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Athanasiadis DI, Carr RA, Smith C, Dirks RC, Hilgendorf W, Stefanidou MN, Selzer D, Stefanidis D. Social support provided to bariatric surgery patients through a facebook group may improve weight loss outcomes. Surg Endosc 2022; 36:7652-7655. [PMID: 35182215 PMCID: PMC8857391 DOI: 10.1007/s00464-022-09067-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/17/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients' social support has been shown to impact outcomes after bariatric surgery. We have previously shown that a Facebook group administered by bariatric providers offers an effective alternative social support mechanism to in-person support groups, with higher patient participation. Our aim was to determine whether participation in this Facebook group could improve patient outcomes after bariatric surgery. METHODS After institutional board approval, our center's Facebook group members were electronically surveyed about their perceived value of group participation and their Facebook group usage frequency. We also collected patient age, sex, insurance, preoperative weight, type of procedure, hospital stay, postoperative complications, and weight loss from the electronic medical record. To assess the impact of Facebook group participation we compared patient outcomes between "frequent users" (those checking the Facebook group's activity at least once a week), "infrequent users", and a control group of all patients operated on during the year prior to the establishment of the Facebook group. The groups were compared after adjusting for potential confounding factors. RESULTS 250 out of 1400 Facebook group patients responded to the survey (18%). 195 patients were frequent and 55 were infrequent users. Outcomes were compared with 211 control patients. The groups did not differ in their baseline characteristics apart from their sex. Frequent users had a higher weight loss compared to the other groups up to 2 years postoperatively but no difference in the overall complications. On multivariable analysis, frequency of Facebook use was the main factor associated with 0.5-, 1-, and 2-year weight loss. CONCLUSION Frequent participation in a Facebook support group after bariatric surgery was associated with improved early weight loss outcomes. If additional longer-term studies confirm our findings, offering similar social support groups may become essential after bariatric surgery, especially during times of social isolation when in-person social support meetings may not be feasible.
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Affiliation(s)
- Dimitrios I Athanasiadis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA
| | - Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA
| | - Craig Smith
- Bon Secours Mercy Health, Virginia Beach, VA, USA
| | - Rebecca C Dirks
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA
| | - William Hilgendorf
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA.,Indiana University Health North Hospital, Carmel, IN, USA
| | | | - Don Selzer
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA.,Indiana University Health North Hospital, Carmel, IN, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA. .,Indiana University Health North Hospital, Carmel, IN, USA.
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2
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Vos EL, Carr RA, Hsu M, Nakauchi M, Nobel T, Russo A, Barbetta A, Tan KS, Tang L, Ilson D, Ku GY, Wu AJ, Janjigian YY, Yoon SS, Bains MS, Jones DR, Coit D, Molena D, Strong VE. Prognosis after neoadjuvant chemoradiation or chemotherapy for locally advanced gastro-oesophageal junctional adenocarcinoma. Br J Surg 2021; 108:1332-1340. [PMID: 34476473 PMCID: PMC8599637 DOI: 10.1093/bjs/znab228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Trials typically group cancers of the gastro-oesophageal junction (GOJ) with oesophageal or gastric cancer when studying neoadjuvant chemoradiation and perioperative chemotherapy, so the results may not be fully applicable to GOJ cancer. Because optimal neoadjuvant treatment for GOJ cancer remains controversial, outcomes with neoadjuvant chemoradiation versus chemotherapy for locally advanced GOJ adenocarcinoma were compared retrospectively. METHODS Data were collected from all patients who underwent neoadjuvant treatment followed by surgery for adenocarcinoma located at the GOJ at a single high-volume institution between 2002 and 2017. Postoperative major complications and mortality were compared between groups using Fisher's exact test. Overall survival (OS) and disease-free survival (DFS) were assessed by log rank test and multivariable Cox regression analyses. Cumulative incidence functions were used to estimate recurrence, and groups were compared using Gray's test. RESULTS Of 775 patients, 650 had neoadjuvant chemoradiation and 125 had chemotherapy. These groups were comparable in terms of clinical tumour and lymph node categories, although the chemoradiation group had greater proportions of white men, complete pathological response to chemotherapy, and smaller proportions of diffuse cancer, poor differentiation, and neurovascular invasion. Postoperative major complications (20.0 versus 17.6 per cent) and 30-day mortality (1.7 versus 1.6 per cent) were not significantly different between the chemoradiation and chemotherapy groups. After adjustment, type of therapy (chemoradiation versus chemotherapy) was not significantly associated with OS (hazard ratio (HR) 1.26, 95 per cent c.i. 0.96 to 1.67) or DFS (HR 1.27, 0.98 to 1.64). Type of recurrence (local, regional, or distant) did not differ after neoadjuvant chemoradiation versus chemotherapy. CONCLUSION In patients undergoing surgical resection for locally advanced adenocarcinoma of the GOJ, OS and DFS did not differ significantly between patients who had neoadjuvant chemoradiation compared with chemotherapy.
