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Megla E, Greenberg R, Bainbridge WA. Dissociation between object detail and spatial memory across exposure time using drawing. J Vis 2022. [DOI: 10.1167/jov.22.14.4216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Abstract
In March 2020, the Toronto Region COVID-19 Hospital Operations Table developed a policy to guide visitor restrictions at six hospitals (Toronto Region COVID-19 Hospital Operations Table 2021). We conducted nine interviews with the developers and implementers of the policy based on the accountability for reasonableness (A4R) framework. Participants agreed that the A4R principles were met suggesting fair development and implementation of the policy. However, recurrent themes suggested that the policy disadvantaged those unable to advocate for themselves and that there were unaccounted costs to patients, such as lost time and function. We suggest that visitor policies incorporate equity considerations upfront and predetermine metrics to measure harms to patients.
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Affiliation(s)
- Vivian Tam
- An emergency medicine physician at the University of Ottawa in Ottawa, ON. She can be reached by e-mail at
| | - Rebecca Greenberg
- An associate professor in the Department of Paediatrics at the University of Toronto in Toronto, ON
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Greenberg R, Goldberg A, Anthony S, Buchman DZ, Delaney S, Gruben V, Holdsworth S, Le Foll B, Leung M, Lien D, Lynch MJ, Selzner N, Chandler JA, Fortin MC. Canadian Society of Transplantation White Paper: Ethical and Legal Considerations for Alcohol and Cannabis Use in Solid Organ Listing and Allocation. Transplantation 2021; 105:1957-1964. [PMID: 33587429 PMCID: PMC8376271 DOI: 10.1097/tp.0000000000003618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue. Until recently, patients in Canada with alcohol-associated liver disease were required to demonstrate abstinence for 6 mo to receive a liver transplant. There is no equivalent rule that is applied consistently for cannabis use. There is some evidence that alcohol and cannabis use disorder pretransplant could be associated with worse outcomes posttransplantation. However, early liver transplantation for patients with alcohol-associated liver disease in France and in the United States has led to challenges of the 6-mo abstinence rule in Canada in the media. It has also resulted in several legal challenges arguing that the rule violates human rights laws regarding discrimination in the provision of medical services and that the rule is also unconstitutional (this challenge is still before the court). Recent legalization of cannabis use for adults in Canada has led to questions about the appropriateness of limiting transplant access based on cannabis use. The ethics committee of the Canadian Society of Transplantation was asked to provide an ethical analysis of cannabis and alcohol abstinence policies. Our conclusions were as follows: neither cannabis use nor the 6-mo abstinence rule for alcohol use should be an absolute contraindication to transplantation, and transplant could be offered to selected patients, further research should be conducted to ensure evidence-based policies; and the transplant community has a duty not to perpetuate stigma associated with alcohol and cannabis use disorders.
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Affiliation(s)
- Rebecca Greenberg
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Aviva Goldberg
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Samantha Anthony
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
| | - Daniel Z. Buchman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | | | - Vanessa Gruben
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Sandra Holdsworth
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Bernard Le Foll
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Dale Lien
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Marie-Josee Lynch
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Research Institute, Toronto, ON, Canada
| | - Nazia Selzner
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Toronto General Research Institute, Toronto, ON, Canada
| | - Jennifer A. Chandler
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Chantal Fortin
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Centre de recherche du CHUM, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, QC, Canada
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Jeffs L, Merkley J, Greenberg R, Ginty L, Amaral N, Maunder R, Wiesenfeld L, Brown S, Shing P, Ronald K. An Academic Health Sciences Centre's Strategy to Enhance Nurse Resilience and Psychological Safety. ACTA ACUST UNITED AC 2021; 34:39-44. [PMID: 34197293 DOI: 10.12927/cjnl.2021.26531] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The rapid cadence of change and the fear of acquiring and spreading COVID-19 - coupled with moral distress exacerbated by fulfilling one's duty to care under extremely challenging conditions - continue to impact nurses' coping ability, resilience and psychological safety globally (McDougall et al. 2020). This paper provides an overview of how an academic health sciences centre (AHSC) has responded to the evolving waves of the COVID-19 pandemic. Specifically, we share our context and the strategies we used to build and enhance nurse resilience and psychological safety at the organizational, clinical team and individual levels. This is followed by a description of our nurses' achievements amid the pandemic.
