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Knight K, Vogel H, Bischoff M, Bajwa K. Ectopic adrenal tissue in a cat that underwent an ovariohysterectomy. J Am Vet Med Assoc 2024; 262:1-3. [PMID: 37988763 DOI: 10.2460/javma.23.09.0518] [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: 09/26/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To describe the use of ultrasound and adrenal function testing to confirm that excised periovarian tissue is normal ectopic adrenal tissue (EAT). ANIMAL A 6-month-old female domestic shorthair cat. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES The cat underwent an ovariohysterectomy procedure, during which abnormal tissue was discovered adjacent to both ovaries. The tissue was removed during the ovariohysterectomy and submitted for histopathology, which was consistent with adrenal gland tissue, initially raising concern for an inadvertent adrenalectomy. Abdominal ultrasound and an adrenal function test were performed that confirmed normal adrenal structure and function; thus, the removed structure was diagnosed as EAT. TREATMENT AND OUTCOME The patient continued to recover from the procedure uneventfully at home. CLINICAL RELEVANCE Parovarian nodules are an uncommon finding but when observed and biopsied, may be mistaken for physiologic adrenal tissue on the basis of histopathologic features alone without awareness of their existence and clinical context. The use of abdominal ultrasound and ACTH stimulation test offers an affirmative method of differentiating adrenal gland tissue from EAT.
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Affiliation(s)
| | - Helena Vogel
- 2College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
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Iranmanesh P, Bajwa K, Snyder B, Wilson T, Chandwani K, Shah S, Wilson E. Trocar site closure with a novel anchor-based (neoClose®) system versus standard suture closure: A prospective randomized controlled trial. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.035] [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]
Abstract
Abstract
Objective
Patients with obesity have a higher risk of trocar site hernia. The objective of the present study was to compare a standard suture passer versus the neoClose® device for port site fascial closure in patients with obesity undergoing laparoscopic bariatric surgery.
Methods
This is a randomized, controlled trial with two parallel arms. Thirty five patients with BMI ≥ 35 kg/m2 and undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass were randomized to each group. Port site fascial closure for trocars ≥ 10 mm was performed with the neoClose® device in the study group and the standard suture passer in the control group. Primary outcomes were time required to complete closure and intensity of postoperative pain at the fascial closure sites. Secondary outcomes were intraabdominal needle depth and incidence of trocar site hernia.
Results
The use of the neoClose® device resulted in shorter closure times (20.2 vs 30.0 s, p = 0.0002), less pain (0.3 vs 0.9, p = 0.002) at port closure sites, and decreased needle depth (3.3 cm vs 5.2 cm, p < 0.0001) compared to the standard suture passer. There was no trocar site hernia at the one-year follow-up in either group.
Conclusion
Use of the neoClose® device resulted in faster fascial closure times, decreased intraoperative needle depth, and decreased postoperative abdominal pain at 1 week as compared to the standard suture passer. These data need to be confirmed on larger cohorts of patients with longer follow-up, especially in terms of long-term hernia recurrence rates.
