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Rigberg D, Smith BK, Sun T, Pearce B, Humphries M, Sheahan M, Coleman D, Lee J. Vascular In-person for Students In the match Trial: An investigation of postinterview site visits to address the limitations of virtual interviews. J Vasc Surg 2024:S0741-5214(24)00926-1. [PMID: 38556041 DOI: 10.1016/j.jvs.2024.03.439] [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: 01/28/2024] [Revised: 03/03/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE The graduate medical education community implemented virtual residency interviews in response to travel restrictions during the COVID-19 pandemic, and this approach has persisted. Although many residency applicants wish to visit in-person prospective training sites, such opportunities could bias programs toward those who are able to meet this financial burden, exacerbating equity concerns. One proposed solution is to offer applicants the opportunity to visit only after a program's rank list is "locked," avoiding favoritism to applicants who visit, but allowing applicants to experience some of the camaraderie, geography, and local effects of an in-person visit. As debate about the optimal format of residency interviews continues, it is important to investigate whether in-person program visits, completed after program rank list certification, provide meaningful benefits to applicants in the residency match process. METHODS All vascular programs entering the 2023 integrated vascular surgery residency match were invited to participate. Programs agreed to certify their National Resident Matching Program rank lists by February 1, 2023. Applicants then had the opportunity to visit the programs at which they interviewed. The particulars of the visit were determined by the individual programs. Applicants completed their standard rank list and locked on the standard date: March 1, 2023. Applicants then completed a survey regarding the impact of the visits on their rank order list decision-making. Program directors (PDs) completed a survey regarding their experiences as well. Data were collected using REDCap. RESULTS Twenty-one of the 74 (28%) programs participated. Nineteen PDs completed the postinterview site visit survey (response rate 90%). Applicants interviewing at the participating programs (n = 112) were informed of the study, offered the opportunity to attend postinterview site visits, and received the survey. Forty-seven applicants responded (response rate 42%). Eighty-six percent of applicants stated that the visit impacted their rank list. Most important factors were esprit de corps of the program (86%), the faculty/trainees/staff (81%), and the physical setting (62%). Seventy-one percent of those participating spent ≤$800 on their visit. Eighty-one percent were satisfied with the process. Twenty-one percent of PDs would have changed their rank list if they could have based on the applicants' in-person visit. Sixty-three percent of the visit sessions cost the programs ≤$500, and 63% were satisfied with the process. CONCLUSIONS This study is the first to document the impact of in-person site visits by applicants on a graduate medical education match process in one specialty. Our results suggest that this process provides meaningful data to applicants that helped them with their decision-making evidenced by most altering their rank lists, while avoiding some of the critical equity issues that accompany traditional in-person interviews. This may provide a model for future interview processes for residency programs.
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Affiliation(s)
| | - Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah, School of Medicine, Salt Lake City, UT
| | - Ting Sun
- Division of Vascular Surgery, Department of Surgery, University of Utah, School of Medicine, Salt Lake City, UT
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Tullos A, Wunnava S, Medina D, Sheahan C, Chawla A, Torrance B, Brooke A, Donovan M, Palit T, Sheahan M. Vascular complications secondary to resuscitative endovascular balloon occlusion of the aorta placement at a Level 1 Trauma Center. J Vasc Surg 2024:S0741-5214(24)00499-3. [PMID: 38493898 DOI: 10.1016/j.jvs.2024.03.020] [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: 10/18/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Resuscitative endovascular balloon occlusion of the aorta (REBOA) is designed to manage severe hemorrhagic shock. Popularized in medical care during military conflicts, the concept has emerged as a lifesaving technique that is utilized around the United States. Literature on risks of REBOA placement, especially vascular injuries, are not well-reported. Our goal was to assess the incidence of vascular injury from REBOA placement and the risk factors associated with injury and death among these patients at our institution. METHODS We performed a retrospective cohort study of all patients who underwent REBOA placement between September 2017 and June 2022 at our Level 1 Trauma Center. The primary outcome variable was the presence of an injury related to REBOA insertion or use. Secondary outcomes studied were limb loss, the need for dialysis, and mortality. Data were analyzed using descriptive statistics, χ2, and t-tests as appropriate for the variable type. RESULTS We identified 99 patients who underwent REBOA placement during the study period. The mean age of patients was 43.1 ± 17.2 years, and 67.7% (67/99) were males. The majority of injuries were from blunt trauma (79.8%; 79/99). Twelve of the patients (12.1%; 12/99) had a vascular injury related to REBOA placement. All but one required intervention. The complications included local vessel injury (58.3%; 7/12), distal embolization (16.7%; 2/12), excessive bleeding requiring vascular consult (8.3%; 1/12), pseudoaneurysm requiring intervention (8.3%; 1/12), and one incident of inability to remove the REBOA device (8.3%; 1/12). The repairs were performed by vascular surgery (75%; 9/12), interventional radiology (16.7%; 2/12), and trauma surgery (8.3%; 1/12). There was no association of age, gender, race, and blunt vs penetrating injury to REBOA-related complications. Mortality in this patient population was high (40.4%), but there was no association with REBOA-related complications. Ipsilateral limb loss occurred in two patients with REBOA-related injuries, but both were due to their injuries and not to REBOA-related ischemia. CONCLUSIONS Although vascular complications are not unusual in REBOA placement, there does not appear to be an association with limb loss, dialysis, or mortality if they are addressed promptly. Close coordination between vascular surgeons and trauma surgeons is essential in patients undergoing REBOA placement.
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Affiliation(s)
- Amanda Tullos
- Division of Vascular and Endovascular Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Sanjay Wunnava
- Division of Vascular and Endovascular Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Daniela Medina
- Division of Vascular and Endovascular Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Claudie Sheahan
- Division of Vascular and Endovascular Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Amit Chawla
- Division of Vascular and Endovascular Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Bruce Torrance
- Division of Vascular and Endovascular Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Amadis Brooke
- Division of Vascular and Endovascular Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Melissa Donovan
- Division of Vascular and Endovascular Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Tapash Palit
- Division of Vascular and Endovascular Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Malachi Sheahan
- Division of Vascular and Endovascular Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, LA.
