Kim A.,Vassar Brothers Medical Center |
Rineer J.,Anderson Cancer Center Orlando |
Choi K.,SUNY Downstate Medical Center |
Rotman M.,SUNY Downstate Medical Center
International Journal of Radiation Oncology Biology Physics | Year: 2011
Purpose: Adjuvant radiation therapy (RT) in early-stage high- to intermediate-risk endometrioid adenocarcinoma is well established and has been shown to improve locoregional control. Its role in the management of early-stage clear cell carcinoma and uterine papillary serous carcinoma (UPSC) remains controversial. Methods and Materials: Using the Surveillance Epidemiology and End Results database, we identified women with American Joint Committee on Cancer Stage Sixth Edition. Stage IA-IIB clear cell carcinoma or UPSC who underwent hysterectomy with or without adjuvant RT between 1988 and 2003. We used Kaplan-Meier and Cox regression analysis to compare overall survival (OS) for all patients. Results: We identified 1,333 women of whom 451 had clear cell carcinoma and 882 had UPSC. Of those patients, 775 underwent surgery alone and 558 received adjuvant RT as well. For Stages I-IIB disease, the median OS with surgery alone was 106 months, vs. 151 months with adjuvant RT (p = 0.006). On subgroup analysis, we saw the benefit from adjuvant RT only in Stage IB-C patients. For Stage IB disease, patients undergoing surgery alone had a median OS of 117 months, vs. median survival not reached with the addition of RT (p = 0.006). For Stage IC disease, surgery alone had a median OS of 35 months vs. 120 months with RT (p = 0.001). Although the apparent benefit of RT diminished when measured via multivariate analysis, the impact of RT on survival did show a trend toward significance (hazard ration 0.808, confidence interval 95% 0.651-1.002, p = 0.052) Conclusion: In FIGO Stage IB-C papillary serous and clear cell uterine carcinoma, adjuvant RT seems to play an important role in improving survival. © 2011 Elsevier Inc.
Mannan R.,Mount Sinai St. Lukes |
Legasto A.,Weill Cornell Imaging at New York Presbyterian |
Connery C.,Vassar Brothers Medical Center
International Journal of Surgery Case Reports | Year: 2015
Introduction Primary malignant melanoma of the esophagus is a rare diagnosis with only a few hundred cases reported in the literature. Due to the aggressive nature of this disease, long-term survivors are exceedingly rare with only a handful of case reports.Presentation of case We report the case of a 38 year old man who presented with chest and back pain. Workup revealed a mediastinal mass and the patient was diagnosed with primary malignant melanoma of the esophagus and treated with radical resection. Despite the poor prognosis associated with primary malignant melanoma of the esophagus, he remains disease free for over 7 years.Discussion Initially primary malignant melanoma of the esophagus was a controversial diagnosis until the demonstration of normal melanocytes in healthy patients. It is an aggressive disease that is nearly uniformly fatal. Review of the literature shows that treatment with radical surgical resection extends prognosis by months while treatment with adjuvant chemotherapy is controversial.Conclusion Primary malignant melanoma of the esophagus is a rare and aggressive disease that should be treated with surgical resection when feasible. We report the rare case of a long term survivor over 7 years since diagnosis. © 2014 The Authors. Published by Elsevier Ltd.
PubMed | Hospital Universitari Of Bellvitge Idibell, Hospitales Universitarios Virgen Macarena y Virgen del Rocio, Autonomous University of Barcelona, Hospital Universitari ValldHebron and 10 more.
