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Fischer LE, Moreno-Garcia F, Tran R, Harmon A, Little C, Domingue G, Stewart K, Mier Giraud F, Thakral R. Prevalence and risk factors for secondary hyperparathyroidism (SHPT) in patients undergoing bariatric surgery. Surg Endosc 2023; 37:8019-8028. [PMID: 37464065 DOI: 10.1007/s00464-023-10218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/11/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Secondary hyperparathyroidism (SHPT) after bariatric surgery has significant adverse implications for bone metabolism, increasing the risk for osteoporosis and fracture. Our aim was to characterize prevalence and identify risk factors for SHPT in bariatric surgery patients. METHODS We performed a single-institution, retrospective chart review of patients who underwent bariatric surgery from June 2017 through December 2021. Demographic and clinical data were collected, including serum parathyroid hormone, calcium, and vitamin D3 at enrollment and 3, 6, and 12-months postoperatively. Chi-square or Fisher's exact tests were used to analyze categorical data and Mann-Whitney U test for continuous data. Multivariable analysis using binomial logistic regression assessed risk factors for SHPT. P-values ≤ 0.05 were considered significant. RESULTS 350 patients were analyzed. SHPT prevalence at any time point was 72.9%. 65.8% had SHPT at enrollment; 45.9% resolved with intensive vitamin supplementation; and 19.7% had recurrent SHPT. New-onset SHPT occurred in 8.6%. Persistent SHPT was present in 42.4% at 1-year. Baseline SHPT correlated with black race and T2DM. SHPT at any time point correlated with T2DM and higher baseline BMI. 1-year SHPT correlated with RYGB, depression, and longer time in program. SHPT was not correlated with %TBWL at any time point. In patients with SHPT, vitamin D3 deficiency prevalence was significantly higher at baseline (77.0%) compared to all post-bariatric time points (16.7%, 17.3%, and 23.1%; P < 0.0001). CONCLUSIONS SHPT is highly prevalent in patients with obesity seeking weight loss surgery. 42% had persistent SHPT at 1-year despite appropriate vitamin supplementation. Current vitamin D3 and calcium supplementation protocols may not effectively prevent SHPT in many post-bariatric patients. Low prevalence of concomitant vitamin D3 deficiency with SHPT after bariatric surgery suggests that there may be alternative mechanisms in this population. Further studies are needed to develop effective treatment strategies to mitigate the adverse effects of bariatric surgery on bone metabolism.
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Affiliation(s)
- Laura E Fischer
- Department of Surgery, University of Oklahoma, Oklahoma City, USA.
- OU Health Metabolic and Bariatric Surgery Program, University of Oklahoma, 1000 N Lincoln Blvd, Suite 3200, Oklahoma City, OK, 73104, USA.
| | | | - Rachel Tran
- University of Oklahoma School of Medicine, Oklahoma City, USA
| | - Allison Harmon
- University of Oklahoma School of Medicine, Oklahoma City, USA
| | - Cooper Little
- University of Oklahoma School of Medicine, Oklahoma City, USA
| | - Grayson Domingue
- Department of Orthopedic Surgery, University of Oklahoma, Oklahoma City, USA
| | - Kenneth Stewart
- Department of Surgery, University of Oklahoma, Oklahoma City, USA
| | - Fernando Mier Giraud
- Department of Surgery, University of Oklahoma, Oklahoma City, USA
- OU Health Metabolic and Bariatric Surgery Program, University of Oklahoma, 1000 N Lincoln Blvd, Suite 3200, Oklahoma City, OK, 73104, USA
| | - Rishi Thakral
- Department of Orthopedic Surgery, University of Oklahoma, Oklahoma City, USA
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Lade C, Ford H, Venincasa K, Lewis S, Lee B, Harmon A, Choi P, Raines A. No prostate? No problem: robotic inguinal hernia repair after prostatectomy. J Robot Surg 2023:10.1007/s11701-023-01586-y. [PMID: 37022558 PMCID: PMC10078048 DOI: 10.1007/s11701-023-01586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 03/26/2023] [Indexed: 04/07/2023]
Abstract
Traditional teaching suggests that prior pelvic operations, including prostatectomy, are a contraindication to laparoscopic inguinal hernia repair. Despite the growing use of robotic platforms in inguinal hernia repair, there are few studies describing robotic-assisted inguinal hernia repairs (RIHR) in this patient population. This study aims to demonstrate that RIHR is safe and effective in repairing inguinal hernias in patients who had previously undergone prostatectomy. We retrospectively reviewed RIHR cases performed from March 2017 to October 2021 by a single surgeon at our university-affiliated community hospital. Cases were reviewed for preoperative considerations, operative times and complications, and postoperative outcomes. A total of 30 patients with prior prostatectomy underwent transabdominal preperitoneal (TAPP) RIHR with mesh. Sixteen of the 30 patients had undergone robot-assisted laparoscopic prostatectomy (RALP), while 14 patients underwent open resection. Seven of the patients had received post-resection radiation and 12 had previous non-urologic abdominal operations. When compared to all RIHRs performed over the same period, duration of surgery was increased. There were no conversions to open surgery. Postoperatively, one patient developed a repair site seroma which resolved after 1 month. Mean follow-up time was 8.0 months. At follow-up, one patient reported experiencing intermittent non-debilitating pain at the repair site and one patient developed an inguinoscrotal abscess of unknown relation to the repair. No patients reported hernia recurrences nor mesh infection. This review suggests that TAPP RIHR can be a safe and effective approach to inguinal hernia repair in patients who have previously undergone prostatectomy, including those who received radiation and those who underwent either open or robotic resections.