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Shayan AM, Singh S, Gao J, Groff RE, Bible J, Eidt JF, Sheahan M, Gandhi SS, Blas JV, Singapogu R. Measuring hand movement for suturing skill assessment: A simulation-based study. Surgery 2023; 174:1184-1192. [PMID: 37597999 PMCID: PMC10592328 DOI: 10.1016/j.surg.2023.07.007] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/22/2023] [Accepted: 07/08/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND To maximize patient safety, surgical skills education is increasingly adopting simulation-based curricula for formative skills assessment and training. However, many standardized assessment tools rely on human raters for performance assessment, which is resource-intensive and subjective. Simulators that provide automated and objective metrics from sensor data can address this limitation. We present an instrumented bench suturing simulator, patterned after the clock face radial suturing model from the Fundamentals of Vascular Surgery, for automated and objective assessment of open suturing skills. METHODS For this study, 97 participants (35 attending surgeons, 32 residents, and 30 novices) were recruited at national vascular conferences. Automated hand motion metrics, especially focusing on rotational motion analysis, were developed from the inertial measurement unit attached to participants' hands, and the proposed suite of metrics was used to differentiate between the skill levels of the 3 groups. RESULTS Attendings' and residents' performances were found to be significantly different from novices for all metrics. Moreover, most of our novel metrics could successfully distinguish between finer skill differences between attending and resident groups. In contrast, traditional operative skill metrics, such as time and path length, were unable to distinguish attendings from residents. CONCLUSION This study provides evidence for the effectiveness of rotational motion analysis in assessing suturing skills. The suite of inertial measurement unit-based hand motion metrics introduced in this study allows for the incorporation of hand movement data for suturing skill assessment.
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Affiliation(s)
| | - Simar Singh
- Department of Bioengineering, Clemson University, SC
| | - Jianxin Gao
- Department of Electrical and Computer Engineering, Clemson University, SC
| | - Richard E Groff
- Department of Electrical and Computer Engineering, Clemson University, SC
| | - Joe Bible
- School of Mathematical and Statistical Sciences, Clemson University, SC
| | - John F Eidt
- Department of Vascular Surgery, Baylor Scott and White Heart and Vascular Hospital, Dallas, TX
| | - Malachi Sheahan
- Division of Vascular and Endovascular Surgery, Department of Surgery, Louisiana State University Health Sciences Centre, New Orleans, LA
| | - Sagar S Gandhi
- University of South Carolina School of Medicine-Greenville, SC; Division of Vascular Surgery, Greenville Health System, SC
| | - Joseph V Blas
- University of South Carolina School of Medicine-Greenville, SC; Division of Vascular Surgery, Greenville Health System, SC
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Sheahan M, Tullos A, Kim J, Sethi D, Owens K, Kenney K, Torrance B, Hollier LH, Sheahan C. The role of vascular surgeons in the management of pediatric bone tumors. J Vasc Surg 2023; 78:223-229. [PMID: 36924975 DOI: 10.1016/j.jvs.2023.03.022] [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: 01/22/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES The objective of this study was to review the outcomes of a multidisciplinary approach to the surgical management of pediatric bone tumors with blood vessel involvement over a 14- year period. METHODS A retrospective review was conducted of all pediatric bone tumor resections performed with the assistance of vascular surgery at our institution between January 2006 and January 2021. Inclusion criteria for the study included the presence of a vascular surgeon at the operative resection and radiographic evidence of major blood vessel involvement. RESULTS From 2006 to 2021, 117 patients underwent a bone tumor resection by a single orthopedic surgeon/vascular surgeon team. Sixty were malignant tumors, and 57 were benign. Of the 117 procedures, 5.1% (6/117) required reconstruction of an artery; five in malignant cases and one in benign. No venous reconstructions were undertaken in this study. Ligation of a major artery without reconstruction was performed in 8.8% (5/57) of malignant and 1.7% (1/60) of benign resections. Despite this vessel-sparing approach, microscopic margins were clear in all cases. Local recurrence occurred in a single patient in the malignant group at 61 months. CONCLUSIONS The ideal management of pediatric bone tumors with major blood vessel involvement remains poorly defined. Our results demonstrate that even in the setting of radiographic evidence of vessel involvement, a multidisciplinary team of vascular and orthopedic surgeons can employ a vessel-sparing approach with minimal blood loss, excellent limb salvage, and minimal local recurrence.
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Affiliation(s)
- Malachi Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University School of Medicine, New Orleans, LA.
| | - Amanda Tullos
- Division of Vascular and Endovascular Surgery, Louisiana State University School of Medicine, New Orleans, LA
| | - Joyce Kim
- Division of Vascular and Endovascular Surgery, Louisiana State University School of Medicine, New Orleans, LA
| | - Danielle Sethi
- Division of Vascular and Endovascular Surgery, Louisiana State University School of Medicine, New Orleans, LA
| | - Kapland Owens
- Division of Vascular and Endovascular Surgery, Louisiana State University School of Medicine, New Orleans, LA
| | - Kevin Kenney
- Division of Vascular and Endovascular Surgery, Louisiana State University School of Medicine, New Orleans, LA
| | - Bruce Torrance
- Division of Vascular and Endovascular Surgery, Louisiana State University School of Medicine, New Orleans, LA
| | - Larry H Hollier
- Division of Vascular and Endovascular Surgery, Louisiana State University School of Medicine, New Orleans, LA
| | - Claudie Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University School of Medicine, New Orleans, LA
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Sheahan M. Ghosts in the machine. J Vasc Surg 2023; 77:1803. [PMID: 37225354 DOI: 10.1016/j.jvs.2023.01.199] [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: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Malachi Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University School of Medicine, New Orleans, LA
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Tullos A, Patel R, Sethi D, Sheahan C, Chawla A, Torrance B, Brooke A, Donovan M, Palit T, Sheahan M. Neighborhood Deprivation Index Is Not Predictive of Patient's Perceived Barriers to Healthcare in an Urban Setting. J Vasc Surg 2023. [DOI: 10.1016/j.jvs.2022.12.046] [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: 02/23/2023]
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Tullos A, Wunnava S, Sheahan C, Chawla A, Torrance B, Brooke A, Donovan M, Palit T, Sheahan M. Vascular Complications Secondary to Resuscitative Endovascular Balloon Occlusion of the Aorta Placement at a Level 1 Trauma Center. J Vasc Surg 2023. [DOI: 10.1016/j.jvs.2022.12.055] [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: 02/25/2023]