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Affiliation(s)
- Lianne Jeffs
- Research and Innovation Lead Scholar in Residence, Nursing and Health Disciplines, Senior Clinician Scientist, Lunenfeld-Tanenbaum Research, Sinai Health, Associate Professor, Bloomberg Faculty of Nursing, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON
| | - Jane Merkley
- Executive Vice President, Chief Nurse, Executive and Chief Operating Officer, Sinai Health, Toronto, ON
| | - Rebecca Greenberg
- Senior Bioethicist, Sinai Health, Associate Professor, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON
| | - Leanne Ginty
- Director, Professional Practice, Nursing, Sinai Health, Toronto, ON
| | - Nely Amaral
- Director, Nursing, Quality and Performance, Magnet Program Director, Sinai Health, Toronto, ON
| | - Robert Maunder
- Chair in Health and Behaviour, Deputy Psychiatrist-in-Chief and Head of Psychiatry Research, Sinai Health, Professor, Department of Psychiatry, University of Toronto, Toronto, ON
| | - Lesley Wiesenfeld
- Psychiatrist-in-Chief Head, Geriatric Psychiatry Consultation, Liaison Service, Sinai Health, Associate Professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON
| | - Susan Brown
- Executive Vice President, People & Culture, Chief Human Resources Officer, Sinai Health, Toronto, ON
| | - Paula Shing
- Interim Director, Professional Practice and Education, Nursing and Health Disciplines, Sinai Health, Toronto, ON
| | - Kara Ronald
- Vice President, Professional Practice, Nursing and Health Disciplines, Sinai Health, Toronto, ON
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Greenberg R, Ballesteros-Gallego F, Allard J, Fortin MC. Organ Transplantation for Foreign Nationals in Canada: A Survey of Transplant Professionals. Can J Kidney Health Dis 2019; 6:2054358119859530. [PMID: 31308952 PMCID: PMC6607567 DOI: 10.1177/2054358119859530] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Transplantation for foreign nationals (non-citizens and non-residents) (FNs) in Canada is a complex issue. Currently, there are no Canadian guidelines for the provision of organ transplantation for FNs, and no empirical data on this issue or on transplant professionals’ practices are available. Objective: This project aimed to gather empirical data on transplant professionals’ perspectives and practices regarding transplantation for FNs. Design: Survey research design. Setting: A Web-based survey of members of the Canadian Society of Transplantation (CST). Participants: All members of the CST were invited to participate between April and June 2016. Measurements: Multiple-choice questions were developed to capture participants’ attitudes toward different fictitious clinical scenarios in which an FN needed a transplant, their experiences with FNs, their attitude toward FNs in need of transplantation, their knowledge about relevant institutional and organ donation organization (ODO) policies, and their perspectives on a quota. There were two questions with a five-point Likert scale to measure respondents’ agreement with statements related to possible policy options and arguments for and against transplantation for FNs. There was one open-ended question about the content of transplant programs’ policies on transplantation for FNs. Methods: Descriptive statistical analysis were performed. Results: A total of 87 transplant professionals completed the survey. Over the 4-year period from 2012 to 2016, 47.1% of respondents dealt with at least one situation of listing or performing a transplant for an FN. Only 19.5% of respondents reported that their transplant program had a policy about transplantation for FNs and 59.7% did not know if their ODO had such a policy. When asked about policy options, 47.5% disagreed with a policy of no transplantation for FNs and 41.4% agreed with offering transplantation for FNs in some circumstances (including life-saving and non–life-saving organs). Study participants agreed that transplantation should not be offered to FNs traveling to Canada specifically for transplantation, that FNs should not be transplanted with organs not suitable for Canadian citizens and that there should not be a transplantation quota for FNs. Participants also seem to be more inclined to offer transplantation of life-saving organs, particularly for children. Limitations: The major limitation of this study is the low response rate of transplant professionals to this survey. Conclusion: This is the first study to describe Canadian transplant professionals’ perspectives on transplantation for FNs. The findings of this study will be of interest for future policy development on access to transplantation for FNs. Further studies are needed to gather various key stakeholders’ perspectives on this issue, as well as to analyze the legal and ethical issues and the economics, to develop future policies.
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Affiliation(s)
- Rebecca Greenberg
- Department of Bioethics, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, ON, Canada.,The Canadian Donation and Transplant Research Program, Edmonton, AB, Canada
| | - Fabián Ballesteros-Gallego
- The Canadian Donation and Transplant Research Program, Edmonton, AB, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Julie Allard
- The Canadian Donation and Transplant Research Program, Edmonton, AB, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Marie-Chantal Fortin
- The Canadian Donation and Transplant Research Program, Edmonton, AB, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Université de Montréal, QC, Canada
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Young RC, Mulsant BH, Sajatovic M, Gildengers AG, Gyulai L, Al Jurdi RK, Beyer J, Evans J, Banerjee S, Greenberg R, Marino P, Kunik ME, Chen P, Barrett M, Schulberg HC, Bruce ML, Reynolds CF, Alexopoulos GS. GERI-BD: A Randomized Double-Blind Controlled Trial of Lithium and Divalproex in the Treatment of Mania in Older Patients With Bipolar Disorder. Focus (Am Psychiatr Publ) 2019; 17:314-321. [PMID: 32015723 PMCID: PMC6996060 DOI: 10.1176/appi.focus.17308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Reprinted with permission from Am J Psychiatry 2017; 174:1086-1093).
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Bianchi A, Greenberg R. Deceased-directed donation: Considering the ethical permissibility in a multicultural setting. Bioethics 2019; 33:230-237. [PMID: 30033562 DOI: 10.1111/bioe.12476] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/22/2018] [Accepted: 05/20/2018] [Indexed: 06/08/2023]
Abstract
This paper explores the ethics of deceased-directed donation (DDD) and brings a unique perspective to this issue-the relevance of providing family-centered care and culturally sensitive care to deceased donors, potential recipients, and their families. The significance of providing family-centered care is becoming increasingly prevalent, specifically in pediatric healthcare settings. Therefore, this topic is especially relevant to those working with and interested in pediatrics. As the world is becoming more diverse with globalization, assessing the cultural aspect of the ethics of DDD is increasingly salient. We provide a brief overview of DDD across the globe, review prominent arguments both for and against DDD, consider family-centered and culturally specific considerations, and offer considerations for the development of a policy or guideline. We determine that the practice of DDD is ethically defensible in certain circumstances and congruent with providing both family-centered and culturally sensitive care. Our analysis is relevant to any country with a diverse population and any healthcare provider or institution that operates under a framework of family-centered care, such as those in pediatric hospitals.
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Affiliation(s)
- Andria Bianchi
- Department of Philosophy, University of Waterloo, Waterloo, Canada
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Abstract
A 62-year-old man with a history of non-insulin-dependent diabetes mellitus, hypertension and obesity, presented for elective lumbar laminectomy for spinal canal stenosis. Twenty minutes after placement in the prone position, he developed left orbital proptosis. The surgery was deferred and a subsequent CT scan showed an orbital haemangioma. This case highlights the importance of meticulous attention to eye-care for patients in the prone position.