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Affiliation(s)
- Caleb Lade
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA.
| | - Hunter Ford
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Kiran Venincasa
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Samara Lewis
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Benjamin Lee
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Allison Harmon
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Preston Choi
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Alexander Raines
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
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Affiliation(s)
- D. Kandasamy
- University of Michigan-Flint, Flint, Michigan,
- University of Colorado-Denver, Denver, Colorado,
| | - D.B. Carr
- Washington University in St. Louis, St. Louis, Missouri,
| | - T.M. Meuser
- University of Missouri-Saint Louis, St. Louis, Missouri
| | - A. Harmon
- Washington University in St. Louis, St. Louis, Missouri,
| | - M. Betz
- University of Colorado-Denver, Denver, Colorado,
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Poda A, Bednar A, Kennedy A, Harmon A, Hull M, Mitrano D, Ranville J, Steevens J. Characterization of silver nanoparticles using flow-field flow fractionation interfaced to inductively coupled plasma mass spectrometry. J Chromatogr A 2011; 1218:4219-25. [DOI: 10.1016/j.chroma.2010.12.076] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 12/15/2010] [Accepted: 12/16/2010] [Indexed: 11/25/2022]
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Abstract
We report a case of stridor in a 32 year old woman. Initial laryngoscopy demonstrated adduction of the vocal cords on inspiration, which reverted to abduction on induction of general anaesthesia. The airway was structurally normal. The most likely diagnosis was paradoxical vocal cord motion, a condition in which psychological stress can precipitate respiratory symptoms and signs due to involuntary adduction of the vocal cords during inspiration. Its importance to the anaesthetist lies in its ability to masquerade as a serious airway or respiratory condition.
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Affiliation(s)
- A Harmon
- Wesley Anaesthesia and Pain Management, Wesley Hospital, Brisbane, Queensland, Australia
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Zheng Y, Prouty SM, Harmon A, Sundberg JP, Stenn KS, Parimoo S. Scd3--a novel gene of the stearoyl-CoA desaturase family with restricted expression in skin. Genomics 2001; 71:182-91. [PMID: 11161812 DOI: 10.1006/geno.2000.6429] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.3] [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: 11/22/2022]
Abstract
Stearoyl-coenzyme A (CoA) desaturase (SCD) is a key enzyme involved in the conversion of saturated fatty acids into monounsaturated fatty acids. Previously, two members of this gene family, namely, Scd1 and Scd2, have been reported. Here we report the identification and characterization of a novel member of this family, Scd3, whose expression is restricted to mouse skin, specifically to the sebaceous gland. The Scd3 gene codes for a transcript of approximately 4.9 kb with an open reading frame that results in a 359-amino-acid protein. Scd3 shares 91 and 88% identity in the protein-coding region with Scd1 and Scd2, respectively, and maps to mouse chromosome 19 in very close proximity to Scd1 and Scd2. Unlike Scd1, Scd3 expression is higher in male mouse skin than in female mouse skin. The promoter sequence of Scd3 reveals similarity with Scd1 in the proximal region but also possesses several distinctive features including the polyunsaturated fatty acid-response element. Scd3 is expressed in the skin of young asebia mutant mice (Scd1(ab2J)/Scd1(ab2J)) in the absence of Scd1. Scd3 expression changes during the mouse hair cycle but not as dramatically as Scd1. The tissue-specific and sex-dependent expression of Scd3 suggests the presence of gene- and hormonal-specific control mechanisms.
