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Meade-Aguilar JA, Figueroa-Parra G, Yang JX, Langenfeld HE, González-Treviño M, Dogra P, Bancos I, Moynagh MR, Murad MH, Prokop LJ, Hanson AC, Crowson CS, Duarte-García A. Clinical presentation and outcomes in patients with antiphospholipid syndrome-associated adrenal hemorrhage. A multicenter cohort study and systematic literature review. Clin Immunol 2024; 260:109906. [PMID: 38244823 DOI: 10.1016/j.clim.2024.109906] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/10/2023] [Accepted: 01/17/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Adrenal hemorrhage (AH) can occur in patients with antiphospholipid Syndrome (APS). We aimed to characterize the clinical manifestations, treatments, and outcomes of patients presenting with APS-associated AH (APS-AH) through a retrospective cohort and a systematic literature review (SLR). METHODS We performed a mixed-source approach combining a multicenter cohort with an SLR of patients with incident APS-AH. We included patients from Mayo Clinic and published cases with persistent positivity for antiphospholipid antibodies and presenting with AH, demonstrated by imaging or biopsy. We extracted demographics, clinical characteristics, laboratory findings, treatment strategies, and outcomes (primary adrenal insufficiency and mortality). We used Kaplan-Meier and Cox models for survival analysis. RESULTS We included 256 patients in total, 61 (24%) from Mayo Clinic and 195 (76%) from the SLR. The mean age was 46.8 (SD 15.2) years, and 45% were female. 69% of patients had bilateral adrenal involvement and 64% presented adrenal insufficiency. The most common symptoms at presentation were abdominal pain in 79%, and nausea and vomiting 46%. Hyponatremia (77%) was the most common electrolyte abnormality. Factors associated with primary adrenal insufficiency were bilateral adrenal involvement at initial imaging (OR 3.73, CI; 95%, 1.47-9.46) and anticardiolipin IgG positivity (OR 3.80, CI; 95%, 1.30-11.09). The survival rate at five years was 82%. History of stroke was associated with 3.6-fold increase in mortality (HR 3.62, 95% CI; 1.33-9.85). CONCLUSION AH is a severe manifestation of APS with increased mortality. Most patients developed permanent primary adrenal insufficiency, particularly those positive for anticardiolipin IgG and bilateral adrenal involvement.
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Affiliation(s)
| | | | - Jeffrey X Yang
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
| | - Hannah E Langenfeld
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | | | - Prerna Dogra
- Division of Endocrinology, Diabetes and Metabolism, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Irina Bancos
- Division of Endocrinology and Metabolism Disorders, Mayo Clinic, Rochester, MN, USA.
| | | | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA.
| | | | - Andrew C Hanson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
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Storandt MH, Tran NH, Ehret CJ, Hanna M, Jochum J, Moynagh MR, Jatoi A. Gastrointestinal perforation after bevacizumab: a multi-site, single-institution study with a focus on survival. World J Surg Oncol 2023; 21:177. [PMID: 37291587 DOI: 10.1186/s12957-023-03058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Bevacizumab-induced gastrointestinal perforation is a rare but potentially devastating adverse event that has generated limited data on overall survival. Yet, such survival data are critical in guiding management. METHODS This multi-site, single-institution retrospective study focused on all cancer patients who had received bevacizumab and who had suffered a well-documented gastrointestinal perforation from January 1, 2004 through January 20, 2022.The main goal was to report survival outcomes; Kaplan Meier curves and Cox survival models were used for this purpose. RESULTS Eighty-nine patients are included in this report with a median age of 62 years (range 26-85). Colorectal cancer was the most common malignancy (n = 42). Thirty-nine patients underwent surgery for the perforation. Seventy-eight were deceased at the time of reporting with an overall median survival of all patients of 2.7 months (range 0-45 months), and 32 (36%) died within 30 days of perforation. In univariable survival analyses, no statistically significant associations were observed for age, gender, corticosteroid use, and time since last bevacizumab dose. However, surgically treated patients manifested a better survival (hazard ratio (HR) 0.49 (95% CI 0.31-0.78); p = 0.003). In multivariable analyses, surgery continued to be associated with improved survival (HR 0.47 (95% CI 0.29-0.74); p = 0.002), and corticosteroid use was associated with worse survival (HR 1.75 (95% CI 1.02-2.99); p = 0.04). CONCLUSION Although gastrointestinal perforation after bevacizumab should be managed on a case-by-case basis, these descriptive survival data can help inform patients, their families, and healthcare providers as challenging management decisions arise.
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Affiliation(s)
| | - Nguyen H Tran
- Department of Oncology, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Mina Hanna
- Department of Oncology, Mayo Clinic, 404 W. Fountain Street, Albert Lea, MN, 56007, USA
| | - Jacob Jochum
- Department of Oncology, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael R Moynagh
- Department of Radiology, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aminah Jatoi
- Department of Oncology, 200 First Street SW, Rochester, MN, 55905, USA.
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3
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Xiao L, Wagle S, Schmitz JJ, Hesley GK, Parvinian A, Brinkman NJ, Moynagh MR. Safety and technical success of diphenhydramine as an alternative local anaesthetic agent for radiology procedures. Clin Radiol 2023; 78:e177-e181. [PMID: 36411091 DOI: 10.1016/j.crad.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/22/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022]
Abstract
AIM To evaluate retrospectively the safety and technical success of subcutaneous diphenhydramine as an alternative local anaesthetic for radiology procedures. MATERIALS AND METHODS Between January 2000 and April 2021, 84 image-guided procedures were performed in 81 adult patients (mean age 61 years, 86% female) using 1% injectable diphenhydramine as a local anaesthetic. Indications were history of severe allergy to "-caine" local anaesthetics in 76 (90%) patients and recent administration of bupivacaine liposomal injectable suspension in eight (10%) patients. Twelve of the 84 (14%) procedures were performed with concomitant moderate sedation. Patient characteristics, procedural techniques, and clinical outcomes were reviewed. Early and delayed (30-day) complications were classified as either related to local diphenhydramine injection or to the procedure itself. Procedure-related complications were gradated using the Clavien-Dindo system. RESULTS Percutaneous biopsy was the most frequently performed procedure (57/84, 67%). Fifty-nine (70%) of the 84 procedures were ultrasound guided. The most common procedural site was the breast (34/84, 40%). All procedures were technically successful. There were two minor injection-related complications related to post-procedural pain. A single minor procedure-related complication involved a patient requiring hospital admission for post-renal biopsy related haematuria. CONCLUSION Injectable diphenhydramine appears to be a safe and effective local anaesthetic alternative in patients with "-caine" class contraindications undergoing radiology procedures. A future prospective trial would be useful to assess the safety profile in an large cohort of patients.