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Affiliation(s)
- E L Vos
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - R A Carr
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - M Hsu
- Department of Bioinformatics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - M Nakauchi
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - T Nobel
- Department of Surgery, Mount Sinai Health System, New York, New York, USA
| | - A Russo
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - A Barbetta
- Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - K S Tan
- Department of Bioinformatics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - L Tang
- Department of Pathology, Experimental and Gastrointestinal Pathology Services, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - D Ilson
- Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - G Y Ku
- Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - A J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Y Y Janjigian
- Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - S S Yoon
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - M S Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - D R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - D Coit
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - D Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - V E Strong
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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3
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Athanasiadis DI, Carr RA, Painter R, Selzer D, Lee NK, Banerjee A, Stefanidis D, Choi JN. Chylous ascites in the setting of internal hernia: a reassuring sign. Surg Endosc 2021; 36:2570-2573. [PMID: 33988770 DOI: 10.1007/s00464-021-08545-4] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chylous ascites is often reported in cases with lymphatic obstruction or after lymphatic injuries such as intraabdominal malignancies or lymphadenectomies. However, chylous ascites is also frequently encountered in operations for internal hernias. We sought to characterize the frequency and conditions when chylous ascites is encountered in general surgery patients. METHODS Data from patients who underwent operations for CPT codes related to open and laparoscopic abdominal and gastrointestinal surgery in our tertiary hospital from 2010 to 2019 were reviewed. Patients with the postoperative diagnosis of internal hernia were identified and categorized into three groups: Internal Hernia with chylous ascites, non-chylous ascites, and no ascites. Demographics, prior surgical history, CT findings, source of internal hernia, open or laparoscopic surgery, and preoperative labs were recorded and compared. RESULTS Fifty-six patients were found to have internal hernias and were included in our study. 80.3% were female and 86% had a previous Roux-en-Y gastric bypass procedure (RYGBP). Laparoscopy was the main approach for all groups. Ascites was present in 46% of the cases. Specifically, chylous ascites was observed in 27% of the total operations and was exclusively (100%) found in patients with gastric-bypass history. Furthermore, it was more commonly associated with Petersen's defect (p < 0.001), while the non-chylous fluid group was associated with herniation through the mesenteric defect (p < 0.001). CONCLUSIONS Chylous ascites is a common finding during internal hernia operations. Unlike other more morbid conditions, identification of chylous ascites during an internal hernia operation appears innocuous. However, in the context of a patient with a history of RYGBP, the presence of chylous fluid signifies the associated small bowel obstruction is likely related to an internal hernia through a patent Petersen's defect.
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Affiliation(s)
- Dimitrios I Athanasiadis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA
| | - Rosalie A Carr
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA
| | - Robert Painter
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Don Selzer
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA
| | - Nicole Kissane Lee
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA
| | - Ambar Banerjee
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA
| | - Dimitrios Stefanidis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA
| | - Jennifer N Choi
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA.
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4
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Peng C, Mesiano D, Carr RA, Eke U, Shim TN. Pruritic eruption in a patient with end-stage renal disease. Clin Exp Dermatol 2020; 46:588-590. [PMID: 33259082 DOI: 10.1111/ced.14495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- C Peng
- Department of Dermatology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - D Mesiano
- Department of Dermatology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - R A Carr
- Department of Histopathology, Warwick Hospital, Warwick, UK
| | - U Eke
- Department of Dermatology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - T N Shim
- Department of Dermatology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
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5
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Roch AM, Carr RA, Watkins JL, Lehman G, House MG, Nakeeb A, Schmidt CM, Ceppa EP, Zyromski NJ. Percutaneous Gastrostomy in Necrotizing Pancreatitis: Friend or Foe? J Gastrointest Surg 2020; 24:2800-2806. [PMID: 31792902 DOI: 10.1007/s11605-019-04469-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/06/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Enteral nutrition plays a central role in managing necrotizing pancreatitis (NP). Although the nasojejunal (NJ) route is widely used, percutaneous gastrostomy (PEG-J) is an alternative technique that is also applied commonly. We hypothesized that NJ and PEG-J had similar morbidity in the setting of NP. METHODS All patients receiving preoperative enteral nutrition before surgical debridement for NP (2005-2015) were segregated into NJ or PEG-J. RESULTS A total of 242 patients had complete data for analysis (155 men/87 women; median age 54 years; 47% biliary and 16% alcohol-related pancreatitis). NJ was used exclusively in 187 patients (77%); 25 patients (10%) were fed exclusively by PEG-J; the remaining 30 patients (13%) had NJ first, followed by PEG-J. Equal proportions of NJ and PEG-J patients reached enteral feeding goal (67% vs. 68%, p ≈ 1) and increased serum albumin (39% vs. 36%, p = 0.87). No difference was seen in rate of pancreatic necrosis infection (NJ 53% vs. PEG-J 49%, p = 0.64). NJ patients had significantly more complications compared to PEG-J (51%vs.27%,p = 0.0015). However, NJ patients had more grade I/II complication, compared to PEG-J patients, who had more grade III/IV complication (Grade I/II: NJ 51%vs. PEG-J 16%; Grade III/IV NJ 0%vs. PEG-J 11%, p < 0.0001). CONCLUSION In necrotizing pancreatitis, NJ and PEG-J both delivered enteral nutrition effectively. Patients with NJ feeding had significantly more complications than those with PEG-J; however, NJ complications were less severe.
