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Kahn L. Lethal autonomous weapon systems and respect for human dignity. Front Big Data 2022; 5:999293. [PMID: 36156937 PMCID: PMC9500208 DOI: 10.3389/fdata.2022.999293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Much of the literature concerning the ethics of lethal autonomous weapons systems (LAWS) has focused on the idea of human dignity. The lion's share of that literature has been devoted to arguing that the use of LAWS is inconsistent with human dignity, so their use should be prohibited. Call this position “Prohibitionism.” Prohibitionists face several major obstacles. First, the concept of human dignity is itself a source of contention and difficult to operationalize. Second, Prohibitionists have struggled to form a consensus about a property P such that (i) all and only instances of LAWS have P and (ii) P is always inconsistent with human dignity. Third, an absolute ban on the use of LAWS seems implausible when they can be used on a limited basis for a good cause. Nevertheless, my main purpose here is to outline an alternative to Prohibitionism and recognize some of its advantages. This alternative, which I will call “Restrictionism,” recognizes the basic intuition at the heart of Prohibitionism - namely, that the use of LAWS raises a concern about human dignity. Moreover, it understands this concern to be rooted in the idea that LAWS can make determinations without human involvement about whom to target for lethal action. However, Restrictionism differs from Prohibitionism in several ways. First, it stipulates a basic standard for respecting human dignity. This basic standard is met by an action in a just war if and only if the action conforms with the following requirements: (i) the action is militarily necessary, (ii) the action involves a distinction between combatants and non-combatants, (iii) noncombatants are not targeted for harm, and (iv) any and all incidental harm to non-combatants is minimized. In short, the use of LAWS meets the standard of basic respect for human dignity if and only if it acts in a way that is functionally isomorphic with how a responsible combatant would act. This approach leaves open the question of whether and under what conditions LAWS can meet the standard of basic respect for human dignity.
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Brady LA, Wozniak ML, Brimmer MJ, Terranova E, Moore C, Kahn L, Vest BM, Thomas M. Coping Strategies and Workplace Supports for Peers with Substance Use Disorders. Subst Use Misuse 2022; 57:1772-1778. [PMID: 36017896 DOI: 10.1080/10826084.2022.2112228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Introduction: Substance use disorder (SUD) peers provide support and navigation through a fragmented treatment system for people who use drugs (PWUD) and those in recovery. While barriers to peers' work are well established, from role ambiguity to stigma surrounding substance use, little research has focused on factors that facilitate peers' work. Methods: We conducted in-depth semi-structured interviews (N=20) with peers as part of an evaluation of a larger project related to the opioid crisis in Western New York. Participants were recruited from a regional peer network via flyers, emails, and a brief presentation. Interviews were conducted in person or by phone, audio recorded, and transcribed. Transcripts were analyzed using thematic content analysis. Results: Peers emphasized two factors: healthy personal coping strategies and strong workplace supports. Coping strategies included a sense of community, setting appropriate boundaries, and self-care routines. At the workplace, peers valued mental and emotional support, as well as professional relationships and organizational policies that made their work easier and supported self-care. For a few peers, professional relationships included advocating on behalf of PWUD by sharing personal experiences of SUD. Conclusions: Peers valued peer colleagues and peer-led organizations, noting how shared experiences of substance use and recovery enabled a unique support system. For peers who lack such support at work, the authors suggest peer networks as an alternative. We also recommend organizational policies and practices to facilitate peers' work, such as promoting peer input and feedback, but further research is needed to measure effects on peer retention and job satisfaction.
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Affiliation(s)
- Laura A Brady
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - M L Wozniak
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - M J Brimmer
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - E Terranova
- Erie County Department of Health, Buffalo, NY, USA
| | - C Moore
- Erie County Department of Health, Buffalo, NY, USA
| | - L Kahn
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - B M Vest
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - M Thomas
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
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Kachroo N, Jain R, Maskal S, Alshara L, Armanyous S, Milk J, Kahn L, Monga M, Sivalingam S. Can CT-Based Stone Impaction Markers Augment the Predictive Ability of Spontaneous Stone Passage? J Endourol 2020; 35:429-435. [PMID: 32883100 DOI: 10.1089/end.2020.0645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: A number of clinical and radiological predictors of either stone impaction or ureteral stone passage (SP) have been proposed. We aimed at identifying the key predictors of successful SP by using readily available CT-based tools/measurements. Methods: Patients presenting to the emergency department from February 2017 to February 2018 with an acute unilateral ureteral stone confirmed on non-contrast CT and managed conservatively were followed for SP. Patients with renal impairment, sepsis or requiring emergent intervention were excluded. Patients were followed at 1 month to confirm SP (stone collection/repeat imaging) or failure of passage. The CT variables analyzed included: Stone factors [location, size, volume, HU density (HUD)], impaction factors [ureteral HUD above and below the stone, maximal ureteral wall thickness (UWT) at the stone site, contralateral UWT, and ureteral diameter above and below the stone]. Binary logistic regression analysis was performed to identify predictors of SP. Results: Forty-nine patients met study inclusion criteria, of whom 32 (65.3%) passed the stone without further intervention. Patients with successful passage were more likely to have smaller, lower volume and less dense stones located in the distal ureter (p < 0.01). Lower ureteral HUD below the stone, lower maximal UWT, and lower ureteral diameter above the stone were associated with successful passage (p < 0.01). On multivariable logistic regression analysis, only maximal UWT at the stone site was a significant independent predictor of SP outcome (p = 0.01). Youden's criterion identified 2.3 mm as the optimal UWT cut-off point, which will accurately predict SP with 82.4% sensitivity and 87.5% specificity. Conclusions: Maximal UWT at the stone site was the most significant predictor of successful passage in acute unilateral ureteral stones, with an optimal cut-off point of 2.3 mm. Further prospective studies are needed to accurately predict spontaneous SP.