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Affiliation(s)
- L Xiao
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - S Wagle
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - J J Schmitz
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - G K Hesley
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - A Parvinian
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - N J Brinkman
- Department of Pharmacy Services, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - M R Moynagh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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Navin PJ, Moynagh MR. Optimal and novel imaging of the adrenal glands. Curr Opin Endocrinol Diabetes Obes 2022; 29:253-262. [PMID: 35621177 DOI: 10.1097/med.0000000000000730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Adrenal imaging forms an important role in the workup of adrenal masses. The purpose of this review is to briefly review the traditional role of imaging in adrenal diseases and highlight the most recent research and new applications aimed to improve diagnostic accuracy. RECENT FINDINGS The current review will focus on new applications of computed tomography (CT), MRI and PET/CT imaging, addressing the implications of artificial intelligence and radiomics in progressing diagnostic accuracy. SUMMARY The new applications of adrenal imaging are improving diagnostic accuracy and expanding the role of imaging, particularly with novel PET radiotracers and the use of artificial intelligence.
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Affiliation(s)
- Patrick J Navin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Steadman JA, Moynagh MR, Oderich GS, Mendes BC. Effective treatment of type IIb endoleak via targeted translumbar embolization. J Vasc Surg Cases Innov Tech 2022; 8:232-236. [PMID: 35493344 PMCID: PMC9046119 DOI: 10.1016/j.jvscit.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/03/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Gustavo S. Oderich
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Bernardo C. Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
- Correspondence: Bernardo C. Mendes, MD, Gonda Vascular Center, 200 First St SW, 55905, Rochester, MN 55905
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Navin PJ, Eickstaedt NL, Atwell TD, Young JR, Eiken PW, Welch BT, Schmitz JJ, Schmit GD, Johnson MP, Moynagh MR. Safety and Efficacy of Percutaneous Image-Guided Mediastinal Mass Core-Needle Biopsy. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1100-1108. [PMID: 34877475 PMCID: PMC8633817 DOI: 10.1016/j.mayocpiqo.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective To retrospectively evaluate the safety and efficacy of percutaneous image-guided mediastinal mass core-needle biopsy. Patients and Methods Retrospective review of an institutionally maintained biopsy registry identified 337 computed tomography- or ultrasound-guided percutaneous mediastinal mass core needle biopsies between October 2002 and August 2017 in a single quaternary referral center. Mean patient age was 51 (range, 18 to 93) years. Procedural techniques, anticoagulation/antiplatelet therapy, and tumor anatomical characteristics were reviewed. Classification and gradation of complications was based on the Clavien-Dindo system. Diagnostic yield was defined as the ratio of diagnostic biopsy to all biopsies performed. Results Mean tumor size was 59.2 (range, 10 to 180) mm with 89.9% (n=303) of lesions located in the prevascular (anterior) mediastinum. There was a single major complication (0.3%) of a symptomatic pneumothorax requiring intervention. There were seven (2.1%) minor complications, including three bleeding complications. A transpleural approach was the only variable associated with an increased complication rate (P<.01). Forty-one (12.2%) patients had a biopsy performed while taking an antiplatelet/anticoagulant agent within the therapeutic window, with a single case (0.3%) associated with a minor bleeding complication. Of 18 (5.3%) procedures performed without cessation of anticoagulant/antiplatelet therapy, there were no bleeding complications. Of all 337 biopsies, 322 (95.5%) were diagnostic. None of the analyzed variables were significantly associated with a nondiagnostic biopsy. Conclusion Image-guided percutaneous core-needle biopsy of mediastinal masses is a safe procedure with high diagnostic yield. Further prospective studies are required to assess the complication profile in higher risk patients.
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Heidari B, Ahmad A, Al-Hijji MA, Aoun J, Singh M, Moynagh MR, Takahashi N, Lerman LO, Alkhouli MA, Lerman A. Muscle fat index is associated with frailty and length of hospital stay following transcatheter aortic valve replacement in high-risk patients. Int J Cardiol 2021; 348:33-38. [PMID: 34871623 DOI: 10.1016/j.ijcard.2021.11.087] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/29/2021] [Accepted: 11/29/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aging is associated with progressive loss of muscle mass, as well as replacement of muscle with fat and fibrous tissue. We studied the contribution of muscle fat content, a surrogate marker of biological aging, to frailty and Length of Hospital Stay (LOS) following Transcatheter Aortic Valve Replacement (TAVR). METHODS We evaluated 415 patients who underwent TAVR from February 2012 to December 2016 at Mayo Clinic, MN, USA. Densities between -190 to -30 Hounsfield Units within the abdominal muscle area were determined as muscle fat. Muscle Fat Index (MFI) was defined as muscle fat mass divided by height squared. LOS was considered as the primary outcome. Stepwise multivariable linear regression was used to identify the predictors of LOS. RESULTS Mean age ± SD of the study population was 81.2 ± 9.6 years and 58.07% were male. Seventy-two patients (17.35%) had frailty. Median (IQR) LOS was 4 (3-6) days. MFI was higher in patients with frailty (median (IQR); 18.1 [13.8-24.2] vs 14.4 [10.6-18.7], p < 0.001) and was positively correlated with LOS (r = 0.129, p = 0.009). In multivariable analysis of predictors of LOS, MFI (β = 0.06, p = 0.022), pre-TAVR atrial fibrillation/flutter (β = 0.5, p = 0.015), and post-TAVR complications (β = 0.91, p < 0.001) were directly, and femoral access route (β = -1.13, p < 0.001) and pre-TAVR hemoglobin (β = -0.35, p = 0.002) were inversely associated with LOS. CONCLUSIONS MFI can be determined from pre-TAVR CT scans and is a novel predictor of LOS following TAVR. This objective indicator can potentially be used in a pre-TAVR clinic to plan for rehabilitation programs in selected patients.
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Affiliation(s)
- Behnam Heidari
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Mohammed A Al-Hijji
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America; Department of Cardiovascular Medicine, Heart Hospital, Hamad Medical Cooperation, Doha, Qatar
| | - Joe Aoun
- Department of Cardiovascular Medicine, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States of America
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Naoki Takahashi
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States of America
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
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Delivanis DA, Andrade Hurtado MD, Cortes T, Athimulam S, Khanna A, Atkinson E, McKenzie T, Takahashi N, Moynagh MR, Bancos I. Abnormal body composition in patients with adrenal adenomas. Eur J Endocrinol 2021; 185:653-662. [PMID: 34406976 PMCID: PMC8511231 DOI: 10.1530/eje-21-0458] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/18/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Increased visceral fat and sarcopenia are cardiovascular risk factors that may explain increased cardiovascular morbidity and frailty in patients with adrenal adenomas. Our objective was to compare body composition measurement of patients with adrenal adenomas to referent subjects without adrenal disease. DESIGN Cross-sectional study, 2014-2018. METHODS Participants were adults with nonfunctioning adrenal tumor (NFAT), mild autonomous cortisol secretion (MACS), and Cushing syndrome (CS) and age, sex, and BMI 1:1 matched referent subjects without adrenal disorders. Main outcome measures were body composition measurements calculated from abdominal CT imaging. Intra-abdominal adipose tissue and muscle mass measurements were performed at the third lumbar spine level. RESULTS Of 227 patients with adrenal adenomas, 20 were diagnosed with CS, 76 with MACS, and 131 with NFAT. Median age was 56 years (range: 18-89), and 67% were women. When compared to referent subjects, patients with CS, MACS, and NFAT demonstrated a higher visceral fat (odds ratio (OR): 2.2 (95% CI: 0.9-6.5), 2.0 (1.3-3.2), and 1.8 (1.2-2.7) and a lower skeletal muscle area (OR: 0.01 (95% CI: 0-0.09), 0.31 (0.18-0.49), and 0.3 (1.2-2.7)) respectively. For every 1 µg/dL cortisol increase after overnight dexamethasone, visceral fat/muscle area ratio increased by 2.3 (P = 0.02) and mean total skeletal muscle area decreased by 2.2 cm2 (P = 0.03). CONCLUSION Patients with adrenal adenomas demonstrate a lower muscle mass and a higher proportion of visceral fat when compared to referent subjects, including patients with NFAT. Even a subtle abnormality in cortisol secretion may impact health of patients with adenomas.