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Affiliation(s)
- Alexandra M Roch
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James L Watkins
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Glen Lehman
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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6
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Agrawal R, Tso S, Eltigani EA, Busam KJ, Taibjee SM, Carr RA. PRAME immunohistochemistry as an adjunct in the diagnosis of paucicellular lentigo maligna in a young man. Br J Dermatol 2020; 184:e122. [PMID: 33140433 DOI: 10.1111/bjd.19599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/07/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- R Agrawal
- South Warwickshire NHS Foundation Trust, Warwickshire, UK
| | - S Tso
- South Warwickshire NHS Foundation Trust, Warwickshire, UK
| | - E A Eltigani
- South Warwickshire NHS Foundation Trust, Warwickshire, UK
| | - K J Busam
- Memorial Sloan Kettering Cancer Centre, 1275 York Avenue, New York, NY, 10065, USA
| | - S M Taibjee
- Dorset County Hospital, Dermatology Department, Williams Ave, Dorchester, DT1 2JY, UK
| | - R A Carr
- South Warwickshire NHS Foundation Trust, Warwickshire, UK
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7
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King NY, Mesiano D, Ahmed I, Carr RA. A common cause of hair loss? Clin Exp Dermatol 2020; 46:203-206. [PMID: 33031596 DOI: 10.1111/ced.14452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/09/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- N Y King
- Departments of, Department of, Dermatology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - D Mesiano
- Departments of, Department of, Histopathology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - I Ahmed
- Departments of, Department of, Dermatology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - R A Carr
- Department of Histopathology, South Warwickshire NHS Foundation Trust, Warwick, UK
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8
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Agrawal R, Karanovic S, Gee BC, Carr RA. A pruritic hyperkeratotic plaque on the foot of a 35-year-old woman. Clin Exp Dermatol 2020; 45:771-774. [PMID: 32320098 DOI: 10.1111/ced.14217] [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] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- R Agrawal
- Departments of, Department of, Dermatology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - S Karanovic
- Departments of, Department of, Dermatology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - B C Gee
- Departments of, Department of, Dermatology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - R A Carr
- Department of, Pathology, South Warwickshire NHS Foundation Trust, Warwick, UK
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9
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Yip-Schneider MT, Soufi M, Carr RA, Flick KF, Wu H, Colgate CL, Schmidt CM. Performance of candidate urinary biomarkers for pancreatic cancer - Correlation with pancreatic cyst malignant progression? Am J Surg 2019; 219:492-495. [PMID: 31554598 DOI: 10.1016/j.amjsurg.2019.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 06/20/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Intraductal papillary mucinous neoplasms (IPMN) are precursors of pancreatic cancer. Potential biomarkers of IPMN progression have not been identified in urine. A few urinary biomarkers were reported to be predictive of pancreatic ductal adenocarcinoma (PDAC). Here, we seek to assess their ability to detect high-risk IPMN. METHODS Urine was collected from patients undergoing pancreatic resection and healthy controls. TIMP-1(Tissue Inhibitor of Metalloproteinase-1), LYVE-1(Lymphatic Vessel Endothelial Receptor 1), and PGEM(Prostaglandin E Metabolite) levels were determined by ELISA and analyzed by Kruskal-Wallis. RESULTS Median urinary TIMP-1 levels were significantly lower in healthy controls (n = 9; 0.32 ng/mg creatinine) compared to PDAC (n = 13; 1.95) but not significantly different between low/moderate-grade (n = 20; 0.71) and high-grade/invasive IPMN (n = 20; 1.12). No significant difference in urinary LYVE-1 was detected between IPMN low/moderate (n = 16; 0.37 ng/mg creatinine) and high/invasive grades (n = 21; 0.09). Urinary PGEM levels were not significantly different between groups. CONCLUSIONS Urinary TIMP-1, LYVE-1, and PGEM do not correlate with malignant potential of pancreatic cysts.
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Affiliation(s)
- Michele T Yip-Schneider
- Departments of Surgery, USA; Departments of Walther Oncology Center, USA; Departments of Indiana University Simon Cancer Center, USA; Departments of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA
| | - Mazhar Soufi
- Departments of Surgery, USA; Departments of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA
| | - Rosalie A Carr
- Departments of Surgery, USA; Departments of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA
| | - Katelyn F Flick
- Departments of Surgery, USA; Departments of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA
| | - Huangbing Wu
- Departments of Surgery, USA; Departments of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA
| | - Cameron L Colgate
- Departments of Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C Max Schmidt
- Departments of Surgery, USA; Departments of Biochemistry/Molecular Biology, USA; Departments of Walther Oncology Center, USA; Departments of Indiana University Simon Cancer Center, USA; Departments of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA.
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10
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Carr RA, Bletsis P, Roch AM, House MG, Zyromski NJ, Nakeeb A, Schmidt CM, Ceppa EP. Corrigendum to "Cystic pancreatic neuroendocrine tumors: A more favorable lesion?" [Pancreatology 19 (2) (March 2019) 372-376]. Pancreatology 2019; 19:903. [PMID: 31387834 DOI: 10.1016/j.pan.2019.07.043] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Panagiotis Bletsis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alexandra M Roch
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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11
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Soufi M, Yip-Schneider MT, Carr RA, Roch AM, Wu HH, Schmidt CM. Multifocal High-Grade Pancreatic Precursor Lesions: A Case Series and Management Recommendations. J Pancreat Cancer 2019; 5:8-11. [PMID: 31289790 PMCID: PMC6608687 DOI: 10.1089/pancan.2019.0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: The risk of developing invasive cancer in the remnant pancreas after resection of multifocal high-grade pancreatic precursor lesions is not well known. We report three patients who were followed up after resection of multifocal high-grade pancreatic intraepithelial neoplasia (PanIN)-3 or intraductal papillary mucinous neoplasia (IPMN), two of whom eventually developed invasive carcinoma. Presentation: 1) 68-year-old woman who had a laparoscopic distal pancreatectomy for multifocal mixed-type IPMN, identified as high-grade on final pathology, with negative surgical margins. During semiannual monitoring, eight years from the first surgery, the patient developed suspicious features prompting surgical resection of the body with final pathology revealing invasive ductal adenocarcinoma in the setting of IPMN. 2) 48-year-old woman who had a distal pancreatectomy for severe acute/chronic symptomatic pancreatitis, with final pathology revealing multifocal high-grade PanIN-3, with negative surgical margins. Despite semiannual monitoring, two years from the first surgery, the patient developed pancreatic adenocarcinoma with liver metastasis. 3) 55-year-old woman who had a Whipple procedure for symptomatic chronic pancreatitis, with multifocal PanIN-3 on final pathology. The patient underwent completion pancreatectomy due to symptomatology and her high-risk profile, with final pathology confirming multifocal PanIN-3. Conclusion: Multifocal high-grade dysplastic lesions of the pancreas might benefit from surgical resection.