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Affiliation(s)
- Y Zheng
- Johnson & Johnson Skin Biology TRC, Grandview Road, Skillman, New Jersey 08558, USA
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Greenberg BD, Ziemann U, Corá-Locatelli G, Harmon A, Murphy DL, Keel JC, Wassermann EM. Altered cortical excitability in obsessive-compulsive disorder. Neurology 2000; 54:142-7. [PMID: 10636140 DOI: 10.1212/wnl.54.1.142] [Citation(s) in RCA: 201] [Impact Index Per Article: 8.4] [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: 11/15/2022] Open
Abstract
OBJECTIVE To assess cortical inhibitory and excitatory mechanisms in obsessive-compulsive disorder (OCD). BACKGROUND Transcranial magnetic stimulation (TMS) studies have found decreased neuronal inhibition and a reduced cortical silent period in the primary motor area in Tourette's syndrome, focal dystonia, and other disorders believed to involve dysfunction of subcortical structures, including the basal ganglia. Dysfunction of the basal ganglia and linked regions also has been implicated in OCD, which has significant clinical and familial overlap with tic disorders. METHODS We applied the TMS techniques previously used in Tourette's syndrome to a group of 16 OCD patients (seven unmedicated) and 11 age-matched healthy volunteers extensively screened for psychopathology. Measures of motor cortex excitability included resting and active motor threshold, cortical silent period duration, and intracortical inhibition and facilitation using a paired-pulse TMS technique with a subthreshold conditioning stimulus. RESULTS Similar to recent findings in Tourette's syndrome and focal dystonia, this study reports significantly decreased intracortical inhibition (ICI) relative to the volunteers at interstimulus intervals from 2 to 5 msec. We also found decreased active and resting motor evoked potential threshold in the OCD patients, another indication of increased cortical excitability. Neither abnormality appeared medication related. The decreases in ICI and motor threshold were greatest in OCD patients with comorbid tics, but remained significant in patients without tics. CONCLUSIONS The data suggest abnormal cortical excitability in obsessive-compulsive disorder. These findings are congruent with the hypothesis that Tourette's syndrome and obsessive-compulsive disorder (OCD) are analogous disorders with overlapping dysfunction in corticobasal circuits. Patients with tic-related OCD may have more abnormal motor cortex excitability than OCD patients without tics.
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Affiliation(s)
- B D Greenberg
- Adult OCD Research Unit, Laboratory of Clinical Science, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892-1264, USA
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Abstract
The costs of providing oncology services in three different ways were measured. Services were provided to a peripheral hospital by: conventional clinics, in which the oncologist worked at the hospital concerned; outreach clinics, in which an oncologist was flown in periodically from a central hospital; telemedicine clinics, in which the oncologist at the central hospital practised via a video-link. During a one-year study period, 2400 patients were seen in conventional clinics, 81 in outreach clinics and 103 in telemedicine clinics. At these workloads the average costs per patient were $149, $897 and $812, respectively. However, the average costs cannot be compared directly without further information about the shape of the unit cost curves.
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Affiliation(s)
- G C Doolittle
- Division of Clinical Oncology, University of Kansas Medical Center, Kansas City 66160-7353, USA.
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Greenberg BD, Ziemann U, Harmon A, Murphy DL, Wassermann EM. Decreased neuronal inhibition in cerebral cortex in obsessive-compulsive disorder on transcranial magnetic stimulation. Lancet 1998; 352:881-2. [PMID: 9742988 DOI: 10.1016/s0140-6736(05)60009-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Costs were monitored for three different types of oncology practice: a telemedicine clinic and a fly-in outreach clinic, both held in rural areas, and a traditional clinic held in a city hospital. Total expenses were calculated over the year May 1995 to April 1996. The average cost per telemedicine visit was $812. The average cost per outreach clinic visit was $897. Flying in oncology support for this practice was therefore about 10% more costly than telemedicine. While the outreach cost may have been inappropriately high due to a slow start-up phase, it was still less expensive during this period to be seen via telemedicine. For comparison, the average cost per traditional oncology clinic visit was $149. However, this figure does not take into account the costs of access to a city-based service by rural patients.
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Affiliation(s)
- G C Doolittle
- University of Kansas Medical Center, Kansas City, USA.
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Sangster TC, Britt HC, Fields DJ, Hansen LF, Lanier RG, Namboodiri MN, Remington BA, Webb ML, Begemann-Blaich M, Blaich T, Fowler MM, Wilhelmy JB, Chan YD, Dacal A, Harmon A, Pouliot J, Stokstad RG, Kaufman S, Videbaek F, Fraenkel Z, Peilert G, Stöcker H, Greiner W, Botvina A, Mishustin IN. Intermediate mass fragment emission in Fe+Au collisions. Phys Rev C Nucl Phys 1992; 46:1404-1415. [PMID: 9968248 DOI: 10.1103/physrevc.46.1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Begemann-Blaich M, Blaich T, Fowler MM, Wilhelmy JB, Britt HC, Fields DJ, Hansen LF, Lanier RG, Massoletti DJ, Namboodiri MN, Remington BA, Sangster TC, Struble GL, Webb ML, Chan YD, Dacal A, Harmon A, Pouliot J, Stokstad RG, Kaufman S, Videbaek F, Fraenkel Z. Fission from Fe and Nb reactions with heavy targets at 50-100 MeV/nucleon. Phys Rev C Nucl Phys 1992; 45:677-688. [PMID: 9967803 DOI: 10.1103/physrevc.45.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Griboff SI, Harmon A, Nester MF. The community hospital and job training. Med Times 1970; 98:116-8. [PMID: 5506733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Harmon A. The broadening scope of purchasing authority. Hospitals 1966; 40:124-30. [PMID: 5917242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Harmon A. Psychologie du Militaire Professionnel. The American Journal of Psychology 1895. [DOI: 10.2307/1411224] [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: 11/10/2022]
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