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Affiliation(s)
- Danae A Delivanis
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Maria D. Andrade Hurtado
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic Health System, La Crosse, WI, USA
| | - Tiffany Cortes
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Shobana Athimulam
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Health System, Detroit, MI, USA
| | - Aakanksha Khanna
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth Atkinson
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Travis McKenzie
- Division of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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Powell GM, Baffour FI, Moynagh MR, Skinner JA, Lam TK, O'Driscoll SW, Glazebrook KN. Preoperative sonographic ulnar nerve mapping in the postoperative elbow. Skeletal Radiol 2021; 50:1219-1225. [PMID: 33009582 DOI: 10.1007/s00256-020-03620-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the technique of sonographic ulnar nerve mapping in the postoperative elbow for surgical planning. MATERIALS AND METHODS A retrospective review of a surgical databank identified 24 patients, all aged 18 years and older with a history of orthopedic elbow surgery, who were referred for preoperative sonographic mapping of the ulnar nerve prior to subsequent surgery. All cases were reviewed for patient demographics, clinical presentation, prior surgical interventions, and ultrasound technique. Charts were reviewed for intraoperative and postoperative outcomes, including nerve injury. RESULTS The cohort included 12 males and 12 females with a mean age of 51 years (range 22-68 years) and a mean BMI of 29 (range 20-48). Preoperative sonographic ulnar nerve mapping occurred following various elbow surgeries including ulnar nerve transposition to assess nerve location prior to subsequent elbow surgery. Of the 24 patients with preoperative sonographic ulnar nerve mapping, subsequent surgery was performed arthroscopically in 14 and open in 10 cases. In 11 of the 24 cases, there was specific mention of a modified approach to joint access which was guided by the ulnar nerve map. There were no perioperative ulnar nerve-related complications, such as nerve transection. CONCLUSION Preoperative mapping can facilitate planning of surgical access and ulnar nerve dissection. Sonographic mapping of the ulnar nerve reduces the potential uncertainty of nerve palpation in a complex postoperative elbow following ulnar nerve transposition. This technique may mitigate the risk of ulnar nerve injury.
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Affiliation(s)
- Garret M Powell
- Department of Radiology, Mayo Clinic, 200 1st St SW., Rochester, MN, 55905, USA
| | - Francis I Baffour
- Department of Radiology, Mayo Clinic, 200 1st St SW., Rochester, MN, 55905, USA.
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, 200 1st St SW., Rochester, MN, 55905, USA
| | - John A Skinner
- Department of Radiology, Mayo Clinic, 200 1st St SW., Rochester, MN, 55905, USA
| | - Tiffany Keller Lam
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW., Rochester, MN, 55905, USA
| | - Shawn W O'Driscoll
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW., Rochester, MN, 55905, USA
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Jang S, Schmitz JJ, Atwell TD, Welch TL, Welch BT, Hobday TJ, Adamo DA, Moynagh MR. Percutaneous Image-Guided Core Needle Biopsy of Neuroendocrine Tumors: How Common Is Intraprocedural Carcinoid Crisis? J Vasc Interv Radiol 2021; 32:745-751. [PMID: 33608193 DOI: 10.1016/j.jvir.2021.01.264] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To retrospectively evaluate the incidence of carcinoid crisis, other complications, and physiologic disturbances during percutaneous image-guided core needle biopsy of neuroendocrine tumors (NETs) in the lung and the liver. MATERIALS AND METHODS Between January 2010 and January 2020, 106 computed tomography (CT) or ultrasound (US)-guided core needle biopsies of lung and liver NETs were performed in 95 consecutive adult patients. The mean age was 64 ± 13 years, and 48% were female. The small bowel was the most common primary site (33%, 31/95), and 32 (34%) patients had pre-existing symptoms of carcinoid syndrome. The mean tumor size was 3.2 ± 2.6 cm, and mean number of passes was 3.4 ± 1.6. A 17/18-gauge needle was used in 91% (96/106) of the biopsies. Thirteen (12%) patients received either outpatient or prophylactic octreotide. RESULTS No patients experienced carcinoid crisis or needed octreotide, inotropes, vasopressors, or resuscitation. A single biopsy procedure (0.9%, 1/106) was complicated by bleeding that required angiographic hepatic artery embolization. Changes in pre-biopsy- versus post-biopsy systolic blood pressure and heart rate were -1.6 mm Hg (P = .390) and 0.6 beat/min (P = .431), respectively. Tumor functional status, overall tumor burden, and the elevation of neuroendocrine markers were not associated with intraprocedural physiologic disturbances. There were 4 minor complications (0.4%, 4/106) associated with the biopsy procedure that were not attributed to hormone excretion from tumor manipulation. CONCLUSIONS Percutaneous image-guided core biopsy of NETs is safe, with low complication rate and no definite carcinoid crisis in the current cohort.
