The Effect of Adoption of an Electronic Health Record on Duplicate Testing.

Background. The electronic health record (EHR) has been promoted as a tool to improve quality of patient care, reduce costs, and improve efficiency. There is little data to confirm that the use of EHR has reduced duplicate testing.

Gastrojejunal Anastomosis Perforation after Gastric Bypass on a Patient with Underlying Pancreatic Cancer: A Case Report and Review of the Literature.

Introduction. We describe a case of gastrojejunal anastomosis perforation after gastric bypass on a patient with underlying pancreatic cancer. Case Description.

A Rare Association of Sinus Venosus-Type Atrial Septal Defect and Persistent Left Superior Vena Cava Detected by Transthoracic Echocardiography and Cardiac Magnetic Resonance Imaging.

Background: Association of persistent left superior vena cava (PLSVC) and sinus venosus-type atrial septal defect (SVASD) is rare. We describe a patient with dilated coronary sinus (CS) found to have PLSVC and SVASD.

Case Report: The patient is a 60-year-old man with history of stroke who underwent a transthoracic echocardiogram (TTE) for evaluation of shortness of breath.

Inadequate Blood Pressure Control in Hypertensive Patients Referred for Cardiac Stress Test.

The current study examined the degree of blood pressure (BP) control and incidence of myocardial ischemia in hypertensive patients (n=2039) referred for cardiac stress test. Patients were categorized into well-controlled (<140/90 mm Hg), poorly controlled (140-160/90-100 mm Hg), and very poorly controlled (>160/100 mm Hg) groups according to their resting BP. The mean age[±standard error of the mean] of the patients was 68±13 years, and 885 (43.

An unusual case of pleural chordoma.

Chordoma is a rare slow-growing neoplasm arising from notochordal remnants. In the United States, the annual incidence of chordoma is 0.08 per 100,000 and is more common in men than in women.

Surgical management of gastrointestinal stromal tumors of the stomach.

Background: Laparoscopy has emerged as the "gold standard" procedure for many diseases that require surgical treatment. Our goal was to assess the outcomes of laparoscopic vs open partial gastrectomies for the management of gastrointestinal stromal tumors of the stomach (gGIST) using a national database.

Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2006-2009), we identified patients who underwent laparoscopic and open partial gastrectomy gGIST.

Intravenous ferric carboxymaltose versus standard medical care in the treatment of iron deficiency anemia in patients with chronic kidney disease: a randomized, active-controlled, multi-center study.

Background: Currently available intravenous (IV) iron agents vary in indication, dosing regimens and safety profiles. Ferric carboxymaltose (FCM) is a stable, non-dextran-containing iron formulation developed for rapid IV administration in high doses with controlled delivery of iron into target tissues. The objective of the present study was to evaluate the safety of FCM compared with standard medical care (SMC) in dialysis (HD) and non-dialysis-dependent (NDD) chronic kidney disease (CKD) patients.

Is there a cause-specific survival benefit of postmastectomy radiation therapy in women younger than age 50 with T3N0 invasive breast cancer? A SEER database analysis: outcomes by receptor status/race/age: analysis using the NCI Surveillance, Epidemiology, and End Results (SEER) database.

Objective: Postmastectomy radiation therapy (PMRT) remains controversial for patients with pathologic stage T3N0 (pT3N0) breast cancer. A Surveillance, Epidemiology, and End Results (SEER) database analysis suggested that PMRT might benefit patients older than age 50. However, the relevance between estrogen receptor (ER), progesterone receptor (PR), race, and PMRT in patients younger than age 50 is unknown.

Cancers of the appendix: review of the literatures.

Cancers of the appendix are rare. Most of them are found accidentally on appendectomies performed for appendicitis. When reviewed, majority of the tumors were carcinoid, adenoma, and lymphoma.

Bundled-rate legislation for Medicare reimbursement for dialysis services: implications for anemia management with ESAs.

With the incidence of ESRD on the rise, there is a continuing need to control anemia-related treatment costs in dialysis patients receiving reimbursement through Medicare. Currently, erythropoiesis-stimulating agents (ESAs) are billed separately from dialysis services, potentially creating little financial incentive for more efficient use. The Medicare Improvement for Patients and Providers Act, passed by the U.

Inducible COX-2 dominates over COX-1 in prostacyclin biosynthesis: mechanisms of COX-2 inhibitor risk to heart disease.

Aim: Our aim is to understand the molecular mechanisms of the selective nonsteroidal anti-inflammatory drugs (NSAID), cyclooxygenase-2 (COX-2) inhibitors', higher "priority" to reduce synthesis of the vascular protector, prostacyclin (PGI2), compared to that of nonselective NSAIDs.

