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Georgette N, Keskey RC, Polcari AM, Slidell MB. Letter to the editor: Time to reconsider the use of Shock Index, Pediatric Adjusted in young children? Mounting evidence suggests that alternative shock indices can more accurately triage injured children. J Trauma Acute Care Surg 2024; 96:e22-e24. [PMID: 37611048 DOI: 10.1097/ta.0000000000003973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
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Vigneswaran J, Keskey RC, Morgan RB, Alverdy JC, Alpert L, Chang E, Weichselbaum R, Zaborina O, Shogan BD. Western Diet-induced Transcriptional Changes in Anastomotic Tissue Is Associated With Early Local Recurrence in a Mouse Model of Colorectal Surgery. Ann Surg 2023; 278:954-960. [PMID: 37522222 PMCID: PMC10775465 DOI: 10.1097/sla.0000000000006052] [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] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To determine the timeframe and associated changes in the microenvironment that promote the development of a diet-induced local-regional recurrence in a mouse model of colorectal surgery. BACKGROUND Postoperative recurrence and metastasis occur in up to 30% of patients undergoing attempted resection for colorectal cancer (CRC). The underlying mechanisms that drive the development of postoperative recurrences are poorly understood. Preclinical studies have demonstrated a diet and microbial-driven pathogenesis of local-regional recurrence, yet the precise mechanisms remain undefined. METHODS BALB/C mice were fed a western diet (WD) or standard diet (SD), underwent a colon resection and anastomosis, given an Enterococcus faecalis enema on postoperative day (POD) 1, and subjected to a CT26 cancer cell enema (mimicking shed cancer cells) on POD2. Mice were sacrificed between POD3 and POD7 and cancer cell migration was tracked. Dynamic changes in gene expression of anastomotic tissue that were associated with cancer cell migration was assessed. RESULTS Tumor cells were identified in mice fed either a SD or WD in both anastomotic and lymphatic tissue as early as on POD3. Histology demonstrated that these tumor cells were viable and replicating. In WD-fed mice, the number of tumor cells increased over the early perioperative period and was significantly higher than in mice fed a SD. Microarray analysis of anastomotic tissue found that WD-fed mice had 11 dysregulated genes associated with tumorigenesis. CONCLUSIONS A WD promotes cancer cells to permeate a healing anastomosis and migrate into anastomotic and lymphatic tissue forming viable tumor nodules. These data offer a novel recurrence pathogenesis by which the intestinal microenvironment promotes a CRC local-regional recurrence.
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Affiliation(s)
- Janani Vigneswaran
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - Robert C. Keskey
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - Ryan B. Morgan
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - John C. Alverdy
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - Lindsay Alpert
- The University of Chicago Medicine, Department of Pathology, Chicago, Illinois, United States
| | - Eugene Chang
- The University of Chicago Medicine, Department of Medicine, Chicago, Illinois, United States
| | - Ralph Weichselbaum
- The University of Chicago Medicine, Department of Radiation and Cellular Oncology, Chicago, Illinois, United States
| | - Olga Zaborina
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - Benjamin D. Shogan
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
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Keskey RC, Hampton DA, Biermann H, Cirone J, Zakrison TL, Cone JT, Wilson KL, Slidell MB. Novel Trauma Composite Score is a more reliable predictor of mortality than Injury Severity Score in pediatric trauma. J Trauma Acute Care Surg 2021; 91:599-604. [PMID: 33871405 DOI: 10.1097/ta.0000000000003235] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The equivalent Injury Severity Score (ISS) cutoffs for severe trauma vary between adult (ISS, >16) and pediatric (ISS, >25) trauma. We hypothesized that a novel injury severity prediction model incorporating age and mechanism of injury would outperform standard ISS cutoffs. METHODS The 2010 to 2016 National Trauma Data Bank was queried for pediatric trauma patients. Cut point analysis was used to determine the optimal ISS for predicting mortality for age and mechanism of injury. Linear discriminant analysis was implemented to determine prediction accuracy, based on area under the curve (AUC), of