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Affiliation(s)
- Samuel Jang
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Thomas D Atwell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Tasha L Welch
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Timothy J Hobday
- Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
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11
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Doolittle DA, Hernandez MC, Baffour FI, Moynagh MR, Takahashi N, Froemming AT, Glazebrook KN, Kim BD. CT-derived sarcopenia should not preclude surgical stabilization of traumatic rib fractures. Eur Radiol Exp 2021; 5:9. [PMID: 33590301 PMCID: PMC7884563 DOI: 10.1186/s41747-021-00206-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Rib fractures are associated with considerable morbidity and mortality. Surgical stabilization of rib fractures (SSRF) can be performed to mitigate complications. Sarcopenia is in general known to be associated with poor clinical outcomes. We investigated if sarcopenia impacted number of days of mechanical ventilation, intensive care unit (ICU) stay, and total hospital stay in patients who underwent SSRF. METHODS A retrospective single institutional review was performed including patients who underwent SSRF (2009-2017). Skeletal muscle index (SMI) was semiautomatically calculated at the L3 spinal level on computed tomography (CT) images and normalized by patient height. Sarcopenia was defined as SMI < 55 cm2/m2 in males and < 39 cm2/m2 in females. Demographics, operative details, and postoperative outcomes were reviewed. Univariate and multivariate analyses were performed. RESULTS Of 238 patients, 88 (36.9%) had sarcopenia. There was no significant difference in number of days of mechanical ventilation (2.8 ± 4.9 versus 3.1 ± 4.3, p = 0.304), ICU stay (5.9 ± 6.5 versus 4.9 ± 5.7 days, p = 0.146), or total hospital stay (13.3 ± 7.2 versus 12.9 ± 8.2 days, p = 0.183) between sarcopenic and nonsarcopenic patients. Sarcopenic patients demonstrated increased modified frailty index scores (1.5 ± 1.1 versus 0.9 ± 0.9, p < 0.001) compared to nonsarcopenic patients. CONCLUSIONS For patients who underwent SSRF for rib fractures, sarcopenia did not increase the number of days of mechanical ventilation, ICU stay, or total hospital stay. Sarcopenia should not preclude the utilization of SSRF in these patients.
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Affiliation(s)
- Derrick A Doolittle
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Matthew C Hernandez
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Francis I Baffour
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Naoki Takahashi
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Adam T Froemming
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Katrina N Glazebrook
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Brian D Kim
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Moynagh MR, Dowdy SC, Welch B, Glaser GE, Schmitz JJ, Jatoi A, Langstraat CL, Block MS, Kurup AN, Kumar A. Image-guided tumor ablation in gynecologic oncology: Review of interventional oncology techniques and case examples highlighting a collaborative, multidisciplinary program. Gynecol Oncol 2020; 160:835-843. [PMID: 33388156 DOI: 10.1016/j.ygyno.2020.12.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/23/2020] [Indexed: 01/20/2023]
Abstract
As interventional oncology services within radiology mature, image-guided ablation techniques are increasingly applied to recurrent gynecologic malignancies. Ablation may be performed using thermal techniques like cryoablation, microwave ablation, or radiofrequency ablation, as well as non-thermal ones, such as focused ultrasound or irreversible electroporation. Feasibility and approach depend on tumor type, size, number, anatomic location, proximity of critical structures, and goals of therapy. Current indications include local control of limited metastatic disease or palliation of painful bone metastases refractory or unsuitable to conventional therapies. Technical aspects of these procedures, including methods to protect nearby critical structures are presented through illustrative examples. Cases amenable to image-guided ablation include, but are not limited to, hepatic or pulmonary metastases, musculoskeletal metastases, retroperitoneal nodal metastases, pelvic side wall disease, abdominal wall disease, and vaginal or vulvar tumors. Protective maneuvers, such as hydro-displacement of bowel, neuromonitoring, and retrograde pyeloperfusion through ureteral stents, permit safe ablation despite close proximity to vulnerable nerves or organs. Image-guided ablation offers an alternative modality to achieve local tumor control without the risks associated with surgery or systemic treatment in appropriately selected patients. A multidisciplinary approach to use of image-guided ablation includes collaboration between gynecologic oncology, interventional radiology, anesthesia, urology and radiation oncology teams allowing for appropriate patient-centered case selection. Long-term follow up and additional studies are needed to determine the oncologic benefits of such techniques.
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Affiliation(s)
- Michael R Moynagh
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Sean C Dowdy
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Brian Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Gretchen E Glaser
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Aminah Jatoi
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Carrie L Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Matthew S Block
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America.
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Navin PJ, Moynagh MR, Atkinson EJ, Tirumanisetty P, LeBrasseur NK, Kumar A, Khosla S, Takahashi N. Establishment of normative biometric data for body composition based on computed tomography in a North American cohort. Clin Nutr 2020; 40:2435-2442. [PMID: 33176926 DOI: 10.1016/j.clnu.2020.10.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Accurate and reproducible biomarkers are required to allow a more personalized approach to patient care. Body composition is one such biomarker affecting outcomes in a range of surgical and oncological conditions. The aim of this study is to determine the age and sex specific distribution of body composition data, based on information gathered from computed tomography (CT). METHODS This prospective study used healthy subjects from the medical records linkage of the Rochester Epidemiology Project, based in Minnesota, USA. Each patient had a CT scan without intravenous contrast performed between 1999 and 2001. Quantification was performed using previously validated semi-automated in-house developed software for body composition analysis. Subcutaneous adipose tissue area, visceral adipose tissue area, intermuscular adipose tissue area and skeletal muscle area were measured and indexed to subject height. Generalized Additive Models for Location, Scale and Shape were used to assess the location, scale, and shape of each variable across age, stratified by sex. Z-scores specific to sex were assessed for each of the parameters analyzed. Age-specific z-scores were calculated using the formula: Z = (Index Variable - μ)/σ or Z = (√ (Index Variable) - μ)/σ. RESULTS There were 692 subjects enrolled in the study. The fitted model equation was offered for each variable with values presented for μ and σ. Modelling with penalized splines was performed for VAT index, IMAT index and total adipose tissue index. Scatterplots of each variable were produced with lines of Z-scores as a visual representation. CONCLUSION This study offers comparative data to allow comparison amongst multiple populations. This will form an important reference for future research and clinical practice.
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Affiliation(s)
- P J Navin
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - M R Moynagh
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - E J Atkinson
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - P Tirumanisetty
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
| | - N K LeBrasseur
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, USA
| | - A Kumar
- Department of Gynecological Surgery, Mayo Clinic, Rochester, USA
| | - S Khosla
- Department of Endocrinology, Mayo Clinic, Rochester, USA
| | - N Takahashi
- Department of Radiology, Mayo Clinic, Rochester, USA.
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Heidari B, Al-Hijji MA, Moynagh MR, Takahashi N, Welle G, Eleid M, Singh M, Gulati R, Rihal CS, Lerman A. Transcatheter aortic valve replacement outcomes in patients with sarcopaenia. EUROINTERVENTION 2019; 15:671-677. [PMID: 31062696 DOI: 10.4244/eij-d-19-00110] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 11/23/2022]
Abstract
AIMS Sarcopaenia is a prevalent disease of ageing, associated with adverse clinical outcomes. We aimed to compare in-hospital adverse outcomes and overall mortality in sarcopaenic and non-sarcopaenic patients undergoing transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS This was a retrospective cohort study including 602 patients who underwent TAVR. Sarcopaenia was defined as skeletal muscle mass index <55.4 cm2/m2 in males and <38.9 cm2/m2 in females obtained through pre-TAVR CT scan. Mortality, length of hospital stay, ICU admission, and Valve Academic Research Consortium (VARC)-2-defined post-TAVR complications were defined as outcomes. Study participants (mean age 80.9±8.9 years and 56.8% male) were followed for a median of 1.5 years. Two thirds of the TAVR population was sarcopaenic. In-hospital outcomes were similar in both groups; however, overall survival was worse in sarcopaenic patients (HR for mortality=1.46 [1.06-2.14], p=0.02). In a multivariable model, sarcopaenia, porcelain aorta, pre-TAVR atrial fibrillation/flutter, severe chronic kidney disease, chronic pulmonary disease, VARC-2 bleeding, acute renal failure following TAVR, and post-TAVR cardiac arrest were predictors of mortality. CONCLUSIONS Sarcopaenic patients had similar in-hospital clinical outcomes to non-sarcopaenic patients following TAVR which reveals TAVR safety in sarcopaenic patients. However, sarcopaenia was an independent risk factor for midterm mortality indicating its potential value in systematic evaluation of this highly comorbid population in order to decide the best treatment approaches.