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Sheahan M, McLafferty B, Sheahan C, Shames M. Hybrid Approach to the Repair of a Large Axillary Pseudoaneurysm in an Infant. Ann Vasc Surg 2022. [DOI: 10.1016/j.avsg.2022.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Tullos A, Sheahan M. The Importance of Simulation in Vascular Training: A Literature Review. Ann Vasc Surg 2022. [DOI: 10.1016/j.avsg.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Treil L, Neumann N, Chanes N, Lejay A, Bourcier T, Bismuth J, Lee JT, Sheahan M, Rouby AF, Chakfé N, Eidt J, Georg Y, Mitchell EL, Rigberg D, Shames M, Thaveau F, Sheahan C. Objective Evaluation of Clock Face Suture Using the Objective Structured Assessment of Technical Skill (OSATS) Checklist. EJVES Vasc Forum 2022; 57:5-11. [DOI: 10.1016/j.ejvsvf.2022.10.001] [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] [Received: 01/11/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
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Pillado EB, Li RD, Eng J, Chia M, Sheahan M, Bilimoria K, Hu YY, Coleman DM. Persistent Racial Discrimination Among Vascular Surgery Trainees Threatens Wellness. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pillado EB, Li RD, Eng J, Chia M, Sheahan M, Bilimoria K, Hu YY, Coleman DM. Defining Sources and Ramifications of Mistreatment Among Female Vascular Surgery Trainees. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Rhudy AK, Patel S, Houser A, Irfan W, Sheahan M. Point-of-care ultrasound for identification of ruptured infrarenal abdominal aortic aneurysm. Echocardiography 2022; 39:841-843. [PMID: 35485978 DOI: 10.1111/echo.15359] [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: 12/29/2021] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 11/27/2022] Open
Abstract
Ruptured abdominal aortic aneurysms (rAAA) are associated with high mortality rates and require prompt diagnosis with subsequent intervention. CT scan is considered the gold standard for diagnosis, however, in the acute setting ultrasound may be a reasonable diagnostic test for certain patients. We report a case that demonstrates the utility of point-of-care ultrasound (PoCUS) in diagnosing rAAA for a patient in extremis. Also, we provide a brief review of literature for the diagnosis of rAAA with ultrasound.
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Affiliation(s)
- Anne Kelly Rhudy
- Division of Vascular Surgery, Louisiana State University Health Sciences, New Orleans, Louisiana, USA
| | - Shivik Patel
- Division of Vascular Surgery, Louisiana State University Health Sciences, New Orleans, Louisiana, USA
| | - Alex Houser
- Division of Vascular Surgery, Louisiana State University Health Sciences, New Orleans, Louisiana, USA
| | - Wajeeh Irfan
- Division of Vascular Surgery, Louisiana State University Health Sciences, New Orleans, Louisiana, USA
| | - Malachi Sheahan
- Division of Vascular Surgery, Louisiana State University Health Sciences, New Orleans, Louisiana, USA
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Sheahan M, Kim J, Unruh M, Torrance B, Batson R, Hollier LH, Sheahan C. Outcomes of a Limb-sparing Approach to Pediatric Bone Tumors With Blood Vessel Involvement. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Harding J, Cardella J, Coleman D, Kim GY, Sheahan M, Wooster M, Ottinger M, Dawn Humphries M. How We Do It: A Multicenter National Experience of Virtual Vascular Surgery Rotations. J Surg Educ 2022; 79:25-30. [PMID: 34353760 DOI: 10.1016/j.jsurg.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/17/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe the development and implementation of virtual vascular surgery rotations among 6 integrated vascular surgery programs. DESIGN A collaborative teleconference retrospectively discussing 6 independently developed virtual vascular surgery rotations to make a framework for future use. SETTING University of California Davis initiated a joint teleconference among the various integrated vascular surgery programs. PARTICIPANTS Vascular surgery faculty and residents from 6 programs participated in the teleconferences and drafting of a framework for building a virtual vascular surgery rotation. RESULTS Four specific domains were identified in discussing the framework to build a virtual vascular surgery rotation: planning, development, curriculum, and feedback. Each domain has specific aspects in making a virtual rotation that has applicability to other surgical rotations that seek to do the same. CONCLUSION Virtual vascular surgery rotations are feasible and important; these electives can be established and implemented successfully with appropriate planning and consideration. This work hopes to help programs navigate this new space in education by making it more transparent and highlighting potential pitfalls.
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Affiliation(s)
- Joel Harding
- University of California Davis Health, Sacramento, California.
| | | | - Dawn Coleman
- Michigan Medicine University of Michigan, Ann Arbor, Michigan
| | - Gloria Y Kim
- Michigan Medicine University of Michigan, Ann Arbor, Michigan
| | - Malachi Sheahan
- Louisiana State University School of Medicine, New Orleans, Louisiana
| | - Mathew Wooster
- Medical University of South Carolina, Charleston, South Carolina University of South Florida Health, Tampa, Florida
| | - Mary Ottinger
- Medical University of South Carolina, Charleston, South Carolina University of South Florida Health, Tampa, Florida
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Shames M, Owens K, Robinson W, Reed A, Lee J, Jordan W, Sheahan M. Vascular Surgery Program Director Work Hours and Compensation Do Not Align with ACGME Proposed Requirements. Ann Vasc Surg 2021. [DOI: 10.1016/j.avsg.2021.01.037] [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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Shames M, Owens K, Robinson WP, Reed AB, Lee JT, Jordan W, Sheahan M. Vascular Surgery Program Director Work Hours and Compensation Do Not Align With Accreditation Council for Graduate Medical Education-Proposed Requirements. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.049] [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: 10/24/2022]
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Sheahan M, Mitchell ME, Chaer R, Brown KR, Rowe VL, Schanzer A, Dalman RL, Upchurch G. Results of the First National Continuous Certification Assessment in Vascular Surgery. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soh I, Money S, Coleman D, Sheahan M, Eidt J, Wohlauer M, Hallbeck MS, Meltzer A. Malpractice Allegations Against Vascular Surgeons: Prevalence, Risk Factors, and Impact on Surgeon Wellness. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kerut CK, Sheahan C, Sheahan M. Six-year history of intermittent symptomatic bilateral vertebral artery stenosis: Imaging and therapeutic intervention. Echocardiography 2020; 37:784-787. [PMID: 32315466 DOI: 10.1111/echo.14656] [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: 12/28/2019] [Revised: 02/23/2020] [Accepted: 03/21/2020] [Indexed: 11/29/2022] Open
Abstract
A 66-year-old man was evaluated for a 6-year history of disabling symptoms of typical intermittent vertebrobasilar (VB) insufficiency. Duplex scanning was "normal," but computed tomographic angiography (CTA) revealed significant bilateral proximal vertebral artery (VA) disease. Angiography with stent placement with the proximal right VA resulted in resolution of symptoms. Symptoms of VB insufficiency may occur from bilateral VA disease, most often involving both proximal segments. Duplex ultrasound has high specificity but relatively low sensitivity for finding hemodynamically significant VA disease. Further imaging with CTA or magnetic resonance angiography (MRA) will help in identification of disease. As with this patient, invasive angiography with percutaneous stenting of the most significantly stenosed VA often results in resolution of symptoms of VB insufficiency.
