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Hayes M, Conlin M, Hougen H, Kopp R. MP57-18 RATE OF BLADDER NECK CONTRACTURE AFTER OPEN AND MINIMALLY INVASIVE RADICAL PROSTATECTOMY OVER 18 YEARS AT THE VETERANS HEALTH ADMINISTRATION. J Urol 2022. [DOI: 10.1097/ju.0000000000002640.18] [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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Mowery A, Conlin M, Clayburgh D. Increased risk of head and neck cancer in Agent Orange exposed Vietnam Era veterans. Oral Oncol 2019; 100:104483. [PMID: 31810040 DOI: 10.1016/j.oraloncology.2019.104483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 11/25/2022]
Abstract
IMPORTANCE United States military personnel during the Vietnam Era were potentially exposed to Agent Orange, a known carcinogen. The link between Agent Orange and head and neck cancers is largely unknown; laryngeal cancer is currently the only subsite with sufficient evidence of an Agent Orange association. OBJECTIVE We aim to determine the relationship between Agent Orange exposure and the incidence of head and neck cancers in Vietnam Era veterans as well as any relationship with head and neck cancer survival. MATERIALS AND METHODS The present study utilizes the Veterans Affairs Corporate Data Warehouse (VA CDW) to identify Vietnam Era veterans, their Agent Orange exposure status, limited demographic data, presence of head and neck cancer, and survival data. RESULTS Of 8,877,971 Vietnam Era veterans, 22% self-reported exposure to Agent Orange, and 54,717 had a diagnosis of head and neck cancer. Agent Orange exposure significantly predicted upper aerodigestive tract carcinoma, with a relative risk (RR) of 1.10. On subsite analysis, Agent Orange exposure (as well as race, gender, and substance use) was significantly associated with oropharyngeal (RR 1.16), nasopharyngeal (RR 1.22), laryngeal (1.11), and thyroid (1.24) cancers. Agent Orange exposure was associated with improved 10-year overall survival in upper aerodigestive tract cancer patients. CONCLUSIONS AND RELEVANCE Self-reported Agent Orange exposure correlated with increased risks of oropharyngeal, nasopharyngeal, laryngeal, and thyroid cancers, and predicted improved survival in upper aerodigestive tract cancer patients. These findings broaden our understanding of the risks of Agent Orange exposure.
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Affiliation(s)
- Alia Mowery
- School of Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Michael Conlin
- Operative Care Division, Portland Veterans Affairs Health Care System, Portland, OR, United States
| | - Daniel Clayburgh
- Operative Care Division, Portland Veterans Affairs Health Care System, Portland, OR, United States; Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, United States.
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Abstract
Importance More than 1.3 million people in the United States have a hematologic malignant tumor currently or in remission. Previous studies have demonstrated an increased risk of secondary neoplasms in patients with hematologic malignant tumors, but research specifically on the risk of head and neck solid tumors in patients with prior hematologic malignant tumors is limited. Objectives To examine a possible association between prior hematologic malignant tumors and risk of head and neck cancer and to assess the overall survival (OS) among these patients. Design, Setting, and Participants This retrospective analysis used the Veterans Affairs (VA) Corporate Data Warehouse (CDW) to identify patients with diagnoses of hematologic malignant tumors and head and neck cancers. All patients in the VA CDW with a birthdate between January 1, 1910, and December 31, 1969, were included, for a cohort of 30 939 656 veterans. Data analysis was performed from August 15, 2018, to January 31, 2019. Exposures Outpatient problem lists were queried for diagnoses of hematologic malignant tumor and associated malignant tumors using International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to categorize patients by history of hematologic malignant tumors. Main Outcomes and Measures Presence of head and neck cancer was determined from ICD-9 and ICD-10 codes of outpatient problem lists, and cancers were grouped by subsite. The OS was determined from date of death or last outpatient visit date. Results Of 30 939 656 patients (27 636 683 [89.3%] male; 13 971 259 [45.2%] white), 207 322 patients had a hematologic malignant tumor, of whom 1353 were later diagnosed with head and neck cancer. A history of hematologic malignant tumors was significantly associated with overall aerodigestive tract cancer, with a relative risk (RR) of 1.6 (95% CI, 1.5-1.7), as well as oral cavity (RR, 1.7; 95% CI, 1.5-1.9), oropharynx (RR, 1.7; 95% CI, 1.5-1.9), larynx (RR, 1.3; 95% CI, 1.2-1.5), nasopharynx (RR, 2.8; 95% CI, 2.1-3.9), sinonasal (RR, 3.0; 95% CI, 2.2-4.1), salivary gland (RR, 2.8; 95% CI, 2.4-3.3), and thyroid (RR, 2.1; 95% CI, 1.9-2.4) tumors on subsite analysis. A prior hematologic malignant tumor was also negatively associated with 2-year and 5-year OS for multiple subsites. Conclusions and Relevance A prior diagnosis of hematologic or associated malignant tumors was associated with an increased risk of solid head and neck cancers in a range of subsites. In addition, for several head and neck cancer subsites, patients with prior hematologic malignant tumors had worse 2-year and 5-year OS. These results indicate that a prior hematologic malignant tumor may be an adverse risk factor in the development and progression of head and neck cancer.