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Affiliation(s)
- Naveen Kachroo
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rajat Jain
- University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Maskal
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Luay Alshara
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.,Division of Urology, Albany Medical College, Albany, New York, USA
| | - Sherif Armanyous
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.,Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason Milk
- Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Leonard Kahn
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Manoj Monga
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.,Department of Urology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Sri Sivalingam
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Jain R, Maskal S, Milk J, Kahn L, Fedrigon D, Sivalingam S. Utility of stone volume estimated by software algorithm in predicting success of medical expulsive therapy. Can Urol Assoc J 2020; 15:E144-E147. [PMID: 32807279 DOI: 10.5489/cuaj.6491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to assess the accuracy of using stone volume (SV) estimated with a software algorithm as a predictor for stone passage in a trial of medical expulsive therapy (MET). METHODS We identified patients with ureteral stones discharged from the emergency department on MET. Patients with infection, non-ureteral stones, or needing immediate surgical intervention were excluded. For each stone, longest dimension (LD) was recorded, and SV was estimated by a computed tomography (CT)-based region-growing (RG) algorithm and standard ellipsoid formula (EF). Stone passage within 30 days was assessed via electronic chart and followup phone call. RESULTS Fifty-one patients were included for analysis (53±16.7 years, 24% female). The mean LD was 4.85±2.02 mm. The mean SV was similar by EF and RG (0.051±0.057cm3 vs. 0.049±0.052 cm3, p=0.28). Thirty-three (65%) patients passed their stone, while 18 (35%) did not. The mean LD for passed stones vs. failed passage was 4.1±1.7 mm vs. 6.2±1.8 mm (p=0.0002); the mean EF volume was 0.028±0.035 cm3 vs. 0.093±0.066 cm3 (p=0.00007); and the mean volume by RG was 0.028±0.027 cm3 vs. 0.088±0.063 cm3 (p=0.00005). CONCLUSIONS The clinical utility of SV estimated by software algorithm as a predictor for success of MET has not previously been examined. We demonstrated that spontaneously passed stones had a significantly smaller volume than those requiring intervention. Further prospective studies are needed to validate these findings and establish volume thresholds for probability of stone passage.
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Affiliation(s)
- Rajat Jain
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Sara Maskal
- Case Western Reserve School of Medicine, Cleveland, OH, United States
| | - Jason Milk
- Cleveland Clinic Department of Emergency Medicine, Cleveland, OH, United States
| | - Leonard Kahn
- Cleveland Clinic Glickman Department of Radiology, Cleveland, OH, United States
| | - Donald Fedrigon
- Case Western Reserve School of Medicine, Cleveland, OH, United States
| | - Sri Sivalingam
- Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, OH, United States
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Gupta N, Kenan S, Kenan S, Kahn L. Surface periosteal chondroblastoma. Human Pathology: Case Reports 2018. [DOI: 10.1016/j.ehpc.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jain R, Omar M, Chaparala H, Kahn A, Li J, Kahn L, Sivalingam S. How Accurate Are We in Estimating True Stone Volume? A Comparison of Water Displacement, Ellipsoid Formula, and a CT-Based Software Tool. J Endourol 2018; 32:572-576. [DOI: 10.1089/end.2017.0937] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rajat Jain
- Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Adam Kahn
- Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jianbo Li
- Cleveland Clinic Foundation, Cleveland, Ohio
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Savant D, Kenan S, Kenan S, Kahn L. Osteogenic melanoma: report of a case mimicking osteosarcoma and review of the literature. Skeletal Radiol 2018; 47:711-716. [PMID: 29196822 DOI: 10.1007/s00256-017-2835-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 02/02/2023]
Abstract
A 32-year-old male presented with a right thumb lesion of 11-month duration. A clinical diagnosis of pyogenic granuloma was entertained but the lesion failed to respond to conservative therapy and eventually necessitated amputation of his thumb. MRI of the right thumb showed an ill-defined, heterogeneously enhancing, infiltrating mass within the dorsal soft tissues abutting the distal phalanx and measuring 4.2 × 2.4 × 0.7 cm. Histologically, the tumor was composed of a high-grade osteosarcoma with a chondrosarcomatous component localized within the underlying bone and a more superficial spindle cell component in the overlying soft tissue. The epidermis was focally ulcerated overlying the lesion. The key to the diagnosis was provided by intense staining of the spindle cell component for S100 protein indicative of a spindle cell melanoma. The presence of an associated osteogenic sarcomatous component established a final diagnosis of osteogenic melanoma. The localization of this element to phalangeal bone is distinctly unusual and resulted in the close resemblance to a primary osteogenic sarcoma.
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Affiliation(s)
- Deepika Savant
- Department of Pathology, Hofstra Northwell School of Medicine, 6 Ohio Drive, New Hyde Park, NY, 11040, USA.
| | - Shachar Kenan
- Department of Orthopaedics, Hofstra Northwell School of Medicine, 6 Ohio Drive, New Hyde Park, NY, 11040, USA
| | - Samuel Kenan
- Department of Orthopaedics, Hofstra Northwell School of Medicine, 6 Ohio Drive, New Hyde Park, NY, 11040, USA
| | - Leonard Kahn
- Department of Pathology, Hofstra Northwell School of Medicine, 6 Ohio Drive, New Hyde Park, NY, 11040, USA
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Abstract
There are 3 histologically benign smooth muscle neoplasms that have unusual growth patterns. These include intravascular leiomyomatosis, benign metastasizing leiomyoma, and leiomyomatosis peritonealis desseminata. We report a unique case of perivascular leiomyomatosis. The tumor showed multiple nodules of benign smooth muscle with some of the nodules closely associated with the periphery of the medial muscle layer of venous channels. All the neoplastic nodules were located on the outer surface of venous channels, thus precluding a diagnosis of intravascular leiomyomatosis. To the best of our knowledge, this is the first documentation of such an entity.
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Abstract
OBJECTIVE Amyloidomas are tumor-like deposits of amyloid. Amyloidoma of the gastrointestinal tract is rare. To the best of our knowledge, this is the first instance of diagnosis of an amyloidoma in the gastrointestinal tract by fine needle aspiration (FNA). STUDY DESIGN We report a case of a 64-year-old male with a history of ulcerative colitis and primary sclerosing cholangitis who was incidentally found to have a mass in the stomach wall. RESULTS Initially thought to be gastrointestinal stromal tumor, FNA demonstrated the lesion to be amyloidoma with a prominent giant cell reaction. This was further confirmed by mass spectrometry. This is the only case report of diagnosis of a gastric amyloidoma by FNA. CONCLUSION The presence of a florid giant cell reaction in the absence of ulceration or an inflammatory or neoplastic lesion should alert the pathologist to the possibility of an amyloidoma. This is the only case report of diagnosis of a gastric amyloidoma by FNA.