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Affiliation(s)
- R Greenberg
- Department of Anaesthesia and Pain Medicine, Alfred Hospital, Commercial Road, Melbourne, Vic. 3181
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Zhang E, DeMora L, Wong J, Al-Saleem T, Greenberg R, Kutikov A, Horwitz E, Hayes S. Definitive Radiation Therapy for Ductal (Endometrioid) Carcinoma of the Prostate: A Matched-Pair Analysis. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.297] [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: 10/28/2022]
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Patankar S, Verma P, Mach R, Greenberg R, Makvandi M. Understanding resistance to PARPi using a novel radiotracer based methodology. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Young RC, Mulsant BH, Sajatovic M, Gildengers AG, Gyulai L, Al Jurdi RK, Beyer J, Evans J, Banerjee S, Greenberg R, Marino P, Kunik ME, Chen P, Barrett M, Schulberg HC, Bruce ML, Reynolds CF, Alexopoulos GS. GERI-BD: A Randomized Double-Blind Controlled Trial of Lithium and Divalproex in the Treatment of Mania in Older Patients With Bipolar Disorder. Am J Psychiatry 2017; 174:1086-1093. [PMID: 29088928 PMCID: PMC6214451 DOI: 10.1176/appi.ajp.2017.15050657] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Clinicians treating older patients with bipolar disorder with mood stabilizers need evidence from age-specific randomized controlled trials. The authors describe findings from a first such study of late-life mania. METHOD The authors compared the tolerability and efficacy of lithium carbonate and divalproex in 224 inpatients and outpatients age 60 or older with bipolar I disorder who presented with a manic, hypomanic, or mixed episode. Participants were randomly assigned, under double-blind conditions, to treatment with lithium (target serum concentration, 0.80-0.99 mEq/L) or divalproex (target serum valproate concentration, 80-99 μg/mL) for 9 weeks. Participants with an inadequate response after 3 weeks received open adjunctive risperidone. The authors hypothesized that divalproex would be better tolerated and more efficacious than lithium. Tolerability was assessed based on a measure of sedation and on the proportions of participants achieving target concentrations. Efficacy was assessed with the Young Mania Rating Scale (YMRS). RESULTS Attrition rates were similar for lithium and divalproex (14% and 18% at week 3 and 51% and 44% at week 9, respectively). The groups did not differ significantly in sedation. Participants in the lithium group tended to experience more tremor. Similar proportions of participants in the lithium and divalproex groups achieved target concentrations (57% and 56%, respectively). A longitudinal mixed model of improvement (change from baseline in YMRS score) favored lithium (change in score, 3.90; 97.5% CI=1.71, 6.09). Nine-week response rates did not differ significantly between the lithium and divalproex groups (79% and 73%, respectively). The need for adjunctive risperidone was low and similar between groups (17% and 14%, respectively). CONCLUSIONS Both lithium and divalproex were adequately tolerated and efficacious; lithium was associated with a greater reduction in mania scores over 9 weeks.
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Affiliation(s)
- Robert C Young
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Benoit H Mulsant
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Martha Sajatovic
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Ariel G Gildengers
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Laszlo Gyulai
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Rayan K Al Jurdi
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - John Beyer
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Jovier Evans
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Samprit Banerjee
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Rebecca Greenberg
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Patricia Marino
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Mark E Kunik
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Peijun Chen
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Marna Barrett
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Herbert C Schulberg
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Martha L Bruce
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Charles F Reynolds
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - George S Alexopoulos
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
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Lee D, Li T, Hallman M, Chen D, Dong Y, Leachman B, Veltchev I, Greenberg R, Sobczak M, Horwitz E. Comparison of Toxicities in High Dose Rate Versus Low Dose Rate Brachytherapy as Monotherapy in Patients with Low to Favorable Intermediate Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1204] [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: 11/28/2022]
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Magliocco A, Moughan J, Simko J, Efstathiou J, Gray P, Hagan M, Kaufman D, Tester W, Zietman A, McCarthy S, Hartford A, Patel A, Rosenthal S, McGowan D, Greenberg R, Schwartz M, Augspurger M, Keech J, Winter K, Shipley W. The Impact of MRE11 in Nuclear to Cytoplasmic Ratio on Outcomes in Muscle Invasive Bladder Cancer: an Analysis of NRG/RTOG 8802, 8903, 9506, 9706, 9906, and 0233. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fortin MC, Buchman D, Wright L, Chandler J, Delaney S, Fairhead T, Gallaher R, Grant D, Greenberg R, Hartell D, Holdsworth S, Landsberg D, Paraskevas S, Tibbles LA, Young K, West L, Humar A. Public Solicitation of Anonymous Organ Donors. Transplantation 2017; 101:17-20. [DOI: 10.1097/tp.0000000000001514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maluki A, Greenberg R, Dodd E, Williams J, Ericson M. 514 Non-traditional skin striae as a manifestation of bartonellosis. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.551] [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: 11/29/2022]
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17
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Haseebuddin M, Uzzo R, Egleston B, Waingankar N, Viterbo R, Greenberg R, Chen D, Smaldone M, Kutikov A. 1024 Tumor anatomic complexity is a predictor of malignancy but not tumor grade in patients with small renal masses (SRMs). ACTA ACUST UNITED AC 2015. [DOI: 10.1016/s1569-9056(15)61012-0] [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: 10/23/2022]
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18
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Chang L, Li T, Horwitz E, Chen D, Viterbo R, Kutikov A, Greenberg R, Buyyounouski M. Toxicity and Biochemical Failure Following Image-Guided Prostate Intensity Modulated Radiation Therapy: Fiducial Markers Versus Electromagnetic Transponders. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.967] [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: 11/17/2022]