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Affiliation(s)
- Alia Mowery
- School of Medicine, Oregon Health and Science University, Portland
| | - Michael Conlin
- Operative Care Division, Portland Veterans Affairs Health Care System, Portland, Oregon
| | - Daniel Clayburgh
- Operative Care Division, Portland Veterans Affairs Health Care System, Portland, Oregon.,Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
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Jiang D, Martinez Acevedo A, Kopp R, Conlin M, Garzotto M, Amling C, Liu JJ. PD51-05 RATE OF ACTIVE SURVEILLANCE AS A MANAGEMENT STRATEGY FOR T1A RENAL MASSES: RESULTS FROM THE NATIONAL CANCER DATABASE. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2345] [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: 11/24/2022]
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Martinez Acevedo A, Conlin M, Kopp R, Liu JJ, Amling C, Garzotto M. MP16-07 SOCIODEMOGRAPHIC PREDICTORS OF MARGIN POSITIVITY AMONG RADICAL PROSTATECTOMY PATIENTS: RESULTS FROM THE NATIONAL CANCER DATA BASE. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.541] [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: 10/17/2022]
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Kapadia AA, Martinez Acevedo A, Liu JJ, Garzotto M, Conlin M, Amling C, Kopp RP. Unconventional Bladder Preservation: Factors Predicting Failure to Receive Definitive Surgery following Chemotherapy for Nonmetastatic Muscle Invasive Bladder Cancer in the National Cancer Database. J Urol 2018; 200:535-540. [PMID: 29551404 DOI: 10.1016/j.juro.2018.03.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE Neoadjuvant chemotherapy is an important adjunct to cystectomy for managing muscle invasive bladder cancer. Using the National Cancer Database we investigated factors that predict failure to undergo surgery following multi-agent chemotherapy for nonmetastatic muscle invasive bladder cancer. MATERIALS AND METHODS We performed a cohort study in patients diagnosed with cT2-4aN0M0 urothelial cell carcinoma of the bladder between 2004 and 2013 who underwent multi-agent chemotherapy. We excluded those with surgery prior to chemotherapy, clinical T4b disease and those who received radiotherapy. Socioeconomic and clinical predictors, including time from diagnosis to treatment, were analyzed using logistic regression for the receipt of surgery after chemotherapy. Cox proportional hazards modeling was applied to perform time dependent analysis. RESULTS Of the 4,640 patients who met our study inclusion and exclusion criteria 4,244 (91%) proceeded to surgery. Negative predictors of surgery included African American or Hispanic race (OR 0.58, p = 0.007 and 0.48, p = 0.002, respectively), increasing age (OR 0.44, p <0.001) and greater time between diagnosis and chemotherapy initiation (fourth quartile greater than 59 days, OR 0.51, p <0.001). African American race (HR 0.79, p <0.001), Medicare (HR 0.86, p <0.001) and other government insurance (HR 0.73, p <0.001) were associated with delayed chemotherapy. CONCLUSIONS Increasing age, African American or Hispanic race and longer time to chemotherapy predicted failure to undergo surgery. Furthermore, African American race was associated with delayed chemotherapy. Chemotherapy was also delayed in patients on Medicare or other government insurance. Longer time to neoadjuvant chemotherapy is a modifiable risk factor that should be closely observed in multimodal cancer treatment.
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Affiliation(s)
- Akash A Kapadia
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | | | - Jen-Jane Liu
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | - Mark Garzotto
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | - Michael Conlin
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | - Christopher Amling
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | - Ryan P Kopp
- Department of Urology, Oregon Health and Science University, Portland, Oregon.
