1
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Hutchings H, Chang D, Ruffin W, Mohan N, Hooper R, Brue K, Okereke I. Effect of cardiothoracic surgery mentorship on underrepresented high school students. J Thorac Cardiovasc Surg 2024; 167:1885-1890. [PMID: 37500055 DOI: 10.1016/j.jtcvs.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/23/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Affiliation(s)
| | - Donald Chang
- Department of Surgery, Henry Ford Health, Detroit, Mich
| | - Wilma Ruffin
- Department of Surgery, Henry Ford Health, Detroit, Mich
| | - Navyatha Mohan
- Division of Cardiothoracic Surgery, Baylor University School of Medicine, Houston, Tex
| | - Rachel Hooper
- Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Kellie Brue
- Department of Surgery, Henry Ford Health, Detroit, Mich
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health, Detroit, Mich.
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2
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Hutchings H, Behinaein P, Enofe N, Brue K, Tam S, Chang S, Movsas B, Poisson L, Wang A, Okereke I. Association of Social Determinants with Patient-Reported Outcomes in Patients with Cancer. Cancers (Basel) 2024; 16:1015. [PMID: 38473374 DOI: 10.3390/cancers16051015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Patient-reported outcome (PRO) scores have been utilized more frequently, but the relationship of PRO scores to determinants of health and social inequities has not been widely studied. Our goal was to determine the association of PRO scores with social determinants. All patients with a new cancer diagnosis who completed a PRO survey from 2020 to 2022 were included. The PRO survey recorded scores for depression, fatigue, pain interference and physical function. Higher depression, fatigue and pain scores indicated more distress. Higher physical condition scores indicated improved functionality. A total of 1090 patients were included. Married patients had significantly better individual PRO scores for each domain. Patients who were able to use the online portal to complete their survey also had better individual scores. Male patients and non-White patients had worse pain scores than female and White patients, respectively. Patients with prostate cancer had the best scores while patients with head and neck and lung cancer had the worst scores. PRO scores varied by cancer disease site and stage. Social support may act in combination with specific patient/tumor factors to influence PRO scores. These findings present opportunities to address patient support at institutional levels.
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Affiliation(s)
- Hollis Hutchings
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
| | - Parnia Behinaein
- School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - Nosayaba Enofe
- Division of Surgical Oncology, Department of Thoracic Surgery, Fox Chase Cancer Center, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Kellie Brue
- School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - Samantha Tam
- Department of Otolaryngology, Henry Ford Health, Detroit, MI 48202, USA
| | - Steven Chang
- Department of Otolaryngology, Henry Ford Health, Detroit, MI 48202, USA
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI 48202, USA
| | - Laila Poisson
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI 48202, USA
| | - Anqi Wang
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI 48202, USA
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
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3
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Zhang Q, Zhu S, Grady SC, Wang A, Hutchings H, Cox J, Popoff A, Okereke I. Spatial and spatio-temporal clusters of lung cancer incidence by stage of disease in Michigan, United States 1985-2018. Geospat Health 2024; 19. [PMID: 38357855 DOI: 10.4081/gh.2024.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024]
Abstract
Lung cancer is the most common cause of cancer-related death in Michigan. Most patients are diagnosed at advanced stages of the disease. There is a need to detect clusters of lung cancer incidence over time, to generate new hypotheses about causation and identify high-risk areas for screening and treatment. The Michigan Cancer Surveillance database of individual lung cancer cases, 1985 to 2018 was used for this study. Spatial and spatiotemporal clusters of lung cancer and level of disease (localized, regional and distant) were detected using discrete Poisson spatial scan statistics at the zip code level over the study time period. The approach detected cancer clusters in cities such as Battle Creek, Sterling Heights and St. Clair County that occurred prior to year 2000 but not afterwards. In the northern area of the lower peninsula and the upper peninsula clusters of late-stage lung cancer emerged after year 2000. In Otter Lake Township and southwest Detroit, late-stage lung cancer clusters persisted. Public and patient education about lung cancer screening programs must remain a health priority in order to optimize lung cancer surveillance. Interventions should also involve programs such as telemedicine to reduce advanced stage disease in remote areas. In cities such as Detroit, residents often live near industry that emits air pollutants. Future research should therefore, continue to focus on the geography of lung cancer to uncover place-based risks and in response, the need for screening and health care services.
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Affiliation(s)
- Qiong Zhang
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan.
| | - Shangrui Zhu
- Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, Michigan.
| | - Sue C Grady
- Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, Michigan.
| | - Anqi Wang
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan.
| | | | - Jessica Cox
- School of Medicine, University of Texas Medical Branch, Galveston, Texas.
| | - Andrew Popoff
- Department of Surgery, Henry Ford Health, Detroit, Michigan.
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health, Detroit, Michigan.
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4
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Malkova K, Wilhelm AB, Uddin H, Okereke I, Muthukumarana V. Non-IgG4-Related Fibrosing Mediastinitis Diagnosed on Core Needle Biopsy and Treated with Steroids: A Case Study and Review of the Differential Diagnoses. Int J Surg Pathol 2024:10668969231219646. [PMID: 38234079 DOI: 10.1177/10668969231219646] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
OBJECTIVES This study aimed to investigate the histological characteristics and treatment efficacy of non-immunoglobulin G4-related fibrosing mediastinitis and discuss differential diagnoses for this rare entity. METHODS We present a case study of non-immunoglobulin G4-related fibrosing mediastinitis diagnosed on core biopsy and treated with steroids. A total of four 18-gauge core needle biopsy specimens were obtained for surgical pathology. Analysis of the patient's medical history, radiological characteristics of fibrosing mediastinitis, histological features, immunohistochemistry results, the differential diagnosis and treatment efficacy of different types of fibrosing mediastinitis was performed. RESULTS This report describes a unique presentation of fibrosing mediastinitis (syncope and weight loss) that was concerning for malignancy. Histological, laboratory and radiographical studies confirmed the diagnosis of non-immunoglobulin G4-related fibrosing mediastinitis. The patient received corticosteroid treatment which showed marked improvement after 1 month of treatment. CONCLUSIONS Fibrosing mediastinitis is an extremely uncommon entity with unknown pathogenesis, and it is more important to rule out malignancy and infection than to delineate between fibrosing mediastinitis and IgG4-related disease. In doing this, we may reasonably initiate a trial of corticosteroids which may prove beneficial, as in this patient. More studies on the pathogenesis of fibrosing mediastinitis are necessary to guide better directed treatments.