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Affiliation(s)
- Christian K Kerut
- Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia
| | - Claudie Sheahan
- Division of Vascular Surgery, Department of Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana
| | - Malachi Sheahan
- Division of Vascular Surgery, Department of Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana
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Sheahan M, Andrews M. The positive impact of prehabilitive parenteral nutrition(PN) on outcome and functional status in colorectal surgery – a case report. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.043] [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: 10/25/2022]
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22
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Kerut EK, To F, Summers KL, Sheahan C, Sheahan M. Statistical and machine learning methodology for abdominal aortic aneurysm prediction from ultrasound screenings. Echocardiography 2019; 36:1989-1996. [PMID: 31682022 DOI: 10.1111/echo.14519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/16/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022] Open
Abstract
A method of analysis of a database of patients (n = 10 329) screened for an abdominal aortic aneurysm (AAA) is presented. Self-reported height, weight, age, gender, ethnicity, and parameters "Heart Problems," "Hypertension," "High Cholesterol," "Diabetes Mellitus," "Smoker Past 2 Years," "Ever Smoked?," "Family History AAA," and "Family History Brain Aneurysm" were provided. Incidence of a AAA (defined as 3 cm diameter) was calculated as a function of age and body mass index (BMI) of greater than or less than a BMI 25 for various patient groups. Age was grouped into one of three categories in 15-year intervals (35-50 years, 50-65 years, and 65 to 80 years). Most patients were Caucasian (n = 8575) and the largest group of patients with a AAA was the Caucasian male (198 of 279 total detected AAAs). A machine learning algorithm was written, with learning inputs from the acquired patient database. Of all groups, Caucasian males were found to have the highest incidence of AAA, with males in general higher than females. Smoking within the past two years was highly associated with AAA incidence, and a past history of smoking to a lesser extent. The incidence of AAA increased with age. When dividing groups into two cohorts by a BMI of 25, generally middle-aged patients with a BMI > 25 had a higher incidence of a AAA. However, in general, the older age group with a BMI < 25 had a higher incidence of AAA. The addition of machine learning allows one to note the effect of an input keeping other input parameters constant. This helps identify a parameter that may be an independent predictor of a particular outcome. When using BMI as the single changing input, an increasing BMI was associated with an increased probability of a AAA, most significantly in middle-aged patients, and then narrowing to similar probabilities in older age. This AAA screening program is ongoing. As data continues to be collected with particularly those patient groups presently underrepresented, questions as to an association of AAA with BMI as a function of age, and also an improvement in machine learning algorithm accuracy for various patient populations will continue.
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Affiliation(s)
- Edmund Kenneth Kerut
- Division of Cardiovascular Diseases, Department of Medicine, LSU Health Sciences Center, New Orleans, Louisiana.,Heart Clinic of Louisiana, Marrero, Louisiana
| | - Filip To
- Department of Agricultural and Biological Engineering, Bagley College of Engineering, Mississippi State University, Mississippi State, Mississippi
| | - Kelli L Summers
- Division of Vascular Surgery, Department of Surgery, LSU Health Sciences Center, School of Medicine, New Orleans, Louisiana
| | - Claudie Sheahan
- Division of Vascular Surgery, Department of Surgery, LSU Health Sciences Center, School of Medicine, New Orleans, Louisiana
| | - Malachi Sheahan
- Division of Vascular Surgery, Department of Surgery, LSU Health Sciences Center, School of Medicine, New Orleans, Louisiana
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Summers KL, Kerut EK, Sheahan C, Unruh M, Chawla A, Brooke EA, Sheahan M. Prevalence of Abdominal Aortic Aneurysms in the United States: Re-evaluating the Screening Guidelines. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.120] [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: 10/26/2022]
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Lalani A, Victoria S, Zea N, Torrance B, Unruh M, Risher W, Batson R, Hollier L, Sheahan M. Aortoiliac Endarterectomy: A Modern Case Series. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Coleman DM, Meltzer AJ, Wohlauer M, Drudi LM, Hallbeck MS, Shanafelt T, Money S, Sheahan M. SS02. Vascular Surgeon Burnout – A Report From the Society for Vascular Surgery Wellness Task Force. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lalani AM, Victoria SE, Zea N, Torrance B, Risher W, Batson R, Palit T, Sheahan M. IP001. Aortoiliac Endarterectomy: A Modern Series. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.126] [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: 10/26/2022]
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Kerut CK, Sheahan C, Sheahan M. Carotid artery fibromuscular dysplasia: Ultrasound and
CT
imaging. Echocardiography 2019; 36:971-974. [DOI: 10.1111/echo.14322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Christian K. Kerut
- Franklin College of Arts and SciencesUniversity of Georgia Athens Georgia
| | - Claudie Sheahan
- Division of Vascular SurgeryDepartment of SurgeryLSU Health Sciences CenterSchool of Medicine New Orleans Louisiana
| | - Malachi Sheahan
- Division of Vascular SurgeryDepartment of SurgeryLSU Health Sciences CenterSchool of Medicine New Orleans Louisiana