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Affiliation(s)
- Mazhar Soufi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University Health, Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, Indiana
| | - Michele T Yip-Schneider
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University Health, Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, Indiana.,Indiana University Cancer Center, Indianapolis, Indiana
| | - Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University Health, Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, Indiana
| | - Alexandra M Roch
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University Health, Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, Indiana
| | - Howard H Wu
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christian Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University Health, Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, Indiana.,Indiana University Cancer Center, Indianapolis, Indiana.,Department of Biochemistry/Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana.,Walther Oncology Center, Indianapolis, Indiana
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12
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Carr RA, Bletsis P, Roch AM, House MG, Zyromski NJ, Nakeeb A, Schmidt CM, Ceppa EP. Cystic pancreatic neuroendocrine tumors: A more favorable lesion? Pancreatology 2019; 19:372-376. [PMID: 30704851 DOI: 10.1016/j.pan.2019.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/24/2018] [Revised: 01/14/2019] [Accepted: 01/20/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic neuroendocrine tumors (PNETs) are predominantly solid lesions with malignant potential. Cystic PNETs are a small subset in which data are scarce. The aim of this study was to compare clinical and biologic differences between cystic and solid PNETs. METHODS Patients with PNETs undergoing pancreatectomy between 1988 and 2016 at a high-volume center were reviewed retrospectively. Demographic, clinical, and histopathologic data were collected and analyzed. RESULTS 347 patients with PNETs were identified; 27% (n = 91) were cystic. Patients with cystic PNETs were generally older (59 vs. 55 years, p = 0.05). Cystic PNETs were more commonly non-functional (95% vs. 82%, p = 0.004), asymptomatic (44% vs. 28%, p = 0.009), and located in the pancreatic body/tail (81% vs. 60%, p < 0.001) than solid PNETs. Although cystic and solid PNETs had similar sizes and pathologic stage at the time of resection, Ki-67 proliferation index (Ki-67 ≤ 9%: 98% vs. 85%; p = 0.007), and histologic grade (grade I: 84% vs. 59%; p = 0.009) had less aggressive features in cystic PNETs. CONCLUSION In addition to reporting a higher than previously published incidence of cystic PNET (27%), this study found significant differences in multiple clinicopathologic variables between cystic and solid PNETs. Cystic PNET may be a distinct and possibly less aggressive subtype of PNET yet have similar pathologic stage, recurrence, and survival to solid PNETs. Cystic PNETs require further attention to better understand the true natural history.
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Affiliation(s)
- Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Panagiotis Bletsis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alexandra M Roch
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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13
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Roch AM, Schneider J, Carr RA, Lancaster WP, House MG, Zyromski NJ, Nakeeb A, Schmidt CM, Ceppa EP. Are BRCA1 and BRCA2 gene mutation patients underscreened for pancreatic adenocarcinoma? J Surg Oncol 2019; 119:777-783. [PMID: 30636051 DOI: 10.1002/jso.25376] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 07/31/2018] [Accepted: 12/30/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Breast cancer (BRCA) mutations account for the highest proportion of hereditary causes of pancreatic ductal adenocarcinoma (PDAC). Screening is currently recommended only for patients with one first-degree relative or two family members with PDAC. We hypothesized that screening all BRCA1/2 patients would identify a higher rate of pancreatic abnormalities. METHODS All BRCA1/2 patients at a single academic center were retrospectively reviewed (2005-2015). Pancreatic abnormalities were defined on cross-sectional imaging as pancreatic neoplasm (cystic/solid) or main-duct dilation. RESULTS Two hundred and four patients were identified with BRCA mutations. Forty-seven (40%) had abdominal imaging (20 computerized tomography and 27 magnetic resonance imaging). Twenty-one percent had pancreatic abnormalities (PDAC [n = 2] and intraductal papillary mucinous neoplasm [IPMN; n = 8]). The prevalence of pancreatic abnormalities and IPMN was higher in BRCA2 patients than in the general population (21% vs 8% and 17% vs 1%; P = 0.0007 and P < 0.0001, respectively), with no influence of family history. Similarly, BRCA1 patients had an increased prevalence of IPMN (8.3% vs 1%; P < 0.0001). CONCLUSIONS In this series, 4% and 17% of BRCA2 patients developed PDAC and IPMN, respectively. Eight percent of BRCA1 patients developed IPMN. Under current recommended screening, 60% of BRCA1/2 patients had incompletely pancreatic assessment. With no influence of family history, this study suggests all BRCA1/2 patients should undergo a high-risk screening protocol that will identify a higher rate of precancerous pancreatic neoplasms amenable to curative resection.