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Affiliation(s)
- Kseniia Malkova
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Alyeesha B Wilhelm
- Department of Pathology, University of Pittsburg Medical Center, Pittsburgh, PA, USA
| | - Hamza Uddin
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
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5
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Hutchings H, Schwarze E, Was J, Cirino J, Okereke I. Trauma pneumonectomy followed by extracorporeal membrane oxygenation cannulation: a case report. AME Case Rep 2023; 8:10. [PMID: 38234349 PMCID: PMC10789886 DOI: 10.21037/acr-23-76] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/12/2023] [Indexed: 01/19/2024]
Abstract
Background Trauma pneumonectomy remains an incredibly morbid procedure, reserved for the most critical cases where it is the only surgical option to stop massive ongoing hemorrhage. There are only few cases reported in the literature of survivors of trauma pneumonectomy complicated by acute respiratory distress syndrome (ARDS). We present our case of long-term survival in this circumstance. Given the limited published research on survival after prolonged veno-venous extracorporeal membrane oxygenation (VV-ECMO), it is important to share our experiences using VV-ECMO as an adjunct for pulmonary recovery. Case Description We present a case of a 35-year-old male patient who survived a gunshot wound to the right lung following trauma pneumonectomy with the assistance of VV-ECMO. He developed postoperative hemodynamic instability and required 38 days of VV-ECMO. He ultimately survived discharge from the hospital. One year after his gunshot injury, the patient was living at home with assistance. Urgent VV-ECMO cannulation and a multi-disciplinary approach was lifesaving in the treatment of this patient's post-pneumonectomy ARDS. Conclusions In review of the literature, ECMO has been used in a few other cases of ARDS following trauma pneumonectomy to allow for full pulmonary recovery. This case highlights the challenges following this morbid procedure, however with a multidisciplinary approach and urgent use of ECMO, a favorable outcome can be achieved.
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Affiliation(s)
| | - Erik Schwarze
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
| | - Jessica Was
- Department of Anesthesiology, Henry Ford Health, Detroit, MI, USA
| | | | - Ikenna Okereke
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
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6
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Johanson H, Okereke I. Commentary: A New Way to Gauge Pectus Severity. Semin Thorac Cardiovasc Surg 2023; 35:213. [PMID: 34838955 DOI: 10.1053/j.semtcvs.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Hollis Johanson
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health System, Detroit, Michigan.
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7
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Mohan N, Okereke I. Reply: You are a leader as well. JTCVS Open 2022; 9:190. [PMID: 36003433 PMCID: PMC9390722 DOI: 10.1016/j.xjon.2021.10.057] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Navyatha Mohan
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health System, Detroit, Mich
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8
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Okereke I. Reply: Point the microscope toward the educator. JTCVS Open 2021; 8:545. [PMID: 36004093 PMCID: PMC9390654 DOI: 10.1016/j.xjon.2021.08.013] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Ikenna Okereke
- Department of Surgery, Henry Ford Health System, Detroit, Mich
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9
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Shenoy R, Okereke I. Commentary: Lung cancer resections during the pandemic. J Thorac Cardiovasc Surg 2021; 164:386-387. [PMID: 34872758 PMCID: PMC8641923 DOI: 10.1016/j.jtcvs.2021.11.038] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Rohit Shenoy
- Department of Surgery, Henry Ford Health System, Detroit, Mich
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health System, Detroit, Mich.
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10
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Johanson H, Okereke I. The Importance of Clinical Decision-Making in Surgical Planning for Non-Small Cell Lung Cancer. Ann Surg Oncol 2021; 29:1509-1510. [PMID: 34748123 DOI: 10.1245/s10434-021-11027-5] [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] [Received: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Hollis Johanson
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
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11
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Wilhelm A, Muthukumarana PV, Uddin H, Okereke I. Non-IgG4-Related Fibrosing Mediastinitis Diagnosed on Needle Biopsy and Treated with Steroids. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.318] [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: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Fibrosing mediastinitis (FM) is a rare and aggressive fibroinflammatory process of the mediastinum. It is a difficult diagnosis, especially on small biopsies as the presentation and the fibrosing background mimics malignancy. Although the exact etiology is unknown, prior fungal infections, certain medications and autoimmune conditions are documented. Significant histopathologic overlap with IgG4-related disease (IgG4-RD) can complicate the diagnosis. An accurate diagnosis is important for treatment as corticosteroids for IgG4-RD is proven to be effective; however, no effective treatment is described for FM. Additionally, immunosuppression would prove harmful in other conditions with fibrosing morphology. We report a very unique case of non-IgG4-related FM that was diagnosed on a needle biopsy and showed marked improvement with corticosteroids.
Methods/Case Report
A 65-year-old man with no significant medical history presented with syncope and recent weight loss. Imaging revealed a pericardial effusion and a heterogeneous 8.1 cm mediastinal mass encasing the great vessels and aortic arch. Needle biopsy showed fibrosis with keloid-type collagen, mixed inflammatory cells, and few benign lymphoid follicles. No evidence of hematolymphoid malignancy, carcinoma, or infection was seen. Serum and tissue IgG-4 studies were negative for IgG4-RD. A diagnosis of FM was made, and a trial of corticosteroids was initiated. Interestingly, the patient showed improvement with a 2.3 cm decrease in lesion size and near-complete resolution of pericardial effusion after one month of treatment.
Results (if a Case Study enter NA)
NA
Conclusion
FM should be included in the differential diagnosis of infiltrative mediastinal masses which presents a diagnostic challenge on limited needle biopsies. Although effective treatment for non-IgG4 related FM is not clearly established, corticosteroids may prove beneficial, as in this patient. Mortality from FM is directly related to the compressive effect on adjacent structures. Early diagnosis and treatment are therefore crucial. Further studies on the pathogenesis are necessary, as well as better directed therapeutic options.