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Baba-Djara M, Conlin M, Trasi R. The ‘Gestalt’ effect: The added-value of integrating leadership,
management, and governance training for postpartum family planning service
providers. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.296] [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: 12/01/2022] Open
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Garzotto M, Edwards J, Conlin M. PD6-08 HOSPITAL READMISSIONS AFTER TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY IN THE VA MEDICAL SYSTEM. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.803] [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: 10/23/2022]
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Werntz R, Martinez Acevedo A, Conlin M, Amling C. PD44-02 TRENDS IN PSA UTILIZATION BY PRIMARY CARE PHYSICIANS: IMPACT OF THE USPSTF RECOMMENDATION. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2548] [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: 11/29/2022]
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Heckler AM, Sung J, Watters S, Martinez Acevedo A, Conlin M, Skoog S. The long-term incidence of urinary tract infection after endoscopic management of vesicoureteral reflux. Urology 2014; 83:1383-7. [PMID: 24685059 DOI: 10.1016/j.urology.2013.12.045] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/17/2013] [Accepted: 12/26/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the long-term urinary tract infection (UTI) rates after endoscopic correction of vesicoureteral reflux and the possible risk factors for urinary infection. MATERIALS AND METHODS A retrospective study of patients who underwent endoscopic management of vesicoureteral reflux at a single institution from 2001 to 2011 was performed. Patients were followed up for a minimum of 1 year. Voiding cystourethrograms were completed 3 months postoperatively. UTI questionnaire pertaining to the patient's UTI history before and after the surgery was mailed to each patient. Data were first evaluated looking only at culture-confirmed UTIs, and a second analysis included all patient-reported and culture-confirmed urinary infections. Factors considered in the analysis included sex, age, preoperative dimercaptosuccinic acid (DMSA) scan, reflux on postoperative voiding cystourethrogram, voiding dysfunction, and preoperative reflux grade. RESULTS Data on 175 patients for a minimum of 1 year were collected. There were 34 of 175 confirmed UTIs after endoscopic management, and 11 confirmed febrile UTIs. There were no significant predictors of febrile or afebrile UTIs in this group. Fifty-three of 175 patients (30%) experienced any UTI, 19 of which were febrile (10%). In this group, recurrent reflux was the only significant predictor of UTI (P=.03) and febrile UTIs (P=.04). Patients with more UTIs preoperatively were more likely to have a postoperative febrile UTI. CONCLUSION Rates of UTI and febrile UTI in endoscopic management are similar and no better than those for open ureteral reimplantation. Longer follow-up suggests an association of recurrent reflux and preoperative UTI rates as predictors of postoperative febrile UTIs. These patients benefit from closer postoperative observation.
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Affiliation(s)
| | | | - Sean Watters
- Oregon Health & Science University, Portland, OR
| | | | | | - Steven Skoog
- Oregon Health & Science University, Portland, OR.
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11
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Sung J, Barry JM, Jenkins R, Rozansky D, Iragorri S, Conlin M, Al-Uzri A. Alemtuzumab induction with tacrolimus monotherapy in 25 pediatric renal transplant recipients. Pediatr Transplant 2013; 17:718-25. [PMID: 24164824 DOI: 10.1111/petr.12159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2013] [Indexed: 12/12/2022]
Abstract
ALA induction in transplantation has been shown to reduce the need for maintenance immunosuppression. We report the outcome of 25 pediatric renal transplants between 2007 and 2010 using ALA induction followed by tacrolimus maintenance monotherapy. Patient ages were 1-19 yr (mean 14 ± 4.1 yr). Time of follow-up was 7-51 months (mean 26 ± 13 months). Tacrolimus monotherapy was maintained in 48% of patients, and glucocorticoids were avoided in 80% of recipients. Mean plasma creatinine and GFR at one yr post-transplant were 0.88 ± 0.3 mg/dL and 104.4 ± 25 mL/min/1.73m(2) , respectively. One, two, and three-yr actuarial patient and graft survival rates were 100%. The incidence of early AR (<12 months after transplantation) was 12%, while the incidence of late AR (after 12 months) was 16%. Forty-four percent of the recipients recovered normal, baseline renal function after an episode of AR, and 44% had persistent renal dysfunction (plasma creatinine 1.0-1.8 mg/dL). One graft was lost four yr after transplantation due to medication non-compliance. Four (16%) patients developed BK or CMV infection. In our experience, ALA induction with tacrolimus monotherapy resulted in excellent short- and mid-term patient and graft survival in low-immunologic risk pediatric renal transplant recipients.