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Sheahan M, Kim JJ, Lalani AM, Sheahan C, Palit T, Torrance B, Unruh M, Batson R. RS09. The Fundamentals of Vascular Surgery: A 6-Year Review of the First U.S. Dedicated Vascular Simulation Course. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sheahan M, Ma X, Paik D, Obuchowski NA, St Pierre S, Newman WP, Rae G, Perlman ES, Rosol M, Keith JC, Buckler AJ. Atherosclerotic Plaque Tissue: Noninvasive Quantitative Assessment of Characteristics with Software-aided Measurements from Conventional CT Angiography. Radiology 2017; 286:622-631. [PMID: 28858564 DOI: 10.1148/radiol.2017170127] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose To (a) evaluate whether plaque tissue characteristics determined with conventional computed tomographic (CT) angiography could be quantitated at higher levels of accuracy by using image processing algorithms that take characteristics of the image formation process coupled with biologic insights on tissue distributions into account by comparing in vivo results and ex vivo histologic findings and (b) assess reader variability. Materials and Methods Thirty-one consecutive patients aged 43-85 years (average age, 64 years) known to have or suspected of having atherosclerosis who underwent CT angiography and were referred for endarterectomy were enrolled. Surgical specimens were evaluated with histopathologic examination to serve as standard of reference. Two readers used lumen boundary to determine scanner blur and then optimized component densities and subvoxel boundaries to best fit the observed image by using semiautomatic software. The accuracy of the resulting in vivo quantitation of calcification, lipid-rich necrotic core (LRNC), and matrix was assessed with statistical estimates of bias and linearity relative to ex vivo histologic findings. Reader variability was assessed with statistical estimates of repeatability and reproducibility. Results A total of 239 cross sections obtained with CT angiography and histologic examination were matched. Performance on held-out data showed low levels of bias and high Pearson correlation coefficients for calcification (-0.096 mm2 and 0.973, respectively), LRNC (1.26 mm2 and 0.856), and matrix (-2.44 mm2 and 0.885). Intrareader variability was low (repeatability coefficient ranged from 1.50 mm2 to 1.83 mm2 among tissue characteristics), as was interreader variability (reproducibility coefficient ranged from 2.09 mm2 to 4.43 mm2). Conclusion There was high correlation and low bias between the in vivo software image analysis and ex vivo histopathologic quantitative measures of atherosclerotic plaque tissue characteristics, as well as low reader variability. Software algorithms can mitigate the blurring and partial volume effects of routine CT angiography acquisitions to produce accurate quantification to enhance current clinical practice. Clinical trial registration no. NCT02143102 © RSNA, 2017 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on September 15, 2017.
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Affiliation(s)
- Malachi Sheahan
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Xiaonan Ma
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - David Paik
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Nancy A Obuchowski
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Samantha St Pierre
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - William P Newman
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Guenevere Rae
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Eric S Perlman
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Michael Rosol
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - James C Keith
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Andrew J Buckler
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
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Bazan HA, Sam AD, Sheahan M, Abbruscato F. Pro‐inflammatory cytokines characterize vulnerable carotid atherosclerotic plaques. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.574.2] [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: 11/11/2022]
Affiliation(s)
- Hernan Antonio Bazan
- Surgery ‐ Section of Vascular Surgery
- Pharmacology & Experimental TherapeuticsLSUHSC School of Medicine ‐ New OrleansNew OrleansLA
| | | | | | - Frank Abbruscato
- Pharmacology & Experimental TherapeuticsLSUHSC School of Medicine ‐ New OrleansNew OrleansLA
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Hayes M, Ashe S, Collins D, Power S, Kenny K, Sheahan M, O'Hagan G, More S. An evaluation of Irish cattle herds with inconclusive serological evidence of bovine brucellosis. Ir Vet J 2009; 62:182-90. [PMID: 21851730 PMCID: PMC3113756 DOI: 10.1186/2046-0481-62-3-182] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Since 1998, there has been a steady decline in herd restrictions and de-populations in Ireland due to bovine brucellosis. There is concern that the interpretation of laboratory results may become increasingly problematic, as brucellosis prevalence falls in Ireland. Therefore, the purpose of the current study was to evaluate the infection status of Irish herds and animals with inconclusive serological evidence of bovine brucellosis. During 12 months from September 1, 2004, laboratory and observational epidemiological data were collected from all Irish herds where animal testing identified at least one animal with a complement fixation test (CFT) reading greater than zero and/or a positive result to the indirect enzyme-linked immunosorbent assay (iELISA). Due to the observational nature of the study, we have robust estimates of the relative, but not the absolute, performance of the CFT, iELISA and brucellin skin test (BST). Herds were divided into three categories (Group A, B or C) on the basis of test results at initial assessment. A total of 639 herds were enrolled into the study, and observed for at least two years following enrolment. A rising CFT titre, with a CFT reading of 111 International CFT Units (IU) or greater at the subsequent blood test, was generally associated with herds where other evidence of infection was also available. Knowledge of the CFT reading at the initial and a subsequent blood test proved useful in distinguishing false-positive and true-positive brucellosis results. There was poor correlation between the CFT and iELISA results, and between the CFT and BST results. As a result of this study, national policy has been modified to include re-sampling of all animals with CFT readings of 20 IU or greater. This project has also led to a reduction in the number of herds restricted, as well as restriction duration. It has also contributed to a reduction in the number of herds listed for contiguous tests, and therefore the potential for contiguity testing of false positive results.