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Affiliation(s)
- A Wilhelm
- Pathology, University of Texas Medical Branch, Galveston, Texas, UNITED STATES
| | - P V Muthukumarana
- Pathology, University of Texas Medical Branch, Galveston, Texas, UNITED STATES
| | - H Uddin
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, UNITED STATES
| | - I Okereke
- Division of Thoracic Surgery, Henry Ford Health System, Detroit, Michigan, UNITED STATES
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Benz C, Martella J, Hamwi B, Okereke I. Factors resulting in postoperative dysphagia following esophagectomy: a narrative review. J Thorac Dis 2021; 13:4511-4518. [PMID: 34422377 PMCID: PMC8339788 DOI: 10.21037/jtd-21-724] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/11/2021] [Indexed: 12/03/2022]
Abstract
Esophagectomy is a technically involved surgery and can have significant postoperative morbidity. Although the mortality rate following esophagectomy has decreased in recent years, this surgical procedure has a relatively high complication rate compared to other surgeries to resect cancer. One of the most common complaints after esophagectomy is dysphagia. Dysphagia after esophagectomy can significantly affect quality of life. Dysphagia is a complication following esophagectomy that can lead to respiratory deterioration and death. The most common sites of postoperative dysphagia are the gastroesophageal anastomosis, gastric conduit, pylorus and the hiatus. Without appropriate treatment of dysphagia, malnutrition and dehydration can develop. These factors can lead to significant impacts to the overall health of a patient and increase mortality. A detailed literature review provided data to support diagnostic modalities and management strategies to treat postoperative dysphagia at these common areas. A systematic, evidence-based approach to diagnosis and treatment of postoperative dysphagia allows for prompt intervention and a decrease in morbidity and mortality. Treatment options for dysphagia vary, depending on the etiology. Based on the location and mechanism of dysphagia, options include stenting, dilation and surgical revision. Early treatment of dysphagia after esophagectomy can lessen the morbidity from this complication and improve quality of life.
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Affiliation(s)
- Cecilia Benz
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Jessica Martella
- University of Texas Medical Branch School of Medicine, Galveston, TX, USA
| | - Basel Hamwi
- University of Texas Medical Branch School of Medicine, Galveston, TX, USA
| | - Ikenna Okereke
- Division of Thoracic Surgery, Henry Ford Health, Detroit, MI, USA
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Leesley H, Okereke I. Commentary: Should Standard Uptake Value Decide Who Gets Surgery? Semin Thorac Cardiovasc Surg 2021; 34:1061-1062. [PMID: 34407432 DOI: 10.1053/j.semtcvs.2021.08.004] [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] [Received: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Haley Leesley
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health System, Detroit, MI.
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14
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Mohan N, Okereke I. Commentary: The behavior of leaders. J Thorac Cardiovasc Surg 2021; 164:e263-e264. [PMID: 34304891 DOI: 10.1016/j.jtcvs.2021.07.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Navyatha Mohan
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health System, Detroit, Mich.
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15
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Benz C, Okereke I. Commentary: Pleurography: We can, but should we? JTCVS Tech 2021; 7:292-293. [PMID: 34318273 PMCID: PMC8312107 DOI: 10.1016/j.xjtc.2021.03.029] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Cecilia Benz
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex
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16
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Taylor M, Wallen T, Mehaffey JH, Shirafkan A, Brescia AA, Freeman K, Louis C, Watson J, Okereke I. Interviews During the Pandemic: A Thoracic Education Cooperative Group and Surgery Residents Project. Ann Thorac Surg 2021; 113:663-668. [PMID: 33774001 DOI: 10.1016/j.athoracsur.2021.02.089] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The 2020 interview cycle for cardiothoracic fellowships was affected by the coronavirus-19 pandemic. Many programs shifted from in-person to virtual interviews. We evaluated applicant perceptions of the various formats. METHODS All 2019-2020 cardiothoracic fellowship applicants received an electronic survey after completion of the match process. The survey assessed number of in-person/virtual interviews completed, perception of efficacy, and likelihood of ranking a program based on format, and strengths/inadequacies of virtual interviews. RESULTS Response rate was 36% (48 of 133). Seventy-three percent of respondents (35 of 48) interviewed with more than 10 programs. Fifty-two percent of respondents (25 of 48) were able to schedule additional interviews once virtual formats were available. A slight majority (56%, 27 of 48) ranked a program at which they had an in-person interview as their first choice. Interviewing at more than 10 programs was associated with an increased likelihood of successfully matching at a program (P = .02). Overwhelmingly, respondents favored an in-person component to the interview process (96%, 46 of 48). Few respondents (29%, 14 of 48) thought they could adequately evaluate a program virtually. The factors that had the highest percentages of adequate portrayal during virtual interviews were the didactic schedule/curriculum (81%, 39 of 48) and case number/autonomy (58%, 28 of 48). The factors with the lowest percentages were culture/personality (19%, 9 of 48) and city/lifestyle (15%, 7 of 48). CONCLUSIONS Applicants strongly favored an in-person component to interviews, highlighting potential deficiencies in the virtual interview process. Programs should consider the addition of virtual tours of their hospitals, narrations from staff, and vignettes from current fellows about lifestyle and well-being.
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Affiliation(s)
- Melissa Taylor
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Tyler Wallen
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - J Hunter Mehaffey
- Division of Cardiac and Thoracic Surgery, University of Virginia, Charlottesville, Virginia
| | - Ali Shirafkan
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Texas
| | | | - Kirsten Freeman
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Clauden Louis
- Division of Cardiac Surgery, University of Rochester, Rochester, New York; Division of Thoracic Surgery, University of Rochester, Rochester, New York
| | - Justin Watson
- Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Texas.
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17
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Luc JGY, Reddy RM, Corsini EM, Carrott PW, David EA, Shemanski K, Fabian T, McCarthy DP, Okereke I, Oliver AL, Turner SR, Vaporciyan AA, Antonoff MB. Are Esophagectomy Board Requirements Achievable? A Multi-Institutional Analysis. Semin Thorac Cardiovasc Surg 2021; 33:1158-1168. [PMID: 33711460 DOI: 10.1053/j.semtcvs.2021.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
Duty-hour restrictions have implications on trainee operative exposure necessary to meet minimum case-volume requirements. We utilized a previously validated simulation model to evaluate the effect of program volume, trainee numbers and complement, and rotation schedule on the probability of achieving adequate esophagectomy case numbers for cardiothoracic surgery trainees. A ProModel simulator centered on probabilistic distributions of operative cases was utilized. Historical data from five 2-year cardiothoracic surgery training programs were obtained from 2016-2018 and used as inputs to the simulator that generated 10,000 "trainee 2-year periods" per program. Programs varied in annual average esophagectomy volume (12-91 per year), with 2-4 trainees graduating over a 2-year training period. If esophagectomy cases were distributed solely based on scheduling and institutional volume, only 60% of evaluated programs could adequately expose all trainees in esophagectomy to meet case requirements. The 3 programs with adequate esophagectomy volumes had averaged 3.3 times (range 3.0-3.6) the minimum number of board-required cases for their programs' trainees. The ability of programs to provide trainees with adequate esophagectomy volume is challenging based on institutional volume and scheduling. Through simulation, we demonstrate that programs need >2 times the expected minimum number of esophagectomies to ensure that >90% of trainees meet case-volume requirements. Programs may consider strategies such as allowing trainees to select cases based on personal need, train fewer fellows, or enable trainees to seek subspecialty exposure externally to achieve minimum esophagectomy case-load requirements.