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Johnston CI, Brown SGA, O'Leary MA, Currie BJ, Greenberg R, Taylor M, Barnes C, White J, Isbister GK. Mulga snake (Pseudechis australis) envenoming: a spectrum of myotoxicity, anticoagulant coagulopathy, haemolysis and the role of early antivenom therapy - Australian Snakebite Project (ASP-19). Clin Toxicol (Phila) 2013; 51:417-24. [PMID: 23586640 DOI: 10.3109/15563650.2013.787535] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Mulga snakes (Pseudechis australis) are venomous snakes with a wide distribution in Australia. Objective. The objective of this study was to describe mulga snake envenoming and the response of envenoming to antivenom therapy. MATERIALS AND METHODS Definite mulga bites, based on expert identification or venom-specific enzyme immunoassay, were recruited from the Australian Snakebite Project. Demographics, information about the bite, clinical effects, laboratory investigations and antivenom treatment are recorded for all patients. Blood samples are collected to measure the serum venom concentrations pre- and post-antivenom therapy using enzyme immunoassay. RESULTS There were 17 patients with definite mulga snake bites. The median age was 37 years (6-70 years); 16 were male and six were snake handlers. Thirteen patients had systemic envenoming with non-specific systemic symptoms (11), anticoagulant coagulopathy (10), myotoxicity (7) and haemolysis (6). Antivenom was given to ten patients; the median dose was one vial (range, one-three vials). Three patients had systemic hypersensitivity reactions post-antivenom. Antivenom reversed the coagulopathy in all cases. Antivenom appeared to prevent myotoxicity in three patients with high venom concentrations, given antivenom within 2 h of the bite. Median peak venom concentration in 12 envenomed patients with samples was 29 ng/mL (range, 0.6-624 ng/mL). There was a good correlation between venom concentrations and the area under the curve of the creatine kinase for patients receiving antivenom after 2 h. Higher venom concentrations were also associated with coagulopathy and haemolysis. Venom was not detected after antivenom administration except in one patient who had a venom concentration of 8.3 ng/ml after one vial of antivenom, but immediate reversal of the coagulopathy. DISCUSSION Mulga snake envenoming is characterised by myotoxicity, anticoagulant coagulopathy and haemolysis, and has a spectrum of toxicity that is venom dose dependant. This study supports a dose of one vial of antivenom, given as soon as a systemic envenoming is identified, rather than waiting for the development of myotoxicity.
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Affiliation(s)
- C I Johnston
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, NSW, Australia
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Mehrazin R, Plimack E, Kutikov A, Tomaszewski J, Hoffman-Censits J, Viterbo R, Greenberg R, Ginzburg S, Corcoran A, Lallas C, Trabulsi E, Wong YN, Boorjian S, Smaldone M, Uzzo R, Chen D. 522 NEOADJUVANT ACCELERATED MVAC IN PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER: A MULTI-INSTITUTIONAL PROSPECTIVELY ACCRUED COHORT. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Greenberg R. 2666 – How pediatric bipolar disorder and pandas/pans symptoms overlap and can cause diagnostic confusion. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)77292-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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22
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Avital S, Inbar R, Karin E, Greenberg R. Is Doppler ultrasonography essential for hemorrhoidal artery ligation? Tech Coloproctol 2012; 16:291-4. [PMID: 22653264 DOI: 10.1007/s10151-012-0844-3] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 05/08/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Doppler ultrasonography enables accurate identification of the terminal branches of the superior rectal artery prior to hemorrhoidal artery ligation (HAL). However, since the positions of these branches have been found to be relatively constant, the question arises as to the necessity of ultrasonography for their identification. The aim of the current study was to examine the positions of all arteries identified and ligated during the HAL procedure. METHODS We recorded the position of all arteries located and ligated in 135 consecutive patients who underwent the HAL procedure during the years 2003 to 2006. RESULTS In all patients, 6-8 terminal arterial branches were located above the dentate line. In 102 (76 %) patients, terminal branches were located in all 6 of the odd-numbered clock positions around the anus (1, 3, 5, 7, 9, and 11 o'clock in the lithotomy position). If we had ligated arteries only at these odd-numbered clock positions, without using Doppler ultrasonography, we would have located all the arteries in 96 (71 %) of our patients. CONCLUSIONS The number and location of arterial branches of the superior rectal artery are relatively constant. Nevertheless, if, Doppler ultrasonography had not been performed and, ligation in the HAL procedure had been at the odd-numbered clock positions only, then at least one artery would have been missed in 29 % of our patients.
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Affiliation(s)
- S Avital
- Department of Surgery 'A', Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weitzman Street, 64239, Tel-Aviv, Israel
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Avital S, Inbar R, Karin E, Greenberg R. Five-year follow-up of Doppler-guided hemorrhoidal artery ligation. Tech Coloproctol 2011; 16:61-5. [PMID: 22190190 DOI: 10.1007/s10151-011-0801-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 12/05/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Doppler-guided hemorrhoidal artery ligation (DGHAL) was described as lower risk and a less painful alternative to hemorrhoidectomy. We report our experience and 5-year follow-up with this procedure. METHODS Between May 2003 and December 2004, 100 patients with symptomatic Grade II or III hemorrhoids underwent ultrasound identification and ligation of 6-8 terminal branches of the superior rectal artery above the dentate line by a single surgeon using local, regional, or general anesthesia. There were 42 men and 58 women (mean age 42 years, median duration of symptoms 6/3 years). A 10-point visual analog scale was used for postoperative pain scoring. Surgical and functional outcome was assessed at 6 weeks and 3 and 12 months after surgery, with long-term follow-up by a telephone questionnaire at 5 years after the procedure. RESULTS The mean operative time was 19 min. Local anal block combined with intravenous sedation (n = 93) or general or spinal (n = 7) anesthesia was used. Only 5 patients were hospitalized overnight. There was no urinary retention, bleeding, or mortality in the immediate postoperative period. The mean pain score decreased from 2.1 at 2 h postoperatively to 1.3 on the first postoperative day. All patients had complete functional recovery by the third postoperative day. Ninety-six patients completed 12 months of follow-up. Eighty-five of these patients (89%) remained asymptomatic at 12 months, though this number dropped to 67/92 (73%) at 5 years. CONCLUSIONS Long-term follow-up confirms the effectiveness of the DGHAL procedure for treatment for Grade II hemorrhoids. The DGHAL procedure alone seems less effective for Grade III hemorrhoids.