Type: Journal Article | Journal: The Journal of antimicrobial chemotherapy | Year: 2016
Our objective was to evaluate the impact of low versus borderline MIC of piperacillin/tazobactam on the clinical outcomes of patients with bacteraemia caused by Enterobacteriaceae who were treated with that antimicrobial.A prospective observational multicentre cohort study was conducted in 13 Spanish university hospitals. Patients >17 years old with bacteraemia due to Enterobacteriaceae who received empirical piperacillin/tazobactam treatment for at least 48 h were included. Outcome variables were clinical response at day 21, clinical response at end of treatment with piperacillin/tazobactam and all-cause 30 day mortality. Univariate and multivariate logistic regression analyses were performed.Overall, 275 patients were included in the analysis; 248 (90.2%) in the low MIC group ( 4 mg/L) and 27 (9.8%) in the borderline MIC group (8-16 mg/L). The biliary tract was the most common source of infection (48.4%) and Escherichia coli was the most frequent pathogen (63.3%). Crude 30 day mortality rates were 10.5% and 11.1% for the low MIC group and the borderline MIC group, respectively (relative risk = 1.06, 95% CI = 0.34-3.27, P = 1). Multivariate analysis of failure at day 21 and at end of treatment with piperacillin/tazobactam and 30 day mortality showed no trend towards increased clinical failure or mortality with borderline MICs (OR = 0.96, 95% CI = 0.18-4.88, P = 0.96; OR = 0.47, 95% CI = 0.10-2.26, P = 0.35; OR = 1.48, 95% CI = 0.33-6.68, P = 0.6).We did not find that higher piperacillin/tazobactam MIC within the susceptible or intermediate susceptibility range had a significant influence on the outcome for patients with bacteraemia due to Enterobacteriaceae.
PubMed | EasyStats Ltd., Royal Brisbane and Womens Hospital, Mount Sinai West Hospital, University of Southern California and Vassar Brothers Medical Center
Type: Journal Article | Journal: Antimicrobial agents and chemotherapy | Year: 2016
Bayesian methods for voriconazole therapeutic drug monitoring (TDM) have been reported previously, but there are only sparse reports comparing the accuracy and precision of predictions of published models. Furthermore, the comparative accuracy of linear, mixed linear and nonlinear, or entirely nonlinear models may be of high clinical relevance. In this study, models were coded into individually designed optimum dosing strategies (ID-ODS) with voriconazole concentration data analyzed using inverse Bayesian modeling. The data used were from two independent data sets, patients with proven or suspected invasive fungal infections (n = 57) and hematopoietic stem cell transplant recipients (n = 10). Observed voriconazole concentrations were predicted whereby for each concentration value, the data available to that point were used to predict that value. The mean prediction error (ME) and mean squared prediction error (MSE) and their 95% confidence intervals (95% CI) were calculated to measure absolute bias and precision, while ME and MSE and their 95% CI were used to measure relative bias and precision, respectively. A total of 519 voriconazole concentrations were analyzed using three models. MEs (95% CI) were 0.09 (-0.02, 0.22), 0.23 (0.04, 0.42), and 0.35 (0.16 to 0.54) while the MSEs (95% CI) were 2.1 (1.03, 3.17), 4.98 (0.90, 9.06), and 4.97 (-0.54 to 10.48) for the linear, mixed, and nonlinear models, respectively. In conclusion, while simulations with the linear model were found to be slightly more accurate and similarly precise, the small difference in accuracy is likely negligible from the clinical point of view, making all three approaches appropriate for use in a voriconazole TDM program.
News Article | February 15, 2017
Highland Ophthalmology Associates (http://www.highlandophthalmology.com), a leading eye specialty center in the Hudson Valley of New York, announced today that it is now providing a new FDA-approved procedure, Avedro Corneal Collagen Cross-Linking, to patients who suffer from Keratoconus. Keratoconus, often referred to as “KC”, is an eye condition in which the cornea weakens and thins over time, causing the development of a cone-like bulge and optical irregularity of the cornea. Though a rare condition, keratoconus typically first appears in individuals who are in their late teens or early twenties. It can result in significant visual loss and, in severe cases, may require corneal transplant surgery to help restore vision. As corneal specialists who have been involved in the care of many Keratoconus patients over the years, Dr. Mary Davidian and Dr. Julia Mathew of Highland Ophthalmology Associates are excited to be able to make use of this new technology. For