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Affiliation(s)
- Behnam Heidari
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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15
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Barreto EF, Poyant JO, Coville HH, Dierkhising RA, Kennedy CC, Gajic O, Nystrom EM, Takahashi N, Moynagh MR, Kashani KB. Validation of the sarcopenia index to assess muscle mass in the critically ill: A novel application of kidney function markers. Clin Nutr 2019; 38:1362-1367. [DOI: 10.1016/j.clnu.2018.05.031] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/28/2018] [Accepted: 05/30/2018] [Indexed: 12/13/2022]
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16
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Lyon TD, Frank I, Takahashi N, Boorjian SA, Moynagh MR, Shah PH, Tarrell RF, Cheville JC, Viers BR, Tollefson MK. Sarcopenia and Response to Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer. Clin Genitourin Cancer 2019; 17:216-222.e5. [PMID: 31060857 DOI: 10.1016/j.clgc.2019.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/09/2019] [Accepted: 03/17/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The objective of the study was to determine whether sarcopenia is associated with pathologic and survival outcomes for patients with muscle-invasive bladder cancer (MIBC) treated with neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). PATIENTS AND METHODS We identified MIBC patients treated with cisplatin-based NAC in our cystectomy registry from 2000 to 2016. Pre- and post-NAC computed tomography images were analyzed with BodyCompSlicer, a validated body composition assessment tool. Sarcopenia was defined as a skeletal muscle index (SMI) below sex-specific international consensus values. Associations of clinical features with pathologic downstaging (<ypT2), major (Clavien III-V) complications, and cancer-specific mortality (CSM) were modeled using multivariable logistic and Cox proportional hazard regression models. RESULTS A total of 183 patients were identified. Median follow-up was 3.0 years (interquartile range, 1.8-5.0), during which time 79 patients died, including 62 of bladder cancer. SMI declined by a median of 8.4% during NAC treatment. In multivariable logistic regression, neither pretreatment sarcopenia nor the amount of muscle mass loss during NAC was associated with downstaging to <ypT2 disease (P > .05). Meanwhile, only post-NAC sarcopenia (hazard ratio, 1.90; 95% confidence interval, 1.02-3.56; P = .04) was independently associated with an increased risk of CSM. CONCLUSION Sarcopenia after NAC and before RC appeared to be prognostic. Although skeletal muscle mass declined significantly during NAC, neither the degree of muscle loss nor pretreatment SMI were significantly associated with downstaging after NAC and RC. These data do not support the use of sarcopenia as a risk stratification tool for selection of patients for or monitoring response to NAC.
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Affiliation(s)
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | | | | | - Paras H Shah
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Robert F Tarrell
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN
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Bhanji RA, Takahashi N, Moynagh MR, Narayanan P, Angirekula M, Mara KC, Dierkhising RA, Watt KD. The evolution and impact of sarcopenia pre- and post-liver transplantation. Aliment Pharmacol Ther 2019; 49:807-813. [PMID: 30714184 DOI: 10.1111/apt.15161] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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] [Received: 09/15/2018] [Revised: 10/10/2018] [Accepted: 01/02/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sarcopenia is associated with both increased wait-list mortality and mortality following liver transplantation. AIMS To determine the course of sarcopenia from transplant evaluation until 1 year post-transplant, and its implications on hospitalisation and mortality following liver transplantation. METHODS Two hundred and ninety-three transplant recipients from 2002 to 2006 had pre-transplant CT scans analysed at the third lumbar region for sarcopenia, myosteatosis and abdominal visceral fat content. Half the recipients had post-transplant CT scan for interpretation (161/293). RESULTS Sarcopenia was present in 146/293 (50%) of the patients pre-transplant. There was a significant decrease in muscle mass (loss 2.0 ± 4.9 cm2 /m2 ; P < 0.001), and an increase in myosteatosis while awaiting liver transplantation. There was no significant change in abdominal visceral fat. For every 1 cm2 /m2 decrease in muscle mass there was an increase in post-transplant length of stay by 0.36 days (P = 0.005). Post-transplant, 98/161 (61%) of patients with CT imaging had sarcopenia (25 de novo and 73 persistent), with continued increase in myosteatosis, lower Hounsfield units (-5.0 [IQR -8.6 to 0.1]; P < 0.001) and an increase in abdominal visceral fat (4.9 [IQR -4.4 to 15.6] cm2 /m2 ; P < 0.001). There was no statistically significant difference in 1-year mortality in patients with de novo sarcopenia compared to patients with sarcopenia both pre- and post-transplant (HR 1.88; P = 0.088). CONCLUSIONS Sarcopenia progresses up to 1 year following liver transplantation and is associated with an increase in post-transplant length of stay.
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Affiliation(s)
- Rahima A Bhanji
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Praveena Narayanan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Mounika Angirekula
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Ross A Dierkhising
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Baffour FI, Moynagh MR, Eiken PW, Welch BT, Kurup AN, Atwell TD, Schmit GD. Effectiveness and Safety of Percutaneous CT-Guided Rib Biopsy. J Vasc Interv Radiol 2019; 30:82-86. [DOI: 10.1016/j.jvir.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/17/2018] [Accepted: 08/06/2018] [Indexed: 11/25/2022] Open
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Bhanji RA, Narayanan P, Moynagh MR, Takahashi N, Angirekula M, Kennedy CC, Mara KC, Dierkhising RA, Watt KD. Differing Impact of Sarcopenia and Frailty in Nonalcoholic Steatohepatitis and Alcoholic Liver Disease. Liver Transpl 2019; 25:14-24. [PMID: 30257063 PMCID: PMC7187989 DOI: 10.1002/lt.25346] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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] [Received: 06/21/2018] [Accepted: 09/05/2018] [Indexed: 12/12/2022]
Abstract
Sarcopenia and frailty are commonly encountered in patients with end-stage liver disease and are associated with adverse clinical outcomes, including decompensation and wait-list mortality. The impact of these entities in patients with differing disease etiologies has not been elucidated. We aim to ascertain the change in their prevalence over time on the wait list and determine their impact on hospitalization, delisting, and wait-list survival, specifically for patients with nonalcoholic steatohepatitis (NASH) and alcoholic liver disease (ALD). Adult patients who were evaluated for their first liver transplant from 2014 to 2016 with a primary diagnosis of NASH (n = 136) or ALD (n = 129) were included. Computed tomography scans were used to determine the presence of sarcopenia and myosteatosis. Frailty was diagnosed using the Rockwood frailty index. Patients with NASH had a significantly lower prevalence of sarcopenia (22% versus 47%; P < 0.001) but a significantly higher prevalence of frailty (49% versus 34%; P = 0.03) when compared with patients with ALD at the time of listing. In patients with NASH, sarcopenia was not associated with adverse events, but a higher frailty score was associated with an increased length of hospitalization (P = 0.05) and an increased risk of delisting (P = 0.02). In patients with ALD, univariate analysis showed the presence of sarcopenia was associated with an increased risk of delisting (P = 0.01). In conclusion, sarcopenia and frailty occur with differing prevalence with variable impact on outcomes in wait-listed patients with NASH and ALD.