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Affiliation(s)
- Deepika Savant
- Department of Pathology, Hofstra Northwell School of Medicine, New Hyde Park, New York, USA
| | - Michael Adler
- Department of Medicine, Hofstra Northwell School of Medicine, New Hyde Park, New York, USA
| | - Leonard Kahn
- Department of Pathology, Hofstra Northwell School of Medicine, New Hyde Park, New York, USA
| | - Rubina Cocker
- Department of Pathology, Hofstra Northwell School of Medicine, New Hyde Park, New York, USA
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Savant D, Kenan S, Kenan S, Kahn L. Extraskeletal osteosarcoma arising in myositis ossificans: a case report and review of the literature. Skeletal Radiol 2017; 46:1155-1161. [PMID: 28536749 DOI: 10.1007/s00256-017-2674-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 02/06/2023]
Abstract
We report a case of a 23-year-old female with pain and fullness in the right popliteal fossa. An MRI scan demonstrated an ossified enhancing soft tissue mass. Evaluation of the resected specimen showed a high-grade extraskeletal osteosarcoma juxtaposed to the three zones of myositis ossificans. At 1-year follow-up the patient is alive and disease free. A review of the literature purporting to document such an association failed to demonstrate a single case in which an osteosarcoma and MO with its zonal architecture co-existed.
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Affiliation(s)
- Deepika Savant
- Department of Pathology, Hofstra Northwell School of Medicine, 6 Ohio Drive, New Hyde Park, Hempstead, NY, 11040, USA.
| | - Shachar Kenan
- Department of Orthopaedics, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Samuel Kenan
- Department of Orthopaedics, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Leonard Kahn
- Department of Pathology, Hofstra Northwell School of Medicine, 6 Ohio Drive, New Hyde Park, Hempstead, NY, 11040, USA
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Savant D, Kahn L. Cardiac myxoma: report of a case with bizarre histiocytic infiltration. Cardiovasc Pathol 2017; 28:11-13. [PMID: 28242485 DOI: 10.1016/j.carpath.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022] Open
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Glass R, Kahn L, Khalid K, Siddiqui MT, Cocker R. Predicting histological subtypes of follicular variant of papillary thyroid carcinoma based on cytomorphology. Can cytomorphology optimize use of molecular testing? J Am Soc Cytopathol 2016; 5:345-350. [PMID: 31042546 DOI: 10.1016/j.jasc.2016.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Follicular variant papillary thyroid carcinoma (FVPTC) can be further subclassified into one of 3 subtypes: non-invasive encapsulated FVPTC, invasive encapsulated FVPTC, and infiltrative FVPTC. Longitudinal and molecular studies have demonstrated that, in terms of both molecular profiles and prognosis, encapsulated FVPTC is comparable to follicular adenoma, invasive FVPTC to follicular carcinoma, and infiltrative FVPTC to classic PTC. To improve triaging and prevent overtreatment of patients with FVPTC, we sought to determine cytologic features likely to occur within each subtype. METHODS A laboratory database search from 2010-2015 was conducted to identify patients with biopsy-proven FVPTC and prior fine-needle aspiration. Surgical specimens were reviewed to determine the appropriate subcategorization. Accompanying cytology reports were reviewed for features common in classic PTC and follicular neoplasms. RESULTS Encapsulated variants were more likely to be graded as Bethesda category 4 compared with invasive or infiltrative variants. In contrast, infiltrative variants were more likely to be graded as Bethesda categories 5 and 6 compared with invasive or encapsulated variants. Compared with the encapsulated variant, infiltrative FVPTC was more likely to have nuclear pseudo-inclusions (31.82% versus 8.11%, P = 0.0468) and less likely to have microfollicular architecture (22.73% versus 54.05%, P = 0.0374). CONCLUSION This study identified cytomorphologic differences between encapsulated and infiltrative FVPTC. With a higher threshold of suspicion for FVPTC, improved awareness of the differences between these subtypes and incorporation of molecular testing, it is likely that the Bethesda category can be revised and patient triaging can be significantly improved.
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Affiliation(s)
- Ryan Glass
- Department of Pathology, Northwell Health, 6 Ohio Drive, Lake Success, New York, 11042
| | - Leonard Kahn
- Department of Pathology, Northwell Health, 6 Ohio Drive, Lake Success, New York, 11042
| | - Kashan Khalid
- Department of Pathology, Northwell Health, 6 Ohio Drive, Lake Success, New York, 11042
| | - Momin T Siddiqui
- Department of Pathology, Emory University Hospital, Atlanta, Georgia
| | - Rubina Cocker
- Department of Pathology, Northwell Health, 6 Ohio Drive, Lake Success, New York, 11042.
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Kahn L, Jackson D, Wang Y, Dyer B, Farwell D, Bewley A, Daly M, Rao S. Outcomes and Prognostic Grouping of Human Papillomavirus–Positive Oropharyngeal Squamous Cell Carcinoma Undergoing TORS/TLM and Adjuvant Radiation Therapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dyer B, Zhao X, Hoffman D, Kahn L, Hodges M, Hayes J, Michaud A, Hess C, Kumaran Nair C, Fragoso R, Valicenti R, Mayadev J. Mortality in Radiation Oncology: A 16-Year Departmental Review. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kahn L, Hodges M, Hayes J, Daly M. Detection and Treatment of Second Primary Lung Cancers Following Initial Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kahn L, Biro EE, Smith RD, Bui CJ. Spina bifida occulta and aperta: a review of current treatment paradigms. J Neurosurg Sci 2015; 59:79-90. [PMID: 25387659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Spina bifida remains a challenging neurosurgical entity to manage despite both an increased awareness of the disease as well as a decreased incidence due to folic acid supplementation. We review the spectrum of neural tube defects, which are the second most common serious congenital defect and the most common of the central nervous system, and discuss the latest management paradigms. The challenges of timely diagnosis and treatment of spina bifida occulta and the latest advances in fetal repair of spina bifida aperta (myelomeningocele) will be discussed. The authors review the literature and share their experience with managing neural tube defects.
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Affiliation(s)
- L Kahn
- Departmentof Neurosurgery, Tulane University School of Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA -
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Abstract
Malakoplakia is a rare granulomatous disease that most commonly occurs in the urinary tract. It is characterized by sheets of histiocytes with granular basophilic inclusions and Michaelis-Gutmann bodies. We present an exceedingly rare case of malakoplakia of the thyroid in a 54-year-old Caucasian woman on immunosuppressive therapy for renal transplant performed in 1994.
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Affiliation(s)
| | | | - Sheng Chen
- Hofstra North Shore-LIJ Health System, Lake Success, NY, USA
| | | | - Leonard Kahn
- Hofstra North Shore-LIJ Health System, Lake Success, NY, USA
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Brandler TC, Reder I, Kahn L. Perirenal myelolipoma diagnosed on imprint: case report and review of the literature. Diagn Cytopathol 2014; 43:230-3. [PMID: 24895157 DOI: 10.1002/dc.23178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 04/06/2014] [Accepted: 05/09/2014] [Indexed: 12/12/2022]
Abstract
Myelolipomas are benign tumors containing adipose tissue and hematopoeitic elements which occur most commonly in the adrenal glands. Extra-adrenal myelolipomas are uncommon with few cases of renal and perirenal myelolipomas in the literature. These cases may be difficult to diagnose based on radiology alone and intraoperative diagnosis can be extremely important in determining the course of surgery. Due to the lipomatous component of the tumor it may be technically difficult to prepare adequate frozen sections; this problem can be obviated by utilization of cytologic imprint preparations. We present a case of perirenal myelolipoma diagnosed intraoperatively utilizing cytologic imprint preparations stained with toluidine blue and hematoxylin and eosin.