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Affiliation(s)
- S Avital
- Department of Surgery A, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 64239, Tel Aviv, Israel
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Abstract
AIM Stapled haemorrhoidopexy (SH) is associated with minor postoperative pain and high overall satisfaction rates. Some patients will have persistent or recurrent symptoms requiring re-intervention. METHOD All patients who underwent SH for grade III internal haemorrhoids and required a second SH (2005-2008) were studied. Grade IV patients were excluded. Data on surgical technique, postoperative pain, complications, time to first bowel movement, functional recovery and suspected reason for first SH failure were retrieved from medical records. Similar data were collected for the second procedure at four postoperative follow-up visits. RESULTS Twelve patients were enrolled. The mean time to recurrent symptoms was 15 months. The indications for repeated surgery were bleeding, prolapse, and pruritus w/wo discharge. Recurrence was attributed to a too high staple line in the first procedure (n = 4) and an incomplete resected ring (n = 1). The median operative time of the second procedure was 24 min (17-29) and the median follow up was 20 ± 4.3 months (15-30). Repeat SH was associated with higher pain scores, more analgesic requirements, and longer recovery period compared to the first procedure. There were no early or late postoperative complications. Histological examination of the 12 tissue doughnuts resected during the second SH showed no smooth muscle fibres in any of the patients. After 12 months of follow up, 10 patients with repeated SH remained asymptomatic, while 2 had recurrent bleeding. CONCLUSION Repeat SH can be performed safely and reliably without risk of complications, but the second SH is associated with more pain and longer recovery time.
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Affiliation(s)
- I White
- Department of Surgery A, Tel-Aviv Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Avital S, Itah R, Skornick Y, Greenberg R. Outcome of stapled hemorrhoidopexy versus doppler-guided hemorrhoidal artery ligation for grade III hemorrhoids. Tech Coloproctol 2011; 15:267-71. [PMID: 21678068 DOI: 10.1007/s10151-011-0699-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 05/30/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the long-term results, early and late complication rates, and overall satisfaction of patients with grade III hemorrhoids treated by stapled hemorrhoidopexy (SH) or Doppler-guided hemorrhoidal artery ligation (DGHAL). METHODS Operative and follow-up patients' data were prospectively collected for patients undergoing either SH or DGHAL by a single surgeon during a 2-year period. A retrospective comparison between patients' outcome operated by one of the two methods was made based on this data. Clinical data on postoperative pain, analgesic requirements, time to first bowel movement and functional recovery were collected at five postoperative follow-up visits (1 and 6 weeks, 6, 12, and 18 months). Data on patient satisfaction, recurrence of hemorrhoidal symptoms and further treatments were obtained by a standardized questionnaire that was conducted during the last visit 18 months postoperatively. RESULTS A total of 63 patients underwent SH (aged 52 ± 3.2 years) and 51 patients underwent DGHAL (aged 50 ± 7.3 years). DGHAL patients experienced less postoperative pain as scored by pain during bowel movement (2.1 ± 1.4 vs. 5.5 ± 1.9 for SH), and required fewer analgesics postoperatively. Hospital stay, time to first bowel movement, and complete functional recovery were also significantly shorter for the DGHAL patients. Nine DGHAL patients (18%) suffered from persistent bleeding or prolapses and required additional treatment compared with 2 (3%) patients in the SH group. SH patients reported greater satisfaction compared with DGHAL patients at 1 year postoperatively. CONCLUSION Both SH and DGHAL are safe procedures and have similar effectiveness for treating grade III hemorrhoids. DGHAL is less painful and provides earlier functional recovery, but is associated with higher recurrence rates and lower satisfaction rates compared with SH.
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Affiliation(s)
- S Avital
- Department of Surgery A, Tel-Aviv Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weitzman Street, 64239, Tel-Aviv, Israel
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Keller L, Ruth K, Horwitz E, Pollack A, Watkins-Bruner D, Konski A, Greenberg R, Price R, Buyyounouski M. The Stamp Test Delivers the Message on Erectile Dysfunction following High Dose IMRT. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1390] [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: 11/29/2022]
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Fragaszy DM, Greenberg R, Visalberghi E, Ottoni EB, Izar P, Liu Q. How wild bearded capuchin monkeys select stones and nuts to minimize the number of strikes per nut cracked. Anim Behav 2010. [DOI: 10.1016/j.anbehav.2010.04.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
I hand-raised chestnut-sided warblers (Dendroica pensylvanica) in a room with eight experimental microhabitats; the microhabitats were removed after 6 weeks. I then measured the response of the warblers to the eight "natal" and eight "novel" microhabitats in two experiments conducted 2 and 4 months after removal. Chestnut-sided warblers responded with decreased feeding latency (neophobia) and a greater preference for foraging at the natal microhabitats. I suggest that an ontogenetic increase in neophobia restricts chestnut-sided warblers to foraging at microhabitats most similar to those experienced as juveniles.