ISS cutoff of 25 (ISS, 25), shock index pediatric adjusted (SIPA), an age-adjusted ISS/abbreviated Trauma Composite Score (aTCS), and our novel Trauma Composite Score (TCS) in blunt trauma. The TCS consisted of significant variables (Abbreviated Injury Scale, Glasgow Coma Scale, sex, and SIPA) selected a priori for each age. RESULTS There were 109,459 blunt trauma and 9,292 penetrating trauma patients studied. There was a significant difference in ISS (blunt trauma, 9.3 ± 8.0 vs. penetrating trauma, 8.0 ± 8.6; p < 0.01) and mortality (blunt trauma, 0.7% vs. penetrating trauma, 2.7%; p < 0.01). Analysis of the entire cohort revealed an optimal ISS cut point of 25 (AUC, 0.95; sensitivity, 0.86; specificity, 0.95); however, the optimal ISS ranged from 18 to 25 when evaluated by age and mechanism. Linear discriminant analysis model AUCs varied significantly for each injury metric when assessed for blunt trauma and penetrating trauma (penetrating trauma-adjusted ISS, 0.94 ± 0.02 vs. ISS 25, 0.88 ± 0.02 vs. SIPA, 0.62 ± 0.03; p < 0.001; blunt trauma-adjusted ISS, 0.96 ± 0.01 vs. ISS 25, 0.89 ± 0.02 vs. SIPA, 0.70 ± 0.02; p < 0.001). When injury metrics were assessed across age groups in blunt trauma, TCS and aTCS performed the best. CONCLUSION Current use of ISS in pediatric trauma may not accurately reflect injury severity. The TCS and aTCS incorporate both age and mechanism and outperform standard metrics in mortality prediction in blunt trauma. LEVEL OF EVIDENCE Retrospective review, level IV.
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Affiliation(s)
- Robert C Keskey
- From the Department of Surgery (R.C.K., D.A.H., T.L.Z., J.T.C., K.L.W., M.B.S.), Section of Trauma and Acute Care Surgery (D.A.H., T.L.Z., J.T.C., K.L.W.), University of Chicago Medicine, Chicago, Illinois; Emory School of Medicine (H.B.), Atlanta, Georgia; Department of Surgery (J.C.), Dartmouth-Hitchcock, Lebanon, New Hampshire; and Section of Pediatric Surgery (M.B.S.), Comer Children's Hospital, University of Chicago Medicine, Chicago, Illinois
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Keskey RC, Slidell MB, Bohr NL, Biermann H, Cirone J, Zakrison T, Cone J, Wilson K, Hampton D. Novel Trauma Composite Score is superior to Injury Severity Score in predicting mortality across all ages. J Trauma Acute Care Surg 2021; 91:621-626. [PMID: 34225345 DOI: 10.1097/ta.0000000000003340] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Injury Severity Score (ISS) is a widely used metric for trauma research and center verification; however, it does not account for age-related physiologic parameters. We hypothesized that a novel age-based injury severity metric would better predict mortality. METHODS Adult patients (≥18 years) sustaining blunt trauma (BT) or penetrating trauma (PT) were abstracted from the 2010 to 2016 National Trauma Data Bank. Admission vitals, Glasgow Coma Scale, ISS, mechanism, and outcomes were analyzed. Patients with incomplete/non-physiologic vital signs were excluded. For each age: (1) a cut point analysis was used to determine the ISS with the highest specificity and sensitivity for predicting mortality and (2) a linear discriminant analysis was performed using ISS, ISS greater than 16, Trauma and Injury Severity Score, and Revised Trauma Scale to compare each scoring system's mortality prediction. A novel injury severity metric, the trauma component score (TCS), was developed for each age using significant (p < 0.05) variables selected from Abbreviated Injury Scale scores, Glasgow Coma Scale, vital signs, and gender. Receiver operator curves were developed and the areas under the curve were compared between the TCS and other systems. RESULTS There 777,794 patients studied (BT, 91.1%; PT, 8.9%). Blunt trauma patients were older (53.6 ± 21.3 years vs. 34.4 ± 13.8 years), had higher ISS scores (11.1 ± 8.5 vs. 8.5 ± 8.9), and lower mortality (2.9% vs. 3.4%) than PT patients (p < 0.05). When assessing the entire PT and BT cohort the optimal ISS cut point was 16. The optimal ISS was between 20 and 25 for BT younger than 70 years. For those older than 70 years, the optimal BT ISS steadily declined as age increased PT's cut point was 16 or less for all ages assessed. When the injury metrics were compared by area under the curve, our novel TCS more accurately predicted mortality across all ages in both BT and PT (p < 0.001). CONCLUSION Injury Severity Score is a poor mortality predictor in older patients and those sustaining penetrating trauma. The age-based TCS is a superior metric for mortality prediction across all ages. LEVEL OF EVIDENCE Clinical outcomes, Level IV.