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Affiliation(s)
- P Iranmanesh
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - K Bajwa
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - B Snyder
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - T Wilson
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - K Chandwani
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - S Shah
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - E Wilson
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
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Aneja VP, Arya SP, Rumsey IC, Kim DS, Bajwa K, Arkinson HL, Semunegus H, Dickey DA, Stefanski LA, Todd L, Mottus K, Robarge WP, Williams CM. Characterizing ammonia emissions from swine farms in eastern North Carolina: part 2--potential environmentally superior technologies for waste treatment. J Air Waste Manag Assoc 2008; 58:1145-1157. [PMID: 18817107 DOI: 10.3155/1047-3289.58.9.1145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The need for developing environmentally superior and sustainable solutions for managing the animal waste at commercial swine farms in eastern North Carolina has been recognized in recent years. Program OPEN (Odor, Pathogens, and Emissions of Nitrogen), funded by the North Carolina State University Animal and Poultry Waste Management Center (APWMC), was initiated and charged with the evaluation of potential environmentally superior technologies (ESTs) that have been developed and implemented at selected swine farms or facilities. The OPEN program has demonstrated the effectiveness of a new paradigm for policy-relevant environmental research related to North Carolina's animal waste management programs. This new paradigm is based on a commitment to improve scientific understanding associated with a wide array of environmental issues (i.e., issues related to the movement of N from animal waste into air, water, and soil media; the transmission of odor and odorants; disease-transmitting vectors; and airborne pathogens). The primary focus of this paper is on emissions of ammonia (NH3) from some potential ESTs that were being evaluated at full-scale swine facilities. During 2-week-long periods in two different seasons (warm and cold), NH3 fluxes from water-holding structures and NH3 emissions from animal houses or barns were measured at six potential EST sites: (1) Barham farm--in-ground ambient temperature anaerobic digester/energy recovery/greenhouse vegetable production system; (2) BOC #93 farm--upflow biofiltration system--EKOKAN; (3) Carrolls farm--aerobic blanket system--ISSUES-ABS; (4) Corbett #1 farm--solids separation/ gasification for energy and ash recovery centralized system--BEST; (5) Corbett #2 farm--solid separation/ reciprocating water technology--ReCip; and (6) Vestal farm--Recycling of Nutrient, Energy and Water System--ISSUES-RENEW. The ESTs were compared with similar measurements made at two conventional lagoon and spray technology (LST) farms (Moore farm and Stokes farm). A flow-through dynamic chamber system and two sets of open-path Fourier transform infrared (OP-FTIR) spectrometers measured NH3 fluxes continuously from water-holding structures and emissions from housing units at the EST and conventional LST sites. A statistical-observational model for lagoon NH3 flux was developed using a multiple linear regression analysis of 15-min averaged NH3 flux data against the relevant environmental parameters measured at the two conventional farms during two different seasons of the year. This was used to compare the water-holding structures at ESTs with those from lagoons at conventional sites under similar environmental conditions. Percentage reductions in NH3 emissions from different components of each potential EST, as well as the whole farm on which the EST was located were evaluated from the estimated emissions from water-holding structures, barns, etc., all normalized by the appropriate nitrogen excretion rate at the potential EST farm, as well as from the appropriate conventional farm. This study showed that ammonia emissions were reduced by all but one potential EST for both experimental periods. However, on the basis of our evaluation results and analysis and available information in the scientific literature, the evaluated alternative technologies may require additional technical modifications to be qualified as unconditional ESTs relative to NH3 emissions reductions.
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Affiliation(s)
- Viney P Aneja
- Department of Marine, Earth, and Atmospheric Sciences, North Carolina State University, Raleigh, NC 27695-8208, USA.
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Weaver CH, Buckner CD, Curtis LH, Bajwa K, Weinfurt KP, Wilson-Relyea BJ, Schulman KA. Economic evaluation of filgrastim, sargramostim, and sequential sargramostim and filgrastim after myelosuppressive chemotherapy. Bone Marrow Transplant 2002; 29:159-64. [PMID: 11850711 DOI: 10.1038/sj.bmt.1703341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2001] [Accepted: 11/01/2001] [Indexed: 11/09/2022]
Abstract
Filgrastim alone and sequential sargramostim and filgrastim have been shown to be more effective than sargramostim alone in the mobilization of CD34(+) cells after myelosuppressive chemotherapy (MC). We sought to compare costs and resource use associated with these regimens. Data were collected prospectively alongside a multicenter, randomized trial of filgrastim, sargramostim, and sequential sargramostim and filgrastim. Direct medical costs were calculated for inpatient and outpatient visits and procedures, including administration of growth factors and MC. We followed 156 patients for 30 days or until initiation of high-dose chemotherapy. The main outcome measures were resource use and costs of inpatient and outpatient visits, platelet and red blood cell transfusions, antibiotic use, and apheresis procedures. Hospital admissions, red blood cell transfusions, and use of i.v. antibiotics were significantly more common in the sargramostim group than in the other treatment arms. In univariate and multivariable analyses, total costs were higher for patients receiving sargramostim alone than for patients in the other groups. Mean costs in multivariable analysis for the filgrastim and sequential sargramostim and filgrastim arms were not significantly different. Filgrastim alone and sequential sargramostim and filgrastim are less costly than sargramostim alone after MC, as well as therapeutically more beneficial.