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Affiliation(s)
- Tamar C Brandler
- Department of Pathology, Hofstra North-Shore LIJ School of Medicine; Lake Success, New York
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Cocker R, McNair SA, Kahn L, Kwon S, Ding X, Zeltsman V, Sung C. Isolated adrenal cryptococcosis, diagnosed by fine-needle aspiration biopsy: a case report. Diagn Cytopathol 2014; 42:899-901. [PMID: 24610787 DOI: 10.1002/dc.23079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 12/03/2013] [Indexed: 11/07/2022]
Abstract
This report documents a case of isolated adrenal gland cryptococcosis without the often reported component of concomitant meningitis or Addison's disease in an immune competent patient. Furthermore, both the patient's lung cancer and adrenal infection with cryptococcus were incidentally discovered during work-up for syncope in the setting of hyponatremia. This case also underscores the diagnostic value of fine-needle aspiration biopsy in this unusual presentation.
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Affiliation(s)
- Rubina Cocker
- Division of Cytopathology, North Shore Long Island Jewish Health System Laboratories, Lake Success, New York
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Kahn L, Fuss M, Wilson D, Merz B, Tanyi J, Thomas C, Hung A. I-125 Plaque Brachytherapy for Choroidal Melanoma: Mature Single-institution Outcomes. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Marshall K, Maddox JF, Lee SH, Zhang Y, Kahn L, Graser HU, Gondro C, Walkden-Brown SW, van der Werf JHJ. Genetic mapping of quantitative trait loci for resistance to Haemonchus contortus in sheep. Anim Genet 2009; 40:262-72. [PMID: 19291139 DOI: 10.1111/j.1365-2052.2008.01836.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper presents results from a mapping experiment to detect quantitative trait loci (QTL) for resistance to Haemonchus contortus infestation in merino sheep. The primary trait analysed was faecal worm egg count in response to artificial challenge at 6 months of age. In the first stage of the experiment, whole genome linkage analysis was used for broad-scale mapping. The animal resource used was a designed flock comprising 571 individuals from four half-sib families. The average marker spacing was about 20 cM. For the primary trait, 11 QTL (as chromosomal/family combinations) were significant at the 5% chromosome-wide level, with allelic substitution effects of between 0.19 and 0.38 phenotypic standard deviation units. In general, these QTL did not have a significant effect on faecal worm egg count recorded at 13 months of age. In the second stage of the experiment, three promising regions (located on chromosomes 1, 3 and 4) were fine-mapped. This involved typing more closely spaced markers on individuals from the designed flock as well as an additional 495 individuals selected from a related population with a deeper pedigree. Analysis was performed using a linkage disequilibrium-linkage approach, under additive, dominant and multiple QTL models. Of these, the multiple QTL model resulted in the most refined QTL positions, with resolutions of <10 cM achieved for two regions. Because of the moderate size of effect of the QTL, and the apparent age and/or immune status specificity of the QTL, it is suggested that a panel of QTL will be required for significant genetic gains to be achieved within industry via marker-assisted selection.
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Affiliation(s)
- K Marshall
- School of Environmental and Rural Science, University of New England, Armidale, NSW 2351, Australia.
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Patel K, Bhuiya T, Chen S, Kenan S, Kahn L. Epidermal inclusion cyst of phalanx: a case report and review of the literature. Skeletal Radiol 2006; 35:861-3. [PMID: 16416148 DOI: 10.1007/s00256-005-0058-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Revised: 10/15/2005] [Accepted: 10/31/2005] [Indexed: 02/02/2023]
Abstract
Epidermal cyst within a toe phalanx is an extremely rare condition. It is important to differentiate this benign lesion, which can be easily treated by curettage, from other benign and malignant lesions of the bone with a similar clinical presentation, and which may require amputation of the toe. This report describes one such lesion in the mid-phalanx of the fourth toe in a 48-year-old woman, and which was successfully identified by intra-operative frozen diagnosis and treated by curettage.
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Affiliation(s)
- Keyur Patel
- Pathology and Laboratory Medicine, Long Island Jewish Medical Center, 170-05 76th Ave, New Hyde Park, NY 11040, USA
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Abstract
One variant of thymic carcinoid has prominent mucinous stroma first reported in 1995. We describe such a case characterized by abundant stromal mucin resulting in a histologic picture resembling of metastatic mucinous adenocarcinoma. This variant seems to behave in an aggressive fashion and should be under the differential diagnoses of mediastinal neoplasm with prominent mucin production.
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Affiliation(s)
- Zhenqiang Gao
- Department of Pathology, Albert Einstein College of Medicine Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA
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Alabert C, Rogers L, Kahn L, Niellez S, Fafet P, Cerulis S, Blanchard JM, Hipskind RA, Vignais ML. Cell type-dependent control of NF-Y activity by TGF-beta. Oncogene 2006; 25:3387-96. [PMID: 16434965 DOI: 10.1038/sj.onc.1209385] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Transforming growth factor beta (TGF-beta) is a pluripotent cytokine that regulates cell growth and differentiation in a cell type-dependent fashion. TGF-beta exerts its effects through the activation of several signaling pathways. One involves membrane proximal events that lead to nuclear translocation of members of the Smad family of transcriptional regulators. TGF-beta can also activate MAPK cascades. Here, we show that TGF-beta induces nuclear translocation of the NF-YA subunit of the transcription factor NF-Y by a process that requires activation of the ERK cascade. This results in increased binding of endogenous NF-Y to chromatin and TGF-beta-dependent transcriptional regulation of the NF-Y target gene cyclin A2. Interestingly, the kinetics of NF-YA relocalization differs between epithelial cells and fibroblasts. NIH3T3 fibroblasts show an elevated basal level of phosphorylated p38 and delayed nuclear accumulation of NF-YA after TGF-beta treatment. In contrast, MDCK cells show low basal p38 activation, higher basal ERK phosphorylation and more rapid localization of NF-YA after induction. Thus, NF-Y activation by TGF-beta1 involves ERK1/2 and potentially an interplay between MAPK pathways, thereby opening the possibility for finely tuned transcriptional regulation.