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Affiliation(s)
- Alexandra M Roch
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Justine Schneider
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - William P Lancaster
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Wiggins J, Shipman A, Mentzel T, Carr RA. An enlarging pedunculated nodule on the shoulder of a 21-year-old man. Clin Exp Dermatol 2018; 43:738-741. [PMID: 29761530 DOI: 10.1111/ced.13550] [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] [Accepted: 09/10/2017] [Indexed: 11/26/2022]
Affiliation(s)
- J Wiggins
- Department of Histopathology, Warwick Hospital, Warwick, Warwickshire, UK
| | - A Shipman
- Queen Alexandra Hospital, Portsmouth, Hampshire, UK
| | - T Mentzel
- Dermatopathology, Bodensee, Friedrichshafen, Germany
| | - R A Carr
- Department of Histopathology, Warwick Hospital, Warwick, Warwickshire, UK
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15
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Carr RA, Kiel BA, Roch AM, Ceppa EP, House MG, Zyromski NJ, Nakeeb A, Schmidt CM. Cancer history: A predictor of IPMN subtype and dysplastic status? Am J Surg 2018; 215:522-525. [DOI: 10.1016/j.amjsurg.2017.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 01/03/2023]
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16
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Carr RA, Yip-Schneider MT, Simpson RE, Dolejs S, Schneider JG, Wu H, Ceppa EP, Park W, Schmidt CM. Pancreatic cyst fluid glucose: rapid, inexpensive, and accurate diagnosis of mucinous pancreatic cysts. Surgery 2017; 163:600-605. [PMID: 29241991 DOI: 10.1016/j.surg.2017.09.051] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/28/2017] [Accepted: 09/28/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The most widely accepted biochemical test for preoperative differentiation of mucinous from benign, nonmucinous pancreatic cysts is cyst fluid carcinoembryonic antigen. However, the diagnostic accuracy of carcinoembryonic antigen ranges from 70% to 86%. Based on previous work, we hypothesize that pancreatic cyst fluid glucose may be an attractive alternative to carcinoembryonic antigen. METHODS Pancreatic cyst fluid was collected during endoscopic or operative intervention. Diagnoses were pathologically confirmed. Glucose and carcinoembryonic antigen were measured using a patient glucometer and automated analyzer/enzyme-linked immunosorbent assay. Sensitivity, specificity, accuracy, and receiver operator characteristic analyses were performed. RESULTS Cyst fluid samples from 153 patients were evaluated (mucinous: 25 mucinous cystic neoplasms, 77 intraductal papillary mucinous neoplasms, 4 ductal adenocarcinomas; nonmucinous: 21 serous cystic neoplasms, 9 cystic neuroendocrine tumors, 14 pseudocysts, 3 solid pseudopapillary neoplasms). Median cyst fluid glucose was lower in mucinous versus nonmucinous cysts (19 vs 96 mg/dL; P < .0001). With a threshold of ≤ 50 mg/dL, cyst fluid glucose was 92% sensitive, 87% specific, and 90% accurate in diagnosing mucinous pancreatic cysts. In comparison, cyst fluid carcinoembryonic antigen with a threshold of >192 ng/mL was 58% sensitive, 96% specific, and 69% accurate. Area under the curve for glucose and CEA were similar at 0.91 and 0.92. CONCLUSION Cyst fluid glucose has significant advantages over carcinoembryonic antigen and should be considered for use as a routine diagnostic test for pancreatic mucinous cysts.
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Affiliation(s)
- Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN
| | - Michele T Yip-Schneider
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN; Walther Oncology Center, Indianapolis, IN; Indiana University Cancer Center, Indianapolis, IN.
| | - Rachel E Simpson
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN
| | - Scott Dolejs
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Justine G Schneider
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Huangbing Wu
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN; Indiana University Cancer Center, Indianapolis, IN
| | - Walter Park
- Department of Medicine, Stanford University, Stanford, CA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN; Walther Oncology Center, Indianapolis, IN; Indiana University Cancer Center, Indianapolis, IN; Department of Biochemistry/Molecular Biology, Indiana University School of Medicine, Indianapolis, IN.
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17
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Carr RA, Roch AM, Zhong X, Ceppa EP, Zyromski NJ, Nakeeb A, Schmidt CM, House MG. Prospective Evaluation of Associations between Cancer-Related Pain and Perineural Invasion in Patients with Resectable Pancreatic Adenocarcinoma. J Gastrointest Surg 2017; 21:1658-1665. [PMID: 28785934 DOI: 10.1007/s11605-017-3513-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/19/2017] [Accepted: 07/19/2017] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Perineural invasion is a unique characteristic of pancreatic adenocarcinoma biology and is present in the majority of resected pathologic specimens. The purpose of this study was to understand the relationships between preoperative pain and perineural invasion in patients with pancreatic adenocarcinoma. METHODS Fifty-two chemotherapy naive patients undergoing resection for pancreatic adenocarcinoma from 2012 to 2014 completed a previously validated Brief Pain Inventory survey for preoperative clinical pain scoring. Preoperative pain was correlated with multiple clinicopathologic features. RESULTS Preoperative pain was not associated with pathologic cancer stage, lymph node status, lymph node positivity ratio, resection margin status, or tumor location within the pancreas. In the subgroup of pancreatic head cancers, pain interference with affect was associated with the absence of perineural invasion (p = 0.02). Patients with stage I cancer had higher pain interference scores than those with stage II cancer (p = 0.02). CONCLUSIONS Preoperative pain does not predict the presence of perineural invasion or other pathologic prognostic factors in patients with resectable pancreatic adenocarcinoma. Higher pain scores in pancreatic head cancers correlated with absence of perineural invasion and early cancer stage. The effects of preoperative pain on quality and interference of daily life deserve further investigation in larger prospective studies involving patients with pancreatic cancer.
