Grave Concerns Expressed by Psychiatrists Over Current Immigration Policies.

As members of the Global Mental Health and Psychiatry Caucus of the American Psychiatric Association (APA), we would like to express our grave concerns about the ongoing policies and treatment of asylum seekers, refugees, and immigrants coming to the United States, and the adverse mental health sequelae that such policies will have on these individuals and populations.

Predicting outcome in the COURAGE trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation): coronary anatomy versus ischemia.

Objectives: The aim of this study was to determine the relative utility of anatomic and ischemic burden of coronary artery disease for predicting outcomes.

Background: Both anatomic burden and ischemic burden of coronary artery disease determine patient prognosis and influence myocardial revascularization decisions. When both measures are available, their relative utility for prognostication and management choice is controversial.

Sialorrhea and aspiration pneumonia: a case study.

This case study compares two different clinical outcomes for a patient with a long-standing psychotic disorder prescribed clozapine on two occasions. During the first trial, clozapine was used at a higher dose for this patient (350-450mg/day) and included clinically significant sialorrhea, pneumonia, and pneumonia-like illnesses requiring immediate medical intervention including hospitalization. There were also patient complaints of fatigue, cough, choking, and constipation leading to poor adherence.

Autism Spectrum Disorder: Correlation between aberrant behaviors, EEG abnormalities and seizures.

The relationship between epilepsy, epileptiform discharges, cognitive, language and behavioral symptoms is not clearly understood. Since difficulties with socialization and maladaptive behaviors are found in children with Autism Spectrum Disorder (ASD), we inquired whether epileptiform activity and seizures are associated with adverse behavioral manifestations in this population. We reviewed our EEG database between 1999-2006, and identified 123 children with ASD.

The pulmonary embolism risk score system reduces the incidence and mortality of pulmonary embolism after gastric bypass.

Background: Pulmonary embolism (PE) is a leading cause of death after roux-en-Y gastric bypass (RYGB); therefore, current recommendations for prophylaxis may be inadequate.

Methods: We reviewed our first 1,341 patients (controls) who underwent RYGB and weighted factors that may have contributed to PE to arrive at a pulmonary embolism risk score (PERS). We postulated that more aggressive prophylaxis in higher risk patients might have reduced the incidence of PE.

Acute coronary syndrome emergency treatment strategies: Improved treatment and reduced mortality in patients with acute coronary syndrome using guideline-based critical care pathways.

Background: An acute coronary syndrome (ACS) emergency treatment strategies (ACSETS) critical care pathway (CCP), embedding guideline-based treatment, was evaluated in a 4-hospital system in Buffalo, NY, for its impact on ACS drug utilization, length of stay, and mortality.

Methods: The study used an observational design comparing pre- (n = 1,240) and post- (n = 1,709) ACSETS implementation cohorts followed over 1 year. Both myocardial infarction (MI) (59%) and unstable angina (UA) (41%) patients were studied.

Pharmacokinetics of Oral Azithromycin in Serum, Urine, Polymorphonuclear Leucocytes and Inflammatory vs Non-Inflammatory Skin Blisters in Healthy Volunteers.

Two open-label studies were conducted to assess the serum, urine, polymorphonuclear (PMN) and red blood cell (RBC) pharmacokinetics of a 5-day course (1500mg total) of oral azithromycin. Inflammatory and non-inflammatory blisters were also induced to study the propensity of azithromycin to preferentially concentrate at a model infection site. 14 subjects participated in the two studies and tolerated azithromycin and the study methods well.

In-situ ablation of breast cancer.

Recent trends in the management of early breast cancer have moved toward breast conservation, without a loss in disease-free intervals or overall survival. The in situ ablation of breast tumors without the need for lumpectomy is the next logical extension of this trend. Advances in stereotactic guided localization, ultrasound and magnetic resonance imaging (MRI) technology has markedly improved our ability to visualize, biopsy and possibly treat breast tumors.

Proximal tibial osteotomy: where did you go?