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Affiliation(s)
- C Alabert
- Institut de Génétique Moléculaire de Montpellier, CNRS-UMR5535-IFR122, Montpellier, France
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Fischer H, Barbas J, Kahn L. Mechanical treatment. Rehab Manag 2005; 18:24, 26-30. [PMID: 16231676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Heidi Fischer
- Sensory Motor Performance Program and Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, USA
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Abstract
The requirements of the new deal for junior doctors' hours has meant that many smaller trusts are unable to provide adequate cover on-call for medical and surgical subspecialties. The care of the acute subspecialty patients has, therefore, shifted to general teams in many trusts. We assessed what impact this had upon the outcome of acute urological cases in our district general hospital by prospectively monitoring acute renal colic admissions over a 12-month period and surveyed the provision of services in other regional hospitals. The shift in care of the acute urological patient was associated with considerable morbidity for patients admitted in our hospital. The additional financial burden due to this morbidity was estimated to be 33000 pounds/annum. The implementation of the new deal must be achieved with every care to minimise the clinical and financial costs of withdrawing acute subspecialty services.
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Affiliation(s)
- G O Hellawell
- Department of Urology, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex, UK. gileshellawell@@hotmail.com
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Lee F, Patel HRH, Copland P, Kahn L. Fowler's syndrome: cause or consequence of insulin resistance? BJU Int 2002; 89:138. [PMID: 11849180 DOI: 10.1046/j.1464-4096.2001.00194.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- F Lee
- Chase Farm Hospital and Institute of Urology and Nephrology, UCL, London, UK.
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Abstract
We studied the roles of mGlu2/3 receptors (mGlu2/3) in glutamatergic transmission at corticostriatal synapses in mice brain slices. Perfusion of the selective mGlu2/3 agonists LY354740 and L-CCG1 caused the long term depression (LTD) of evoked synaptic responses. Photonic and electronic microscopy showed mGlu2/3 on axonal fibers and glial processes but not on striatal dendrites. mGlu2/3-LTD was independent of synaptic activity and insensitive to specific antagonists of dopamine D1, D2, GABA(B), N-methyl-D-aspartate or adenosine A1 receptors. Manipulation of the cAMP/protein kinase A cascade had no effect on the mGlu2/3-LTD. In contrast, MEK1-2 inhibitors reduced both mGlu2/3 initial depression and LTD suggesting the involvement of the mitogen activated kinase pathway in mGlu2/3-LTD.
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Affiliation(s)
- L Kahn
- CNRS UPR 9023, 141, Rue de la Cardonille, 34094 Montpellier Cedex 05, France
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Kahn L. [The mating call of the world]. Rev Int Hist Psychanal 2001; 4:543-61. [PMID: 11631253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Abstract
Most reported thoracic desmoid tumors originate from the chest wall. However, intrathoracic desmoid tumors are rare. The pathogenesis of these tumors is unclear but antecedent trauma and operation have been implicated. Desmoid tumors can present either with pain or be incidentally detected on radiographic studies. We describe the case of a 60-year-old woman with an intrathoracic desmoid detected on a routine screening chest roentgenogram who underwent complete surgical resection of the tumor.
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Affiliation(s)
- M Iqbal
- Division of Cardiothoracic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York 11042, USA
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Alexander HM, Cummings CL, Kahn L, Snow AA. Seed size variation and predation of seeds produced by wild and crop-wild sunflowers. Am J Bot 2001; 88:623-627. [PMID: 11302847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The movement of pollen between crop and wild sunflowers (both Helianthus annuus) has led to concerns about the possible introduction of crop transgenes into wild populations. The persistence of crop traits in wild populations will depend in part on the relative fitness of crop-wild hybrid vs. wild plants. Using seeds from two large experimental field plots, we found that seeds produced by crop-wild plants were twice the size of wild seeds and differed in coloration. Head diameter, date of flowering, identity of mother plant, and levels of predispersal predation explained some variation in mean seed size. We hypothesized that postdispersal vertebrate seed predation would be affected by seed size, with hybrid seeds preferentially eaten. In each of three field trials, significantly more hybrid seeds were eaten (62% of hybrid seed; 42% of wild seed). Within the category of wild seeds, larger seeds were preferentially eaten; however among hybrid seeds, predation was not significantly related to seed size. In this study, differential predation thus reduces hybrid fitness and would presumably slow the spread of transgenes into wild populations.
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Affiliation(s)
- H M Alexander
- Department of Ecology and Evolutionary Biology, University of Kansas, Lawrence, Kansas 66045 USA; and
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Kahn L, Jordaan H. The swallowing and voicing characteristics of pharyngeal dystonia: a single case report. S Afr J Commun Disord 2001; 48:21-31. [PMID: 14968693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
This paper describes the swallowing difficulty and abnormal voicing characteristics of a subject with pharyngeal dystonia. This rare form of dystonia, considered to be a neurological condition resulting in involuntary spasm of the muscles of the pharynx, has not been documented in terms of its effects on the acoustic properties of the voice. This study revealed that during pharyngeal spasm, there are significant delays in voice onset time, a reduction in fundamental frequency, an increased percentage of sub-harmonics and variability in the amplitude perturbation quotient as well as shimmer. There was also evidence of these characteristics during periods of 'spasm-free' voice production, suggesting that the condition might be more consistent than what the subject described. Resonance disturbances were observed in spasm, which might explain the 'hollow' and affected voice quality. The subject also reported severe swallowing difficulties during the periods of spasm, characterised by a tight constriction at the level of the subject's throat. It is clear that an abnormality at the level of the cricopharyngeal muscle has a dual effect on the acoustic properties of the voice and on swallowing.
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Affiliation(s)
- L Kahn
- Department of Speech Pathology and Audiology, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
We report an unusual case of Epstein-Barr virus (EBV)-associated mucosal-associated lymphoid tissue (MALT) lymphoma involving the lungs, kidneys, and axillary lymph nodes in a child with congenital hypoadrenalism and panhypopituitarism. The patient presented with an aggressive clinical course and histologic evolution. Initial biopsies (1994) of the lung and kidney revealed histologic features of low-grade B-cell MALT lymphoma with lymphoepithelial lesions within the renal tubules and bronchial epithelium. Subsequent biopsies (1996, 1997, and 1999) revealed progressively greater cytologic atypia, polymorphism, and necrosis; an increased mitotic rate; and a preponderance of large cells, indicative of progression from a low-grade to a high-grade MALT lymphoma. Immunophenotyping of the lung and lymph node lesions revealed identical surface marker profiles: cells were CD19(+), CD20(+), immunoglobulin (Ig) G(+), kappa(+), lambda(-), CD5(-), CD10(-), CD23(-), and IgM(-), and also negative for T-cell markers. Genotypic analysis demonstrated the presence of immunoglobulin heavy chain rearrangement and monoclonality of EBV in the lung lesion by Southern blot hybridization and polymerase chain re()action (PCR). The clinicopathologic features suggest that these lesions might represent an immunosupression-related continuum of low-grade to high-grade MALT lymphomas. Infection with EBV may have contributed to this tumor's aggressive clinical and histologic evolution.