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Affiliation(s)
- Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis
| | - Rishindra M Reddy
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Erin M Corsini
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Department of Thoracic and Cardiovascular Surgery, UT MD Anderson Cancer Center, Houston, Texas
| | - Philip W Carrott
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of General Thoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Elizabeth A David
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Kimberly Shemanski
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Thomas Fabian
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of Thoracic Surgery, Albany Medical Center, Department of Surgery, Albany Medical College, Albany, New York
| | - Daniel P McCarthy
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Section of Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ikenna Okereke
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Aundrea L Oliver
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Simon R Turner
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Ara A Vaporciyan
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Department of Thoracic and Cardiovascular Surgery, UT MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Thoracic Education Cooperative Group, Thoracic Surgical Directors Association, Chicago, Illionis; Department of Thoracic and Cardiovascular Surgery, UT MD Anderson Cancer Center, Houston, Texas; Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California.
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Velasquez C, Okereke I. Commentary: Teamwork is needed to prevent aorto-conduit fistulas from being fatal. JTCVS Tech 2021; 7:336-337. [PMID: 34318284 PMCID: PMC8311679 DOI: 10.1016/j.xjtc.2021.02.021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Camilo Velasquez
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex
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19
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Suzuki Y, Okereke I. Commentary: Perspectives after surgical training in Japan and the United States. J Thorac Cardiovasc Surg 2020; 163:359-360. [PMID: 33454103 DOI: 10.1016/j.jtcvs.2020.12.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Yota Suzuki
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex.
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20
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Mobli K, Okereke I. Commentary: Are cardiothoracic trainees operating enough? J Thorac Cardiovasc Surg 2020; 161:1077-1078. [PMID: 33419549 DOI: 10.1016/j.jtcvs.2020.11.116] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Keyan Mobli
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex.
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21
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Mohan N, Hughes B, Williams T, Perez A, Tyler D, Okereke I. Use of Surgical Simulation by Underrepresented High School Students to Address Diversity Gaps in Surgery. Ann Surg Open 2020; 1:e013. [PMID: 37637451 PMCID: PMC10455432 DOI: 10.1097/as9.0000000000000013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/15/2020] [Indexed: 11/25/2022] Open
Abstract
Recent tragedies have displayed systemic inequities in our society. Our institution has created a program for underrepresented high school students in our surgical simulation lab. The students have responded very favorably, and their interest in a surgical career and self-confidence increased significantly.
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Affiliation(s)
- Navyatha Mohan
- From the Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Byron Hughes
- From the Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Taylor Williams
- From the Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Alexander Perez
- From the Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Douglas Tyler
- From the Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX
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22
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Okereke I. Commentary: We need diversity in cardiothoracic surgery. J Thorac Cardiovasc Surg 2020; 162:1789-1790. [PMID: 33353746 DOI: 10.1016/j.jtcvs.2020.11.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex.
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23
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Williams SB, Shan Y, Jazzar U, Kerr PS, Okereke I, Klimberg VS, Tyler DS, Putluri N, Lopez DS, Prochaska JD, Elferink C, Baillargeon JG, Kuo YF, Mehta HB. Proximity to Oil Refineries and Risk of Cancer: A Population-Based Analysis. JNCI Cancer Spectr 2020; 4:pkaa088. [PMID: 33269338 PMCID: PMC7691047 DOI: 10.1093/jncics/pkaa088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/11/2020] [Accepted: 09/22/2020] [Indexed: 11/15/2022] Open
Abstract
Background The association between proximity to oil refineries and cancer rate is largely unknown. We sought to compare the rate of cancer (bladder, breast, colon, lung, lymphoma, and prostate) according to proximity to an oil refinery in Texas. Methods A total of 6 302 265 persons aged 20 years or older resided within 30 miles of an oil refinery from 2010 to 2014. We used multilevel zero-inflated Poisson regression models to examine the association between proximity to an oil refinery and cancer rate. Results We observed that proximity to an oil refinery was associated with a statistically significantly increased risk of incident cancer diagnosis across all cancer types. For example, persons residing within 0-10 (risk ratio [RR] = 1.13, 95% confidence interval [CI] = 1.07 to 1.19) and 11-20 (RR = 1.05, 95% CI = 1.00 to 1.11) miles were statistically significantly more likely to be diagnosed with lymphoma than individuals who lived within 21-30 miles of an oil refinery. We also observed differences in stage of cancer at diagnosis according to proximity to an oil refinery. Moreover, persons residing within 0-10 miles were more likely to be diagnosed with distant metastasis and/or systemic disease than people residing 21-30 miles from an oil refinery. The greatest risk of distant disease was observed in patients diagnosed with bladder cancer living within 0-10 vs 21-30 miles (RR = 1.30, 95% CI = 1.02 to 1.65), respectively. Conclusions Proximity to an oil refinery was associated with an increased risk of multiple cancer types. We also observed statistically significantly increased risk of regional and distant/metastatic disease according to proximity to an oil refinery.
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Affiliation(s)
- Stephen B Williams
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Yong Shan
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Usama Jazzar
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Preston S Kerr
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna Okereke
- Department of Surgery, Division of Thoracic Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - V Suzanne Klimberg
- Department of Surgery, Division of Surgical Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Nagireddy Putluri
- Department of Molecular and Cellular Biology, Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - David S Lopez
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - John D Prochaska
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Cornelis Elferink
- Department of Pharmacology and Toxicology, Center for Environmental Toxicology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Jacques G Baillargeon
- Department of Medicine, Division of Epidemiology, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Medicine, Division of Epidemiology, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Hemalkumar B Mehta
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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24
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Suzuki Y, Okereke I. Commentary: The changing role of the Thoracic Surgery Residents Association over time. J Thorac Cardiovasc Surg 2020; 162:929-930. [PMID: 32977959 DOI: 10.1016/j.jtcvs.2020.09.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Yota Suzuki
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex.
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25
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Shirafkan A, Okereke I. Commentary: Are thoracic surgery program websites a charming enough vitrine? J Thorac Cardiovasc Surg 2020; 162:733-734. [PMID: 32753107 PMCID: PMC7358750 DOI: 10.1016/j.jtcvs.2020.06.120] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ali Shirafkan
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex.