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Affiliation(s)
- Jennifer Sung
- Department of Urology, Oregon Health and Science University, Portland, OR, USA
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12
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Herman L, Conlin M, Watson P, Froelich J, Kanelos D, St Amant R, Yau M, Rhees B, Monane M, McPherson J. Abstract 340: Improved Patterns for Advanced Non-Invasive Diagnostic Testing Using a Personalized Gene Expression Score among Patients Presenting to Primary Care Clinicians with Symptoms of Suspected Obstructive Coronary Artery Disease: Results from the IMPACT-PCP (Investigation of a Molecular Personalized Coronary Gene Expression Test on Primary Care Practice Pattern) Trial. Circ Cardiovasc Qual Outcomes 2013. [DOI: 10.1161/circoutcomes.6.suppl_1.a340] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Chest pain is the chief complaint in ~10,000 visits/day in the primary care provider (PCP) office and results in approximately $5 billion/yr in testing costs. Better methods are needed to more accurately assess the CAD risk of patients (pts) in an office-based, non-invasive fashion and to optimize referrals to advanced non-invasive testing for further evaluation and care planning.
Hypothesis:
We hypothesized that gene expression score (GES) results would lead to a change in the PCP’s diagnostic evaluation of stable pts presenting in the ambulatory setting with symptoms suggestive of obstructive CAD.
Methods:
The IMPACT-PCP Trial was a multi-center, prospective study which enrolled 251 consecutive pts with no history of CAD seen by nine clinicians for evaluation of chest pain and related symptoms. All patients underwent GES testing: the clinician’s diagnostic strategy was evaluated before and after the GES result was known. The GES is a blood-based molecular diagnostic test with a 96% NPV for excluding the diagnosis of obstructive CAD (defined as at least one vessel with ≥50% coronary artery stenosis by quantitative coronary angiography or core-lab CT-angiography) in symptomatic patients. The primary outcome of interest was the decision change in the diagnostic testing pattern pre/post GES testing as measured by McNemar’s test and logistic regression modeling.
Results:
Characteristics of the 251 pts eligible for primary endpoint analysis included 140 (56%) women, mean age of 56.2 years (SD± 13.0), average BMI of 29.7 (SD± 6.7), and mean GES of 16 (SD± 10). Following GES, a decision change in treatment plan (e.g. MPI, CTA, and cardiac catheterization) was noted in 145 pts (58% observed vs 10% expected change, p<0.001). More patients had a decreased (n=93, 37%) versus increased (n=52, 21%) intensity of testing (p<0.001). In particular, among the 127 low GES pts (51% of study pts), 60% (76/127) had decreased testing and only 2% (3/127) had increased testing. Follow-up is ongoing, with 233 (93%) pts having completed 30-day follow-up. There has been one MACE event (stroke) reported.
Conclusion:
The GES was associated with a statistically significant and clinically relevant change in clinical decision making among pts evaluated for suspected symptomatic CAD. In conclusion, the addition of the GES showed clinical utility above and beyond conventional decision-making by optimizing the pt’s diagnostic evaluation, particularly around the reduction in the intensity of diagnostic testing among low GES patients.
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VanDlac A, McNamara S, Conlin M, Amling C, Koppie T. 1296 IDENTIFYING THE INCIDENCE AND RISK FACTORS FOR VENOUS THROMBOEMBOLIC EVENTS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2650] [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: 11/27/2022]
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Duty B, Conlin M, Wagner M, Bayne A, Adams G, Fuchs E. Supracostal tubeless percutaneous nephrolithotomy: a retrospective cohort study. J Endourol 2012; 27:294-7. [PMID: 22973820 DOI: 10.1089/end.2012.0218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the safety of tubeless percutaneous nephrolithotomy in patients undergoing supracostal percutaneous renal access. PATIENTS AND METHODS Between October 1999 and October 2010, 302 patients underwent percutaneous nephrolithotomy via a supracostal access tract. Two hundred forty-eight (82.1%) patients had a nephrostomy tube placed at the end of the case and 54 (17.9%) did not. The medical records of both cohorts were compared regarding patient demographics (age, sex, body mass index, preoperative creatinine level), operative characteristics (estimated blood loss, length of stay, treatment efficacy), and complication rates (overall, thoracic, hemorrhage necessitating transfusion). RESULTS Patient demographics did not differ between the tubeless and nephrostomy tube groups. Estimated blood loss was significantly less in the tubeless patients (67 mL vs 123 mL; P=0.019). The tubeless group had a shorter mean length of stay than the nephrostomy tube group (2.5 vs 3.4 days, P<0.01). Treatment success was comparable between the two groups (tubeless 81.5% vs nephrostomy tube 77.8%; P=0.553). Overall complication (P=0.765) and blood transfusion (P=0.064) rates were equivalent. Chest complications were higher in the tubeless group (22.2%) compared with the nephrostomy tube patients (10.9%) (P=0.024). Nevertheless, chest complications necessitating intervention were not different (P=0.152). CONCLUSIONS Tubeless supracostal percutaneous nephrolithotomy was associated with less intraoperative blood loss and a shorter hospital stay. Although the tubeless group experienced more chest complications overall, the need for intervention was no different among the two cohorts. Tubeless supracostal percutaneous nephrolithotomy appears safe.
