Anesthetic considerations in the surgical repair of intracranial aneurysms: New York University Medical Center, New York, U.S.A.
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Examination of records of daily visits to emergency rooms for asthma covering 25 years from New Orleans and 9 years from New York City reveals a distinct day-of-the-week pattern in New York City whereas no such pattern is discernible in New Orleans. The difference in daily patterns of asthma attacks in the populations from the two cities strongly suggests a different environmental etiologic agent acting on these two populations. It is proposed herein that in New York susceptible individuals are exposed to some agents or factors triggering attacks which are present in the home environment where most of their time is spent on weekends, while in New Orleans, homes are not as sealed off from the outside air, because of the warmer climate, so that the agent triggering attacks is as common outdoors as indoors, and thus there is little difference between weekend and weekday exposure.
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Eosinophilia-myalgia syndrome (EMS) has been linked to ingestion of tryptophan contaminated with 1,1'-ethylidene-bis[L-tryptophan] (EBT), but other contaminants have received little study. The authors identified 101 lots of L-tryptophan that had been consumed either by persons with EMS or by asymptomatic tryptophan users and quantified the amounts of EBT and five other contaminants in each lot. After stratification of case and noncase lots by time of manufacture to adjust for the strong sequential pattern over time among case and noncase lots, higher EBT levels were still associated with a lot's case status, but the association lacked statistical significance (p = 0.120, odds ratio = 1.56, 95% confidence interval 0.758-3.23). While these findings do not rule out the possibility that EBT is the etiologic agent in EMS, they raise the possibility that other chemical contaminants in manufactured tryptophan modify the effects of EBT or that the causal agent of EMS is an entirely distinct compound.
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A 1990-1991 New York State Department of Health (NYSDOH) assessment of the ongoing tuberculosis (TB) epidemic in New York City (NYC) led to legislative enactment of policy recommendations to help stem the epidemic. The principal strategy entailed mobilization of community resources for TB directly observed therapy (DOT) to supplement the DOT available from the NYC Department of Health (NYCDOH). For implementation, the NYSDOH engaged a coalition of public and private health care providers in a TB DOT Provider Network. Network participants include freestanding facilities, many of which already have preexisting affiliative relationships through which DOT can be extended. The number of individuals receiving DOT in NYC has increased more than 10-fold in two years. Over 1,000 individuals have completed their anti-TB treatment while enrolled in the network.
HIGHLIGHTS OF THE STUDY. In 1983, for the first time since 1977, the average voluntary hospital in New York City did not incur a deficit. Nevertheless, voluntary hospitals in New York City continued to have a lower return on their assets than voluntary hospitals in the rest of the state, in the Mid-Atlantic region, and in the nation. New York City voluntary hospitals would need 85 percent of their total assets to repay their debt, while the comparison groups would use less than 60 percent. The annual rate of growth in hospital expenses among New York City voluntary hospitals declined from almost 12 percent between 1981 and 1982 to less than 9.5 percent between 1982 and 1983, which also was almost a full percentage point below the national rate of increase. Between 1982 and 1983, the value of uncompensated care provided by New York City voluntary hospitals increased from 3.4 percent to 3.7 percent of total operating expenses. Fourteen of the 49 New York City voluntary hospitals studied were financially stressed in 1983, compared to 18 in 1982. Without the additional revenues received from the NYPHRM pools, 10 more New York City voluntary hospitals would have had bottom-line deficits. More details on the financial condition of New York City voluntary hospitals in 1983, and first year of NYPHRM, follow. Definitions, data sources, and methods are described in an appendix to the report, which also includes a glossary of financial terms.
New York State has reported more AIDS cases (26,576) through November 1989 than any other state, accounting for 23 percent of all reported cases in the nation at the time. New York City has reported 22,231 (84 percent) of the statewide cases. The epidemiology of AIDS in New York State has been easily influenced by the large number of cases among IVDUs. Whereas intravenous drug use accounts for 16 percent of adult/adolescent cases in the rest of the nation, it accounts for 39 percent of the cases in New York State. Intravenous drug use is the leading exposure category among racial minorities, with a disproportionately high rate of cases among Blacks and Hispanics. The epidemic among women and children has also been severe, resulting from intravenous drug use by women, heterosexual transmission from drug users to women, and perinatal transmission to their children.
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This history of the Renal Section at New York University School of Medicine ascribes its birth to a policy introduced by John Henry Wyckoff in 1924 that divided the Department of Medicine into sections devoted to the various subspecialties. Physicians selected to head each section sought further training. William Goldring, asked to organize the kidney section, spent a sabbatical year working with Homer William Smith, chairman and professor of the department of physiology at New York University School of Medicine. The second event was the development of a postdoctoral fellowship program in which medical school graduates, following completion of their intern and residency program, returned to basic science departments for exposure to and training in research in preparation for their return to clinical medicine. The aim of this fellowship program was to introduce the experimental method, which had been productive in the physical sciences, to the study and treatment of disease in man. The third event was the continuous collaboration between members of the Department of Medicine and the Department of Physiology under the chairmanship of Homer Smith. Experimental protocols in cardiovascular and renal physiology developed in the laboratory were carried over to Bellevue Hospital for studies and treatment of patients with hypertensive and renal diseases under the direction of members of the Renal Section. The final step conceived by Saul J. Farber, Chairman and Professor of the Department of Medicine was unification into a single group of all faculty members working in the field of hypertensive and renal diseases in Bellevue, University, and Manhattan Veterans Administration Hospitals. The Renal Section then can attribute its origin and development to the establishment of divisions within the Department of Medicine, the postdoctoral fellowship program, and the collaboration between the Departments of Medicine and Physiology. The establishment of the Renal Section served as a prototype for organizing medical school faculties into teams responsible for teaching, investigation, and treating hypertensive and renal diseases and spawned nephrology as a subspecialty of Internal Medicine.
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