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At least 19 recordsLinked to original sources
PubMed1992

The role of surgery in treating pleuropulmonary suppurative disease--review of 77 cases managed at Queens Hospital Center between 1986 and 1989.

Despite the generally salutary experience in recent years of managing suppurative pleuropulmonary disease, empyemas and lung abscesses have persisted and increased in incidence in hospitals such as Queens Hospital Center that serve large numbers of the socioeconomically disadvantaged. This study documents the etiology, clinical presentation, treatment, and treatment results of suppurative pleuropulmonary disease at Queens Hospital Center, which serves a large segment of the urban poor, many of whom are black. Results indicate that contributory or antecedent etiologic factors include a history of prior disease (specifically pneumonia, lung abscess, obstructive lung disease, pulmonary neoplasia, and tuberculosis); a predisposition to constitutional or immunologic deficiencies (specifically, alcoholism, anemia/malnutrition, drug abuse, and acquired immunodeficiency syndrome [AIDS]); conditions contributing to tracheobronchial aspiration (specifically, alcoholism and seizure disorders); and a miscellaneous group such as prior surgery, cardiovascular disease, and sepsis syndrome. The patients in this study were young with maximal incidence occurring in the third to fifth decades of life. Patients were predominantly male (75%) and black (66%). There were 18 deaths (23%), with sepsis being the cause in 10 (56%). Most surgical interventions were conservative, ie, bronchoscopies (48), thoracenteses (43), and tube thoracotomies (39). Thirty-one open thoracotomies were performed for drainage, decortication, or pulmonary resection. The surgical mortality was three cases or 5% of the patients who underwent surgery. The designated incidence of proven AIDS in this series (29%) was low, undoubtedly because many patients refused testing, and the multiple gram-positive and gram-negative infections that were seen did not conform to the Centers for Disease Control criteria for diagnosis and case reporting for AIDS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Carcinoma of the esophagus seen in a 12-year period at Queens Hospital Center.

One hundred forty patients with carcinoma of the esophagus treated over a 12-year period at Queens Hospital Center were reviewed. Comparable numbers of patients were assigned at random to radiation therapy alone, surgical treatment with radiation, or treatment with combinations of radiation and chemotherapy pre- or postoperatively. Surgical mortality (survival 1 month or less) was 9 patients of 34, or approximately 26%. Mean survival including the early deaths was 7.5 months. Deaths were primarily due to respiratory tract complications, either alone or in combination, with three cases of anastomotic leaks, sepsis, inanition, and progressing carcinoma. Fifty-two patients received radiation therapy alone. Although there were only six deaths (10%) within the first month of treatment, average survival was 8.4 months, only marginally greater than those treated by surgery. Of 13 patients treated with combined radiation and chemotherapy, no deaths occurred within the first month of treatment, but the average survival was only 6.5 months. Of nine patients treated with chemotherapy alone, no deaths occurred within the first month of treatment, but mean survival of this small group was only 4.9 months. Efficacy of chemotherapy and radiation therapy as definitive, adjuvant, or palliative therapy, in spite of recent somewhat optimistic reports, remains to be proven. Exploratory surgery should be retained as an essential staging and therapeutic modality in those patients in whom definite evidence establishing inoperability is lacking; ie, tumor fixation to vital structures, distant metastases, and other medical contraindications to surgery. Endoscopic instrumentation with the yttrium aluminum garnet laser appears to have a future as preliminary to surgery or definitive (palliative) management of obstructing esophageal carcinoma.

Adenocarcinoma↗
PubMed1989

Thoracic empyema: a five-year experience at Queens Hospital Center.

A retrospective analysis of 48 cases of thoracic empyema is presented along with a management protocol, which includes empiric antibiotic therapy or combinations thereof and an aggressive primary surgical procedure that results in minimal morbidity and mortality. In this series, there were eight deaths (16.6%). The contributing etiologic agents, however, have shifted from traditional causes, such as posttonsillectomy, postdental extractions, and bronchiectasis, to stupor caused by excessive alcoholism and drug addiction, also involving direct access through injectables into the cardiovascular system.