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MESH Headings
- Biomarkers, Tumor/analysis
- Blotting, Southern
- Cell Transformation, Viral
- Child
- DNA, Neoplasm/analysis
- DNA, Viral/analysis
- Epstein-Barr Virus Infections/genetics
- Epstein-Barr Virus Infections/pathology
- Epstein-Barr Virus Infections/virology
- Fatal Outcome
- Flow Cytometry
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/genetics
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/immunology
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunoenzyme Techniques
- Immunophenotyping
- Kidney Neoplasms/chemistry
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Kidney Neoplasms/virology
- Lung Neoplasms/chemistry
- Lung Neoplasms/genetics
- Lung Neoplasms/pathology
- Lung Neoplasms/virology
- Lymphoma, B-Cell, Marginal Zone/chemistry
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/virology
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Polymerase Chain Reaction
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Affiliation(s)
- J Tao
- Department of Pathology, Long Island Jewish Medical Center, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA
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Bott SR, Kahn L, Copland RF. Metallic stents for malignant and benign ureteric obstruction. BJU Int 2000; 86:407. [PMID: 10930957 DOI: 10.1046/j.1464-410x.2000.00842-8.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tao J, Valderrama E, Kahn L. Congenital acute T lymphoblastic leukaemia: report of a case with immunohistochemical and molecular characterisation. J Clin Pathol 2000; 53:150-2. [PMID: 10767833 PMCID: PMC1763291 DOI: 10.1136/jcp.53.2.150] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A newborn infant with congenital T cell lymphoblastic leukaemia presented with hepatosplenomegaly and pancytopenia at birth and died on the 21st day of multi-organ failure. Biopsy and necropsy examination showed extensive atypical lymphoid infiltrates in the lungs, liver, spleen, kidneys, lymph nodes, and bone marrow. Immunohistochemically, the lymphoid cells were TdT+, CD3+, CD45RO+, and CD10-, CD79a-, CD20-. Genotypic analysis using polymerase chain reaction showed T cell receptor gamma chain gene rearrangement and absence of immunoglobulin heavy chain gene rearrangement. This appears to be the first documented case of congenital T cell lymphoblastic leukaemia. The case had unusual histological and immunogenotypic features, disseminated early, and pursued a highly aggressive course. Consideration of the diagnosis is of paramount importance. The immunophenotypic studies and molecular characterisation of such congenital leukaemias are critical in arriving at a definite diagnosis.
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Affiliation(s)
- J Tao
- Department of Pathology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA
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Kahn L, Baxter FJ, Dauphin A, Goldsmith C, Jackson PA, McChesney J, Miller JD, Takeuchi HL, Young JE. A comparison of thoracic and lumbar epidural techniques for post-thoracoabdominal esophagectomy analgesia. Can J Anaesth 1999; 46:415-22. [PMID: 10349919 DOI: 10.1007/bf03012939] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To compare thoracic epidural analgesia (TEA) using a bupivacaine/fentanyl mixture and lumbar epidural analgesia (LEA) with morphine, in respect to the time to extubation and the quality of post-operative analgesia, in patients having thoracoabdominal esophagectomy. METHODS Twenty two patients scheduled for elective thoracoabdominal esophagectomy were randomized to TEA or LEA. Postoperatively, the TEA group received Patient Controlled Epidural Analgesia (PCEA) with bupivacaine 0.125% and 5 microg x ml(BI) fentanyl, and the LEA group received PCEA with 0.2 microg x ml(BI) morphine. A blinded observer assessed criteria for tracheal extubation and the time of tracheal extubation was recorded. Early extubation was defined as tracheal extubation within four hours postoperatively. Visual analogue pain scores at rest (Static Visual Analogue Pain Scores, SVAPS) and with movement (Dynamic Visual Analogue Pain Scores, DVAPS) were recorded at 1, 6, 12, 18 and 24 hr post-extubation. Failure of the epidural protocol (FEP) was defined as a request for additional analgesia. RESULTS Tracheal extubation was achieved in 70% of the LEA and 100% of the TEA at four hours postoperatively (P=NS). However, the TEA group achieved earlier extubation times when assessed with log rank testing (P = 0.01). By six hours post-extubation FEP had occurred in 50% of the LEA group but in none of the TEA group (P = 0.01). Mean SVAPS and DVAPS were lower in the TEA than in the LEA group at all measured times (P < 0.01). CONCLUSION This study has demonstrated superior pain control in patients undergoing thoraco-abdominal esophagectomy treated with TEA than with LEA, particularly for pain with movement. Tracheal extubation occurred earlier in the TEA group, but this difference was not significant at four hours postoperatively.
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Affiliation(s)
- L Kahn
- Department of Anesthesia, St. Joseph's Hospital, Hamilton, Ontario, Canada.