The prevalence of knee osteotomy seems to have diminished. Better total knee arthroplasty (TKA) results, greater survival, increased use of unicompartmental arthroplasty, and decreased surgeon confidence for osteotomy are likely causes. However, continued use of knee osteotomy is encouraged by this author.

Pharmacokinetics and metabolism of moxifloxacin.

Moxifloxacin is a recently developed fluoroquinolone antibiotic. It is rapidly absorbed following oral administration, reaching a mean peak drug plasma concentration (C(max)) of approximately 3.56 mg/l within 2 h after a 400 mg dose.

Diagnosing Hirschsprung's disease: increasing the odds of a positive rectal biopsy result.

Background/purpose: Rectal biopsies are performed as a definitive means of diagnosing Hirschsprung's Disease (HD) in children presenting with constipation. The authors hypothesized that key features in the history, physical examination, and radiographic evaluation would allow us to avoid unnecessary rectal biopsies.

Methods: A retrospective analysis was conducted on patients undergoing rectal biopsy between 1995 and 2001.

Preoperative angiography and intraoperative transit time flow measurement to detect coronary graft patency in reoperations: an integrated approach--a case report.

Coronary angiography is the gold standard for preoperative diagnosis of coronary artery disease. In reoperative coronary artery surgery the physiologic significance of suspect lesions by angiography can be confirmed by direct intraoperative measurement of blood flow in the old grafts; such interpretation can prevent unnecessary graft revisions.

Graft patency verification in coronary artery bypass grafting: principles and clinical applications of transit time flow measurement.

The increasing popularity of beating-heart coronary surgery has raised concerns and doubts about the quality of the coronary anastomoses performed. Intraoperative graft patency verification methods are not commonly used after coronary surgery and, most of the cardiac surgeons, rely on the simple clinical signs (electrocardiogram tracings and hemodynamic stability) to make a diagnosis of coronary graft occlusion. New transit time ultrasound based methods for graft-patency verification have been adopted in many centers during beating-heart and traditional bypass grafting.

Graft revision after transit time flow measurement in off-pump coronary artery bypass grafting.

Objective: To determine whether coronary graft patency can be predicted by transit time flow measurement (TTFM).

Methods: From May 1 1997 to December 31 1998, TTFM was prospectively evaluated in 409 patients undergoing coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB). All grafts (1145) were tested with TTFM.

Juvenile papillomatosis of the breast in male infants: two case reports.

Juvenile papillomatosis of the breast ("Swiss cheese disease") is a benign localized proliferative condition of the breast which occurs almost exclusively in young adult women. Patients with this lesion often have a family history of breast carcinoma, and rarely carcinoma may coexist with the lesion at the time of diagnosis. We present two cases of male infants with juvenile papillomatosis of the breast.

Conversion to cardiopulmonary bypass in off-pump coronary artery bypass grafting: its effect on outcome.

The surgical outcome of patients requiring conversion to cardiopulmonary bypass (CPB) during myocardial revascularization using the less invasive surgical approach (LISA) was assessed. The LISA was recently introduced as a technique for complete myocardial revascularization without CPB. It combines avoidance of CPB with the versatility of a median sternotomy for access to all coronary vessels.

Accuracy of biopsy and cytology for the preoperative diagnosis of colorectal adenocarcinoma.

Background And Objectives: Endoscopic biopsy for the diagnosis of colorectal adenocarcinoma is not accurate in every case. Brush cytology can increase the sensitivity for the diagnosis of gastroesophageal lesions when combined with biopsy, but very little information is available for these techniques in the diagnosis of colorectal adenocarcinoma.

Methods: A retrospective medical records review of 110 patients was performed.

Contractile properties of intralobar pulmonary arteries and veins in the fetal lamb model of congenital diaphragmatic hernia.

Background/purpose: Pulmonary hypertension plays a significant role in the pathophysiology of congenital diaphragmatic hernia (CDH). Although there has been an intensive research effort directed at mediators that may cause pulmonary vasoconstriction, no single agent has been identified. The authors hypothesize that there may be an alteration in the cGMP-nitric oxide (NO) pathway of vasodilatation contributing to the pulmonary hypertension observed in CDH.