Main Methods: COX-1 or COX-2 was co-expressed with PGI2 synthase (PGIS) in COS-7 cells. The Km and initial velocity (½t Vmax) of the coupling reaction between COX-1 and COX-2 to PGIS were established.

Prostacyclin therapy for pulmonary arterial hypertension.

In pulmonary arterial hypertension, the blood vessels that carry blood between the heart and lungs are constricted, making it difficult for the heart to pump blood through the lungs. Prostacyclin, a prostanoid metabolized from endogenous arachidonic acid through the cyclooxygenase (COX) pathway, is a potent vasodilator that has been identified as one of the most effective drugs for the treatment of pulmonary arterial hypertension. Currently, prostacyclin and its analogues are widely used in the clinical management of pulmonary arterial hypertension patients.

Comparison of microarray analysis of fine needle aspirates and tissue specimen in thyroid nodule diagnosis.

Microarray technology provides a new opportunity to improve the diagnostic accuracy of fine needle aspiration (FNA) in evaluating thyroid nodules. Here, we evaluate whether ex vivo FNA and tissue samples can be used interchangeably in microarray and whether the method of acquisition affects the precision of the gene list that is generated. To assess whether FNA samples provide adequate material for reliable gene expression analysis, paired tissue and FNA samples were collected from 13 thyroid nodules; 7 malignant, 6 benign.

Instantly Converting Atrial Fibrillation into Sinus Rhythm by a Digital Rectal Exam on a 29-year-Old Male.

Vagal maneuvers cause increase in vagal tone, which has been shown to slow many types supraventricular tachycardia, such as atrial fibrillation (AF). However, the conversion of AF to sinus rhythm is usually not associated with vagal manuvers. Thus, AF is classically treated with medication and electrical cardioversion.

Endogenous adenosine down-modulates mid-trimester intraamniotic tumor necrosis factor-alpha production.

Problem: To determine whether adenosine in amniotic fluid down-regulates pro-inflammatory cytokine production.

Method Of Study: Mid-trimester amniotic fluid from 21 women was incubated ex vivo in the presence or absence of human adenosine deaminase, the enzyme that irreversibly degrades adenosine. After 24 hr, supernatants were assayed by ELISA for tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, and IL-10.

Solitary fibrous tumor of the parapharyngeal space.

Solitary fibrous tumors are benign neoplasms of mesenchymal origin. They usually arise from the visceral or parietal pleura and peritoneum, although they have been found in many areas throughout the body. We report a case of solitary fibrous tumor of the parapharyngeal space.

Current technique for resection of mediastinal goiter.

We have developed a combined surgical technique involving traction sutures, the harmonic scalpel, and laryngeal nerve monitoring for the removal of mediastinal goiters. This technique is safe, expeditious, and effective; it minimizes the risk of blood loss or nerve injury; and it obviates the need for sternotomy. During a 4-year period, we performed this operation on 21 patients.

Primary B cell lymphoma of the external auditory canal.

Temporal bone lymphomas are rare and typically metastatic neoplasms. We describe a case of primary B cell lymphoma that originated in the external auditory canal of an elderly woman. The diagnosis was based on histopathologic examination supplemented by immunophenotypic analysis.

Improving hospital systems for the care of women with major obstetric hemorrhage.

Objective: When 2 maternal deaths due to hemorrhage occurred at New York Hospital Queens in 2000-2001, a multidisciplinary team implemented systemic change. Our objective was to improve outcomes of episodes of major obstetric hemorrhage.

Methods: We report outcomes before (2000-2001) and after (2002-2005) the introduction of a patient safety program aimed at improving the care of women with major obstetric hemorrhage.

West Nile virus during pregnancy: a case study of early second trimester maternal infection.

A woman who contracted West Nile virus (WNV) neuroinvasive illness during her second trimester subsequently elected to terminate her pregnancy due to concerns of possible adverse effects of WNV on her developing fetus. Consent was obtained to test maternal and post-mortem fetal tissues for WNV infection. Fetal blood, liver, kidneys, spleen, umbilicus and amniotic fluid were negative for WNV RNA by polymerase chain reaction and negative for WNV IgM antibodies by ELISA, indicating that in this case there was no evidence of WNV transmission to the fetus.

How often should a port-A-cath be flushed?

While it is important during treatment to flush the port-A-cath (PAC) with heparin regularly, catheter maintenance needs to be evaluated in those patients who, after completion of therapy, retained their ports for extended periods of time. The manufacturer has recommended monthly accession to maintain catheter patency and function. Our objective is to demonstrate that a longer interval between maintenance accessions of PACs still may be medically safe, convenient, and more efficient.