patients, it offers the hope of possibly being able to avoid major corneal transplant surgery and maintain good visual acuity through implementation of this 1 hour, out-patient procedure. The corneal collagen cross-linking procedure stiffens corneas that have been weakened and, in many cases, helps halt progression of the Keratoconus disease process, allowing good vision to be maintained. The procedure involves applying numbing drops to the eye and then gently removing the surface layer of the cornea. Next, Photrexa® Viscous drops are applied to the eye over a 30-minute period. The cornea is then exposed to UV light with the use of the Avedro KXL® System for 30 minutes, while additional Photrexa® Viscous drops are applied. The patient returns home with a bandage contact lens in place to help with discomfort and is monitored by their Highland Ophthalmology eye surgeon over the next few weeks. Currently, the Avedro KXL® System with the Photrexa® Viscous drops is the first and only FDA-approved corneal collagen cross-linking treatment available in the United States. As corneal specialists, the doctors at Highland Ophthalmology are fully certified to offer this latest treatment to Keratoconus patients. For more information about corneal collagen cross-linking and Keratoconus, contact Highland Ophthalmology Associates by calling 845-562-0138 or visit http://www.highlandophthalmology.com. About Highland Ophthalmology Associates, LLC Highland Ophthalmology Associates has been providing specialty eye care services in Orange County, NY and the Greater Hudson Valley area since 1997. As a highly established eye care center, the primary goal of Highland Ophthalmology Associates is to provide patients with personalized eye care, including the latest technology in Cataract, Cornea, Dry Eye and Glaucoma treatment. We have assembled a team of some of the country’s finest ophthalmologists and optometrists, making Hudson Valley a destination for people who want the best in eye health and vision correction. The medical team of experienced, highly respected and devoted specialists is comprised of Dr. Mary Davidian, Dr. Thien (Tim) Huynh, Dr. Julia Mathew, Dr. Michael Stagner and Dr. Sharon Powell. The medical doctors of Highland Ophthalmology Associates are affiliated with leading medical and academic centers in the Hudson Valley and Greater NY Metropolitan Area, including the New York Eye and Ear Infirmary, Westchester Medical Center, Central New York Eye Center and Vassar Brothers Medical Center. For more information please visit http://www.highlandophthalmology.com.
Hurewitz A.N.,Winthrop University |
Khan S.U.,Vassar Brothers Medical Center |
Groth M.L.,Winthrop University |
Patrick P.A.,Winthrop University |
And 2 more authors.
Journal of General Internal Medicine | Year: 2011
BACKGROUND: Aggressive weight-based dosing guidelines help achieve prompt therapeutic anticoagulation in patients with venous thromboembolism (VTE). While obese patients with VTE face an increased risk of recurrence, physicians typically resist prescribing doses two to three times the usual dose because of concern about bleeding complications. OBJECTIVE: To examine the use of unfractionated heparin in obese patients with VTE at an academic teaching hospital in order to document the extent and pattern of underprescribing in this high-risk patient population. DESIGN: Three-year, cross-sectional consecutive case series. PATIENTS: Adult inpatients with VTE and a body mass index ≥30 kg/m 2 who were treated with unfractionated heparin. MEASUREMENTS: Time to achievement of therapeutic anticoagulation (activated partial thromboplastin time >60 s) and gap between recommended and prescribed heparin doses. RESULTS: Time to attainment of therapeutic anticoagulation exceeded 24 h in 29% of study patients (n=84) and exceeded48 h in 14% ofpatients. In 75 patients (89%), the prescribed bolus dose fell below the recommended dose of 80 units/kg, and in 64 patients (76%) the initial continuous infusion fell more than 100 units/h below - in some cases more than 1000 units/h below - the recommended dose of 18 units/kg/h. There was a significant correlation between time to therapeutic anticoagulation and initial infusion dose (Spearman r=-0.27; p<0.02). Each decrease of 1 unit/kg/h translated to a delay ranging from about 0.75 h to 1.5 h over the range of prescribed doses (6 to 22 units/kg/h). CONCLUSIONS: A substantial proportion of obese patients treated with unfractionated heparin experienced a delay >24 h in achieving adequate anticoagulation, and the vast majority received an inadequate heparin bolus or initial continuous infusion (or both) according to current dosing guidelines. © 2010 Society of General Internal Medicine.