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Affiliation(s)
- Rosalie A Carr
- Department of General Surgery, Indiana University School of Medicine, 515 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Alexandra M Roch
- Department of General Surgery, Indiana University School of Medicine, 515 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Xin Zhong
- Department of General Surgery, Indiana University School of Medicine, 515 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Eugene P Ceppa
- Department of General Surgery, Indiana University School of Medicine, 515 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Nicholas J Zyromski
- Department of General Surgery, Indiana University School of Medicine, 515 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Attila Nakeeb
- Department of General Surgery, Indiana University School of Medicine, 515 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - C Max Schmidt
- Department of General Surgery, Indiana University School of Medicine, 515 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Michael G House
- Department of General Surgery, Indiana University School of Medicine, 515 Barnhill Drive, Indianapolis, IN, 46202, USA.
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Watchorn RE, Thomas S, Miller C, Carr RA, Koch D, Thomas P, Taibjee SM. Keratoacanthoma management: results of a survey of U.K. dermatologists and surgeons. Br J Dermatol 2017; 178:e49-e50. [PMID: 28758190 DOI: 10.1111/bjd.15858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- R E Watchorn
- Department of Dermatology, Royal Devon & Exeter Hospital, Exeter, U.K
| | - S Thomas
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, U.K
| | - C Miller
- Research & Development, Dorset County Hospital, Dorchester, U.K
| | - R A Carr
- Department of Histopathology, Warwick Hospital, Warwick, U.K
| | - D Koch
- Department of Dermatology, Dorset County Hospital, Dorchester, U.K
| | - P Thomas
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, U.K
| | - S M Taibjee
- Department of Dermatology, Dorset County Hospital, Dorchester, U.K
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19
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Sud A, Shipman AR, Odeke M, Varma K, Read-Jones M, Carr RA. Follicular porokeratosis: four new cases. Clin Exp Dermatol 2017; 42:881-886. [PMID: 28748571 DOI: 10.1111/ced.13195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2016] [Indexed: 01/01/2023]
Abstract
Porokeratosis, a disorder of keratinisation, is clinically characterized by the presence of annular plaques with a surrounding keratotic ridge. Clinical variants include linear, disseminated superficial actinic, verrucous/hypertrophic, disseminated eruptive, palmoplantar and porokeratosis of Mibelli (one or two typical plaques with atrophic centre and guttered keratotic rim). All of these subtypes share the histological feature of a cornoid lamella, characterized by a column of 'stacked' parakeratosis with focal absence of the granular layer, and dysmaturation (prematurely keratinised cells in the upper spinous layer). In recent years, a proposed new subtype, follicular porokeratosis (FP_, has been described, in which the cornoid lamella are exclusively located in the follicular ostia. We present four new cases that showed typical histological features of FP.
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Affiliation(s)
- A Sud
- Department of Dermatology, Warwick Hospital, Warwick, Warwickshire, UK.,Department of Cellular Pathology, Warwick Hospital, Warwick, Warwickshire, UK
| | - A R Shipman
- Department of Dermatology, Warwick Hospital, Warwick, Warwickshire, UK
| | - M Odeke
- Department of Plastic Surgery, University Hospital Coventry and Warwickshire, Coventry, Warwickshire, UK
| | - K Varma
- Department of Dermatology, Nuffield Health Wolverhampton Hospital, Wolverhampton, West Midlands, UK
| | - M Read-Jones
- Hastings House Medical Centre, Wellesbourne, Warwick, Warwickshire, UK
| | - R A Carr
- Department of Cellular Pathology, Warwick Hospital, Warwick, Warwickshire, UK
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20
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Carr RA, Chung CW, Schmidt CM, Jester A, Kilbane ME, House MG, Zyromski NJ, Nakeeb A, Schmidt CM, Ceppa EP. Impact of Fellow Versus Resident Assistance on Outcomes Following Pancreatoduodenectomy. J Gastrointest Surg 2017; 21:1025-1030. [PMID: 28194616 DOI: 10.1007/s11605-017-3383-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 12/02/2016] [Accepted: 01/31/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Participation by surgical trainees in complex procedures is key to their development as future practicing surgeons. The impact of surgical fellows versus general surgery resident assistance on outcomes in pancreatoduodenectomy (PD) has not been well studied. The purpose of this study was to determine differences in patient outcomes based on level of surgical trainee. METHODS Consecutive cases of PD (n = 254) were reviewed at a single high-volume institution over a 2-year period (July 2013-June 2015). Thirty-day outcomes were monitored through the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) and Quality In-Training Initiative. Patient outcomes were compared between PD assisted by general surgery residents versus hepatopancreatobiliary fellows. RESULTS The hepatopancreatobiliary surgery fellows and general surgery residents participated in 109 and 145 PDs, respectively. The incidence of each individual postoperative complication (renal, infectious, pancreatectomy-specific, and cardiopulmonary), total morbidity, mortality, and failure to rescue were the same between groups. CONCLUSIONS Patient operative outcomes were the same between fellow- and resident-assisted PD. These results suggest that hepatopancreatobiliary surgery fellows and general surgery residents should be offered the same opportunities to participate in complex general surgery procedures.
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Affiliation(s)
- Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Catherine W Chung
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Christian M Schmidt
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Andrea Jester
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Molly E Kilbane
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA.