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Affiliation(s)
- M Hayes
- Centre for Veterinary Epidemiology and Risk Analysis, UCD School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
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Bazan HA, Sheahan M, Dardik A. Carotid endarterectomy with simultaneous retrograde common carotid artery stenting: Technical Considerations. Catheter Cardiovasc Interv 2008; 72:1003-7. [DOI: 10.1002/ccd.21730] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Maithel SK, Pomposelli F, Williams M, Sheahan M, Scovell S, Campbell D, LoGerfo FW, Hamdan AD. Creatinine clearance but not serum creatinine alone predicts long-term postoperative survival. J Am Coll Surg 2004. [DOI: 10.1016/j.jamcollsurg.2004.05.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pomposelli FB, Kansal N, Hamdan AD, Belfield A, Sheahan M, Campbell DR, Skillman JJ, Logerfo FW. A decade of experience with dorsalis pedis artery bypass: analysis of outcome in more than 1000 cases. J Vasc Surg 2003; 37:307-15. [PMID: 12563200 DOI: 10.1067/mva.2003.125] [Citation(s) in RCA: 213] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to review our experience over the last decade with the dorsalis pedis bypass for ischemic limb salvage in patients with diabetes mellitus. METHODS The study was a retrospective analysis of a computerized vascular registry and chart review. From January 10, 1990 to January 11, 2000, 1032 bypasses to the dorsalis pedis artery were performed in 865 patients (27.6% of the 3731 lower extremity arterial bypass procedures performed in that time period). Five hundred ninety-seven patients (69%) were male, with a mean age of 66.8 years. Ninety-two percent had diabetes mellitus. All procedures were done for limb salvage. Conduits included 317 nonreversed saphenous vein (30.7%), 273 in situ (26.4%), 235 reversed vein (22.8%), 170 arm vein (16.5%), 35 other vein (3.4%), and two polytetrafluoroethylene (0.2%) grafts. The inflow arteries were as follows: 294 common femoral (28.5%), 550 popliteal (53.2%), 114 superficial femoral (11%), and 74 other (7.2%). RESULTS The mortality rate within 1 month of surgery was 0.9%, and 42 grafts (4.2%) failed in the same interval, although 13 were successfully revised. In a follow-up period that ranged from 1 to 120 months (mean, 23.6 months), primary patency, secondary patency, limb salvage, and patient survival rates were 56.8%, 62.7%, 78.2%, and 48.6%, respectively at 5 years and 37.7%, 41.7%, 57.7%, and 23.8% at 10 years. Both polytetrafluoroethylene grafts failed in less than 1 year. Primary graft patency was worse in female patients (46.5% female versus 61.6% male at 5 years; P <.009) but better in patients with diabetes (65.9% diabetes mellitus versus 56.3% non-diabetes mellitus at 4 years; P <.04). Saphenous vein grafts performed better than all other conduits with a secondary patency rate of 67.6% versus 46.3% at 5 years (P <.0001). Multivariate analysis showed that length of stay greater than 10 days and dorsalis pedis bypass for the surgical indication of previous graft occlusion were independently predictive of worse graft patency at 1 year and use of saphenous vein as conduit was predictive of better patency. CONCLUSION Dorsalis pedis bypass is durable with a high likelihood of ischemic foot salvage over many years. Saphenous vein is the preferred conduit when available. Short vein grafts from distal inflow sites are possible in more than 50% of cases. These results justify the routine use of pedal arterial reconstruction for patients with diabetes with ischemic foot complications.
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Affiliation(s)
- Frank B Pomposelli
- Division of Vascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, MA 02215, USA.
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Ramdev P, Rayan SS, Sheahan M, Hamdan AD, Logerfo FW, Akbari CM, Campbell DR, Pomposelli FB. A decade experience with infrainguinal revascularization in a dialysis-dependent patient population. J Vasc Surg 2002; 36:969-74. [PMID: 12422107 DOI: 10.1067/mva.2002.128297] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although previous series have reported outcomes of lower extremity (LE) revascularization in patients with end-stage renal disease, the issue of LE bypass for limb salvage in this group has not been resolved. We herein present the largest series to date of a 10-year single-institution experience with LE bypass in patients with dialysis dependence. METHODS With prospectively entered data from a university teaching hospital's vascular registry, we reviewed the records of all patients with dialysis dependence who underwent LE arterial bypass between January 1, 1990, and May 31, 1999. RESULTS A total of 146 consecutive patients (177 limbs) underwent infrainguinal revascularization, of whom nearly all (92%) had diabetes and tissue loss (91%). The in-hospital mortality rate was 3% (five patients). The rates for perioperative congestive heart failure, myocardial infarction, arrhythmia, and wound infection were 2%, 3%, 5%, and 10%, respectively. The actuarial graft primary and secondary patency rates at 1 and 3 years were 84% and 85%, and 64% and 68%, respectively. The limb salvage rates were 80% and 80% at 1 and 3 years. The 1-year and 3-year cumulative survival rates were 60% and 18%, respectively. At 5 years, survival was poor with only 5% of the entire cohort of 146 patients still alive. Multivariate logistic regression analysis at 6 months identified age (odds ratio, 0.96, 0.91) and number of years on dialysis (odds ratio, 0.79, 0.74) as significant (P <.05) negative predictors of both limb salvage and survival, respectively. CONCLUSION Infrainguinal arterial reconstruction can be performed on patients with dialysis dependence with acceptable rates of limb salvage given the high incidence rate of perioperative complications and poor longevity of this patient group. Advanced age and number of years on dialysis seem to correlate with poorer outcome.
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Affiliation(s)
- Pranay Ramdev
- Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Yao J, Takeuchi M, Teupe C, Sheahan M, Connolly R, Walovitch RC, Fetterman RC, Church CC, Udelson JE, Pandian NG. Evaluation of a new ultrasound contrast agent (AI-700) using two-dimensional and three-dimensional imaging during acute ischemia. J Am Soc Echocardiogr 2002; 15:686-94. [PMID: 12094166 DOI: 10.1067/mje.2002.119114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND A new intravenous contrast agent, AI-700, was evaluated to determine whether a bolus injection could be used to detect myocardial perfusion abnormalities during acute ischemia by using 2-dimensional (2D) and 3-dimensional (3D) myocardial contrast echocardiography. METHODS 2D MCE was performed in 14 closed-chest dogs during coronary occlusion by using both continuous and triggered gray scale harmonic imaging and triggered power Doppler imaging. 3D MCE (open-chest) and nuclear perfusion imaging were performed in 10 of the 14 dogs. Postmortem triphenyl tetrazolium chloride (TTC) staining was performed to verify infarction. RESULTS Thirteen of the 14 dogs had infarct by TTC; all 10 that had nuclear imaging showed a perfusion defect. Of the 13 dogs that had infarction, perfusion defects were detected in all (13 of 13) by gray scale harmonic imaging (sensitivity = 100%), and in 11 of 13 by power Doppler imaging (sensitivity = 85%). All 10 dogs that had nuclear imaging showed perfusion defects by gray scale harmonic imaging (sensitivity = 100%) and 8 of 10 by power Doppler imaging (sensitivity = 80%). The perfusion defect size, derived from 3D imaging (25% +/- 12%) correlated well with that from nuclear imaging (24% +/- 12%) (y = 0.9x + 3.8, r = 0.96, mean difference = 1.3% +/- 2.6%). The perfusion defect mass by 3D (22 +/- 14 g) also correlated well with the infarct mass by TTC staining (24 +/- 16 g) (y = 0.8x + 2.9, r = 0.89, P <.001, mean difference = -2.8 +/- 7.6 g). CONCLUSION After a single bolus of AI-700, both 2D and 3D MCE could accurately detect perfusion defects representing the area at risk of infarction during acute ischemia compared with nuclear imaging and predicted the size of infarction as verified by TTC staining.
