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Patterson, NJ, United States

Rosenberg M.,St Josephs Regional Medical Center | Lamba S.,The New School | Misra S.,Vanderbilt University
Clinics in Geriatric Medicine | Year: 2013

Patients with serious or life-threatening illness are likely to find themselves in an emergency department at some point along their trajectory of illness, and they should expect to receive high-quality palliative care in that setting. Recently, emergency medicine has increasingly taken a central role in the early implementation of palliative care. This article presents an overview of palliative care in the emergency department and describes commonly encountered palliative emergencies, strategies for acute symptom management, communication strategies, and issues related to optimal use of hospice service in the emergency department. © 2013 Elsevier Inc.

Chowdhury D.N.,St Josephs Regional Medical Center | Dhadham C.G.,Seton Hall University | Shah A.,Seton Hall University | Baddoura W.,Seton Hall University
Journal of Global Infectious Diseases | Year: 2014

Strongyloides stercoralis (S. stercoralis) is a soil transmitted intestinal roundworm that has a unique ability to multiply within the human host and reinfect the human carrier by a process of autoinfection. By this property, S. stercoralis can persist as an occult infection for many decades. In situations of immunosuppression or other permissive gastrointestinal conditions, there occurs a massive increase in parasite multiplication. The parasites penetrate through the intestinal mucosa and are carried in circulation and can cause multisystem involvement. We report a case of a 76-year-old Columbian male who presented with intractable vomiting and hyponatremia who was then diagnosed to have syndrome of inappropriate antidiuretic hormone (SIADH). The patient's symptoms improved after treatment with two doses of ivermectin and his serum sodium levels returned to normal. S. stercoralis infection should be suspected in patients from endemic regions who present with gastrointestinal symptoms and unexplained hyponatremia.

Moskowitz R.,St Josephs Regional Medical Center | Rundback J.,The Interventional Institute at Holy Name Medical Center
Annals of vascular surgery | Year: 2014

Rupture of a middle colic artery branch aneurysm is a rare presentation of visceral artery aneurysms. We report a case of a 53-year-old male complaining of acute-onset abdominal pain found to have a massive intraabdominal hematoma secondary to a leaking branch aneurysm of the middle colic artery. The patient underwent laparotomy and ligation of the aneurysm after an attempted endovascular intervention. Following the case report, a review of the literature entailing incidence, presentation, possible etiologies, and potential management strategies is presented. Copyright © 2014 Elsevier Inc. All rights reserved.

Lapalorcia L.M.,Asl 1 of Umbria | Podda S.,St Josephs Regional Medical Center | Campiglio G.,Private Practice | Cordellini M.,Asl 1 of Umbria
Aesthetic Plastic Surgery | Year: 2013

Background: We present a rare case involving severe hypertrophy of the labia majora. This 39-year-old married woman developed a clinically noticeable bilateral lipodystrophy of her labia majora following the administration of chronic antiretroviral therapy. Different combination drug regimens that included drugs like Crixivan®, Epivir®, and Zerit® were administered to the patient from 1998 to 2005. The patient is currently on a single drug regimen of Atripla® with the disease under control and no other comorbidities. The severity of the pubic protuberance created an appearance resembling male genitalia, even when covered by underwear. This anatomical abnormality obviously impaired her social life and forced her to avoid wearing tight pants, swimming garments, and tight clothes in general. She also avoided any sexual activity. Methods: Her pubic hair was shaved. Crural creases and vulvar mucosa were marked in order not to be violated. The estimated amount of skin and fat to be removed was marked. Intraoperative tailor-tacking suturing was used to mark the extent of the resection of the labia majora. Sutures were left in place to verify the accurate tension of the remaining skin. The procedure was performed with the patient under general anesthesia. Labial skin resection was performed by sharp dissection. Electrocautery was then used to excise the lobulated fat accumulation. Two layers of 3/0 Vicryl® sutures were used in the lax subcutaneous tissue. 4/0 Vicryl® rapide was used on the skin to approximate wound edges. Suction drains were left in place for 48 h to reduce the dead space and to manage postoperative bleeding. The patient was instructed to keep ice and compression pads on the area for the first 24 h and to keep the area clean. This was followed by the application of antibiotic ointment two times a day on the wounds to avoid blood crust formation and to keep the skin soft. Results: Stitches were removed on POD 14 after an overall uneventful postoperative course. The sensitivity of the labia majora's interior aspect was preserved, even initially. With the legs slightly open, the labia majora just covered the entrance to the vagina. The clitoris and labia minora became visible again, restoring a normal anatomical appearance. Moderate edema was observed for 4 weeks after surgery. Conclusion: The surgical technique used provided an excellent result according to the patient, who regained her self-confidence and started having a normal sexual life again. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2013 Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.

Su E.P.,Cornell University | Su S.L.,St Josephs Regional Medical Center
Orthopedics | Year: 2011

Hip resurfacing has been performed for over a decade but still raises controversy as an alternative to traditional total hip arthroplasty (THA). Concerns exist about the potential complications of hip resurfacing, including femoral neck fracture and osteonecrosis of the femoral head. Recently, attention has been given to the metal-on-metal bearing of hip resurfacing with regard to production of metal ions, possible tissue necrosis, and rare instances of metal hypersensitivity. Given the success of the goldstandard THA, it is understandable why some surgeons believe metal-on-metal surface replacement to be "a triumph of hope over reason." However, this article opposes that viewpoint, demonstrating that data exist to justify the practice of preserving bone in younger patients. Hip resurfacing can maintain femoral bone without the expense of removing additional acetabular bone by using modern implants with incremental sizing. Furthermore, many of the problems cited with the bearing couple (such as excess metal production) have been due to poor implant designs, which have now been removed from the market. Finally, we now realize that the metal-on-metal articulation is more sensitive to malposition; thus, good surgical technique and experience can solve many of the problems that have been cited in the past. National registry results confirm that in a select population, hip resurfacing performs comparably to THA, while fulfilling the goal of bone preservation.

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