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Affiliation(s)
- C H Weaver
- CancerConsultants.com, Inc, Ketchum, ID, USA
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DesHarnais Castel L, Bajwa K, Markle JP, Timbie JW, Zacker C, Schulman KA. A microcosting analysis of zoledronic acid and pamidronate therapy in patients with metastatic bone disease. Support Care Cancer 2001; 9:545-51. [PMID: 11680835 DOI: 10.1007/s005200100249] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [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: 10/27/2022]
Abstract
Our goal was to calculate resource use associated with administration of zoledronic acid, compared with pamidronate, as palliative care for patients with metastatic bone lesions. We conducted a time-and-motion study of therapy administration at each of three outpatient chemotherapy infusion sites participating in clinical trials of zoledronic acid and pamidronate. We developed a data-collection instrument to record all staff effort and patient resource use in drug administration. The main outcome measures were (a) direct costs of therapy administration per patient and (b) opportunity benefits expressed as the availability of resources gained per year. The average visit time for patients receiving the study dose of zoledronic acid, 4 mg, was 1 h, 6 min, compared to 2 h, 52 min for patients receiving a 90-mg dose of pamidronate. Infusion time accounted for much of the difference. In the base-case analysis, total direct costs per patient were $728 for zoledronic acid and $776 for pamidronate. The opportunity benefit for infusion of zoledronic acid vs pamidronate in the base case was 1.8 chairs per day, or 426 chairs per 240-workday year. Results were sensitive to changes in infusion facility size, days of operation, and average number of patients treated. Shorter infusion time associated with the administration of zoledronic acid, compared with pamidronate, yields substantial time savings for patients, as well as opportunity benefits for outpatient oncology facilities.
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Affiliation(s)
- L DesHarnais Castel
- Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27715, USA.
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Abstract
Cecal volvulus is a rare cause of intestinal obstruction after major abdominal surgery. A case of cecal volvulus occurring in the early postoperative period after left colon resection for malignancy is presented. Clinical evaluation and plain abdominal radiographs suggesting cecal volvulus prompted laparotomy and correction. Delay in diagnosis results in high mortality, and treatment depends largely on the viability of the involved intestine. This report describes the second case of cecal volvulus complicating a left colectomy. It was treated by detorsion and reperitonealization cecopexy.
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Affiliation(s)
- C W Konvolinka
- Department of Surgery, Conemaugh's Memorial Medical Center, an affiliate of Temple University, Johnstown, Pennsylvania 15905, USA
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Singh M, Shirley B, Bajwa K, Samara E, Hora M, O'Hagan D. Controlled release of recombinant insulin-like growth factor from a novel formulation of polylactide-co-glycolide microparticles. J Control Release 2001; 70:21-8. [PMID: 11166404 DOI: 10.1016/s0168-3659(00)00313-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [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: 10/18/2022]
Abstract
The purpose of the current study was to develop a controlled-release delivery system for recombinant insulin-like growth factor (rhIGF-I). Polylactide-co-glycolide (PLG) microparticles with entrapped rhIGF-I were prepared by a novel emulsion based solvent evaporation process. Microparticles with two loading levels of rhIGF-I were prepared (4 and 20% w/w). The integrity of released rhIGF-I was characterized by RP-HPLC, SDS-PAGE and a bioactivity assay. In vitro and in vivo release profiles of rhIGF-I from these microparticles were also evaluated. Reproducible batches of microparticles with 4% and 20% w/w loading of rhIGF-I were prepared, with excellent encapsulation efficiency (81 and 85% of total protein respectively entrapped). The protein retained integrity after the microencapsulation process as evaluated by RP-HPLC, SDS-PAGE and bioactivity assay. The in vitro profiles exhibited a significant burst release of rhIGF-I (20-30%), followed by controlled release of protein for up to 28 days. A similar level of burst release was observed in vivo, followed by controlled release of protein for 14-18 days. In addition, there was a surprisingly close correlation between in vitro and in vivo release rates. PLG microparticles with entrapped rhIGF-I are a promising delivery system which may allow rhIGF-I to be used for a broad range of therapeutic indications.
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Affiliation(s)
- M Singh
- Chiron Corporation, 4560 Horton Street, Emeryville, CA 94608, USA.