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Affiliation(s)
- Brian Duty
- Department of Urology, Smith Institute for Urology, Hofstra University, North Shore-Long Island Jewish Health System, New Hyde Park, NY 11042, USA.
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Go S, Conlin M, Hooper JE, Troxell ML. Polyoma virus nephropathy-related mass lesion in an apparently immunocompetent patient. Int Urol Nephrol 2011; 44:1585-8. [PMID: 21559788 DOI: 10.1007/s11255-011-9985-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 04/29/2011] [Indexed: 12/13/2022]
Abstract
Polyoma virus is a recognized cause of hemorrhagic cystitis, viral nephropathy, and ureteral stricture in renal and stem cell transplant recipients. Rarely, polyoma virus causes native kidney and bladder pathology in heavily immunosuppressed patients. We report a unique case of native kidney polyoma virus nephropathy, urothelial ulceration, and renal pelvic fibrosis presenting as a mass lesion in a non-debilitated, apparently immunocompetent man. Based on radiologic, ureterorenoscopic, and urine cytologic findings, a laparoscopic nephrectomy was performed. However, nephrectomy revealed a hemorrhagic scar-like lesion, with urothelial ulceration, but no neoplasm or malignancy. Histopathologic evaluation and immunostaining revealed polyoma viral infection in the nearby renal medulla. This case adds polyoma virus nephropathy to the differential diagnosis of non-neoplastic and reactive masses, which may mimic renal malignancy.
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Affiliation(s)
- Stephanie Go
- Department of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd L418, Portland, OR 97239, USA
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Hedges J, Conlin M. 2065 TOLL-LIKE RECEPTOR 3 (TLR3) PRETREATMENT PROTECTS IN RENAL ISCHEMIC INJURY. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.2125] [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: 10/19/2022]
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Abstract
OBJECTIVE An update on ureteroscopy with focus on current technology and newer instrumentation is presented. METHODS A literature search through Medline-indexed journals as well as personal comments are included in this review. Topics such as new semirigid and flexible ureteroscopes, lasers, ureteral access sheats, wires and stone extraction devices are outlined. RESULTS Thanks to the continuous advances of technology and miniaturization of instruments, ureteroscopy is an ever-expanding field. A clear outline of the available instruments and techniques with reference to published results catches the status of this dynamic field. CONCLUSIONS Urologists are faced with a host of new products related to ureteroscopy every year. This review serves to identify the most useful and proven advances in the field and helps in selecting the equipment needed for a successful minimally invasive approach to upper urinary tract pathologies.
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Affiliation(s)
- Maurizio Buscarini
- Division of Urology and Renal Transplantation, Oregon Health and Science University, Portland, OR, USA.
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Winfield H, Tally G, Wong M, Te A, Assimos D, Conlin M, Duchene D, Cadeddu J, Hemal A. Survey of Endourology. J Endourol 2007. [DOI: 10.1089/end.2007.9881] [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: 11/12/2022] Open
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Buscarini M, Conlin M, Sokoloff M. Laparoscopic partial nephrectomy: a review. MINERVA UROL NEFROL 2007; 59:89-97. [PMID: 17431373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Surgical treatment of renal cell carcinoma has evolved dramatically in the last 10 years. With the improvement of radiological imaging and minimally invasive nephron sparing techniques, more and more lesions can be managed laparoscopically. Stage migration to earlier lesions has followed the wider use of cross sectional tridimensional imaging. Open partial nephrectomy has been the benchmark to which laparoscopic partial nephrectomy (LPN) has been compared. In this review we focus on the available recent literature data on LPN and we outline the key surgical points.