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Abstract
The sternoclavicular joint (SCJ) is anatomically and clinically significant considering its proximity to important neuro-vascular structures like the subclavian vessels and the phrenic nerve. Infections of this joint masquerade multiple disorders, delay diagnosis and spread to the bone and deep tissues. There is no standardized workup and treatment protocol for sternoclavicular joint infections (SCJI) as defined in literature. Here, we review the existing literature to understand the current knowledge of the diagnosis and treatment of SCJI. We searched English publications in PubMed and included clinical trials, case reports, case series, retrospective cohort studies, literature and systematic reviews after excluding non-infectious etiology of SCJ pathologies. There are many risk factors for SCJI, such as immunocompromised status, intravenous drug use, trauma and arthropathies. But a large percentage of patients with disease have none of these risk factors. SCJIs can present with fever, joint swelling, immobility, and rarely with vocal cord palsy or dysphagia. While Staphylococcus aureus causes over 50% of SCJI cases, other pathogens such as Pseudomonas and Mycobacterium are frequently seen. When diagnosed early, the infection can be medically managed with antibiotics or joint aspirations. Most cases of SCJI, however, are diagnosed after extensive spread to soft tissue and bones requiring en-bloc resection with or without a muscle flap. Complications of undertreatment can range from simple abscess formation to mediastinitis, even sepsis. SCJIs are rare but serious infections prompting early detection and interventions. Most cases of SCJI treated adequately show complete resolution in months while retaining maximum functionality. Key features of proper healing include aggressive physiotherapy to prevent adhesive shoulder capsulitis and decreased range of motion.
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Affiliation(s)
- Sadia Tasnim
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Ali Shirafkan
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Williams SB, Shan Y, Jazzar U, Kerr P, Okereke I, Klimberg VS, Tyler DS, Putluri N, Lopez DS, Prochaska JD, Elferink C, Baillargeon JG, Kuo YF, Mehta HB. Proximity to oil refineries and risk of cancer: A population-based analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e13586] [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: 11/20/2022] Open
Abstract
e13586 Background: Proximity to oil refineries and cancer incidence is largely unknown. We sought to compare the incidence of cancer (bladder, breast, colon, lung, lymphoma, and prostate) according to proximity to an oil refinery in the State of Texas. Methods: A total of 6,302,265 persons aged ≥20 years from January 1, 2001 through December 31, 2014 were identified. We used zero-inflated Poisson regression models to examine the association of proximity to an oil refinery with cancer incidence. Results: We observed that proximity to an oil refinery was associated with a significantly increased risk of incident cancer diagnosis across all cancer types. For example, persons residing within 0-10 (Risk Ratio (RR) 1.16, 95% Confidence Interval (CI) 1.13-1.19) and 11-20 (RR 1.08, 95% CI 1.05-1.11) miles were significantly more likely to be diagnosed with lymphoma than individuals who lived within 21-30 miles from an oil refinery. We also observed differences in stage of cancer at diagnosis according to proximity to an oil refinery. We also found persons residing within 0-10 miles were more likely to be diagnosed with distant metastasis and/or systemic disease than people residing 21-30 miles from an oil refinery. The greatest risk of distant disease was observed in patients diagnosed with bladder cancer living within 0-10 vs. 21-30 miles (RR 1.33, 95% CI 1.06-1.68), respectively. Conclusions: Proximity to an oil refinery was associated with an increased risk of multiple cancer types. We also observed significantly increased risk of regional and distant/metastatic disease according to proximity to an oil refinery.
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Affiliation(s)
| | - Yong Shan
- The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Usama Jazzar
- The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Preston Kerr
- The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Ikenna Okereke
- The University of Texas Medical Branch at Galveston, Galveston, TX
| | | | - Douglas S. Tyler
- The University of Texas Medical Branch at Galveston, Galveston, TX
| | | | - David S Lopez
- The University of Texas Medical Branch at Galveston, Galveston, TX
| | - John D Prochaska
- The University of Texas Medical Branch at Galveston, Galveston, TX
| | | | | | - Yong-Fang Kuo
- University of Texas Medical Branch at Galveston, Galveston, TX
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28
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Nishi SPE, Zhou J, Okereke I, Kuo YF, Goodwin J. Use of Imaging and Diagnostic Procedures After Low-Dose CT Screening for Lung Cancer. Chest 2020; 157:427-434. [PMID: 31521671 PMCID: PMC7005377 DOI: 10.1016/j.chest.2019.08.2187] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/06/2019] [Accepted: 08/10/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clinical trials have demonstrated a mortality benefit from lung cancer screening by low-dose CT (LDCT) in current or past tobacco smokers who meet criteria. Potential harms of screening mostly relate to downstream evaluation of abnormal screens. Few data exist on the rates outside of clinical trials of imaging and diagnostic procedures following screening LDCT. We describe rates in the community setting of follow-up imaging and diagnostic procedures after screening LDCT. METHODS We used Clinformatics Data Mart national database to identify enrollees age 55 to 80 year who underwent screening LDCT from January 1, 2016, to December 31, 2016. We assessed rates of follow-up imaging (diagnostic chest CT scan, MRI, and PET) and follow-up procedures (bronchoscopy, percutaneous biopsy, thoracotomy, mediastinoscopy, and thoracoscopy) in the 12 months following LDCT for lung cancer screening. We also assessed these rates in an age-, sex-, and number of comorbidities-matched population that did not undergo LDCT to estimate rates unrelated to the screening LDCT. We then reported the adjusted rate of follow-up testing as the observed rate in the screening LDCT population minus the rate in the non-LDCT population. RESULTS Among 11,520 enrollees aged 55 to 80 years who underwent LDCT in 2016, the adjusted rates of follow up 12 months after LDCT examinations were low (17.7% for imaging and 3.1% for procedures). Among procedures, the adjusted rates were 2.0% for bronchoscopy, 1.3% for percutaneous biopsy, 0.9% for thoracoscopy, 0.2% for mediastinoscopy, and 0.4% for thoracotomy. Adjusted rates of follow-up procedures were higher in enrollees undergoing an initial screening LDCT (3.3%) than in those after a second screening examination (2.2%). CONCLUSIONS In general, imaging and rates of procedures after screening LDCT was low in this commercially insured population.
