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New Hyde Park, NY, United States

Kory P.,Beth Israel Deaconess Medical Center | Guevarra K.,Beth Israel Deaconess Medical Center | Guevarra K.,Newark Beth Israel Medical Center | Mathew J.P.,Beth Israel Deaconess Medical Center | And 3 more authors.
Anesthesia and Analgesia | Year: 2013

BACKGROUND: The video laryngoscope (VL) has been shown to improve laryngoscopic views and first-attempt success rates in elective operating room and simulated tracheal intubations compared with the direct laryngoscope (DL). However, there are limited data on the effectiveness of the VL compared with the DL in urgent endotracheal intubations (UEIs) in the critically ill. We assessed the effectiveness of using a VL as the primary intubating device during UEI in critically ill patients when performed by less experienced operators. METHODS: We compared success rates of UEIs performed by Pulmonary and Critical Care Medicine (PCCM) fellows in the medical intensive care unit and medical or surgical wards. A cohort of PCCM fellows using GlideScope VL as the primary intubating device was compared with a historical cohort of PCCM fellows using a traditional Macintosh or Miller blade DL. The primary measured outcome was first-attempt intubation success rate. Secondary outcomes included total number of attempts required for successful tracheal intubation, rate of esophageal intubation, need for supervising attending intervention, duration of intubation sequence, and incidence of hypoxemia and hypotension. RESULTS: There were 138 UEIs, with 78 using a VL and 50 using a DL as the primary intubating device. The rate of first-attempt success was superior with the VL as compared with the DL (91% vs 68%, P < 0.01). The rate of intubations requiring ≥3 attempts (4% vs 20%, P < 0.01), unintended esophageal intubations (0% vs 14%, P < 0.01), and the average number of attempts required for successful tracheal intubation (1.2 ± 0.56 vs 1.7 ± 1.1, P < 0.01) all improved significantly with use of the VL compared with the DL. CONCLUSIONS: UEI using a VL as the primary device improved intubation success and decreased complications compared with a DL when PCCM fellows were the primary operators. These data suggest that the VL should be used as the primary device when urgent intubations are performed by less experienced operators. Copyright © 2013 International Anesthesia Research Society. Source

Gelman J.,University of California at Irvine | Liss M.A.,University of California at Irvine | Cinman N.M.,North Shore Long Island Jewish Medical Center
Journal of Endourology | Year: 2011

Urethral strictures are often initially managed with dilation using sequential metal sounds or filiform and follower dilators. While these techniques often successfully achieve at least a temporary increase to the caliber of the area of stricture, they are performed without visual guidance, and complications can include false passage and urethral perforation. We describe the first use of balloon dilator that allows the safe, controlled, and gentle and dilation of urethral strictures under direct vision. © 2011, Mary Ann Liebert, Inc. Source

Sgaglione N.A.,North Shore Long Island Jewish Medical Center
Instructional course lectures | Year: 2010

The current approaches to treating articular cartilage defects in the knee comprise a spectrum from pharmacologic therapies to total knee arthroplasty. Nonsurgical treatment can include anti-inflammatory medications, bracing, and physical therapy. Surgical treatments include reconstructive repair of a small or large defect using microfracture, osteochondral autograft transplantation, autologous chrondrocyte transplantation, or osteochondral allograft transplantation; realignment procedures including osteotomies; and unicompartmental arthroplasty. A comprehensive algorithm can be used to determine the appropriate treatment for knee defects. Source

Chowdhury M.,Yeshiva University | Shore-Lesserson L.,North Shore Long Island Jewish Medical Center | Leyvi G.,Yeshiva University
Journal of Cardiothoracic and Vascular Anesthesia | Year: 2014

Objective The goal of this study was to evaluate the ability of Thromboelastograph with Platelet Mapping (TEG-PMTM) to predict postoperative bleeding tendency in patients with a history of recent anti-platelet therapy undergoing coronary artery bypass grafting (CABG). Design A retrospective analysis. Association between predictor variables (MA ADP [maximum amplitude produced by adenosine diphosphate], MA AA [maximum amplitude produced by arachidonic acid], percent of platelets inhibited by clopidogrel, percent of platelets inhibited by aspirin) and the outcomes as elevated chest tube drainage (CTD) and blood transfusion were investigated by logistic regression model. CTD was considered elevated if it was≥600 mL within 12 hours after surgery. Setting A university hospital. Participants Patients on antiplatelet therapy scheduled to undergo CABG that had TEG-PMTM done as a point-of-care test. Interventions None. Results A total of 78 patients had preoperative TEG-PMTM test and on-pump CABG surgeries performed on the same day. Among them, 20 patients (25.6%) had elevated CTD. Decreased MAADP (odds ratio [OR] 0.94), increased percent inhibition of platelets by clopidogrel (OR 1.03), and lower body mass index (BMI) (OR 0.78) were significantly associated with elevated CTD. The same parameters were also associated with platelets transfusion: MAADP (OR 0.94), percent of inhibition of platelets by clopidogrel (OR 1.03) and BMI (OR 0.77). Conclusions TEG-PMTM parameters and BMI are predictive of elevated CTD and platelets transfusion. A 1 mm decrease in MAADP increases the likelihood of elevated CTD and the likelihood of platelets transfusion by 6% whereas 1 unit decrease in BMI is associated with an increased likelihood of elevated CTD and platelets transfusion by 22% and 23% respectively. © 2014 Elsevier Inc. Source

LaPorta T.F.,Long Island Jewish Medical Center | Richter A.,North Shore Long Island Jewish Medical Center | Sgaglione N.A.,Long Island University | Grande D.A.,Feinstein Institute for Medical Research
Orthopedic Clinics of North America | Year: 2012

The repair of articular cartilage defects in patients' knees presents a particular challenge to the orthopedic surgeon because cartilage lacks the ability to repair or regenerate itself. Various cartilage repair techniques have not produced a superior or uniform outcome, which has led to a new generation of cartilage repair based on tissue-engineering strategies and the use of biological scaffolds. Clinical advances have been made regarding the regeneration of articular cartilage, and continue to be made toward the achievement of a suitable treatment method for resurfacing osteochondral defects, through cartilage tissue engineering and the use of pluripotent cells seeded on bio-scaffolds. © 2012 Elsevier Inc. Source

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