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Affiliation(s)
- R Greenberg
- Department of Zoological Research, National Zoological Park, Smithsonian Institution, Washington, DC 20008
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Belani CP, Waterhouse DM, Ghazal H, Ramalingam SS, Bordoni R, Greenberg R, Levine RM, Waples JM, Jiang Y, Reznikoff G. Phase III study of maintenance gemcitabine (G) and best supportive care (BSC) versus BSC, following standard combination therapy with gemcitabine-carboplatin (G-Cb) for patients with advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7506] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Greenwald S, Horsager A, Humayun M, Greenberg R, McMahon M, Fine I. Brightness as a function of current amplitude in human retinal electrical stimulation. J Vis 2010. [DOI: 10.1167/9.8.1054] [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: 11/24/2022] Open
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Toofan M, Bhakta N, Greenberg R, Rush C, Kjar D, Drigalla D. 204: Endotracheal Intubation Success in an Ambulance by Emergency Medical Out-of-Hospital Personnel Using Direct and Glidescope® Laryngoscopes. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.233] [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: 11/25/2022]
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Patel P, Melissa S, Brunko M, Domeier R, Funk D, Greenberg R, Judge T, Lowell M, MacDonald R, Madden J, Thomas S, Howard Z. 196: Intubation Success Rates in Helicopter Emergency Medical Services: A Prospective Multicenter Analysis. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.224] [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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Greenberg R. Recognizing the Similarities and Differences Between Pediactric Bipolar Disorder (PBPD) and Autistic Spectrum Disorders (ASD). Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70812-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Recent studies have indicated a significant increase in the number of children diagnosed with psychiatric disorders. This is especially true for pediatric bipolar disorder and autistic spectrum disorders this includes autism, Asperger's and pervasive developmental disorder not otherwise specified. The purpose of this presentation is to define these two disorders and help elucidate the overlap and the differences between them, as well as help elucidate when a youngsters has both.On the surface these two diagnoses can look quite similar. In both the child can show signs of inappropriate and an excessive of response to frustration, overreaction to sensory stimuli, and rigid behavior with difficulty accepting change and transitions, as well as an intense and obsessional interest in certain topics. Sleep difficulties, limited eating repetitore, problems with inattention, poor social skills etc. are also common to both disorders. The number of children that have both disorders is still unknown but clinically appears more common than previously believed. The importance of recognizing the coexistence of both disorders can have a major effect on the approach to treatment and the individual's resultant level of functioning.This presentation will address the following question:1.How are BPD and ASD identified?2.What are the differences between adult and pediatric bipolar disorder?3.In what ways do the symptoms of PBPD and ASD overlap?4.How does one separate the two disorders?5.When should both diagnoses be given?6.How does having both affect the approach to treatment?
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Buyyounouski M, Li T, Al-Saleem T, Horwitz E, Konski A, Feigenberg S, Uzzo R, Greenberg R, Pollack A. Predicting Local Persistence of Intermediate and High-risk Prostate Cancer using Percentage of Adenocarcinoma in Pretreatment Biopsy Tissue. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1103] [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: 10/21/2022]
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Czuczman MS, Reeder CB, Polikoff J, Chowhan NM, Esseessee I, Greenberg R, Ervin-Haynes A, Pietronigro D, Zeldis JB, Witzig TE. International study of lenalidomide in relapsed/refractory aggressive non-Hodgkin’s lymphoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Greenberg R. Is it pediatric bipolar disorder, ADHD or both? Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.413] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hurford TA, Helfenstein P, Hoppa GV, Greenberg R, Bills BG. Eruptions arising from tidally controlled periodic openings of rifts on Enceladus. Nature 2007; 447:292-4. [PMID: 17507977 DOI: 10.1038/nature05821] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 03/30/2007] [Indexed: 11/09/2022]
Abstract
In 2005, plumes were detected near the south polar region of Enceladus, a small icy satellite of Saturn. Observations of the south pole revealed large rifts in the crust, informally called 'tiger stripes', which exhibit higher temperatures than the surrounding terrain and are probably sources of the observed eruptions. Models of the ultimate interior source for the eruptions are under consideration. Other models of an expanding plume require eruptions from discrete sources, as well as less voluminous eruptions from a more extended source, to match the observations. No physical mechanism that matches the observations has been identified to control these eruptions. Here we report a mechanism in which temporal variations in tidal stress open and close the tiger-stripe rifts, governing the timing of eruptions. During each orbit, every portion of each tiger stripe rift spends about half the time in tension, which allows the rift to open, exposing volatiles, and allowing eruptions. In a complementary process, periodic shear stress along the rifts also generates heat along their lengths, which has the capacity to enhance eruptions. Plume activity is expected to vary periodically, affecting the injection of material into Saturn's E ring and its formation, evolution and structure. Moreover, the stresses controlling eruptions imply that Enceladus' icy shell behaves as a thin elastic layer, perhaps only a few tens of kilometres thick.
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Affiliation(s)
- T A Hurford
- Planetary Geodynamics Laboratory, NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA.
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Affiliation(s)
- R Greenberg
- Departments of Genetics, University of Wisconsin, Madison, Wisconsin
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Greenberg R, Grossman Z, Goldstein L, Berkovitch M, Kozer E. How much acetaminophen do paediatricians prescribe? A survey among Israeli paediatricians. J Clin Pharm Ther 2005; 30:443-6. [PMID: 16164490 DOI: 10.1111/j.1365-2710.2005.00661.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/28/2022]
Abstract
OBJECTIVE To describe the current practice of Israeli paediatricians regarding acetaminophen dosing. METHODS A cross-sectional survey among 200 paediatricians. The paediatricians were questioned of the recommended dose of acetaminophen, and whether they give prescriptions for acetaminophen and instruct their patients how to use it. RESULTS The response rate was 36%. When asked on the recommended dose of acetaminophen, 30 (42%) physicians gave doses different from the dose recommended by the Israeli formulary. Thirty (42%) of the paediatricians answered that they usually or always give prescriptions for antipyretics. CONCLUSIONS A large percentage of Israeli paediatricians do not provide parents proper instructions regarding the correct dosing of acetaminophen.