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Affiliation(s)
- Shawn P E Nishi
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Galveston, TX.
| | - Jie Zhou
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Galveston, TX
| | - Ikenna Okereke
- Department of Surgery, University of Texas Medical Branch, Galveston, Galveston, TX
| | - Yong-Fang Kuo
- Department of Preventive Medicine, University of Texas Medical Branch, Galveston, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Galveston, TX
| | - James Goodwin
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Galveston, TX; Department of Preventive Medicine, University of Texas Medical Branch, Galveston, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Galveston, TX
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29
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Ziapour B, Mostafidi E, Sadeghi-Bazargani H, Kabir A, Okereke I. Timing to perform VATS for traumatic-retained hemothorax (a systematic review and meta-analysis). Eur J Trauma Emerg Surg 2019; 46:337-346. [PMID: 31848631 DOI: 10.1007/s00068-019-01275-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE In this systematic review, we analyzed the optimal time range to evacuate traumatic-retained hemothorax using video-assisted thoracoscopic surgery (VATS). METHODS We searched PubMed, EMBASE, the Cochrane Register of Controlled Trials, Google Scholar, and the U.S. National Library of Medicine clinical trials database up to February 2019. Randomized controlled trials (RCTs) and observational studies with relevant data were included. Data were extracted from studies that reported the success, mortality, or length of hospital stay (LOS) after using VATS during at least two out of three of our time-ranges of interest: days 1-3 (group A), days 4-6 (group B), and day 7 or later (group C). RESULTS Six cohort studies with 476 total participants were included in the meta-analysis. The patients in group A had a significantly higher success rate than those in group C (RR = 0.42; 95% CI = 0.21-0.84, p = 0.01). The total LOS for patients whose retained hemothorax was evacuated in group A was 4.7 days shorter than that for those in group B (95% CI = - 5.6 to - 3.8, p = 0.006). Likewise, group B patients were discharged 18.1 days earlier than group C patients (95% CI = - 22.3 to - 14, p < 0.001). Short-term mortality was not decreased by early VATS. CONCLUSIONS Our results indicate that VATS should be considered within the first three days of admission if this intervention is the clinician's choice to evacuate a traumatic-retained hemothorax. Protocol registration number in PROSPERO: CRD42017046856.
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Affiliation(s)
- Behrad Ziapour
- Tufts Medical Center, 800 Washington Street #1035, Boston, MA, 02111, USA.
| | | | - Homayoun Sadeghi-Bazargani
- Department of Statistics and Epidemiology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ikenna Okereke
- Chief of Thoracic Surgery, Division of Cardiovascular and Thoracic Surgery, Program Director, Cardiothoracic Fellowship Program, Division of Cardiothoracic Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0528, USA
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30
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Okereke I. Commentary: The transition from resident to attending is a marathon, not a sprint. J Thorac Cardiovasc Surg 2019; 159:1161-1162. [PMID: 31668535 DOI: 10.1016/j.jtcvs.2019.09.096] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex.
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31
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Taylor M, Okereke I. Commentary: Is radiation needed after resecting an early-stage small cell lung cancer? J Thorac Cardiovasc Surg 2019; 158:1678. [PMID: 31606166 DOI: 10.1016/j.jtcvs.2019.08.092] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Melissa Taylor
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex.
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32
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Okereke I. The changing landscape of esophageal disease. J Thorac Dis 2019; 11:S1579-S1580. [PMID: 31489223 DOI: 10.21037/jtd.2019.08.47] [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: 11/06/2022]
Affiliation(s)
- Ikenna Okereke
- Chief, Thoracic Surgery, Granville T. Hall Chair in General Surgery, Program Director, Cardiothoracic Surgery Fellowship Program, Associate Professor of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA
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33
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Suzuki Y, Robinson S, Okereke I. Association of a Giant Lymphoma Mass With Occupational Benzene Exposure. J Med Cases 2019; 10:274-276. [PMID: 34434322 PMCID: PMC8383537 DOI: 10.14740/jmc3364] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/09/2019] [Indexed: 11/11/2022] Open
Abstract
Benzene is a chemical widely used in industrial settings and known to have hematopoietic toxicity. Previous literature has been inconsistent regarding a direct association of benzene exposure with lymphoma. A young patient with a strong history of benzene exposure presented with a 17-cm chest wall lymphoma and purulent drainage from the mass. He underwent resection of the mass. Pathologic analysis revealed a high-grade diffuse large B-cell lymphoma. The wound ultimately healed well and the patient received adjuvant chemotherapy. Though the overall literature has been inconsistent regarding the association of benzene with lymphoma, our report highlights the possibility that a very extensive exposure history may be a risk factor for the development of lymphoma.
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Affiliation(s)
- Yota Suzuki
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Shawn Robinson
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
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34
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Abstract
The incidence of esophageal diseases such as esophageal adenocarcinoma (EAC) and gastroesophageal reflux disease (GERD) have been increasing over the last 40 years. The esophageal microbiome appears to have a role in the development of some disease processes, and could also serve as markers of early diseases of the esophagus. A literature review was performed examining the role of the microbiome in the development of esophageal disease. In addition, the results of several studies and experiments were included in the review. Both EAC and GERD have increased in incidence over the last 40 years. Barrett's esophagus (BE) is a risk factor for EAC. Patients with BE appear to have a microbiome expression pattern distinct from patients without BE. The distinct pattern may be related to factors within the distal esophagus such as a more acidic environment, intraluminal stasis and other elements. It remains unclear whether the change in microflora leads to esophageal disease, or whether the disease process within the esophagus allows these particular organisms to experience overgrowth compared to other microflora. Patient factors such as body mass index (BMI), diet and geographic location also appear to affect the esophageal microbiome. There is an association with the esophageal microbiome and several esophageal diseases. Future studies should examine these correlations more closely. The distinct patterns may be able to serve as a marker of early disease, and possibly lead to a mechanism for the development of esophageal disease.
