomatic but diagnosed on early screening mammograms. Seventy-five percent (39/52) of the cancers had an invasive component and 87% (45/52) were intermediate to high grade. Sixty percent (31/52) of subjects had stage 0 or I disease, but 40% (21/52) had later stage disease (stage II or greater). The vast majority of the cancers were ER+ (82%) and PR+ (78%). Fifty-six percent (28/50; 2 unknown) of the subjects had a documented history of hormonal contraception. Fifty-three percent (27/51; 1 unknown) of had no family history of breast cancer whatsoever, and 80% (41/51) had no family history of breast cancer in a first degree relative. Six were positive for BRCA 1, 2, or a variant (6/52 = 12%). © 2015 - IOS Press and the authors. All rights reserved.

Baron K.T.,New York Presbyterian Weill Cornell | Arleo E.K.,New York Presbyterian Weill Cornell | Robinson C.,New York Presbyterian Weill Cornell | Sanelli P.C.,New York Presbyterian Weill Cornell
Emergency Radiology | Year: 2012

The objectives of this study were to document the utilization of MRI compared with CT in pregnant patients presenting with acute nontraumatic abdominal pain at our institution and to compare the diagnostic performance of the two modalities. A retrospective review identified all pregnant patients at our institution who had MRI or CT exams of the abdomen and/or pelvis for acute nontraumatic abdominal pain over a 3-year period from January 2008 through December 2010. The imaging diagnoses were compared with pathologic data or operative findings as the primary reference standard or with clinical follow-up and laboratory data as the secondary reference standard. Patients without surgically proven diagnoses were followed clinically until delivery, when possible. Ninety-four pregnant patients were included in this study: 61 MRI exams were performed in 57 patients, 44 CT exams were performed in 43 patients (including six patients who had both), and 72 patients (77 %) had ultrasound prior to cross-sectional imaging, with the appendix specifically assessed in 25 patients but visualized in only two of them. Of 61 MRI exams, 24 were considered positive for imaging diagnoses, 33 were negative, and 4 were equivocal. Of 44 CT exams, 24 were positive and 20 were negative. The test characteristics for MRI and CT in the diagnosis of acute abdominal pain were as follows: sensitivity 91 and 88 %, specificity 85 and 90 %, positive predictive value 81 and 91 %, negative predictive value 94 and 8 5 %, and diagnostic accuracy 88 and 88 %, respectively. Differences were not statistically significant (p value01). The majority of MRIs (34/61056 %) were read by emergency radiologists. MRI and CT performed equally well in the evaluation of acute nontraumatic abdominal pain during pregnancy. Given its lack of ionizing radiation, MRI may be preferable. Given that the majority of MRIs were read by radiologists specializing in emergency imaging, this is a technique that emergency radiologists should be comfortable interpreting. © Am Soc Emergency Radiol 2012.

Arleo E.K.,New York Presbyterian Weill Cornell | Troiano R.N.,New York Presbyterian Weill Cornell | Da Silva R.,New York Presbyterian Weill Cornell | Greenbaum D.,New York Presbyterian Weill Cornell | Kliman H.J.,Yale University
American Journal of Perinatology | Year: 2014

Objective The objective of this study was to use two-dimensional (2D) ultrasound (US) during routine prenatal surveillance to develop normative estimated placental volume (EPV) growth curves. Study Design Patients ≥ 18 years old with singleton pregnancies were prospectively followed from 11 weeks gestational age (GA) until delivery. At routine US visits, placental width, height, and thickness were measured and EPV calculated using a validated mathematical model. Results In this study, 423 patients were scanned between 9.7 and 39.3 weeks GA to generate a total of 627 EPV calculations. Readings were clustered at 12 and 20 weeks, times of routine scanning. The mean EPV was 73 ± 47 cc at 12.5 ± 1.5 weeks (n = 444) and 276 ± 106 cc at 20 ± 2 weeks (n = 151). The data best fit a parabolic function as follows: EPV = (0.384GA - 0.00366GA2)3. Tenth and 90th percentile lines were generated with ± 1.28 SE offset. EPV readings below the 10th or above the 90th percentiles tended to be associated with either small or large newborns, respectively. Conclusion Routine 2D US created EPV growth curves, which may be useful for stratifying patients into prenatal risk groups. © 2014 by Thieme Medical Publishers, Inc.

PubMed | New York Presbyterian Weill Cornell and Hospital for Special Surgery
Type: Journal Article | Journal: The Physician and sportsmedicine | Year: 2016

Head injuries are relatively common in ice hockey, with the majority represented by concussions, a form of mild traumatic brain injury. More severe head injuries are rare since the implementation of mandatory helmet use in the 1960s. We present a case of a 27 year-old male who sustained a traumatic intraparenchymal hemorrhage with an associated subdural hematoma resulting after being struck by a puck shot at high velocity. The patient presented with expressive aphasia, with no other apparent neurologic deficits. Acutely, he was successfully treated with observation and serial neuroimaging studies ensuring an absence of hematoma expansion. After a stable clinical picture following 24hours of observation, the patient was discharged and managed with outpatient speech therapy with full resolution of symptoms and return to play 3 months later. We will outline the patient presentation and pertinent points in the management of acute head injuries in athletes.

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