Adolescent↗
PubMed1988

Malaria. A city hospital experience.

We reviewed the charts of 24 patients with malaria seen at the Queens Hospital Center, Jamaica, NY, over the past five years. Twenty-three patients were foreign citizens. Eighteen patients were infected with Plasmodium vivax and six with Plasmodium falciparum. Malaria was suspected on admission in 19 of the 23 hospitalized patients. Five patients were admitted with unrelated diagnoses, and four of these experienced diagnostic delay. All diagnoses were confirmed with thin blood smears. Twenty-one patients were febrile, and 18 patients had prominent gastrointestinal tract symptoms. Serum glucose level was increased in nine patients, and hypoglycemia occurred in one. Four patients also had intestinal parasites. Malaria should be suspected in travelers with gastrointestinal tract symptoms, and patients with malaria may have other parasitic infections. Most patients with P vivax infections can be treated as outpatients, since the course is usually uncomplicated.

Adolescent↗
PubMed1997

The value of repeat Pap smear at the time of initial colposcopy.

OBJECTIVE: The objective was to determine if repeating a Pap smear at the time of an initial colposcopy has sufficient clinical benefit to justify its clinical and financial costs. METHODS: The records were reviewed of all patients who had an initial colposcopy at Queens Hospital Center between 1984 and 1995. Data were gathered regarding the referral cytology, the cytology done at the time of colposcopy, and the results of any biopsies which were taken. The terminology for cytology and histology done prior to 1989 was adjusted to the Bethesda classification system. A repeat Pap smear was defined as clinically valuable if it would have changed the patient's management, i.e., if it suggested more advanced disease than the referral Pap and that the disease was not identified on the colposcopically directed biopsy. RESULTS: Two thousand nine hundred sixty-nine records were reviewed. In 139 cases, no Pap smear was repeated at the time of colposcopy. Of the remaining 2830 women, only 1347 (47.6%) showed exact correlation between their referral Pap smear and the Pap done at the time of colposcopy. In another 1016 (35.9%), the Pap at colposcopy was within one grade of the referral Pap. In 312 women, the Pap at the time of colposcopy was a higher grade than the referral Pap. However, in 236, the higher grade of disease was detected by the colposcopically directed biopsy. Of the remaining 76 women, 58 had a normal biopsy, but their Pap at the time of colposcopy showed low-grade squamous intraepithelial lesions (44) or high-grade squamous intraepithelial lesions (HGSIL) (14). Seventeen others had a biopsy showing low-grade dysplasia while the Pap at the time of colposcopy showed HGSIL. In 1 patient, the repeat Pap showed malignant cells while the biopsy showed a high-grade lesion. Based on the triage protocols at our institution, this means that a repeat Pap at the time of colposcopy would have indicated a cone biopsy in 31 patients (1.1%) and more careful follow-up of another 44 patients (1.6%). Skipping the repeat Pap smear would not have resulted in any missed cancers. In our series of 2830 patients, the cost savings of skipping the repeat smear would have been $68,580 or $24.23 per patient. On a national level, skipping the repeat smear would save more than $24,000,000 annually. CONCLUSION: Using current triage protocols at our institution, repeating the Pap smear at the time of an initial colposcopy would have changed the management in 2.7% of patients and indicated a conization in only 1.1% of patients. It is doubtful that this justifies its cost and the potential detrimental effects on the colposcopic examination.

Adolescent↗
PubMed1988

Development of Nelson's syndrome in a patient with recurrent Cushing's disease. Analysis of secretory behavior of the pituitary tumor.

