Ten-year survival in multiple myeloma: report of two cases and review of the literature.
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Biomedical subjects
Publications and source records attributed to F Rosner.
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This article reports the results of a retrospective study of 11 patients with rhabdomyolysis-induced acute renal failure. All patients had multiple risk factors for rhabdomyolysis, the most common of which were alcoholism, illicit drug abuse, compression, and trauma. Patients with combined alcohol/illicit drug abuse had more severe electrolyte imbalances than patients without alcohol/illicit drug abuse. Myoglobinuria was detected in only half the patients despite rhabdomyolysis and urine "hematest" positivity. The serum creatine phosphokinase level was elevated in all of the patients, which is a good marker for rhabdomyolysis. Rhabdomyolysis is a relatively common disorder in municipal hospitals. Routine serum creatine phosphokinase levels should be checked on patients at risk, especially alcoholics, illicit drug abusers, and older patients.
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An intravenous line insertion and blood drawing team was introduced as a pilot project in a large municipal hospital in the New York City. The program successfully accomplished the goals of reducing house staff workload, improving house staff morale and patient care, and increasing available time for house staff education.
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Two hundred fifty-eight graduates (80%) of a fifth pathway program provided information about their professional careers. Fifty-nine percent practice primary care medicine, 25% are surgeons, and 16% are in support services such as psychiatry and radiology. Fifty-four percent are board certified, many of whom are doubly-board certified and some of whom hold prestigious academic positions. We conclude that properly educated fifth pathway graduates can become productive and respected members of the medical profession and contribute significantly to meeting the health-care needs of the patients and communities they serve.
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In June 1988, the New York State Hospital Review and Planning Council approved major revisions in the state hospital code (Part 405). Among the most controversial of these changes were the recommendations of the Bell Commission concerning limitations on resident work hours, new emergency service requirements, and enhancements in ancillary staffing. The ancillary staffing mandated by the new code regulations for teaching hospitals include the provision at all times of intravenous services, phlebotomy services, messenger services, transport services, nurses aides, housekeeping services, and other ancillary support in a manner sufficient to meet patient care needs and to prevent adverse impact on the delivery of medical and nursing care. The intent of the new health code requirements is to reduce or eliminate many of the nonphysician tasks performed by residents so as to effectively reduce their workload. We conducted a survey of Medicine residents at Queens Hospital Center to assess the amount of time they presently devote to nonphysician tasks, their perceptions of the need for ancillary staff to relieve them of the burden of these nonphysician tasks, and their evaluation of the effectiveness of a recently instituted intravenous therapy team.
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Five patients were treated at the Queens Hospital Center between 1987 and 1989 for tuberculosis of the spine. All were members of low socioeconomic status minority groups: four were black and one was Asian. Three were intravenous drug abusers and were positive for human immunodeficiency virus (HIV), one was homeless and suffering from alcoholism, and one had just arrived in the United States from a region in Asia endemic for tuberculosis. All three HIV positive patients had negative tuberculin skin test results, had no radiographic signs of pulmonary involvement, and were anemic on presentation; one of them had a bone marrow biopsy that was positive for acid-fast bacilli. Since there may be a prolonged delay without significant radiographic findings, a high index of suspicion is necessary to make the diagnosis of tuberculosis of the spine.