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Affiliation(s)
- Jiefen Yao
- Cardiovascular Imaging and Hemodynamic Laboratory Division of Cardiology, Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, USA
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Hamdan AD, Saltzberg SS, Sheahan M, Froelich J, Akbari CM, Campbell DR, LoGerfo FW, Pomposelli FB. Lack of association of diabetes with increased postoperative mortality and cardiac morbidity: results of 6565 major vascular operations. Arch Surg 2002; 137:417-21. [PMID: 11926945 DOI: 10.1001/archsurg.137.4.417] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS A number of preoperative factors, including diabetes mellitus (DM), have been cited as increasing risk in patients undergoing major vascular operations. In smaller studies at our institution we have not found this to be apparent. This study reviewed all major vascular operations to confirm our bias that DM is not associated with increased mortality or cardiac morbidity. DESIGN Case series retrospectively reviewed from a vascular registry established in 1990. SETTING Tertiary care center. PATIENTS Consecutive sample of 6565 patients who underwent lower extremity revascularization or carotid or aortic procedures, grouped by presence or absence of DM. MAIN OUTCOME MEASURES Postoperative mortality, congestive heart failure, or myocardial infarction. RESULTS Patients with DM made up 62.3% of the population, and those without diabetes, 37.7%. Average age of the DM group was 67.1 years, with 61.3% male and 38.7% female. Average age of the non-DM group was 70.6 years, with 61.8% male and 38.2% female. The rates of overall postoperative mortality, myocardial infarction, and congestive heart failure were 1.14%, 1.59%, and 1.13%, respectively. Comparing the DM with the non-DM group, these rates were 0.96% vs 1.46%, 1.77% vs 1.30%, and 1.13% vs 1.14%, respectively. Using multivariate analysis, the DM group had an inverse relationship to perioperative death, with an odds ratio of 0.53 (P =.01). The factors that were associated with increased mortality were hemodialysis and history of congestive heart failure. Previous myocardial infarction was the only factor that predicted postoperative myocardial infarction. Kaplan-Meier survival curves showed a significantly decreased survival in the DM group during the next 5 years (P<.001). CONCLUSIONS Diabetes alone does not confer a higher mortality or cardiac morbidity rate with major vascular procedures. However, long-term survival is significantly worse in this group of patients.
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Affiliation(s)
- Allen D Hamdan
- Harvard Medical School, Division of Vascular Surgery, Beth Israel Deaconess Medical Center, West Campus, 110 Francis St, Suite 5B, Boston MA, 02215, USA.
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Nathanson DR, Sheahan M, Chao L, Wallack MK. Intracolonic use of vancomycin for treatment of clostridium difficile colitis in a patient with a diverted colon: report of a case. Dis Colon Rectum 2001; 44:1871-2. [PMID: 11742178 DOI: 10.1007/bf02234471] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Clostridium difficile-associated pseudomembranous colitis (PMC) is a common affliction of postoperative patients. Risk factors include antibiotic therapy, recent surgery, and hospitalization (1,2,3). We present a case of PMC in a diverted colon and its treatment using vancomycin enemas.
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Affiliation(s)
- D R Nathanson
- Department of Surgery, Metropolitan Hospital Center, New York Medical College, NY, USA
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Yao J, Teupe C, Takeuchi M, Avelar E, Sheahan M, Connolly R, Ostensen J, Pandian NG. Quantitative 3-dimensional contrast echocardiographic determination of myocardial mass at risk and residual infarct mass after reperfusion: experimental canine studies with intravenous contrast agent NC100100. J Am Soc Echocardiogr 2000; 13:570-81. [PMID: 10849511 DOI: 10.1067/mje.2000.104646] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Two-dimensional contrast echocardiography has been shown to enable the evaluation of myocardial perfusion abnormalities. However, its ability to quantify a regional myocardial mass is limited. The goal of this study was to examine the quantitative value of 3-dimensional echocardiography (3DE) in the estimation of myocardial mass at risk, salvaged mass, and residual infarct mass after intravenous injection of contrast. We created acute coronary occlusion, followed by reperfusion in 10 dogs. Three-dimensional echocardiographic data were acquired at the end of each stage, and the perfusion defect mass and dysfunctional mass were measured. The true mass at risk and infarct mass were determined by anatomic methods. The anatomic mass at risk (x) (27.1+/-14.6 g or 23.8%+/-9.7% of the left ventricle [%LV]) correlated well with the 3DE-determined perfusion defect mass (y) during coronary occlusion (y = 0.5x+8.9; r = 0.90; P<.001; mean difference -4.8+/-8.1 g; or y = 0.7x + 6.5; r = 0.83, P<.01; mean difference -0.1+/-5.4 %LV). Good correlation was also found between the anatomic infarct mass (x) (9.3+/-8.1 g or 9.1+/-8.8 %LV) and the 3DE perfusion defect mass after reperfusion (y) (y = 1.2x+1.2; r = 0.93; P<.001; mean difference 2.3+/-4.0 g; or y = 1. 3x, r = 0.98, P <.0001; mean difference 2.7+/-3.7 %LV). The salvaged mass was 13.6 +/-11.0 %LV from anatomic methods and 14.2+/-13.0 %LV by 3DE. To conclude, with the use of intravenous contrast, 3DE could quantify the actual mass at risk during acute ischemia, and in the setting of reperfusion, the residual infarct mass and salvaged mass.