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Affiliation(s)
- R Greenberg
- Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center, Zerifin, Israel
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40
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Pujana MA, Han JDJ, Starita LM, Tewari M, Ahn JS, Assmann V, ElShamy WM, Rual JF, Gelman R, Gunsalus K, Greenberg R, Bohian B, Bertin N, Ayivi-Guedehoussou N, Nathanson KL, Weber BL, Hill DE, Livingston DM, Parvin JD, Vidal M. A model of the BRCA1/BRCA2 network. Breast Cancer Res 2005. [PMCID: PMC4233616 DOI: 10.1186/bcr1195] [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: 11/10/2022] Open
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41
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Konski AA, Feigenberg S, Raysor S, Eisenberg D, Mirchandani I, Uzzo RG, Greenberg R, Horwitz E, Pollack A, Hanks G, Watkins-Bruner D. Twenty-five percent positive biopsy rate in a high risk prostate cancer screening program with a PSA ≤ 2.5 ng/ml. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. A. Konski
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - S. Feigenberg
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - S. Raysor
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - D. Eisenberg
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - I. Mirchandani
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - R. G. Uzzo
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - R. Greenberg
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - E. Horwitz
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - A. Pollack
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - G. Hanks
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - D. Watkins-Bruner
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
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Abstract
BACKGROUND Complete excision is the preferred treatment for pilonidal sinus disease. We describe a new technique of excision and tension-free primary closure of pilonidal sinus disease, combined with application of fibrin glue in order to obliterate the dead space and to promote wound healing. METHODS A curved incision of the carried out, 2-3 cm lateral to the opening of the sinus, done under general or spinal anesthesia, and a thick flap was created by undercutting the medial edge and advancing it across the midline. The sinus was completely excised with all of its extensions. The flap was then sutured back to its original place by several interrupted monofilament mattress sutures. Then, 2-4 ml of fibrin glue was injected through the original pilonidal sinus opening to the sinus bed in order to obliterate the dead space. RESULTS Thirty patients with pilonidal sinus disease were treated by this technique. In four patients, there was a temporary purulent discharge through the opening of the sinus, and there were no other complications. The mean period for returning to daily activities and to work for patients was 11 days (SD=6 days). No infection or recurrent disease was noticed during the follow-up period (23+/-3 months). CONCLUSIONS Complete excision with tension free closure with fibrin glue application may be a useful technique for the treatment of pilonidal sinus disease.
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Affiliation(s)
- R Greenberg
- Department of Surgery A, Tel-Aviv Medical Center Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, Tel-Aviv 64239, Israel.
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Wong Y, Sherman E, Hudes G, Haas N, Konski A, Uzzo R, Greenberg R, Beck R. Modeling the cost-effectiveness of treatment options for patients with clinical stage I non seminomatous germ cell tumors (NGSCT). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Y. Wong
- Fox Chase Cancer Center, Philadelphia, PA
| | - E. Sherman
- Fox Chase Cancer Center, Philadelphia, PA
| | - G. Hudes
- Fox Chase Cancer Center, Philadelphia, PA
| | - N. Haas
- Fox Chase Cancer Center, Philadelphia, PA
| | - A. Konski
- Fox Chase Cancer Center, Philadelphia, PA
| | - R. Uzzo
- Fox Chase Cancer Center, Philadelphia, PA
| | | | - R. Beck
- Fox Chase Cancer Center, Philadelphia, PA
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Greenberg R, Barnea Y, Kaplan O, Kashtan H, Skornick Y. Detection of cancer cells in the axillary drainage using RT-PCR after operations for breast cancer. Breast 2004; 13:49-55. [PMID: 14759716 DOI: 10.1016/j.breast.2003.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 10/26/2022] Open
Abstract
The object of this study was to examine whether MUC-1 can be detected in the axillary lymphatic drainage of patients who have undergone conservative surgery for breast cancer and to assess the correlations between the presence of MUC-1 and prognostic factors in breast cancer. Sixty-eight women with invasive ductal carcinoma of the breast underwent wide local excision and axillary lymph node dissection. Axillary drains were inserted in all these cases, and the presence of MUC-1 and beta-actin was evaluated by RT-PCR in the lymphatic fluid collected after the operation. Prognostic factors included tumour size and grade, vascular and lymphatic invasion, clearance margins of the resected specimens and status of the axillary lymph nodes. RT-PCR assays for MUC-1 in the axillary fluid were positive in 17 patients (25%). The presence of MUC-1 was associated with increased tumour size and showed a positive correlation with axillary lymph node metastases and incomplete resection of the tumour. RT-PCR can disclose cancer cells in the axillary fluid after conservative surgery for breast cancer. The presence of MUC-1 in the axillary drainage may be associated with poor prognostic features, and its detection may have implications for therapy as it suggests that re-excision should be considered.
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Affiliation(s)
- R Greenberg
- Department of Surgery A, Tel-Aviv Sourasky Medical Center, Israel.
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45
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Abstract
Aortic dissection is a complex manifestation of disease of the arterial wall. The severity and consequences of a dissection are related to the physical characteristics and anatomic location of the tear as well as the underlying patient physiology. Despite in vitro and in vivo modeling advances, our understanding of the pathophysiology has been limited to evaluations of the success and failure of various treatment modalities. The indications for intervention have historically included rupture, intractable pain or hypertension, distal ischemia and degeneration of the aortic wall causing aneurysm formation. The management decisions for patients with dissections are dependent upon the abnormal anatomy, the acuity of the patient presentation, and physiology. Despite the availability of open surgery as a therapeutic option, acute dissections with evidence of ischemia are now handled using an endovascular approach that is specifically directed at the cause of the ischemia. Endovascular treatments include the placement of a stentgraft into the proximal aorta, branch vessel stenting, uncovered stent placement in the abdominal aorta, and aortic fenestrations. Chronic dissections, in contrast, are still most frequently managed with open surgical techniques. However, a subset of patients that are not candidates for traditional surgical repair of the thoracoabdominal aorta may be managed with a combined open mesenteric revascularization with subsequent endovascular grafting of the thoracoabdominal aorta.