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Affiliation(s)
- M Buscarini
- Division of Urology and Renal Transplantation, Oregon Health and Science University, Portland, OR, USA.
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Abstract
There is an insufficient supply of deceased donor kidneys for transplantation. One solution is to increase the number of living donor kidney transplants. Our kidney transplant database was reviewed for 3 periods of 12 months each, separated by 5 years, to show the trends in kidney transplant donor sources and the influence of biologically unrelated living renal donors, minimally invasive living renal donor surgery, transplantation of ABO-incompatible kidneys from living donors, and transplantation in spite of positive cross-matches on the numbers of renal transplants and 1-year kidney transplant survival rates at our center. When results for 1993 were compared with 2003, the annual number of living donor renal transplants increased from 25 to 86, and the annual number of deceased donor renal transplants decreased from 108 to 63. The total number of kidney transplants increased by 12%. However, 1-year living donor kidney transplant survivals were not significantly different (94% for transplants done in 1993 vs 98% for transplants done in 2003). The strategies of living donor renal transplants from genetically unrelated donors, ABO-incompatible donors, and cross-match positive donors as well as the introduction of hand-assisted laparoscopic donor nephrectomy increased the number of living renal donor renal transplants at our center without compromising short-term kidney transplant survival rates.
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Affiliation(s)
- John M Barry
- Division of Urology and Renal Transplantation, Department of Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
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Abstract
Using detailed panel data on local alcohol policy changes in Texas, this paper tests whether the effect of these changes on alcohol-related accidents depends on whether the policy change involves where the alcohol is consumed and the type of alcohol consumed. After controlling for both county and year fixed effects, we find evidence that: (i) the sale of beer and wine may actually decrease expected accidents; and (ii) the sale of higher alcohol-content liquor may present greater risk to highway safety than the sale of just beer and wine.
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Affiliation(s)
- R Baughman
- Center for Policy Research, Syracuse University, NY 13244-1020, USA
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Conlin M. Current and Coming in Endourology: Highlights of the 18th World Congress on Endourology and SWL and the 16th Basic Research Symposium September 14-17, 2000, São Paulo, Brazil. Rev Urol 2001; 3:6-9. [PMID: 16985685 PMCID: PMC1476035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Abstract
We report the case of a patient who developed an obstructing calculus embedded at the ureteropelvic junction after treatment of ureteropelvic junction obstruction with the Acucise cutting balloon catheter. Within the length of the stone, we found a wire consistent with the cutting wire. To our knowledge, this is the first report of a fractured and retained cutting wire resulting in calculus formation.
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Affiliation(s)
- J E Johnson
- Oregon Health Sciences University, Portland, Oregon, USA
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Paduch DA, Conlin M, Dematos A, Rabkin J, Orloff S, Pfister M, Barton R. Arterial duodenovesical fistula after simultaneous pancreas and kidney transplantation. J Urol 2000; 164:1296. [PMID: 10992386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- D A Paduch
- Divisions of Urology and Renal Transplantation, and Liver and Pancreas Transplantation, and Dotter Interventional Institute, Oregon Health Sciences University, Portland, Oregon, USA
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Conlin M. CT After Nephrostolithotomy and Endoscopic Resection of TCC. Rev Urol 2000; 2:92-3. [PMID: 16985744 PMCID: PMC1476113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Lingeman JE, Conlin M, Pearle MS. Controversial cases in endourology. J Endourol 1999; 13:709-12. [PMID: 10646675 DOI: 10.1089/end.1999.13.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J E Lingeman
- Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana, USA
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Grasso M, Conlin M, Bagley D. Retrograde ureteropyeloscopic treatment of 2 cm. or greater upper urinary tract and minor Staghorn calculi. J Urol 1998; 160:346-51. [PMID: 9679874] [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: 02/08/2023]
Abstract