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Affiliation(s)
- Robert C Keskey
- From the Department of Surgery (R.C.K., M.B.S., T.Z., J.C., K.W., D.H.), Section of Trauma and Acute Care Surgery, (T.Z., J.C., K.W., D.H.), Section of Vascular Surgery and Endovascular Therapy (N.L.B.), The University of Chicago Medicine; Department of Nursing Research and Evidence-Based Practice (N.L.B.), UChicago Medicine, Chicago, Illinois; Emory School of Medicine (H.B.), Atlanta, Georgia; Department of Surgery, Section of General Surgery (J.C.), Dartmouth-Hitchcock, Lebanon, New Hampshire; and Section of Pediatric Surgery (M.B.S.), The University of Chicago Medicine, Comer Children's Hospital, Chicago, Illinois
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Keskey RC, Hampton DA, Wilson KL, Slidell MB. Patient age must be incorporated into future paediatric injury severity scoring systems. Lancet Child Adolesc Health 2021; 5:e39. [PMID: 34399088 DOI: 10.1016/s2352-4642(21)00246-7] [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] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Robert C Keskey
- Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - David A Hampton
- Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Kenneth L Wilson
- Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Mark B Slidell
- Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA.
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Abstract
Small bowel obstruction is a common clinical occurrence, primarily caused by adhesions. The diagnosis is usually made on the clinical findings and the presence of dilated bowel loops on plain abdominal radiograph. Computed tomography (CT) is increasingly used to diagnose the cause and location of the obstruction to aid in the timing of surgical intervention. We used a retrospective chart review to identify patients with a diagnosis of small bowel obstruction between 2009 and 2012. We compared the findings on CT with the findings at operative intervention. Sixty patients had abdominal CT and subsequent surgical intervention. Eighty-three per cent of CTs were correct for small intestine involvement and 80 per cent for colon involvement. The presence of adhesions or perforation was correctly identified in 21 and 50 per cent, respectively. Sixty-four per cent correctly identified a transition point. The presence of a mass was correctly identified in 69 per cent. Twenty per cent of the patients who had ischemic small bowel at surgery were identified on CT. CT has a role in the clinical assessment of patients with small bowel obstruction, identifying with reasonable accuracy the extent of bowel involvement and the presence of masses and transition points. It is less reliable at identifying adhesions, perforations, or ischemic bowel.