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Bajwa K, Szabo E, Kjellstrand CM. A prospective study of risk factors and decision making in discontinuation of dialysis. Arch Intern Med 1996; 156:2571-7. [PMID: 8951300] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Discontinuation of dialysis is a common cause of death. We performed a prospective study to determine if a detailed description of patients could be used to identify those at risk for discontinuing dialysis. METHODS Two hundred thirty-five dialysis patients were studied for 3 1/2 years. Using questionnaires, medical chart analyses, and interviews, 300 sociodemographic, quality-of-life, medical and dialysis variables were prospectively obtained. The association of these variables with death from discontinuation of dialysis was studied in univariate and multivariate analyses. RESULTS Seventy-six patients (32%) died during the follow-up period, 31 (41%) of cardiovascular problems, 13 (17%) of discontinuation of dialysis, and 32(42%) of other causes. Patients who discontinued dialysis were older (mean age, 66 vs 54 years), were more likely to be divorced or widowed (46% vs 16%), were more likely to live in nursing homes (31% vs 6%), spent less time outdoors (23% vs 53%), had twice as much comorbidity as other patients (major comorbidity score, 1.2 vs 0.6), had the same psychological quality-of-life score (60 vs 62) but a lower score on the Karnovsky Scale, and a higher physical discomfort index. In multivariate analysis, comorbidity, widowed or divorced status, and severe pain were independent predictors of discontinuation of dialysis, but no reliable predictive model could be created. A detailed analysis of the final event indicated that a relentless succession of problems often led nursing home patients to discontinue dialysis. These problems are common to all dialysis patients, especially those who have no one to support them in their suffering. CONCLUSIONS Discontinuation of dialysis is common, and can been seen as a failure of and a relief from long-term dialysis. We believe mortality caused by discontinuation of dialysis could be decreased by better psychological support and improved management of ischemic problems and pain. We found no predictable model for such patients, but many successive acute problems in widowed and divorced patients seem to trigger the decision.
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Affiliation(s)
- K Bajwa
- Department of Medicine, University of Alberta, Edmonton
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Becker AB, Black C, Lilley MK, Bajwa K, Ford-Hutchinson AW, Simons FE, Tagari P. Antiasthmatic effects of a leukotriene biosynthesis inhibitor (MK-0591) in allergic dogs. J Appl Physiol (1985) 1995; 78:615-22. [PMID: 7759431 DOI: 10.1152/jappl.1995.78.2.615] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 01/27/2023] Open
Abstract
Peptidoleukotrienes may be important mediators of human bronchial asthma. Accordingly, the effects of a selective leukotriene (LT) biosynthesis inhibitor (MK-0591) were assessed in allergic dogs characterized by acute bronchoconstriction and subsequent airway hyperresponsiveness induced by inhaled ragweed allergen. Peak acute increases in airway resistance (Rrs) induced by ragweed were associated with increased bronchoalveolar lavage histamine concentration, and neither parameter was inhibited by MK-0591 (8 micrograms.kg-1.min-1 i.v.). However, the duration of the bronchoconstriction was significantly decreased by MK-0591, with a reduction in the area under the curve of 40% (P < 0.05). Associated with the acute bronchoconstriction in placebo-treated animals was a fivefold increase in urinary LTE4 excretion (as seen with allergic asthmatic patients), which was reduced to < 10% of basal values by MK-0591. Similarly, whole blood LTB4 biosynthesis was abolished in the MK-0591-treated animals. Bronchial hyperresponsiveness preallergen (measured as the percent concentration of acetylecholine required to increase Rrs by 5 cmH2O.l-1.s) tended to improve with MK-0591 (0.41 +/- 0.15 vs. 0.23 +/- 0.05%). Five hours after allergen inhalation, the percent concentration declined substantially in the placebo group (0.07 +/- 0.02%; P < 0.01), revealing an increased airway responsiveness that was significantly blunted by MK-0591 (0.26 +/- 0.07%; P < 0.001). These data suggest that selective inhibition of LT biosynthesis by novel compounds such as MK-0591 may modify the airway changes associated with bronchial hyperresponsiveness, as well as offer symptomatic relief in asthma.
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Affiliation(s)
- A B Becker
- Department of Pharmacology, Merck Frosst Centre for Therapeutic Research, Pointe Claire, Quebec, Canada
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