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21
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Carr RA, Yip-Schneider MT, Dolejs S, Hancock BA, Wu H, Radovich M, Schmidt CM. Pancreatic Cyst Fluid Vascular Endothelial Growth Factor A and Carcinoembryonic Antigen: A Highly Accurate Test for the Diagnosis of Serous Cystic Neoplasm. J Am Coll Surg 2017; 225:S1072-7515(17)30452-0. [PMID: 28633941 PMCID: PMC6037560 DOI: 10.1016/j.jamcollsurg.2017.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/03/2017] [Accepted: 05/05/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Accurate differentiation of pancreatic cystic lesions is important for pancreatic cancer early detection and prevention as well as avoidance of unnecessary surgical intervention. Serous cystic neoplasms (SCN) have no malignant potential, but may mimic premalignant mucinous cystic lesions: mucinous cystic neoplasm (MCN) and intraductal papillary mucinous neoplasm (IPMN). We recently identified vascular endothelial growth factor (VEGF)-A as a novel pancreatic fluid biomarker for SCN. We hypothesize that combining cyst fluid carcinoembryonic antigen (CEA) with VEGF-A will improve the diagnostic accuracy of VEGF-A. METHODS Pancreatic cyst/duct fluid was collected from consenting patients undergoing surgical cyst resection with corresponding pathologic diagnoses. Pancreatic fluid VEGF-A and CEA levels were detected by ELISA. RESULTS One hundred forty-nine patients with pancreatic cystic lesions met inclusion criteria. Pathologic diagnoses included pseudocyst (n=14), SCN (n=26), MCN (n=40), low/moderate grade IPMN (n=34), high grade IPMN (n=20), invasive IPMN (n=10) and solid pseudopapillary neoplasm (n=5). VEGF-A was significantly elevated in SCN cyst fluid compared to all other diagnoses (p<0.001). With a threshold of >5,000 pg/ml, VEGF-A alone has 100% sensitivity and 83.7% specificity to distinguish SCN from other cystic lesions. With a threshold of ≤10ng/ml, CEA alone identifies SCN with 95.5% sensitivity and 81.5% specificity. Sensitivity and specificity of the VEGF-A/CEA combination are 95.5% and 100% respectively. The c-statistic increased from 0.98 to 0.99 when CEA was added to VEGF-A alone in the ROC analysis. CONCLUSIONS Although VEGF-A alone is a highly accurate test for SCN, the combination of VEGF-A with CEA approaches the gold-standard of pathologic diagnosis, thus importantly avoiding false positives. Patients with a positive test indicating benign SCN can be spared a high risk surgical pancreatic resection.
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Affiliation(s)
- Rosalie A. Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
- Department of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN
| | - Michele T. Yip-Schneider
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
- Department of Walther Oncology Center, Indianapolis, IN
- Department of Indiana University Cancer Center, Indianapolis, IN
- Department of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN
| | - Scott Dolejs
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Bradley A. Hancock
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Huangbing Wu
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
- Department of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN
| | - Milan Radovich
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
- Department of Walther Oncology Center, Indianapolis, IN
- Department of Indiana University Cancer Center, Indianapolis, IN
| | - C. Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
- Department of Biochemistry/Molecular Biology, Indiana University School of Medicine, Indianapolis, IN
- Department of Walther Oncology Center, Indianapolis, IN
- Department of Indiana University Cancer Center, Indianapolis, IN
- Department of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN
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22
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Roch AM, Bigelow K, Schmidt CM, Carr RA, Jester AL, Ceppa EP, House MG, Zyromski NJ, Nakeeb A, Schmidt CM. Management of Undifferentiated Solitary Mucinous Cystic Lesion of the Pancreas: A Clinical Dilemma. J Am Coll Surg 2017; 224:717-723. [PMID: 28126546 DOI: 10.1016/j.jamcollsurg.2016.12.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Management of solitary mucinous cystic lesions of the pancreas (MCLs) relies on correct differentiation between branch duct intraductal papillary mucinous neoplasm (BD-IPMN) and mucinous cystic neoplasm (MCN). Current international consensus guidelines recommend resection for MCN, and unifocal BD-IPMN can be followed in the absence of worrisome features/high-risk stigmata. We hypothesized that preoperative differentiation of solitary MCLs is suboptimal, and that all solitary MCLs should be treated similarly. STUDY DESIGN A retrospective review of an institutional database (2003 to 2016) identified 711 patients who underwent resection for pancreatic cyst. Only lesions that met cytologic or biochemical criteria for diagnosis of MCLs were included. Mucinous cystic neoplasms were defined by presence of ovarian stroma on pathology. Patients with formal preoperative diagnosis of BD-IPMN (multifocality, GNAS mutation) were excluded. RESULTS One hundred and eighty solitary MCLs were identified on preoperative imaging (mean age 54 years, 24% men). On surgical pathology, 108 were MCNs and 72 BD-IPMNs. There was no difference in invasive rate (7 of 108 [6.5%] MCNs vs 4 of 72 [5.6%] BD-IPMN; p ≈ 1). Pancreatic ductal connectivity was reported on imaging/endoscopy in 10 of 108 (9%) MCNs and 22 of 72 (31%) BD-IPMNs, representing 67% accuracy in differentiating MCNs from BD-IPMNs. On multivariate analysis, typical risk factors failed to predict invasiveness in either MCNs or BD-IPMNs. When all undifferentiated solitary MCLs were analyzed together, older age (p = 0.03) and cyst size (p = 0.04) were associated with increased invasive rate in multivariate analysis. CONCLUSIONS Unreliable differentiation and limited ability to predict invasiveness make solitary MCLs clinically challenging. With similar invasive rates, MCN and unifocal BD-IPMNs should be merged into one new entity for management, the undifferentiated solitary MCL.