Mody K.P.,Columbia University |
Lyons J.J.,Vassar Brothers Medical Center |
Jorde U.P.,Montefiore Medical Center |
Uriel N.,University of Chicago
Circulation | Year: 2015
A 35-year-old woman with no past medical history presented to her local emergency room with 2 days of fevers, chills, and myalgias. She was febrile with a temperature of 102°F, blood pressure of 95/60 (72) mm Hg, heart rate of 110 bpm, respiratory rate of 20 breaths per minute, and an oxygen saturation of 100% on 2 L oxygen. The physical examination was notable for cool extremities, clear lungs, and tachycardic heart sounds with no s3, s4, or friction rub. The patient decompensated quickly and developed hypotension, requiring rapid uptitration of norepinephrine to 12 μg · kg-1•min-1. The ECG (Figure 1) showed sinus tachycardia with ST-segment elevation in the inferolateral leads. Laboratory results were notable for cardiac troponin of 3.89 ng/mL (normal range, 0-0.08 ng/mL), venous lactate of 3.5 mmol/L (normal range, 0.50-2.20 mmol/L), white blood cell count of 17.0×109 per 1 L (normal range, 3.5-9.1×109 per 1 L), and hemoglobin of 12.4 g/dL (normal range, 13.3-16.2 g/ dL) with preserved hepatic and renal function. © 2015 American Heart Association, Inc.
Nitzkorski J.R.,Vassar Brothers Medical Center |
Willis A.I.,Temple University |
Nick D.,Temple University |
Zhu F.,Fox Chase Cancer Center |
And 2 more authors.
Annals of Surgical Oncology | Year: 2013
Background: Few studies have evaluated disparities of race and socioeconomic status (SES) with outcomes in patients with rectal cancer. We hypothesize that disparities exist in the treatment and outcomes among patients with rectal cancer. Methods: Medical records of all patients with rectal cancer treated from 2000 to 2009 at an NCI cancer center (Fox Chase Cancer Center) and an urban academic center (Temple University Hospital) were retrospectively reviewed from a prospectively maintained tumor registry database. SES was estimated using census data. Quartiles of income and education based on zip codes were calculated. Lowest vs other quartiles were compared. Clinicopathologic variables included: initial stage, chemotherapy refusal, sphincter preservation, and overall survival (OS). Results: A total of 748 patients were included in the analysis (581 white, 135 black, 6 other, 26 unknown). No difference in race, SES, or insurance status was seen with regard to stage at presentation. Chemotherapy and radiation refusal was rare. After excluding stage IV patients; sphincter preservation was more common among those with higher income. Median OS for all stages was worse for nonwhite patients (31 vs 50 months, p < .001), and those with low income and education. OS disparities were most pronounced among nonwhite patients with advanced disease. Insurance was not associated with a survival difference. Age, stage, and race were independent predictors of survival. Conclusions: Disparity exists in outcomes of patients with rectal cancer. Nonwhite race is associated with worse OS, and lower SES is associated with lower OS and sphincter preservation among patients with rectal cancer. © 2013 Society of Surgical Oncology.
Lascher S.,Vassar Brothers Medical Center
Care Management Journals | Year: 2013
St. Vincent's Catholic Medical Centers of New York initiated a study in 2009 to assess the health needs of residents of New York City (NYC) municipal housing at the Robert Fulton public housing complex in Manhattan. The aim of this project was to provide valid data on perceived health services needs of the residents of a NYC housing project. These data may also be used to support hospital and community collaborative strategic decisions for developing resident-appropriate health and social services and would be valuable for use in formulating policies and programs by other interested nonprofit health and social services organizations and government. We designed a 28-item instrument and pilot tested it with our research team and members of the population under study. The English and Spanish surveys were designed as an inperson surveyor-administered instruments addressing four domains: demographics, access and barriers to health care services, risk behaviors, and perceived health needs. The sampling was an apartment-level stratified random sampling. A 20%, 188 apartment sample was drawn from the population of 944 housing units. Our response rate was 92% (173/188 apartments). Background, methods, and demographic results are reported in this article. A second article will report on the needs assessment results. © 2013 Springer Publishing Company.
Salzman M.,Albert Einstein Medical Center |
Friedman J.,Vassar Brothers Medical Center
American Journal of Emergency Medicine | Year: 2012
Splenic laceration is an uncommon complication of cardiopulmonary resuscitation (CPR). We report a case of bystander CPR-induced splenic laceration with hepatosplenic hematoma complicating management of a patient with cardiovascular collapse because of acute myocardial infarction. © 2012 Elsevier Inc.