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Hurtado C, Bradley J, Burns AR, Bradley J, Karkouti K, Hurtado C, Burns AR, Bradley J, Anderson R, Abrahamson SD, Mazer CD, Hung OR, Comeau L, Fisher JA, Tessler J, Rucker J, Mathicu A, Murray-Foster S, Tz-Chong C, Chi-Yuan L, Tsuda T, Tabuchi A, Sasano H, Kiriyama M, Okada A, Hayano J, Takeuchi A, Katsuya H, Tousignant CP, Mazer CD, Tousignant CP, Mazer CD, Ling E, Arellano R, Dowd N, Karski J, Cheng D, Carroll-Munro J, Rose DK, Mazer CO, Cohen MM, Wigglesworth D, McKay WPS, Teskey RJ, Militzer J, Kember G, Blanchet T, Gregson PH, Howells SR, Robblee JA, Breen TW, Dierenfield L, McNeil T, Breen TW, McNeil T, Dierenfield L, Nicholson DJ, Kowalski SE, Hamilton GA, Meyers MP, Serrette C, Duke PC, Custeau I, Martin R, Larabée S, Pirlet M, Pilote M, Tetrault JP, Tsui BCH, Gupta S, Finucane B, Weisbrod MJ, Chan VWS, Kaszas Z, Dragomir C, Cohen MR, Gandhi M, Clanachan AS, Finegan BA, Isaac L, Splinter WM, Hall LA, Gould HM, Rhine EJ, Bergeron L, Girard M, Drolet P, Truong HHL, Boucher C, Vézina D, Lessard MR, Gourdeau M, Trépanier CA, Yang T, Breen TW, Macarthur A, Chouinard P, Fugère F, Ruel M, Tarkkila P, Silvasti M, Tuominen M, Svartling N, Rosenberg PH, Bond DM, Rudan JF, Adams MA, Tsang BK, Keahey W, Gagliese L, Jackson M, Ritvo P, Wowk A, Sandler AN, Katz J, Laffey JG, Boylan JF, Badner NH, Komar WE, Bond DM, Cherry RA, Spadafora SM, Butler RJ, McHardy F, Fortier J, Chung F, Marshall S, Krishnathas A, Wong J, Chung F, Ritchie E, McHardy F, Marshall S, Fortier J, Meikle A, Avery N, van Vlymen J, Parlow JL, Sinclair D, Chung F, Mezei G, Jin F, Chung F, Norris A, Ganeshram T, MacLeod BA, Azmudéh A, Franciosi LG, Ries CR, Schwarz SKW, McKay WPS, Gregson PH, McKay BWS, Blanchet T, Meuret P, Bonhomme V, Plourde G, Fiset P, Backman SB, Vesely A, Takeuchi A, Sommer L, Rucker J, Greenwald J, Lavine E, Iscoe S, Volgyesi G, Fedorko L, Fisher J, Lobato EB, Sulek CA, Davies LK, Gearen PF, Bellemare F, Donati F, Couture J, Joo HS, Rose DK, Kapoor S, Shayan S, Karkouti K, LeDez KM, Au J, Tucker JH, Redmond EB, Gadag V, Penney C, Hare GMT, Lee TDG, Hirsch GM, Yang F, Troncy E, Blaise G, Naito Y, Arisawa S, Ide M, Nakano S, Yamazaki K, Kawamura T, Nara N, Wakusawa R, Inada K, Hudson RJ, Singh K, Harding GA, Henderson BT, Thomson IR, Harding GA, Hudson RJ, Thomson IR, Thomson IR, Singh K, Hudson RJ, Wherrett CG, Miller DR, Giachino AA, Turek MA, Rody K, Vaghadia H, Chan V, Ganapathy S, Lui A, McKenna J, Zimmer K, Schwarz SKW, MacLeod BA, Ries CR, Franciosi LG, Regan WD, Davidson RG, Nevin K, Escobedo S, Mitmaker E, Tessler MJ, Kardash K, Kleiman SJ, Rossignol M, Kahn L, Baxter F, Dauphin A, Goldsmith C, Jackson P, McChesney J, Miller J, Takeuchi L, Young E, Klubien K, Bandi E, Carli F, Dattilo K, Tong D, Bhandari M, Carli F, Klubien K, Mazza L, Wykes L, Sommer LZ, Rucker J, Veseley A, Levene E, Greenwald Y, Volgyesi G, Fedorko L, Iscoe S, Fisher JA, Tian GF, Baker AJ, Reinders FX, Baker AJ, Moulton RJ, Brown JIM, Schlichter L, Troncy E, Van Tulder L, Carignan S, Prénovault J, Collet JP, Shapiro S, Guimond JG, Blait L, Ducruet T, Francœur M, Charbonneau M, Cousineau G, Blaise G, Wong DR, McCall M, Walsh F, Kurian R, Keith M, Sole MJ, Jeejeebhoy KN, Mazer CD, Whitten E, Norman PH, Aucar JA, Coveler LA, Solgonick RM, Bastien Y, Mazer B, Lihara K, Orser BA, Tymianski M, Finucane BT, Zaman N, Kashkari I, Tawfik S, Tarn YK, Slinger PD, McRae K, Winton T, Sandier AN, Zamora JE, Salpeter MJ, Bai D, MacDonald JF, Orser BA, Mayson K, Gofton E, Chambers K, Belo SE, Kay JC, Mazer CD, Hall SRR, Wang L, Milne B, Loomis C, Tsang BK, He Z, Wougchanapai W, Ho IK, Eichhorn JH, Tsang BK, Ma T, Wongchanapai W, He Z, Ho IK, Eicnhorn JH, Tsang BK, Wongchanapai W, He Z, Ho IK, Eichhorn JH, Murphy DB, Murphy MB, Bonhomme V, Meuret P, Backman SB, Plourde G, Fiset P, Stein RD, Backman SB, Collier B, Polosa C, Li CY, Chou TC, Wang JY, Fuller J, Butler R, Spadafora S, Donen N, Brownell L, Donen N, Brownell L, Shysh S, Carter K, Eagle C, Devito I, Halpern S, Devitt JH, Yee DA, deLacy JL, Oxorn DC, Morris GF, Yip RW, Gregoret-Quinn MG, Seal RF, Smith LJ, Jones AB, Tang C, Clanachan AS, Gallant BJ, Nadwidny LA, Goresky GV, Cowtan T, Bridge HS, Montgomery CJ, Kennedy RA, Merrick PM, Yamashita M, Wada K, LeMay S, Hardy JF, Morgan P, Halpern S, Evers J, Ronaldson P, Rose DK, Dexter F, Cohen MM, Wigglesworth D, Writer D, Muir H, Shukla R, Nunn R, Scovil J, Pridham J, Rosaeg O, Sandier A, Morley-Foster P, Lucy S, Crone LA, Zimmer K, Wilson DJ, Heid R, Douglas MJ, Rurak DW, Fabrizi A, Crochetière CT, Roy L, Villeneuve E, Lortie L, Katsiris S, Leighton B, Halpern S, Wilson D, Kronberg J, Swica L, Midgley J, Nunn R, Muir H, Shukla R, Smith B, Rooney ME, Campbell DC, Riben CM, Crone LA, Yip RW, Halpern S, Halpern S, MacDonell J, Levine T, Wilson D. Abstracts. Can J Anaesth 1998. [PMCID: PMC7103902 DOI: 10.1007/bf03019217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
PURPOSE The purpose of this report is to emphasise the role of the Acute Pain Service in managing local anaesthetic epidural infusions for postoperative pain management, the importance of vigilant monitoring, and to offer some guidelines to using local anaesthetic epidural infusions. CLINICAL FEATURES A 34-yr-old man with long-standing insulin dependent diabetes mellitus underwent a total proctocolectomy for inflammatory bowel disease. A T9-10 epidural catheter was placed prior to induction of general anaesthesia. Postoperatively, a continuous epidural infusion of fentanyl/bupivacaine was used for postoperative pain management. Total lithotomy time was four hours. On day four he was noted to have complete right sided femoral and left sided lateral femoral cutaneous nerve of thigh neuropathies. A computerised tomography scan and a magnetic resonance imaging excluded a central lesion. Electromyelography confirmed peripheral nerve injuries. CONCLUSION This patient's neurological deficits were not due to the epidural analgesia. However, epidural infusion of local anaesthetic caused a delay in recognising a potential neurological complication. When using local anaesthetic epidural infusions, it is important to exclude other causes of motor block before attributing it to the local anaesthetic.