A markedly cushingoid 32-year-old man presented to Queens Hospital Center with headache, hyperpigmentation, and visual field loss. Twelve years earlier, he had undergone subtotal adrenalectomy for Cushing's disease, but symptoms of hypercortisolemia promptly recurred. Workup revealed the presence of a large, expanding intrasellar mass, plasma ACTH levels between 3,000 and 10,000 pg/ml, and markedly elevated cortisol levels. The secretion of ACTH (mainly ACTH 1-39-like peptide) by the pituitary tumor showed neither diurnal periodicity nor response to a variety of pharmacologic agents known to affect ACTH secretion. The patient demonstrates a rarely observed presentation of Nelson's syndrome, with aggressive adrenotropic pituitary tumor growth even in the presence of chronic hypercortisolemia.

Adrenalectomy↗
PubMed1999

Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature.

BACKGROUND: Human immunodeficiency virus (HIV)-associated pericardial effusion is common. We present its clinical features, cause, and prognosis on the basis of a review of 40 cases at a single public hospital. METHODS: A retrospective study was conducted of 122 patients with pericardial effusion (of which 40 were HIV associated) admitted to Queens Hospital Center from January 1988 to April 1997. A review of the literature is also presented. RESULTS: Forty patients with HIV-associated pericardial effusion represent 33% of the 122 patients with pericardial effusion admitted during that period. The most common symptom of the 40 patients was dyspnea (75%). Echocardiogram detected small effusions in 18 (45%), moderate effusions in 10 (25%), and large effusions in 12 (30%). Sixteen (40%) patients had cardiac tamponade, in 15 of whom pericardiocentesis or pericardiostomy was performed. Causes of cardiac tamponade were Mycobacterium species in 3 (19%), Streptococcus pneumoniae in 1 (6%), Staphylococcus aureus in 1 (6%), Kaposi's sarcoma in 1 (6%), and unknown in 10 (63%). In comparison, causes of cardiac tamponade in 74 cases of acquired immunodeficiency syndrome in the literature were 45% idiopathic, 20% mycobacteria, 19% bacteria, 7% lymphoma, 5% Kaposi's sarcoma, 3% viruses, and 1% fungus. Thirteen of the 40 patients were lost to follow-up. Among the other 27, 11 (41%) were alive at 3 months and 5 (19%) at 1 year. Ten of the 27 patients had cardiac tamponade, of whom 5 (50%) were alive at 3 months and 3 (30%) at 1 year. CONCLUSIONS: HIV-associated pericardial effusion is the most common type of pericardial effusion in our inner city hospital. Causes are diverse. The development of pericardial effusion predicts a poor prognosis in HIV infection.

Adult↗
PubMed1998

Indications for cone biopsy: pathologic correlation.

OBJECTIVE: Our purpose was to determine the ability of different indications for cone biopsy to predict the presence of disease in the cone specimen and the utility of conization for low-grade disease. STUDY DESIGN: The records were reviewed of all patients who had an excisional cone biopsy at Queens Hospital Center between 1984 and 1995. Data were gathered regarding cytologic studies, visualization of the transformation zone, colposcopically directed biopsy, and endocervical curettage. The indications for the cone procedure were grouped as being for treatment (biopsy-proved disease) (indication A), discrepancy between cytologic and histologic diagnoses (indication B), positive endocervical curettage results (indication C), and transformation zone not fully visualized (indication D), and combinations of the above. RESULTS: Two thousand nine hundred sixty-nine records were reviewed. Of these, 604 had cone biopsies. Three hundred twenty-three of 355 (91%) cone biopsies done for indication A alone had disease on the cone specimen (defined as any grade of dysplasia or condyloma). Forty of 47 (85.1%) cone biopsies done for indication B alone had disease of the cone specimen. Forty-three of 46 (93.5%) cone biopsies done for indication C alone had disease on the cone specimen. Ninety-one cone procedures were done for a combination of indications A and D, with 87 (95.6%) showing disease on the cone specimen. Thirty-one procedures were done for a combination of indications B and D, with 25 (80.6%) showing disease on the cone specimen. Cone procedures were done on 32 women for a combination of indications C and D, and 30 (93.8%) had disease on the cone specimen. Two cone procedures were done because of the colposcopic appearance alone; one had high-grade disease on the cone specimen. Age did not help to predict the likelihood that disease would be found on the cone specimen. The data were then reanalyzed to determine the likelihood of finding high-grade disease (cervical intraepithelial neoplasia grades 2 or 3 or invasive cancer) on the cone specimen. Overall, those with preoperative high-grade cytologic or histologic characteristics (cervical intraepithelial neoplasia grades 2 or 3) were much more likely to have high-grade disease (277/371 [74.7%]) than were those with preoperative low-grade cytologic or histologic characteristics (condyloma or cervical intraepithelial neoplasia grade 1) (49/233 [21.0%]) (p < 0.001). CONCLUSION: Neither age nor the preoperative grade of disease are good discriminators of the likelihood that disease will be found on a conization specimen. However, patients who have high-grade disease on the preoperative evaluation are much more likely than those with only low-grade disease to have high-grade dysplasia or cancer on a subsequent conization.