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Affiliation(s)
- Rahima A. Bhanji
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Cassie C. Kennedy
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Kristin C. Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Ross A. Dierkhising
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Kymberly D. Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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20
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Wilson TJ, Maldonado AA, Amrami KK, Glazebrook KN, Moynagh MR, Spinner RJ. The anatomic location and importance of the tibialis posterior fascicular bundle at the sciatic nerve bifurcation: report of 3 cases. J Neurosurg 2018; 131:1869-1875. [PMID: 30579281 DOI: 10.3171/2018.8.jns181190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/16/2018] [Indexed: 11/06/2022]
Abstract
The authors present the cases of 3 patients with severe injuries affecting the peroneal nerve combined with loss of tibialis posterior function (inversion) despite preservation of other tibial nerve function. Loss of tibialis posterior function is problematic, since transfer of the tibialis posterior tendon is arguably the best reconstructive option for foot drop, when available. Analysis of preoperative imaging studies correlated with operative findings and showed that the injuries, while predominantly to the common peroneal nerve, also affected the lateral portion of the tibial nerve/division near the sciatic nerve bifurcation. Sunderland's fascicular topographic maps demonstrate the localization of the fascicular bundle subserving the tibialis posterior to the area that corresponds to the injury. This has clinical significance in predicting injury patterns and potentially for treatment of these injuries. The lateral fibers of the tibial division/nerve may be vulnerable with long stretch injuries. Due to the importance of tibialis posterior function, it may be important to perform internal neurolysis of the tibial division/nerve in order to facilitate nerve action potential testing of these fascicles, ultimately performing split nerve graft repair when nerve action potentials are absent in this important portion of the tibial nerve.
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Affiliation(s)
- Thomas J Wilson
- 1Department of Neurosurgery, Stanford University, Stanford, California
| | - Andres A Maldonado
- Departments of2Neurosurgery and.,3Department of Plastic, Hand and Reconstructive Surgery, BG Unfallklinik, Frankfurt, Germany
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Abstract
Image-guided, minimally invasive, percutaneous thermal ablation of bone metastases has unique advantages compared with surgery or radiation therapy. Thermal ablation of osseous metastases may result in significant pain palliation, prevention of skeletal-related events, and durable local tumor control. This article will describe current thermal ablation techniques utilized to treat bone metastases, summarize contemporary evidence supporting such thermal ablation treatments, and outline an approach to percutaneous ablative treatment.
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Lee TH, Setty PT, Parthasarathy G, Bailey KR, Wood-Wentz CM, Fletcher JG, Takahashi N, Khosla S, Moynagh MR, Zinsmeister AR, Bharucha AE. Aging, Obesity, and the Incidence of Diverticulitis: A Population-Based Study. Mayo Clin Proc 2018; 93:1256-1265. [PMID: 30193674 PMCID: PMC6200415 DOI: 10.1016/j.mayocp.2018.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/16/2018] [Accepted: 03/06/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To understand why the population-based incidence of diverticulitis has increased over time, we studied temporal changes in age, body mass index (BMI), and diverticulitis in Olmsted County, Minnesota. PARTICIPANTS AND METHODS We compared the BMIs of 2967 patients with diverticulitis and 9795 people without diverticulitis from January 1, 1980, through December 31, 2007. Because BMI is a surrogate for adipose tissue, computed tomographic estimations of abdominal fat content were compared between 381 diverticulitis cases and 381 age- and sex-matched controls. RESULTS Between 1980 and 2007, the prevalence of obesity increased from 12% to 49% in the population and from 19% to 40% in patients with diverticulitis (P<.001 for both). Temporal trends in age, BMI, and the increased incidence of diverticulitis in people with normal BMI accounted for 48%, 47%, and 20%, respectively, of corresponding trends in diverticulitis. The secular decline in the proportion of people with normal BMI was partly offset by an increased incidence of diverticulitis in such people. In the case-control study, BMI was greater in cases than in controls (P=.001). However, after incorporating abdominal visceral (odds ratio [OR], 2.4; 95% CI, 1.6-3.7) and subcutaneous (OR, 2.9; 95% CI, 1.7-5.2) fat content (both associated with diverticulitis), BMI was associated with lower risk (OR, 0.8; 95% CI, 0.7-0.8) of diverticulitis. CONCLUSION Aging, increasing obesity, and the increased incidence of diverticulitis in people with normal BMI account for the temporal increase in diverticulitis. Rather than BMI per se, increased abdominal visceral and subcutaneous fat are independently associated with diverticulitis. The incidence of diverticulitis, which is among the most common gastrointestinal diagnoses in hospitalized patients, has increased markedly since 2000. This study suggests that aging, increasing obesity, and the increased incidence of diverticulitis in people with normal BMI account for the temporal increase in diverticulitis.
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Affiliation(s)
- Tae Hee Lee
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | | | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | | | | | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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Delivanis DA, Iñiguez-Ariza NM, Zeb MH, Moynagh MR, Takahashi N, McKenzie TJ, Thomas MA, Gogos C, Young WF, Bancos I, Kyriazopoulou V. Impact of hypercortisolism on skeletal muscle mass and adipose tissue mass in patients with adrenal adenomas. Clin Endocrinol (Oxf) 2018; 88:209-216. [PMID: 29115003 DOI: 10.1111/cen.13512] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 01/25/2023]
Abstract
CONTEXT Abdominal visceral adiposity and central sarcopenia are markers of increased cardiovascular risk and mortality. OBJECTIVE To assess whether central sarcopenia and adiposity can serve as a marker of disease severity in patients with adrenal adenomas and glucocorticoid secretory autonomy. DESIGN Retrospective cohort study. PATIENTS Twenty-five patients with overt Cushing's syndrome (CS), 48 patients with mild autonomous cortisol excess (MACE) and 32 patients with a nonfunctioning adrenal tumour (NFAT) were included. METHODS Medical records were reviewed, and body composition measurements (visceral fat [VAT], subcutaneous fat [SAT], visceral/total fat [V/T], visceral/subcutaneous [V/S] and total abdominal muscle mass) were calculated based on abdominal computed tomography (CT). RESULTS In patients with overt CS, when compared to patients with NFAT, the V/T fat and the V/S ratio were increased by 0.08 (P < .001) and by 0.3 (P < .001); however, these measurements were decreased by 0.04 (P = .007) and 0.2 (P = .01), respectively, in patients with MACE. Total muscle mass was decreased by -10 cm2 (P = .02) in patients with overt CS compared to patients with NFAT. Correlation with morning serum cortisol concentrations after dexamethasone suppression testing revealed that for every 28 nmol/L cortisol increase there was a 0.008 increase in V/T (P < .001), 0.02 increase in the V/S fat ratio (P < .001) and a 1.2 cm2 decrease in mean total muscle mass (P = .002). CONCLUSIONS The severity of hypercortisolism was correlated with lower muscle mass and higher visceral adiposity. These CT-based markers may allow for a more reliable and objective assessment of glucocorticoid-related disease severity in patients with adrenal adenomas.