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Affiliation(s)
- L Kahn
- Department of Anesthesia, St. Joseph's Hospital, Hamilton, Ontario, Canada.
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Schuval S, Kahn L, Zahtz G, Sood S. Invasive cytomegalovirus infection of the palate in an HIV-infected infant. Pediatr AIDS HIV Infect 1996; 7:266-8. [PMID: 11361720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- S Schuval
- Department of Pediatrics, Schneider Children's Hospital, New Hyde Park, NY, USA
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Johnson H, Belluco C, Masood S, Azama A, Kahn L, Wise L. Preoperative factors of prognostic significance in gastric cancer. J Natl Med Assoc 1995; 87:423-6. [PMID: 7595964 PMCID: PMC2607846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study was undertaken to investigate the ability of local anatomical and primary histological features of gastric cancers, as well as DNA analysis, to predict prognosis. Using multivariate analysis, results indicate that location of a tumor in the gastric cardia, poor differentiation, involvement of adjacent organs, and aneuploidy are all independent predictors of survival. All of the factors studied can be determined by endoscopic procedures preoperatively on patients with gastric cancers and could be helpful in selecting some patients for perioperative adjunctive therapies.
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Affiliation(s)
- H Johnson
- Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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Affiliation(s)
- R Weiss
- Department of Otolaryngology and Communicative Disorders, Long Island Jewish Medical Center, New Hyde Park, NY 11042
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Citron M, Schoenhaus M, Rothenberg H, Kostroff K, Wasserman P, Kahn L, White A, Burns G, Held D, Yarosh D. O6-methylguanine-DNA methyltransferase in normal and malignant tissue of the breast. Cancer Invest 1994; 12:605-10. [PMID: 7994595 DOI: 10.3109/07357909409023045] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
An important component of high-dose chemotherapy/autologous bone marrow support regimens for adjuvant treatment of breast cancer is carmustine. Preclinical studies have shown that the level of the DNA repair protein O6-methylguanine-DNA methyltransferase is correlated with the resistance of cultured human tumor cells to this drug, but little is known about transferase levels of breast tissue in vivo. We measured the DNA repair activity in 80 tissue samples from 65 patients, including normal, abnormal, benign, and malignant specimens. Wide interindividual variations was observed and average transferase levels were similar in normal and benign tissue. However, transferase levels were significantly elevated in stage I-IV disease. In addition, the frequency of samples with no detectable transferase was greatly reduced in this malignant group, and transferase was positively correlated with the presence of positive nodes, a marker for disease progression. In contrast, transferase levels were not correlated with age or estrogen receptor status, and the levels in normal tissue did not vary between patients with benign or malignant disease. These results suggest that this DNA repair activity may be increased in breast cancer relative to normal tissue and encourage further study of the predictive value of transferase measurements in high-dose chemotherapy/autologous bone marrow transplant for breast cancer.
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Affiliation(s)
- M Citron
- Long Island Jewish Medical Center, New Hyde Park, New York Applied Genetics Inc., Freeport, New York
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Jawad AS, Kahn L, Copland RF, Henderson DC, Abdul-Ahad AK. Reactive arthritis associated with Bacillus Calmette-Guerin immunotherapy for carcinoma of the bladder: a report of two cases. Br J Rheumatol 1993; 32:1018-20. [PMID: 8220923 DOI: 10.1093/rheumatology/32.11.1018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- A S Jawad
- Department of Rheumatology, Chase Farm Hospital, Enfield, Middlesex
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Kahn L. Let us now revisit prepaid group practice. Mo Med 1993; 90:589-93. [PMID: 8232163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
American medicine will soon enter health care reform. The Clinton Administration's Task Force on Health Care Reform is likely to introduce change that relies heavily on managed care, a field now dominated by the health insurance industry. Physicians can manage health care themselves by forming Prepaid Group Practices (PGPs). PGPs combine health insurance functions with physician managed health care. They can negotiate directly with health care purchasers, thereby abrogating the commercial health insurance industry.
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Affiliation(s)
- L Kahn
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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Abstract
Tumors in the gastric cardia and the body/antrum were studied to determine the effect of ploidy and S-phase fractions on patient survival. Forty-two percent of tumors were located in the cardia and 58% in the body/antrum. Nodal metastases occurred more often with cardia tumors than with body/antrum tumors (86% vs 65%). Aneuploidy occurred more frequently in patients with cardia tumors than in patients with body/antrum tumors (39% vs 20%). Metastasis to lymph nodes was more common in patients with aneuploidy than in patients with diploidy (31% vs 7%). S-phase fractions were not different between aneuploid and diploid tumors. More patients with diploid cancer were alive at 5 years than were patients with aneuploid tumors (90% vs 10%). We conclude that primary cellular differences in gastric tumors of the cardia or body/antrum determine patient survival.
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Affiliation(s)
- H Johnson
- Department of Surgery, Long Island Jewish Medical Center, Albert Einstein College of Medicine, NY
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Citron M, Schoenhaus M, Graver M, Hoffman M, Lewis M, Wasserman P, Niederland M, Kahn L, White A, Yarosh D. O6-methylguanine-DNA methyltransferase in human normal and malignant lung tissues. Cancer Invest 1993; 11:258-63. [PMID: 8485648 DOI: 10.3109/07357909309024850] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M Citron
- Division of Hematology/Oncology, Long Island Jewish Medical Center, New Hyde Park, New York 11042
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Abstract
One hundred patients with node-negative breast cancer were examined to analyze the influence of tumor size, nuclear grade, and DNA content determined by flow cytometry on overall survival. Patients with diploid cancers lived significantly longer than those with aneuploid cancers (126 +/- 8 vs 80 +/- 11 months). Patients with an S-phase fraction less than 10% lived significantly longer than those with S-phase fractions 10% or greater (122 +/- 8 vs 85 +/- 10 months). Tumor size had the major impact on survival, and multivariate analysis of variance by the Cox proportional hazards model showed the greatest effect on prognosis. Tumor grade did not significantly influence overall survival.
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Affiliation(s)
- H Johnson
- Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, NY
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