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Affiliation(s)
- J Yao
- Cardiovascular Imaging and Hemodynamic Laboratory Division of Cardiology, Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
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Takeuchi M, Ogunyankin K, Pandian NG, McCreery TP, Sweitzer RH, Caldwell VE, Unger EC, Avelar E, Sheahan M, Connolly R. Enhanced visualization of intravascular and left atrial appendage thrombus with the use of a thrombus-targeting ultrasonographic contrast agent (MRX-408A1): In vivo experimental echocardiographic studies. J Am Soc Echocardiogr 1999; 12:1015-21. [PMID: 10588775 DOI: 10.1016/s0894-7317(99)70096-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Echocardiographic evaluation for the recognition of intravascular and left atrial appendage thrombus remains a difficult problem. A thrombus-specific ultrasonographic contrast agent has the potential for an alternative approach for their delineation. The aim of this study was to investigate the usefulness of thrombus-specific contrast agent MRX-408A1 for the detection of acute experimentally created intravascular and intracardiac thrombus. In the first study, we created inferior vena cava thrombus in 9 dogs. With the use of fundamental 2-dimensional echocardiography imaging, we recorded images of the inferior vena cava thrombus at baseline (n = 9), with the thrombus-specific contrast agent MRX-408A1 (n = 9), and with nonspecific contrast agent MRX-113 (n = 6). In the second study, we created a left atrial appendage thrombus in 8 dogs. We imaged left atrial appendage thrombus at baseline and during MRX-113 and MRX-408A1 infusion. Thrombus was successfully created in all dogs in study 1 and in 6 of 8 dogs in study 2. MRX-408A1 produced a visually apparent increase in ultrasonographic contrast enhancement of the thrombus in all cases in which thrombus was found on autopsy. In both studies, MRX-408A1 increased the videointensity of the thrombus significantly compared with baseline images and images obtained during MRX-113 infusion. The size of the visually detectable thrombus on the image was also significantly larger during MRX-408A1 infusion than at baseline and during MRX-113 infusion. These data provide in vivo demonstration of the efficacy of a thrombus-specific contrast agent, MRX-408A1, in the detection of acute intravascular and intracardiac thrombus. It has the potential to improve the diagnostic accuracy of ultrasonography for the detection of acute thrombi at various cardiovascular sites in the clinical setting.
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Affiliation(s)
- M Takeuchi
- Cardiovascular Imaging and Hemodynamic Laboratory, Division of Cardiology, Tufts-New England Medical Center, Boston, MA 02111, USA
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Abstract
The Australian Council on Healthcare Standards (ACHS) Evaluation and Quality Improvement Program (EQuIP) calls on healthcare organizations to increase their focus on patients by using leadership to coordinate, and continuous improvement to guide, care delivery. At a large acute care private facility in Melbourne, a program has been developed to create a 'care partnership', characterized by shared decision making, collaboration and conciliation. This program enhances patient care through the coordination of three strategies, a patient communication strategy, an evaluation strategy and a quality improvement strategy. The program has resulted in patient guided reforms such as redesign of a patient information booklet, a hospital-wide discharge planning improvement initiative and a hospital-wide strategy to improve pain management. Through the creation of a care partnership, this program helps an acute care hospital focus its services and processes on one of its key customer groups, patients.
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Affiliation(s)
- M Sheahan
- Patient Liaison Coordinator, Epworth Hospital, Richmond, Vic, Australia
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Sheahan M. Preservation of the Native Aortic Valve in Children With Aortic Insufficiency. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(97)84192-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Takeuchi M, McCreary T, Avelar E, Sheahan M, Connolly R, Santanen A, Unger E, Pandian N. Enhanced visualization of intravascular thrombus with the use of a thrombus targeting ultrasound contrast agent (MRX408): evidence from in vivo experimental echocardiographic studies. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)80892-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Haverty TP, Sanders M, Sheahan M. OKT3 treatment of cardiac allograft rejection. J Heart Lung Transplant 1993; 12:591-8. [PMID: 8369321] [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: 01/30/2023] Open
Abstract
Since the initial report of the murine monoclonal antibody OKT3 for acute kidney rejection, a significant body of information has been collected regarding the efficacy of OKT3 in reversing acute allograft rejections in kidney, liver, and heart transplant recipients. The use of OKT3 therapy for the reversal of cardiac allograft rejection in patients in whom other therapeutic alternatives have failed or are contraindicated is described. Treatment with OKT3 reversed acute heart rejection in 102 of 113 patients (90%). Complete reversal was achieved in 63 patients, and partial reversal in 39 patients. At 2 years, graft and patient survival rate was 77% and 65%, respectively. No significant differences were noted in reversal rate and in 12-month graft and patient survival rates between those patients experiencing one rejection episode and those patients experiencing two or more rejection episodes. Comparable reversal rates and graft and patient survival rates were achieved in patients whether OKT3 was administered as the primary rejection therapy or as rescue therapy. Adverse events were common in the first 2 days of therapy, but they were well tolerated in most patients. Infectious complications occurred in 49% of patients in whom most infections were not serious. On the basis of this experience, OKT3 appears highly effective in reversing acute cardiac allograft rejection.
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Affiliation(s)
- T P Haverty
- R.W. Johnson Pharmaceutical Research Institute, Department of Immunobiology, Raritan, N.J. 08869-0602
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Friedman J, Barnes L, Sheahan M, Tsai H, Goldstein G. Orthoclone OKT3 treatment of acute renal allograft rejection. Transplant Proc 1987; 19:46. [PMID: 3105144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Malabsorption of fermentable material in a variety of foods was assessed by measurement of breath H2 excretion. Breath H2 increased well above that observed in fasting subjects after ingestion of 100 g of carbohydrate in oats, whole wheat, potatoes, corn, and baked beans. Rice caused only a minimal increase in H2 excretion and hamburger was associated with no increase. We estimated the malabsorption of fermentable material by comparing the H2 excretion for 9 h after ingestion of various complex carbohydrates with that after 10 g of lactulose. The mean malabsorption of fermented material after 100-g carbohydrate meals was 20 g for baked beans; 7-10 g for wheat, oats, potatoes, and corn; and 0.9 g for rice. Whole oats or whole wheat resulted in 2-5 times more H2 than did the refined flours. As purified fiber appeared to be a poor substrate for H2 production by fecal homogenates, we conclude that most complex carbohydrates, with the exception of rice, contain a good deal of fermentable material that escapes small bowel absorption and it seems likely that this fermentable material is malabsorbed starch.
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Wolf L, Sheahan M, McCormick J, Michel B, Moskowitz RW. Classification criteria for systemic lupus erythematosus. Frequency in normal patients. JAMA 1976; 236:1497-9. [PMID: 1085375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
One hundred healthy women were examined prospectively during their annual physical examination for any of the preliminary criteria of systemic lupus erythematosus (SLE). No patient had more than three of the criteria; 50 (50%) had none. The preliminary criteria were effective in excluding normal patients. Three of 19 patients taking oral contraceptives had serum antinuclear antibody (ANA), whereas only one of 81 non-pill users had serum ANA (P less than .05). None of these patients with positive ANA had clinical evidence of SLE.
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Gauthier L, Sheahan M, Sutherland M. Unit-based inservice education. Can Nurse 1967; 63:39-42. [PMID: 6028115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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