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Affiliation(s)
- Rebecca E. Barnett
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville, Louisville, Kentucky
- Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky
| | - Jason Younga
- Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky
| | - Brady Harris
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Robert C. Keskey
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Daryl Nisbett
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Jonathan Perry
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville, Louisville, Kentucky
| | - William G. Cheadle
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville, Louisville, Kentucky
- Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky
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Keskey RC, LaJoie AS, Sutton BS, Kim IK, Cheadle WG, McMasters KM, Ajkay N. Cost-effectiveness Analysis of Contralateral Prophylactic Mastectomy Compared to Unilateral Mastectomy with Routine Surveillance for Unilateral, Sporadic Breast Cancer. Ann Surg Oncol 2018; 24:3903-3910. [PMID: 29039025 DOI: 10.1245/s10434-017-6094-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Contralateral prophylactic mastectomy (CPM) rates in younger women with unilateral breast cancer have more than doubled. Studies of cost and quality of life of the procedure remain inconclusive. METHODS A cost-effectiveness analysis using a decision-tree model in TreeAge Pro 2015 was used to compare long-term costs and quality of life following unilateral mastectomy (UM) with routine surveillance versus CPM for sporadic breast cancer in women aged 45 years. A 10-year risk period for contralateral breast cancer (CBC), reconstruction, wound complications, cost of routine surveillance, and treatment for CBC were used to estimate accrued costs. In addition, a societal perspective was used to estimate quality-adjusted life years (QALYs) following either treatment for a period of 30 years. Medical costs were obtained from the 2014 Medicare physician fee schedule and event probabilities were taken from recent literature. RESULTS The mean cost of UM with surveillance was $14,141 and CPM was $20,319. Treatment with CPM resulted in $6178 more in costs but equivalent QALYs (17.93) compared with UM over 30 years of follow-up. Even with worst-case scenario and varying assumptions, CPM is dominated by UM in terms of cost and quality. CONCLUSIONS From this refined model, UM with routine surveillance costs less and provides an equivalent quality of life. Patients undergoing CPM may eliminate the anxiety of routine surveillance, but they face the burden of higher lifetime medical costs.
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Affiliation(s)
- Robert C Keskey
- The Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Department of Surgery, University of Chicago, Chicago, IL, USA
| | - A Scott LaJoie
- University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA
| | - Brad S Sutton
- Department of Medicine, Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, KY, USA.,Center for Health Process Innovation, University of Louisville, Louisville, KY, USA
| | - In K Kim
- Center for Health Process Innovation, University of Louisville, Louisville, KY, USA.,Department of Pediatrics, Emergency Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - William G Cheadle
- The Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kelly M McMasters
- The Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Nicolas Ajkay
- The Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
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Weaver JL, Barnett RE, Patterson DE, Ramjee VG, Riedinger E, Younga J, Sepulveda EA, Keskey RC, Cheadle WG. Large-bowel disease presenting as small-bowel obstruction is associated with a poor prognosis. Am J Emerg Med 2016; 34:477-9. [DOI: 10.1016/j.ajem.2015.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 11/24/2015] [Accepted: 12/08/2015] [Indexed: 02/07/2023] Open
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Barnett RE, Conklin DJ, Ryan L, Keskey RC, Ramjee V, Sepulveda EA, Srivastava S, Bhatnagar A, Cheadle WG. Anti-inflammatory effects of miR-21 in the macrophage response to peritonitis. J Leukoc Biol 2015; 99:361-71. [PMID: 26382295 DOI: 10.1189/jlb.4a1014-489r] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 09/02/2015] [Indexed: 01/03/2023] Open
Abstract
We investigated the role of microRNA-21 in the macrophage response to peritonitis; microRNA-21 expression increases in peritoneal macrophages after lipopolysaccharide stimulation but is delayed until 48 hours after cecal ligation and puncture. MicroRNA-21-null mice and bone marrow-derived cell lines were exposed to cecal ligation and puncture or lipopolysaccharide, and survival, microRNA-21 levels, target messenger RNAs and proteins, and cytokines were assayed. Macrophages were also transfected with microRNA-21 mimics and antagomirs, and similar endpoints were measured. Survival in microRNA-21-null mice was significantly decreased after lipopolysaccharide-induced peritonitis but unchanged after cecal ligation and puncture compared with similarly treated wild-type mice. MicroRNA-21 expression, tumor necrosis factor-α, interleukin 6, and programmed cell death protein 4 levels were increased after lipopolysaccharide addition in peritoneal cells. Pelino1 and sprouty (SPRY) messenger RNAs were similarly increased early, whereas programmed cell death protein 4 messenger RNA was decreased after lipopolysaccharide, and all microR-21 target messenger RNAs were subsequently decreased by 24 hours after lipopolysaccharide. Transfection with mimics and antagomirs led to appropriate responses in microRNA-21 and tumor necrosis factor-α. Knockdown of microRNA-21 in bone marrow-derived cells showed increased tumor necrosis factor-α and decreased interleukin 10 in response to lipopolysaccharide. Target proteins were unaffected by knockdown as was extracellular signal-regulated kinase; however, the nuclear factor κB p65 subunit was increased after lipopolysaccharide in the microRNA-21 knockout cells. In contrast, there was little change in these parameters after cecal ligation and puncture induction between null and wild-type mice. MicroRNA-21 is beneficial to survival in mice following lipopolysaccharide peritonitis. Overexpression of microRNA-21 decreased tumor necrosis factor-α secretion, whereas suppression of microRNA-21 expression increased tumor necrosis factor-α and interleukin 6, and decreased interleukin 10 levels after lipopolysaccharide. Protein targets of microRNA-21 were not different following suppression of microRNA-21. Nuclear factor κB was increased by suppression of microRNA-21. These findings demonstrate microRNA-21 is beneficial in modulating the macrophage response to lipopolysaccharide peritonitis and an improved understanding of the anti-inflammatory effects of microRNA-21 may result in novel, targeted therapy against peritonitis and sepsis.
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Affiliation(s)
- Rebecca Elise Barnett
- *Hiram C. Polk, Jr., MD, Department of Surgery, School of Medicine, and Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, USA; and Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Daniel J Conklin
- *Hiram C. Polk, Jr., MD, Department of Surgery, School of Medicine, and Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, USA; and Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Lindsey Ryan
- *Hiram C. Polk, Jr., MD, Department of Surgery, School of Medicine, and Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, USA; and Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Robert C Keskey
- *Hiram C. Polk, Jr., MD, Department of Surgery, School of Medicine, and Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, USA; and Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Vikram Ramjee
- *Hiram C. Polk, Jr., MD, Department of Surgery, School of Medicine, and Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, USA; and Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Ernesto A Sepulveda
- *Hiram C. Polk, Jr., MD, Department of Surgery, School of Medicine, and Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, USA; and Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Sanjay Srivastava
- *Hiram C. Polk, Jr., MD, Department of Surgery, School of Medicine, and Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, USA; and Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Aruni Bhatnagar
- *Hiram C. Polk, Jr., MD, Department of Surgery, School of Medicine, and Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, USA; and Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - William G Cheadle
- *Hiram C. Polk, Jr., MD, Department of Surgery, School of Medicine, and Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, USA; and Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
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Roberts H, Rai SN, Pan J, Rao JM, Keskey RC, Kanaan Z, Short EP, Mottern E, Galandiuk S. Extraintestinal manifestations of inflammatory bowel disease and the influence of smoking. Digestion 2015; 90:122-9. [PMID: 25277851 DOI: 10.1159/000363228] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 07/04/2013] [Accepted: 04/28/2014] [Indexed: 02/04/2023]
Abstract
AIMS To define the number/frequency of organ systems affected by extraintestinal manifestations (EIMs), to identify factors affecting the clinical course of inflammatory bowel disease (IBD) and EIM development, and to determine the impact of smoking, disease duration and location on the diagnosis of EIMs in Crohn's disease (CD) and ulcerative colitis (UC). METHODS IBD patients were derived from a single university colorectal surgery practice. Smoking data were obtained through a modified Behavioral Risk Factor Surveillance System survey. The frequencies of arthritis/arthralgia, primary sclerosing cholangitis (PSC), ocular and cutaneous EIMs were determined. RESULTS Of the 757 patients evaluated (CD 488, UC 269), 50% had ≥1 EIM. Arthritis/arthralgia, cutaneous and ocular EIMs were significantly higher in frequency in CD compared to UC patients. Prolonged disease duration was associated with increased prevalence of arthritis/arthralgia in IBD (p ≤ 0.001) as well as PSC (p = 0.049), ocular (p = 0.030) and cutaneous (p = 0.009) EIMs in CD. Disease location affected the occurrence of EIMs in CD. Smoking appeared to increase the prevalence of ocular EIMs in UC (p = 0.026). CONCLUSION Arthritis/arthralgia, cutaneous and ocular EIMs occurred in a significantly higher proportion of CD patients. CD patients with longer disease duration had a significantly higher prevalence of PSC, ocular and cutaneous EIMs. Smoking was found to increase ocular EIMs in UC.