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Affiliation(s)
- R Greenberg
- The Cleveland Clinic Foundation, Departments of Vascular Surgery and Biomedical Engineering, 9500 Euclid Ave S40, Cleveland, OH 44195, USA
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46
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Abstract
BACKGROUND AND STUDY AIMS We aimed to study the technical feasibility, safety, efficacy and complications of endoscopic feeding tube placement in patients who had previously undergone subtotal gastrectomy. We also investigated whether jejunal feeding tube placement (percutaneous endoscopic jejunostomy [PEJ]) is superior to gastric feeding tube placement (percutaneous endoscopic gastrostomy [PEG]) in the prevention of aspiration pneumonia in patients with subtotal gastrectomy. PATIENTS AND METHODS A retrospective cohort study was carried out which included 48 patients treated between 1995 and 2001. Participants were selected from 3400 patients who were referred for PEG placement. The study group consisted of 15 consecutive patients with a prior subtotal gastrectomy. The control group comprised 33 randomly selected patients with intact stomachs. The primary end point of the study concerned the safety of PEG placement. The secondary end points included the efficacy and technical difficulty of the procedure. RESULTS PEG/PEJ placement was successful in 14 of the 15 patients (93 %) who had previously had a subtotal gastrectomy. None of the study patients developed procedure-related complications. Feeding intolerance was more common in patients with gastrectomy compared with patients with an intact stomach, but the difference did not reach statistical significance (10 % vs. 3 %, P>0.05). A significantly higher incidence of pneumonia was observed in patients with gastrectomy compared with patients with an intact stomach (P=0.01). Subgroup analysis showed that the risk was higher with jejunal tube placement compared with gastric tube placement (42 % vs. 12 %, P=0.001). CONCLUSION PEG/PEJ placement in patients with gastrectomy is a technically safe procedure. These patients are at higher risk of aspiration pneumonia and risk is higher with jejunal tube placement compared with gastric tube placement.
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Affiliation(s)
- P Singh
- Department of Biostatistics, Mailman School of Public Health, Columbia Unversity, New York, USA.
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Berkovitch M, Heyman E, Afriat R, Matz-Khromchenko I, Avgil M, Greenberg R, Zimmerman DR, Berman S, Weissgarten J. Copper and zinc blood levels among children with nonorganic failure to thrive. Clin Nutr 2003; 22:183-6. [PMID: 12706136 DOI: 10.1054/clnu.2002.0619] [Citation(s) in RCA: 15] [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: 11/18/2022]
Abstract
BACKGROUND AND AIMS Copper and zinc deficiency are commonly reported among children with organic failure to thrive. In contrast, reports on copper and zinc status in children with non-organic failure to thrive are scarce. The goal of this study was to evaluate copper and zinc blood levels and nutritional intake among children with non-organic failure to thrive. METHODS A study group of 32 children with non-organic failure to thrive were investigated and compared with 32 healthy controls. Each child had copper and zinc blood level measurements. In addition, the study group underwent evaluation of thyroid function, immunoglobulins, endomesial antibodies and xylose test. A dietary questionnaire that included a diet history and a 24-h dietary recall was administered to parents by a dietician. Weight for height, height for age and mean daily intake of calories, protein, copper and zinc were calculated. RESULTS There were no significant differences between the two groups in either socioeconomic status or caloric, copper or zinc intake. Protein intake was significantly lower in the study group (P<0.0001). Plasma copper levels were within the normal range in both groups (P=0.3). Zinc plasma levels were significantly higher in the study group as compared to controls (P=0.03); however, they remained within the normal range in both groups. CONCLUSIONS Children with non-organic failure to thrive can maintain plasma copper and zinc levels within normal range and similar to normal controls.
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Affiliation(s)
- M Berkovitch
- Division of Pediatrics, Sackler School of Medicine, Tel-Aviv University, Assaf Harofeh Medical Center, Zerifin, Israel
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Nesher E, Aizner A, Kashtan H, Kaplan O, Kluger Y, Greenberg R. Portal vein air embolization after blunt abdominal trauma: a case report and review of the literature. Eur J Emerg Med 2002; 9:163-5. [PMID: 12131641 DOI: 10.1097/00063110-200206000-00012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 01/22/2023]
Abstract
Gas in the portal vein is a rare and often fatal condition in surgical patients. However, the presence of gas in the mesenteric and portal veins in association with abdominal trauma is a transient incidental finding that resolves spontaneously. We describe a young patient with Crohn's disease who suffered air embolism of the portal veins secondary to blunt abdominal trauma. The condition was clinically benign and resolved spontaneously. The pathogenesis is discussed and a review of the literature is provided.
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Affiliation(s)
- E Nesher
- Department of Surgery A, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv 64239, Israel
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Berkovitch M, Greenberg R, Gendler L, Avgil M, Bulkowstein M, Sthal B, Kessler A, Merlob P. Sore Throat Treatment during Pregnancy. Clin Drug Investig 2002; 22:135-9. [DOI: 10.2165/00044011-200222020-00008] [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: 11/02/2022]
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50
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Karin E, Greenberg R, Avital S, Aladgem D, Kluger Y. The management of stab wounds to the heart with laceration of the left anterior descending coronary artery. Eur J Emerg Med 2001; 8:321-3. [PMID: 11785602 DOI: 10.1097/00063110-200112000-00014] [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: 11/25/2022]
Abstract
Penetrating cardiac injuries are an increasing cause of traumatic deaths in urban areas. The management of these injuries has undergone a transition from simple pericardiocentesis to cardiac ultrasound evaluation in the stable patient, and emergency thoracotomy and repair of myocardial wounds in the unstable patient in extremes. The incidence of traumatic coronary artery injury is not accurately known because not all victims are examined. With the improvement in emergency medical services, including speed of transportation of these patients, better resuscitation, and knowledgeable use of cardiac ultrasound or emergency room thoracotomy, more patients with coronary artery injuries will survive and reach the operating room. The operative management of the injured coronary artery is dependant on the location of the injury and whether there is myocardial dysfunction. Distal injuries with small myocardial infarction should be treated by ligation alone. Proximal injury and those injuries associate with larger area of ischaemia or infarction are best treated with coronary artery bypass. The role of cardiopulmonary bypass pump in these patients should be evaluated depending on the homodynamic stability of the patient. We present two cases of cardiac stab wounds with transection of the left anterior descending (LAD), which were successfully managed. A literature review regarding the management of combined cardiac and coronary artery injuries is also provided.
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Affiliation(s)
- E Karin
- Department of Surgery A, Tel-Aviv Medical Center, Tel-Aviv University, Israel
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