Adolescent↗
PubMed1990

Survey of nonphysician tasks performed by medicine residents at a municipal hospital.

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.

Allied Health Personnel↗
PubMed1979

Long-term survival in a case of stage IV carcinoma of the ovary treated with a single chemotherapeutic agent.

A case of stage IV carcinoma of the ovary is presented which was treated approximately six years ago in the Department of Radiation Therapy at Queens Hospital Center. On September 12, 1972, the patient had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a papillary scirrhous cystadenocarcinoma of the left ovary. At the time of the operation, the patient was found to have stage IV carcinoma of the ovary due to metastases of the liver and rectum. She was scheduled to receive pelvic-abdominal postoperative radiation therapy via the moving strip technique. Unfortunately, after completion of two strips, the patient could not tolerate treatment. She then began chemotherapy with a single agent, chlorambucil.Chlorambucil, 0.2 mg/kg/day×25 days/course was administered. The patient received 18 courses. Treatment dosage on a few occasions was decreased and increased again, due to drops in hemoglobin level and white blood cell and platelet counts. At the time of this presentation, the patient has no signs or symptoms of the disease. The introduction of megavoltage radiotherapy and adjuvant chemotherapy postoperatively has significantly improved the prognosis for patients with ovarian carcinoma. However, despite progress in radiotherapy, some patients cannot sustain this kind of treatment due to the unwanted side effects. Such was the case in this patient. She was switched to chemotherapy with excellent results in response and survival, even cure.

Adenocarcinoma, Scirrhous↗
PubMed1990

Pott's disease in urban populations. A report of five cases and a review of the literature.

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.

Adult↗
PubMed1979

Experience of children with sickle cell anemia in a regular summer camp.

The Sickle Cell Program of the Queens Hospital Center Affiliation of the Long Island Jewish-Hillside Medical Center arranged for a group of children from the hospital Sickle Cell Clinic to spend one week during the summer of 1978 in a sleepaway camp for healthy children. This paper analyzës the results of the experience.

Anemia, Sickle Cell↗
PubMed1978

The effectiveness of sickle cell education in New York City public elementary schools.

The present study attempts to ascertain the effectiveness of the health education component of the Queens Hospital Center Sickle Cell Education & Screening Program. The study is limited to children in grades four through six in the New York City public school system. Such elementary school students, representing a large segment of the population, are easily accessible and can be effectively educated about sickle cell disease. The findings indicate that professional sickle cell educators can successfully teach young children about the disease and can do so more effectively than the average schoolteacher.

Anemia, Sickle Cell↗
PubMed1995

Neurocysticercosis: Report of fifteen cases.