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Affiliation(s)
- Henry Roberts
- Department of Surgery, Price Institute of Surgical Research and Section of Colorectal Surgery, University of Louisville School of Medicine, Louisville, Ky., USA
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Barnett RE, Keskey RC, Linsky PL, Byam J, Mathis TJ, Cheadle WG. Tension-free Open Mesh Cooper's Ligament Repair for Femoral Hernia. Am Surg 2013. [DOI: 10.1177/000313481307900936] [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: 11/17/2022]
Affiliation(s)
- Rebecca Elise Barnett
- Robley Rex Louisville VAMC and Hiram C. Polk Jr. MD Department of Surgery University of Louisville School of Medicine Louisville, Kentucky
| | - Robert C. Keskey
- Robley Rex Louisville VAMC and Hiram C. Polk Jr. MD Department of Surgery University of Louisville School of Medicine Louisville, Kentucky
| | - Paul L. Linsky
- Robley Rex Louisville VAMC and Hiram C. Polk Jr. MD Department of Surgery University of Louisville School of Medicine Louisville, Kentucky
| | - Jerome Byam
- Robley Rex Louisville VAMC and Hiram C. Polk Jr. MD Department of Surgery University of Louisville School of Medicine Louisville, Kentucky
| | - Trevor J. Mathis
- Robley Rex Louisville VAMC and Hiram C. Polk Jr. MD Department of Surgery University of Louisville School of Medicine Louisville, Kentucky
| | - William G. Cheadle
- Robley Rex Louisville VAMC and Hiram C. Polk Jr. MD Department of Surgery University of Louisville School of Medicine Louisville, Kentucky
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Barnett RE, Keskey RC, Linsky PL, Byam J, Mathis TJ, Cheadle WG. Tension-free open mesh Cooper's ligament repair for femoral hernia. Am Surg 2013; 79:952-953. [PMID: 24069997] [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: 06/02/2023]
Affiliation(s)
- Rebecca Elise Barnett
- Robley Rex Louisville VAMC and Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
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13
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Barnett RE, Younga J, Harris B, Keskey RC, Nisbett D, Perry J, Cheadle WG. Accuracy of computed tomography in small bowel obstruction. Am Surg 2013; 79:641-643. [PMID: 23711277] [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: 06/02/2023]
Abstract
Small bowel obstruction is a common clinical occurrence, primarily caused by adhesions. The diagnosis is usually made on the clinical findings and the presence of dilated bowel loops on plain abdominal radiograph. Computed tomography (CT) is increasingly used to diagnose the cause and location of the obstruction to aid in the timing of surgical intervention. We used a retrospective chart review to identify patients with a diagnosis of small bowel obstruction between 2009 and 2012. We compared the findings on CT with the findings at operative intervention. Sixty patients had abdominal CT and subsequent surgical intervention. Eighty-three per cent of CTs were correct for small intestine involvement and 80 per cent for colon involvement. The presence of adhesions or perforation was correctly identified in 21 and 50 per cent, respectively. Sixty-four per cent correctly identified a transition point. The presence of a mass was correctly identified in 69 per cent. Twenty per cent of the patients who had ischemic small bowel at surgery were identified on CT. CT has a role in the clinical assessment of patients with small bowel obstruction, identifying with reasonable accuracy the extent of bowel involvement and the presence of masses and transition points. It is less reliable at identifying adhesions, perforations, or ischemic bowel.
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Affiliation(s)
- Rebecca E Barnett
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville, Louisville, Kentucky 40292, USA
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