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Affiliation(s)
- Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Catherine Hamilton
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Alison Wenholz
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Vikram Jala
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX, USA
| | - Thao Giang
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Sandy Reynolds
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Aaron Miller
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Richard Pyles
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
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Okereke I, Hamilton C, Reep G, Krill T, Booth A, Ghouri Y, Jala V, Andersen C, Pyles R. Microflora composition in the gastrointestinal tract in patients with Barrett's esophagus. J Thorac Dis 2019; 11:S1581-S1587. [PMID: 31489224 DOI: 10.21037/jtd.2019.06.15] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The incidence of esophageal adenocarcinoma (EAC) has been increasing over the last 40 years. While Barrett's esophagus is a known risk factor for the development of EAC, the role of the microflora in the development of EAC is still largely unknown and is being investigated further by multiple centers. Our goal was to identify trends in microflora composition along various aspects of the upper gastrointestinal tract in patients with Barrett's esophagus. Methods After obtaining institutional review board approval, 12 patients agreed to participate in the study. While endoscopy was performed for surveillance Barrett's monitoring, additional biopsies of esophageal mucosa were taken from the (I) proximal esophagus, (II) mid-esophagus, (III) distal esophagus, and (IV) Barrett's esophagus. Additional swabs were also taken from the uvula and the endoscope used during the procedure. The swabs from the uvula and endoscope were obtained prior to the endoscope entering the stomach, to prevent exposing the endoscope to the acidic environment of the stomach. The most common bacterial elements were identified by amplifying sample DNA using a panel of 5 "universal" fusion primer pairs. The 400-500 base pair fragments created an overlap which covered 95% of the bacterial 16s gene. Results Throughout the esophagus, 34 bacterial genera were found which had a relative abundance of >1.0. Streptococcal genera were prevalent in all aspects of the esophagus, ranging from 16% to 70% of the bacterial community. Haemophilus genera were uniquely abundant in the Barrett's esophageal tissue but relatively absent elsewhere in the upper gastrointestinal tract. Overall, the percentage of Gram-positive organisms was much higher in the proximal than distal esophagus. The microflora pattern obtained from the uvula and endoscopic swabs did not correlate with any of the tissue biopsies along any aspect of the esophagus. Conclusions In patients with Barrett's esophagus, Streptococcal genera are widespread throughout the esophagus. Gram-positive genera tend to decrease as a percentage of overall flora distally. Obtaining a simple swab of the oropharynx or endoscope itself appears to be a poor substitute for tissue biopsy of esophageal mucosa when evaluating microflora patterns.
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Affiliation(s)
- Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Catherine Hamilton
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Gabriel Reep
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX, USA
| | - Timothy Krill
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX, USA
| | - Adam Booth
- Division of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Yezaz Ghouri
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX, USA
| | - Vikram Jala
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX, USA
| | - Clark Andersen
- Department of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Richard Pyles
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
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Ayub A, Nunez Lopez O, Booth A, Okereke I. Pulmonary hepatoid adenocarcinoma. J Thorac Cardiovasc Surg 2019; 158:e139-e140. [PMID: 31358339 DOI: 10.1016/j.jtcvs.2019.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/23/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Adil Ayub
- Department of Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Omar Nunez Lopez
- Department of Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Adam Booth
- Department of Pathology, University of Texas Medical Branch, Galveston, Tex
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex.
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Wenholz A, Xu XM, Nawgiri R, Okereke I. A prospective analysis of touch preparation cytology for intraoperative detection of mediastinal lymph node metastases. J Am Soc Cytopathol 2018; 8:84-88. [PMID: 31287424 DOI: 10.1016/j.jasc.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/01/2018] [Accepted: 12/03/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Patients diagnosed with lung cancer may require immediate evaluation of mediastinal lymph nodes to determine treatment plan. Typically, frozen section (FS) analysis has been used, but this analysis can be time-consuming and uses more tissue than touch preparation (TP) cytologic analysis. TP accuracy has been studied in other organs, but no prospective studies comparing TP to FS have been performed on mediastinal lymph nodes in lung cancer. Our goal was to compare the accuracy of TP to FS in these cases. MATERIALS AND METHODS After obtaining institutional review board approval, all patients undergoing mediastinal lymph node evaluation for a diagnosis of lung cancer were asked to participate. If consent was given, TP and FS analyses were performed on all mediastinal lymph node stations in all patients and compared to permanent hematoxylin and eosin analysis. Data were collected prospectively. RESULTS Twenty patients were enrolled. Mean age was 67.7 years. Fifty-five percent (11 of 20) of patients were men. The mean number of lymph node stations sampled in each patient was 3.4. In predicting the stage of the patient, TP had a sensitivity and specificity of 95% and 100%, respectively. FS had a lower sensitivity, 85%, and a specificity of 100%. On permanent analysis, metastatic foci ranged in size from 0.15 mm to 1.5 mm. CONCLUSIONS TP was more sensitive than FS in detecting mediastinal lymph node metastases. The technical difficulty of obtaining full-thickness sections without creating significant artifact may contribute to the lower sensitivity of FS in detecting micrometastases.
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Affiliation(s)
- Alison Wenholz
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Xiao-Meng Xu
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | - Ranjana Nawgiri
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Texas.
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Abstract
Postoperative thyroid storm represents a diagnostic dilemma in patients with overlooked hyperthyroid state undergoing a nonthyroid surgery. We report a 30-year-old female with a history of mixed connective tissue disease who presented with an anterior mediastinal mass and underwent a thoracoscopic resection of the mass. On postoperative day 1, she had an acute change in mental status with fever, tachycardia and hypercapnic respiratory failure requiring intubation and mechanical ventilation. An elevated free thyroxine concentration and almost undetectable serum thyroid stimulating hormone suggested thyroid storm as the culprit. The patient was rendered euthyroid after initiation of therapy with propylthiouracil/methimazole, potassium iodide oral solution and systemic steroid. Histopathology of the resected anterior mediastinal mass showed thymic hyperplasia. In retrospect, the patient had hyperthyroid symptoms before surgery, but this diagnosis was overlooked. Non-thyroid surgeries can trigger thyroid storm in the setting of poorly controlled or overlooked hyperthyroidism. Although uncommon, thyroid storm should be considered in differential diagnosis of perioperative tachycardia and respiratory failure. We emphasize on the importance of preoperative thyroid workup in patients with tachycardia, palpitation, labile blood pressure, unexplained weight changes or poorly controlled anxiety. The significance of a proper preoperative assessment cannot be overestimated.
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Affiliation(s)
| | | | - Ikenna Okereke
- Surgery, University of Texas Medical Branch, Galveston, USA
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Lu R, Brown K, Okereke I. Cologastric strictures: What is the best treatment? J Surg Case Rep 2017; 2017:rjw229. [PMID: 28069881 PMCID: PMC5220118 DOI: 10.1093/jscr/rjw229] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 31-year-old gentleman who had undergone an emergent esophagectomy and reconstruction with a colon interposition graft, presented with a long-standing cologastric stricture. He had undergone multiple attempts at endoscopic dilation over multiple decades with little symptomatic relief. He underwent a resection and reconstruction of the anastomosis entirely through an abdominal approach. He did well from surgery and experienced complete symptomatic relief immediately. Complications of colon interposition grafts can occasionally be treated using an abdominal incision only.