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Affiliation(s)
- Danae A Delivanis
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Nicole M Iñiguez-Ariza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Melinda A Thomas
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Charalambos Gogos
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - William F Young
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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Takahashi N, Sugimoto M, Psutka SP, Chen B, Moynagh MR, Carter RE. Validation study of a new semi-automated software program for CT body composition analysis. Abdom Radiol (NY) 2017; 42:2369-2375. [PMID: 28389787 DOI: 10.1007/s00261-017-1123-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Computed tomography (CT) has been increasingly used to quantify abdominal muscle and fat in clinical research studies, and multiple studies have shown importance of body composition in predicting clinical outcome. The purpose of study is to compare newly developed semi-automated software (BodyCompSlicer) to commercially available validated software (Slice-O-Matic) for CT body composition analysis. METHODS CT scans of abdomen at L3 level in 30 patients were analyzed by two reviewers and using two softwares (BodyCompSlicer and Slice-O-Matic). Body composition analysis using BodyCompSlicer was semi-automated. The program automatically segmented subcutaneous fat (SF), skeletal muscle (SM), and visceral fat (VF) areas. Reviewers manually corrected the segmentation using computer-mouse interface as necessary. Body composition analysis using Slice-O-Matic was performed by manually segmenting each area using computer-mouse interface (brush tool). After segmentation, SM, SF, and VF areas were calculated using CT attenuation thresholds. Inter-observer and inter-software variability of measurements were analyzed using intraclass correlation coefficients (ICC) and coefficient of variation (COV). RESULTS Inter-observer ICC and COV using BodyCompSlicer were 0.997 and 1.5% for SM, 1.000 and 0.8% for SF, and 1.000 and 1.0% for VF, whereas those using Slice-O-Matic were 0.993 and 2.5% for SM, 0.995 and 3.1% for SF, and 0.999 and 2.3% for VF. Inter-software ICCs and COV were 0.995-0.995 and 2.0-2.1% for SM, 0.991-0.994 and 3.4-3.9% for SF, and 0.998-0.998 and 2.8-3.3% for VF. Time to analyze 30 cases was 70-100 min and 150-180 min using BodyCompSlicer and Slice-O-Matic, respectively. CONCLUSION BodyCompSlicer is comparable to Slice-O-Matic for CT body composition analysis.
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Malik N, Claus PL, Illman JE, Kligerman SJ, Moynagh MR, Levin DL, Woodrum DA, Arani A, Arunachalam SP, Araoz PA. Air embolism: diagnosis and management. Future Cardiol 2017. [DOI: 10.2217/fca-2017-0015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Air embolism is an uncommon, but potentially life-threatening event for which prompt diagnosis and management can result in significantly improved patient outcomes. Most air emboli are iatrogenic. Arterial air emboli may occur as a complication from lung biopsy, arterial catheterization or cardiopulmonary bypass. Immediate management includes placing the patient on high-flow oxygen and in the right lateral decubitus position. Venous air emboli may occur during pressurized venous infusions, or catheter manipulation. Immediate management includes placement of the patient on high-flow oxygen and in the left lateral decubitus and/or Trendelenburg position. Hyperbaric oxygen therapy is the definitive treatment which may decrease the size of air emboli by facilitating gas reabsorption, while also improving tissue oxygenation and reducing ischemic reperfusion injury.
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Affiliation(s)
- Neera Malik
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - Paul L Claus
- Department of Hyperbaric & Altitude Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Jeffery E Illman
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - Seth J Kligerman
- Department of Radiology & Nuclear Medicine, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201, USA
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - David L Levin
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - David A Woodrum
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - Arvin Arani
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | | | - Philip A Araoz
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
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Valesano JC, Schmitz JJ, Kurup AN, Schmit GD, Moynagh MR, Atwell TD, Lewis BD, Lee RA, Callstrom MR. Outcomes of Ultrasound-Guided Thrombin Injection of Nongroin Arterial Pseudoaneurysms. J Vasc Interv Radiol 2017; 28:1156-1160. [PMID: 28578990 DOI: 10.1016/j.jvir.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate success and complication rates of percutaneous ultrasound-guided thrombin injection of nongroin pseudoaneurysms (PSAs). MATERIALS AND METHODS Retrospective review of a prospectively maintained institutional database yielded 39 cases of arterial PSAs occurring at nongroin sites that were treated with percutaneous ultrasound-guided thrombin injection between 2000 and 2016 (average patient age 69.2 y ± 14.0). Of PSAs, 74.4% (29/39) arose in the upper extremities, and 92.3% (36/39) were iatrogenic. The brachial artery was the most commonly affected vessel (51.3% [20/39]), and arterial access was the most common cause (56.4% [22/39]). Average overall PSA size was 2.4 cm (range, 0.5-7.2 cm); average amount of thrombin injected was 320 IU (range, 50-2,000 IU). Technical success was defined as absence of flow within the PSA immediately after thrombin injection. Treatment success was defined as sustained thrombosis on follow-up imaging obtained at 1-3 days after treatment. RESULTS Technical and treatment success rates of thrombin injections were 100% (39/39) and 84.8% (28/33), respectively. Longer term follow-up imaging (average 71 d; range, 12-201 d) was available for 7 of the treatment successes with 100% (7/7) showing sustained thrombosis. Comparing treatment successes and failures, there was no significant difference in average PSA size (2.3 cm vs 2.0 cm, P = .51) or average amount of thrombin injected (360 IU vs 180 IU, P = .14). There were no complications. CONCLUSIONS Ultrasound-guided thrombin injection is a safe, efficacious treatment option for PSAs arising in nongroin locations.