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Affiliation(s)
- Alexandra M Roch
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Katherine Bigelow
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Christian M Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Andrea L Jester
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
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23
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Carr RA, Roch AM, Shaffer K, Aboudi S, Schmidt CM, DeWitt J, Ceppa EP, House MG, Zyromski NJ, Nakeeb A, Schmidt CM. Smoking and IPMN malignant progression. Am J Surg 2016; 213:494-497. [PMID: 28129918 DOI: 10.1016/j.amjsurg.2016.10.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 07/25/2016] [Revised: 09/29/2016] [Accepted: 10/14/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with intraductal papillary mucinous neoplasm (IPMN) are at risk for invasive pancreatic cancer. We aim to characterize the impact of smoking on IPMN malignant progression. METHODS Patients undergoing pancreatic resection for IPMN (1991-2015) were retrospectively reviewed using a prospectively collected database. RESULTS Of 422 patients identified, 324 had complete data for analysis; 55% were smokers. Smoking status did not impact IPMN malignant progression (smokers/non-smokers: 22%/18% invasive grade; p = 0.5). Smokers were younger than non-smokers at the time of IPMN diagnosis (63 versus 68 years; p = 0.001). This association also held in the invasive IPMN subgroup (65 versus 72 years, p = 0.01). Despite this observation, rate of symptoms at diagnosis, cancer stage, and median survival were the same between smokers and non-smokers. CONCLUSION Although smoking is not associated with IPMN malignant progression, invasive IPMN is diagnosed at a younger age in smokers. These data suggest tobacco exposure may accelerate IPMN malignant progression.
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Affiliation(s)
- R A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A M Roch
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K Shaffer
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S Aboudi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C M Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J DeWitt
- Department of Medicine, Division of Gastroenterology, Indiana University Hospital, Indianapolis, IN, USA
| | - E P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C M Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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King T, Carr RA, Sharma M. A painful leg ulcer. Clin Exp Dermatol 2016; 42:106-108. [PMID: 27917526 DOI: 10.1111/ced.12963] [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] [Accepted: 02/14/2016] [Indexed: 12/01/2022]
Affiliation(s)
- T King
- Department of Dermatology, Derby Teaching Hospitals, Derby, UK
| | - R A Carr
- Department of Histopathology, South Warwickshire NHS Trust, Warwickshire, UK
| | - M Sharma
- Department of Dermatology, Derby Teaching Hospitals, Derby, UK
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Carr RA, Rejowski BJ, Cote GA, Pitt HA, Zyromski NJ. Systematic review of hypertriglyceridemia-induced acute pancreatitis: A more virulent etiology? Pancreatology 2016; 16:469-76. [PMID: 27012480 DOI: 10.1016/j.pan.2016.02.011] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [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: 08/25/2015] [Revised: 02/02/2016] [Accepted: 02/19/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We sought to define the severity and natural history of hypertriglyceridemia induced acute pancreatitis (HTG-AP), specifically whether HTG-AP causes more severe AP than that caused by other etiologies. METHODS Systematic review of the English literature. RESULTS Thirty-four studies (15 countries; 1972-2015) included 1340 HTG-AP patients (weighted mean prevalence of 9%). The median admission triglyceride concentration was 2622 mg/dl (range 1160-9769). Patients with HTG have a 14% weighted mean prevalence of AP. Plasmapheresis decreased circulating triglycerides, but did not conclusively affect AP mortality. Only 7 reports (n = 392 patients) compared severity of HTG-AP to that of AP from other etiologies. Of these, 2 studies found no difference in severity, while 5 suggested that HTG-AP patients may have increased severity compared to AP of other etiology. CONCLUSIONS 1) hypertriglyceridemia is a relatively uncommon (9%) cause of acute pancreatitis; however, patients with hypertriglyceridemia have a high (14%) incidence of acute pancreatitis; 2) plasmapheresis may offer specific therapy unique to this patient population; and 3) data specifically comparing the severity of HTG-AP with AP caused by other etiologies are heterogeneous and scarce.
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Affiliation(s)
- Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin J Rejowski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gregory A Cote
- Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Henry A Pitt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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Pratsou P, Dharma B, Carr RA. Spontaneously regressing papules and nodules with alarming histology. Clin Exp Dermatol 2013; 39:242-4. [PMID: 24289309 DOI: 10.1111/ced.12221] [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] [Accepted: 06/08/2013] [Indexed: 11/28/2022]
Affiliation(s)
- P Pratsou
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Hartley EE, Taibjee SM, Carr RA, Dharma B. Longstanding cobblestone plaque in the lumbar region of a 13-year-old boy. Clin Exp Dermatol 2013; 39:99-101. [PMID: 23758318 DOI: 10.1111/ced.12174] [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] [Accepted: 02/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- E E Hartley
- Department of Pathology, Warwick Hospital, Warwick, Warwickshire, UK
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Sherley-Dale AC, Carr RA, Dharmagunawardena B. Darier's disease associated with bullous pemphigoid in a Blaschkoid distribution. Clin Exp Dermatol 2013; 38:672-4. [PMID: 23758056 DOI: 10.1111/ced.12103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2012] [Indexed: 11/30/2022]
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Affiliation(s)
- T N Shim
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
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Kluk J, Ungureanu S, Bedlow A, Carr RA, