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Stamford, CT, United States

Latchman P.L.,City College of New York | Mathur M.,Stamford Hospital | Bartels M.N.,City College of New York | Axtell R.S.,Southern Connecticut State University | De Meersman R.E.,City College of New York
Clinical Autonomic Research | Year: 2011

Purpose To evaluate baroreflex sensitivity and autonomic control in a cohort of normotensive obese (OB) children. Method A cross-sectional investigation, in which, baroreflex sensitivity and autonomic control were evaluated using transfer function and power spectral density analysis (PSDA) of the electrocardiogram and beat-to-beat blood pressures in normotensive OB children and normal weight normotensive controls. All methods used were noninvasive and data were captured while seated and at rest. Results The OB and control subjects non-obese (NO) were of similar age (OB 9.1 ± 1.9 years vs.NO9.2 ± 1.4 years). The OB group was classified as having a BMI greater than the 95th percentile adjusted for age and gender, and a NO group with a BMI at or less than the 95th percentile (BMI percentile OB. 97.5 ± 1.3 vs. NO 58.5 ± 24.1). Both groups had similar normotensive blood pressures. T tests revealed that baroreflex sensitivity and HFRR were significantly reduced in the OB 9.2 ± 2.7 vs. 15.2 ± 4.7 (ms/mmHg) and 6.7 ± 1.1 vs. 8.2 ± 1.1 ms 2, respectively, while LF SBP and LF/HF ratio were significantly increased in the OB 11.9 ± 5.6 vs. 8.2 ± 4.7 mmHg 2 and 1.2 ± 0.7 vs. 0.54 ± 0.3, respectively. Conclusions Normotensive OB children exhibited significantly reduced baroreflex sensitivity, parasympathetic control as well as increased sympathetic control when compared with healthy, NO controls. Findings in this investigation raise the awareness that autonomic dysfunction is present in young OB normotensive children. © Springer-Verlag 2011. Source

Cho J.-H.,Kyung Hee University | Brodsky M.,Stamford Hospital | Kim E.-J.,Kyung Hee University | Cho Y.-J.,Kyung Hee University | And 3 more authors.
Pain Medicine (United States) | Year: 2012

Objective. The objective of this study was to evaluate the efficacy of a hydrogel patch containing capsaicin 0.1% compared with a placebo hydrogel patch without capsaicin to treat chronic myofascial neck pain. Design. The study was designed as a double-blinded randomized controlled trial. Setting. The study was set at Kyung-hee University Hospital at Gangdong, Korea. Subjects. Sixty-one participants between 18 and 65 years with at least 3 months duration of neck pain and a clinical presentation of myofascial pain syndrome were enrolled in the study from September 1 to November 20, 2010. Interventions. Participants received capsaicin 0.1% hydrogel patches or control hydrogel patches without capsaicin according to the randomization scheme. All participants were instructed to apply one patch to each side of the neck and shoulder girdle overlying the point of maximal pain for 12 hours daily during the duration of the 4-week study. Outcome Measures. Each participant completed five surveys at baseline, at 2 weeks after the start of treatments, and at the conclusion of the 4-week study. The primary outcome measure was visual analog scale (VAS). Other outcome measures included the Neck Disability Index (NDI), Beck's Depression inventory (BDI), Short Form 36 Korean version, and Euroqol 5-D. Results. Fifty-seven patients completed the study. The mean VAS, NDI, and BDI scores were significantly decreased at 2 and 4 weeks after the start of the intervention in both groups. There was no significant difference between the two groups in any of the outcome measures. Conclusions. Future research may help to discern specific effects of capsaicin, trigger point stimulation by application of the patch, and the placebo effect. Wiley Periodicals, Inc. Source

Bhalani V.V.,Stamford Hospital
Connecticut medicine | Year: 2012

Splenosis is the autotransplantation of splenic tissue to abnormal sites, either the abdomen or thorax, following traumatic injury of the spleen. For splenic tissue to reach the thorax, there must be concomitant diaphragmatic injury. Thoracic splenosis is usually discovered incidentally on routine thoracic imaging as single or multiple, indeterminate pleural-based masses limited to the left hemithorax. Traditionally, diagnosis required invasive procedures and/or surgery to acquire tissue samples in order to rule out other causes of lung masses, ie, cancer. We report a case in which nuclear imaging was used to make the diagnosis of thoracic splenosis, thus preventing the need for invasive procedures and avoiding unnecessary patient apprehension. Source

Tejwani R.,Stamford Hospital | Parry M.F.,Columbia University
Infectious Diseases in Clinical Practice | Year: 2011

BACKGROUND: Episodes of central venous catheter-related bacteremia (CVCB) have become common events in patients with long-term indwelling central venous catheters. Because no standardized treatment for CVCB exists, novel approaches have been used to salvage catheters where vascular access is limited. Use of antibiotic solutions to fill catheter lumens has been shown to prevent CVCB and may be useful for the treatment of already-infected catheters. METHODS: We retrospectively examined patient records over a 10-year period at a 300-bed community hospital to evaluate the effectiveness of antibiotic lock therapy (ALT) for catheter salvage in patients experiencing CVCB to determine what criteria might be useful for clinicians deciding between ALT and device removal. RESULTS: Of 458 episodes of CVCB, ALT was attempted in 116 cases (25.3%). Of these, successful salvage was achieved in 86 cases (74.1%), whereas 30 attempts at salvage (25.9%) failed. Average duration of treatment was 13.4 days. Treatment effectiveness varied based on infecting organism, ranging from 78.9% (15/19) for gram-negative bacilli to 42.8% (9/21) for Staphylococcus aureus. The success of antimicrobial lock therapy was independent of patient age or sex, underlying disease, comorbidity, or catheter type. It was most dependent on the infecting organism and the availability of an appropriate antimicrobial agent to treat it. CONCLUSIONS: Antibiotic lock therapy is a useful, although not universally applicable, treatment for CVCB allowing successful catheter salvage in up to 75% of cases without requiring catheter removal and replacement. Copyright © 2011 by National Foundation for Infectious Diseases. Source

Krinsley J.S.,Stamford Hospital
Hospital practice (1995) | Year: 2011

Intensive monitoring of blood glucose concentrations in critically ill patients has become a standard of care in intensive care units over the past 10 years, following the publication of a single-center randomized trial targeting euglycemia in postoperative patients. This article summarizes the literature describing the relationship between hyperglycemia and mortality in the critically ill, the main findings of the major interventional trials of intensive insulin therapy, the association between hypoglycemia and increased glycemic variability with adverse outcomes, and the impact of a preexisting diagnosis of diabetes. A framework for understanding dysglycemia in the critically ill, an approach that recognizes disturbances in the "3 domains" of glycemic control--hyperglycemia, hypoglycemia, and increased glycemic variability--is presented. Finally, practical considerations relating to the implementation of glycemic management protocols are discussed. Source

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