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Affiliation(s)
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Grant D Schmit
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Thomas D Atwell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Bradley D Lewis
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Robert A Lee
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Matthew R Callstrom
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Kumar A, Moynagh MR, Multinu F, Cliby WA, McGree ME, Weaver AL, Young PM, Bakkum-Gamez JN, Langstraat CL, Dowdy SC, Jatoi A, Mariani A. Muscle composition measured by CT scan is a measurable predictor of overall survival in advanced ovarian cancer. Gynecol Oncol 2016; 142:311-6. [PMID: 27235857 DOI: 10.1016/j.ygyno.2016.05.027] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To assess the impact of muscle composition and sarcopenia on overall survival in advanced epithelial ovarian cancer (EOC) after primary debulking surgery (PDS). METHODS Women with stage IIIC/IV EOC who underwent PDS with curative intent between 1/1/2006 and 12/31/2012 were included. Patient variables and vital status were abstracted. Body composition was evaluated in a semi-automated process using Slice-O-Matic software v4.3 (TomoVision). Skeletal muscle area and mean skeletal muscle attenuation were recorded. Associations with overall survival were evaluated using Cox proportional hazards models and recursive partitioning. RESULTS We identified 296 patients and 132 (44.6%) were classified as sarcopenic. The average mean skeletal muscle attenuation of the entire cohort was 33.4 Hounsfield units (HU). A multivariate model of overall risk of death included histology, residual disease, and mean skeletal attenuation. Among patients without residual disease, overall survival, but not progression free survival was significantly different between patients with low versus high mean skeletal attenuation (median survival, 2.8 vs. 3.3years). Among patients with residual disease, overall survival was significantly different between patients with low versus high mean skeletal attenuation ≥36.40 vs. <36.40 HU (median survival, 2.0 vs. 3.3years). CONCLUSIONS Sarcopenia and low mean skeletal muscle attenuation are common in women undergoing PDS for advanced EOC. These factors are associated with poorer outcomes, and can be used in preoperative risk stratification and patient counseling. Further research into body composition and whether this risk factor can be altered via nutrition or fitness in this population is warranted.
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Affiliation(s)
- Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Francesco Multinu
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - William A Cliby
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Phillip M Young
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Jamie N Bakkum-Gamez
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Carrie L Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Sean C Dowdy
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Aminah Jatoi
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
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Psutka SP, Boorjian SA, Moynagh MR, Schmit GD, Costello BA, Thompson RH, Stewart-Merrill SB, Lohse CM, Cheville JC, Leibovich BC, Tollefson MK. Decreased Skeletal Muscle Mass is Associated with an Increased Risk of Mortality after Radical Nephrectomy for Localized Renal Cell Cancer. J Urol 2016; 195:270-6. [DOI: 10.1016/j.juro.2015.08.072] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 01/12/2023]
Affiliation(s)
| | | | | | | | - Brian A. Costello
- Division of Medical Oncology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Christine M. Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Psutka SP, Boorjian SA, Moynagh MR, Schmit GD, Frank I, Carrasco A, Stewart SB, Tarrell R, Thapa P, Tollefson MK. Mortality after radical cystectomy: impact of obesity versus adiposity after adjusting for skeletal muscle wasting. J Urol 2014; 193:1507-13. [PMID: 25464002 DOI: 10.1016/j.juro.2014.11.088] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE We assess the impact of obesity, as measured conventionally by body mass index vs excess adiposity as measured by fat mass index, on mortality after radical cystectomy for bladder cancer, adjusting for the presence of skeletal muscle wasting. MATERIALS AND METHODS This retrospective cohort study included 262 patients treated with radical cystectomy for bladder cancer between 2000 and 2008 at the Mayo Clinic. Lumbar skeletal muscle and adipose compartment areas were measured on preoperative imaging. Overall survival was compared according to gender specific consensus fat mass index and skeletal muscle index thresholds as well as conventional body mass index based criteria. Predictors of all cause mortality were assessed by multivariable modeling. RESULTS Increasing body mass index correlated with improved overall survival (p=0.03) while fat mass index based obesity did not (p=0.08). After stratification by sarcopenia, no obesity related 5-year overall survival benefit was observed (68% vs 51.4%, p=0.2 obese vs normal and 40% vs 37.4%, p=0.7 sarcopenia vs sarcopenic/obese). On multivariable analysis class I obesity according to body mass index (HR 0.79, p=0.33) or fat mass index criteria (HR 0.85, p=0.45) was not independently associated with all cause mortality after adjusting for sarcopenia (HR 1.7, p=0.01) as well as age, performance status, pTN stage and smoking status. However, in patients with normal lean muscle mass each 1 kg/m(2) increase in weight or adipose mass was associated with a 7% to 14% decrease in all cause mortality. CONCLUSIONS After adjusting for lean muscle wasting, neither measurements of obesity nor adiposity were significantly associated with all cause mortality in patients treated with radical cystectomy, although subanalyses suggest a potential benefit among those with normal lean muscle mass.
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Affiliation(s)
- Sarah P Psutka
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Grant D Schmit
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Robert Tarrell
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Prabin Thapa
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Psutka SP, Carrasco A, Schmit GD, Moynagh MR, Boorjian SA, Frank I, Stewart SB, Thapa P, Tarrell RF, Cheville JC, Tollefson MK. Sarcopenia in patients with bladder cancer undergoing radical cystectomy: impact on cancer-specific and all-cause mortality. Cancer 2014; 120:2910-8. [PMID: 24840856 DOI: 10.1002/cncr.28798] [Citation(s) in RCA: 218] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/28/2014] [Accepted: 04/17/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND The authors evaluated sarcopenia as a predictor of cancer-specific survival (CSS) and overall survival (OS) among patients with urothelial cancer of the bladder undergoing radical cystectomy (RC). METHODS The lumbar skeletal muscle index (SMI) of 205 patients treated with RC for urothelial cancer between 2000 and 2007 was measured. Sarcopenia was classified according to international consensus definitions (SMI of < 55 cm(2)/m(2) for men and < 39 cm(2)/m(2) for women). The CSS and OS were estimated using the Kaplan-Meier method and compared with the log-rank test. Variables associated with CSS and all-cause mortality were summarized with hazard ratios (HRs). RESULTS Of 205 patients, 141 (68.8%) were sarcopenic. Patients with sarcopenia were older, but were otherwise similar to patients without sarcopenia with respect to sex, Charlson comorbidity index, American Society of Anesthesiologists score, Eastern Cooperative Oncology Group performance status, receipt of neoadjuvant chemotherapy, TNM stage of disease, and tumor grade (P > .05 for all). The median follow-up was 6.7 years, during which time 135 patients died, including 91 who died of bladder cancer. Sarcopenic patients had significantly worse 5-year CSS (49% vs 72%; P = .003) and OS (39% vs 70%; P = .003) compared with patients without sarcopenia. Moreover, sarcopenia was found to be independently associated with both increased CSS (HR, 2.14; P = .007) and all-cause mortality (HR, 1.93; P = .004) on multivariable analysis. CONCLUSIONS The presence of sarcopenia was found to significantly increase a patient's risk of CSS and all-cause mortality after undergoing RC for bladder cancer.
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Affiliation(s)
- Sarah P Psutka
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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