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New Hyde Park, NY, United States

Pomeranz H.D.,North Shore Long Island Jewish Health System
Journal of Neuro-Ophthalmology | Year: 2016

Background: A cause and effect relationship between phosphodiesterase-5 inhibitor (PDE5I) use and nonarteritic anterior ischemic optic neuropathy (NAION) has been hypothesized based on case reports. Evidence Acquisition: Review of literature. Results: Thirty-nine case reports in the peer-reviewed medical literature have documented a possible relationship between PDE5I consumption and NAION. However, pertinent details, such as the dose and frequency of PDE5I use, and elapsed time between ingestion and onset of vision loss, are lacking from many of these reports. Investigations regarding alterations in ocular perfusion in research subjects who ingested sildenafil have been inconclusive because they have not been performed on subjects with "disc at risk" or risk factors for NAION. One case-crossover study demonstrated a 2-fold increase in risk of NAION after ingestion of PDE5I. Conclusions: When a diagnosis of NAION is made, an inquiry should be made as to whether any PDE5I was ingested before the onset of vision loss. If so, the patient should be counseled regarding the possibility that continued PDE5I use may increase the risk of NAION in the fellow eye. Patients with a known history of previous NAION should be cautioned regarding the use of PDE5I for erectile dysfunction or pulmonary hypertension because of the potential increased risk of fellow eye involvement. © 2016 by North American Neuro-Ophthalmology Society. Source

Nosseir S.B.,North Shore Long Island Jewish Health System
Obstetrics and Gynecology | Year: 2010

Background: Osteomyelitis associated with using synthetic mesh for laparoscopic sacral colpopexy is rare. Case: We present a patient who developed Staphylococcus sacral osteomyelitis after sacral colpopexy with synthetic mesh and titanium tack fixation to the sacral promontory in the absence of mesh erosion or fistula formation. The patient presented with low back pain 6 weeks postoperatively. Magnetic resonance imaging, bone aspirate, and culture confirmed sacral osteomyelitis and discitis 10 weeks after surgery. The patient underwent 8 weeks of outpatient antibiotic treatment. Six months after surgery, serial laboratory values have demonstrated excellent response to antibiotic treatment, and the patient has clinically improved without the need for mesh removal. Conclusion: We recommend a high index of suspicion for osteomyelitis in patients who present with back pain after sacral colpopexy. Osteomyelitis can occur as a complication of laparoscopic, robotic sacral colpopexy using mesh in the absence of abscess or fistula formation. © 2010 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. Source

Wagner B.,North Shore Long Island Jewish Health System
Journal for healthcare quality : official publication of the National Association for Healthcare Quality | Year: 2012

A comprehensive perinatal safety initiative (PSI) was incrementally introduced from August 2007 to July 2009 at a large tertiary medical center to reduce adverse obstetrical outcomes. The PSI introduced: (1) evidence-based protocols, (2) formalized team training with emphasis on communication, (3) standardization of electronic fetal monitoring with required documentation of competence, (4) a high-risk obstetrical emergency simulation program, and (5) dissemination of an integrated educational program among all healthcare providers. Eleven adverse outcome measures were followed prospectively via modification of the Adverse Outcome Index (MAOI). Additionally, individual components were evaluated. The logistic regression model found that within the first year, the MAOI decreased significantly to 0.8% from 2% (p<.0004) and was maintained throughout the 2-year period. Significant decreases over time for rates of return to the operating room (p<.018) and birth trauma (p<.0022) were also found. Finally, significant improvements were found in staff perceptions of safety (p<.0001), in patient perceptions of whether staff worked together (p<.028), in the management (p<.002), and documentation (p<.0001) of abnormal fetal heart rate tracings, and the documentation of obstetric hemorrhage (p<.019). This study demonstrates that a comprehensive PSI can significantly reduce adverse obstetric outcomes, thereby improving patient safety and enhancing staff and patient experiences. © 2011 National Association for Healthcare Quality. Source

Harden C.L.,North Shore Long Island Jewish Health System
CONTINUUM Lifelong Learning in Neurology | Year: 2014

Purpose of review: This review encompasses issues regarding the management of women with epilepsy and pregnancy, including preconception planning, antiepileptic drug (AED) effects on the exposed offspring, and consequences of seizures during pregnancy, with an emphasis on counseling points and risk management. Recent findings: In utero valproate exposure continues to show the highest risk of congenital malformations and of adverse cognitive outcomes, including autism, compared to other AEDs. In utero topiramate exposure is associated with facial clefts. In utero exposure to lamotrigine, carbamazepine, phenytoin, and levetiracetam has been evaluated in large numbers of offspring, and all of these AEDs have a low risk of major congenital malformations, near 2.5%. The risk of major congenital malformations due to in utero AED exposure is dose associated. Folic acid taken at the time of conception decreases the risk of adverse cognitive outcomes. AED polytherapy may adversely affect fertility, and in utero exposure of AED polytherapy is associated with infants who are small for their gestational age. Seizure freedom before pregnancy is a good predictor of remaining seizure free during pregnancy. Summary: Counseling points are complex for managing women with epilepsy contemplating pregnancy, including evaluation of AED choice and dose. The physician must have knowledge of the issues to enable an honest discussion and appropriate decision making in partnership with the patient. Copyright © 2014 American Academy of Neurology. Source

Zhang I.,North Shore Long Island Jewish Health System | Zaorsky N.G.,Fox Chase Cancer Center | Palmer J.D.,Thomas Jefferson University | Mehra R.,Chase Medical | Lu B.,Thomas Jefferson University
The Lancet Oncology | Year: 2015

The incidence of brain metastases has increased as a result of improved systemic control and advances in imaging. However, development of novel therapeutics with CNS activity has not advanced at the same rate. Research on molecular markers has revealed many potential targets for antineoplastic agents, and a particularly important aberration is translocation in the ALK gene, identified in non-small-cell lung cancer (NSCLC). ALK inhibitors have shown systemic efficacy against ALK-rearranged NSCLC in many clinical trials, but the effectiveness of crizotinib in CNS disease is limited by poor blood-brain barrier penetration and acquired drug resistance. In this Review, we discuss potential pathways to target ALK-rearranged brain metastases, including next generation ALK inhibitors with greater CNS penetration and mechanisms to overcome resistance. Other important mechanisms to control CNS disease include targeting pathways downstream of ALK phosphorylation, increasing the permeability of the blood-brain barrier, modifying the tumour microenvironment, and adding concurrent radiotherapy. © 2015 Elsevier Ltd. Source

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