BACKGROUND: Neurocysticercosis (NCC), which is caused by the encysted larvae of the porcine tapeworm Taenia solium, is uncommon in developed countries. METHODS: Fifteen cases were reviewed retrospectively from the medical records of patients admitted to Queens Hospital Center, a 550-bed acute care municipal hospital in New York City, from 1986 through 1992. All patients were immigrants from Central and South America. Nine were men and six were women; age range was 11-80 years, mean 33.8 years. Thirteen of the 15 patients (86%) were admitted with seizures. One patient had a strokelike syndrome with transient slurred speech and confusion. RESULTS: Diagnosis was based on clinical findings, CT or MRI studies (100%), and ELISA titers (81%). Cerebrospinal fluid abnormalities were noted in 5 of 7 samples obtained. Twelve adult patients with NCC were treated with praziquantel and steroids, and their courses were uncomplicated, except for one patient who required ventricular shunt placement for hydrocephalus. CONCLUSIONS: NCC should be suspected in immigrants from Central and South America who have seizures; it may complicate the differential diagnosis of various central nervous system syndromes. Available therapies entail risks and uncertainties. The ultimate approach is prevention of infestation.

Adolescent↗
PubMed2004

The Jordanian cesarean section rate.

OBJECTIVE: This study was conducted to determine the Jordanian cesarean rate and to examine the related indications for cesarean section (CS) in comparison with international rates. METHODS: Between 1990 to 2001, there were 243271 deliveries at 7 major military hospitals, (King Hussein Medical Center; Queen Alia Hospital, Amman; Prince Hashem Ben Al-Hussein Hospital, Al-Zarqa; Prince Ali Ben Al-Hussein Hospital, Al-Karaq; Prince Zaid Ben Al-Hussein, Al-Tafileh; Prince Rashid Ben Al-Hassan, Irbid; Princess Haya Al-Hussein, Aqaba) that reflect the main cities in Jordan, of which 22621 CS were performed. Two periods for the study were taken, the first from January 1990 to December 1992 and the second from January 1999 to December 2001 to examine the changes in the rate and indications for CS. Cesarean deliveries were classified according to 5 indications: breech presentation, dystocia, repeat cesareans, fetal distress and "others". Comparison by indication between the 2 periods and with the United States of America (USA) studies was discussed. Significance of differences was assessed using Chi-Square test. RESULTS: Out of 48280 deliveries performed during the first period, 3854 CS were performed with an incidence of 8%, while 8353 CS were performed during the second period out of 76611 deliveries with an incidence of 10.9%. This difference in rate showed 2.9 per hundred deliveries increase in the cesarean rate between the 2 periods. Comparison between the 2 periods showed no significant change in CS rate for breech category (p=0.158). A highly significant increase was found for fetal distress category (p=0.000), while dystocia and repeat CS showed a high significant decrease in CS rate (p=0.000) in the second study period. Analysis of the Jordanian CS rate and related indications for the operation compared with USA reports showed a high significant increase in Jordanian cesarean rate for breech, fetal distress and "other" categories (p=0.000), while a high significant decrease for dystocia and repeat cesarean was found (p=0.000). CONCLUSION: The lower cesarean rate in Jordan is attributed to lower frequencies of CS for dystocia, due to more accuracy in estimation of the fetal body weight, and with proper use of oxytocin dosage, which can correct malrotation of vertex leading to subsequent reduction in CS rate for dystocia. Policies, such as: active management of labor, trial of scar, maintenance of the skills required to supervise vaginal delivery when there is a breech presentation and better definition of the deliveries in which fetal monitoring will be useful in the diagnosis of fetal distress; all will achieve acceptable cesarean rate.

Cesarean Section↗
PubMed2005

Reducing restraints: alternatives to restraints on an inpatient psychiatric service--utilizing safe and effective methods to evaluate and treat the violent patient.

This paper describes the violence safety program instituted at Elmhurst Hospital Center in Queens, New York City in 2001, which significantly reduced the use of restraints and seclusion department wide, while providing a safe and therapeutic environment for patient recovery. The hospital service and program instituted is described, followed by restraint and seclusion data since 1998, and the program's results through 2003. Concurrent data in areas that could be affected by a reduction in restraint and seclusion such as self-injurious behaviors and altercations; use of emergency medication; use of special observation and length of stay data are also presented. In addition, types and frequency of alternative methods utilized to avoid restraints and seclusion are described.

Antipsychotic Agents↗