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Affiliation(s)
- Richard Lu
- Division of Hepatopancreaticobiliary Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Kimberly Brown
- Division of Hepatopancreaticobiliary Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Affiliation(s)
- Ikenna Okereke
- Thoracic Surgery, University of Texas Medical Branch, Galveston, TX 77551
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Okereke I. How should we treat air leaks? J Thorac Cardiovasc Surg 2015; 149:960-1. [PMID: 25680750 DOI: 10.1016/j.jtcvs.2015.01.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 01/10/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Ikenna Okereke
- Division of Thoracic Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
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Hardacker TJ, Ceppa D, Okereke I, Rieger KM, Jalal SI, LeBlanc JK, DeWitt JM, Kesler KA, Birdas TJ. Treatment of clinical T2N0M0 esophageal cancer. Ann Surg Oncol 2014; 21:3739-43. [PMID: 25047477 DOI: 10.1245/s10434-014-3929-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Management of clinical T2N0M0 (cT2N0M0) esophageal cancer remains controversial. We reviewed our institutional experience over 21 years (1990-2011) to determine clinical staging accuracy, optimal treatment approaches, and factors predictive of survival in this patient population. METHODS Patients with cT2N0M0 esophageal cancer determined by endoscopic ultrasound (EUS) were identified through a prospectively collected database. Demographics, perioperative data, and outcomes were examined. Cox regression model and Kaplan-Meier plots were used for statistical survival analysis. RESULTS A total of 731 patients underwent esophagectomy, of whom 68 cT2N0M0 patients (9 %) were identified. Fifty-seven patients (84 %) had adenocarcinoma. Thirty-three patients (48.5 %) were treated with neoadjuvant chemoradiation followed by surgery, and 35 underwent surgical resection alone. All resections except one included a transthoracic approach with two-field lymph node dissection. Thirty-day operative mortality was 2.9 %. Only 3 patients (8.5 %) who underwent surgery alone had T2N0M0 disease identified by pathology: the disease of 15 (42.8 %) was found to be overstaged and 17 (48.5 %) understaged after surgery. Understaging was more common in poorly differentiated tumors (p = 0.03). Nine patients (27.2 %) had complete pathologic response after chemoradiotherapy. Absence of lymph node metastases (pN0) was significantly more frequent in the neoadjuvant group (29 of 33 vs. 21 of 35, p = 0.01). Median follow-up was 44.2 months. Overall 5-year survival was 50.8 %. On multivariate analysis, adenocarcinoma (p = 0.001) and pN0 after resection (p = 0.01) were significant predictors of survival. CONCLUSIONS EUS was inaccurate in staging cT2N0M0 esophageal cancer in this study. Poorly differentiated tumors were more frequently understaged. Adenocarcinoma and absence of lymph node metastases (pN0) were independently predictive of long-term survival. pN0 status was significantly more common in patients undergoing neoadjuvant therapy, but long-term survival was not affected by neoadjuvant therapy. A strategy of neoadjuvant therapy followed by resection may be optimal in this group, especially in patients with disease likely to be understaged.
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Affiliation(s)
- Thomas J Hardacker
- Section of Thoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA,
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Murthy SC, Okereke I, Mason DP, Rice TW. A Simple Solution for Complicated Pleural Effusions. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)30384-1] [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: 10/22/2022]
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Murthy SC, Okereke I, Mason DP, Rice TW. A simple solution for complicated pleural effusions. J Thorac Oncol 2006; 1:697-700. [PMID: 17409939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Complicated pleural effusions are difficult to manage with conventional strategies. In this study, we review the safety, efficacy, and durability of PleurX catheters (Denver Biomedical, Golden, CO) for managing complicated pleural effusions and describe a patient population who might benefit. PATIENTS AND METHODS From July 1999 to February 2003, 63 PleurX catheters were placed in 58 symptomatic patients (an additional five had bilateral catheters) to manage complicated pleural effusions. Patients selected for catheter placement tended to have poor performance status (Eastern Cooperative Oncology Group < or =2) or had failed standard therapies. Of the 63 catheters, 52 (83%) were placed because of malignant complicated pleural effusions. A registry of patients was constructed, and data were obtained from review of medical records. Nonparametric estimates of freedom from reintervention and overall survival were obtained by the Kaplan-Meier method. RESULTS Catheter-related complications were noted in four of 58 patients (7%) and included one each of pneumothorax, seroma, empyema, and pain syndrome. Freedom from reintervention for effusion management was 95%. Of the patients, 86% (50 of 58) experienced dyspnea relief. There were no procedure-related mortalities. Catheters remained functional up to 330 days, and four of 63 (6%) required one-time thrombolysis with tissue plasminogen activator. CONCLUSIONS PleurX catheters are safe, effective, and durable solutions for complicated pleural effusions and seem to provide an attractive alternative for patients who have few other palliative options. We consider the catheters as first-line therapy for these patients.
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Affiliation(s)
- Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Abstract
BACKGROUND Air leak after pulmonary resection is a common occurrence that is incompletely characterized. Our objectives were to determine prevalence of air leak and identify its risk factors, characterize its duration and discover its correlates, and evaluate its clinical importance. METHODS Air leak was studied in 319 patients undergoing isolated anatomic lobectomy between January 1998 and July 2001. Risk factors for air leak were identified by logistic regression of patient characteristics, indications for lobectomy, lobe resected, and fissure management. Factors associated with air leak duration were sought by time-related analysis. Association of complications with air leak was evaluated by propensity-matched pairs analysis. RESULTS Prevalence: Air leak prevalence was 58% (186 patients). It occurred less frequently after left lower lobectomy (p < 0.0001) and later in the series (p = 0.008). It was surgeon dependent (p = 0.007) but not associated with forced expiratory volume in 1 second. DURATION The 10th, 50th, and 90th percentiles of air leak duration were 1.6, 3, and 7 days, respectively. No factors, including fissure management, were reliably associated with air leak duration. IMPORTANCE Air leak was associated with more complications (30% vs 18%, p = 0.07) and protracted hospital course (p = 0.02). CONCLUSIONS Postoperative air leak is a common occurrence after lobectomy, but fortunately it is self-limiting in most patients. Air leak is independently associated with longer hospital stay and other postoperative complications. Surgical technique is important and may be the only modifiable factor.
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Affiliation(s)
- Ikenna Okereke
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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