PURPOSE Upper urinary tract calculi that are too large to treat with extracorporeal shock wave lithotripsy are most commonly cleared with percutaneous endoscopic techniques. In a select group of patients who were poor candidates for percutaneous nephrostolithotomy we used retrograde endoscopic lithotripsy, and define the safety and efficacy of this modality in treating large, noninfectious stone burdens (2 cm. or greater). MATERIALS AND METHODS A total of 51 patients with 66 large (2 cm. or greater) upper urinary tract stones were chosen for retrograde ureteroscopic surgery. Many of these patients had co-morbid conditions that precluded or complicated standard percutaneous treatment. Lithotripsy was based on the application of small diameter fiberoptic ureteroscopes and the holmium laser lithotriptor. Specifically, the 200 micro. laser fiber was used when lower pole renal access was required. Successful therapy was defined as total fragmentation of a stone burden with creation of fine sand and 2 mm. or smaller debris. Second look endoscopy was commonly performed in select patients with large branched calculi or stone burdens in excess of 3 cm. to rule out and treat large residual fragments. RESULTS Of 51 patients 48 were treated solely in a retrograde ureteroscopic manner and in 3 either failure of lower pole access or infectious material encountered on initial endoscopy led to conversion to more standard percutaneous techniques. In 34 of 45 renal (76%), and 20 of 21 ureteral (95%) complete ureteroscopic fragmentation of the respective stone burden was accomplished after a single session. Second look endoscopy defined significant residual fragments requiring additional endoscopic lithotripsy in 8 of 15 large renal (53%) and 1 of 3 complex ureteral stone burdens. Success, that is complete pulverization of the stone burden to fine dust and small 2 mm. fragments, increased to 41 of 45 renal (91%) and all 21 ureteral calculi after these second look procedures. One patient required a third session to treat completely an exceptionally large (6 cm.) renal stone burden composed of pure cystine, thus increasing the overall success rate for renal calculi to 93%. Six-month followup data were available for 25 patients with large calculi treated ureteroscopically, of whom 15 (60%) had completely clear imaging, 6 (24%) had small lower pole debris that was decreasing on serial imaging and 4 (16%) had new stone growth which was, in part, related either to uncorrectable metabolic disorders or chronic renal scarring and urinary stasis. There were no intraoperative complications. Three postoperative complications included pyelonephritis in 1 patient, prostatic bleeding in 1 on anticoagulant therapy and a cerebral vascular accident 24 hours after the procedure in 1 with severe vascular disease. CONCLUSIONS Large and complex upper urinary tract calculi can be addressed safely and efficiently with retrograde endoscopic techniques.
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Affiliation(s)
- M Grasso
- New York University, New York, USA
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Abstract
BACKGROUND AND METHODS Only a few pharmacoepidemiology studies have included very old subjects and most studies included both healthy and very ill people. Interpretation of data from these investigations is limited because of the mix of health status in the populations studied. We examined drug use in a group of active, relatively healthy, older people. Sixty-one attendees at a national convention, aged 76-96 years, volunteered to participate in a study on health status in a very old, ambulatory population. Medication histories, selected blood biochemistry analyses, a mental status examination, and other data were collected. RESULTS The mean number of prescription and nonprescription drugs used per person was 2.02 and 1.85, respectively. More than a quarter of the sample population took no prescription medications and two-thirds used two or fewer prescription drugs. Sixteen percent of those taking prescription medications experienced adverse effects from their current drug regimens. Although falling was prevalent among our study subjects, there were similar drug-use patterns in those who did and who did not fall. CONCLUSIONS In a group of relatively healthy and functional very old people, we found that drug use was not excessive, although adverse effects were still prevalent. In addition, most subjects were knowledgeable about their medications. These studies demonstrate that extreme age alone does not always result in sickness, frailty, and overuse of medications.
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Affiliation(s)
- J C Delafuente
- Department of Pharmacy Practice, College of Pharmacy, University of Florida, Gainesville
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Conlin M, Forrest HS, Bruice TC. Replacement of methoxatin by 4,7-phenanthroline-5,6-dione and the inability of other phenanthroline quinones, as well as 7,9-di-decarboxy methoxatin, to serve as cofactors for the methoxatin-requiring glucose dehydrogenase of Acinetobacter calcoaceticus. Biochem Biophys Res Commun 1985; 131:564-6. [PMID: 4052066 DOI: 10.1016/0006-291x(85)91273-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Glucose dehydrogenase from A. calcoaceticus has been dissociated into apoenzyme and methoxatin coenzyme, and enzyme activity restored by replacing coenzyme with 4,7-phenanthroline-5,6-dione but not with 1,10- nor 1,7-phenanthroline-5,6-diones nor with 7,9-decarboxy methoxatin.
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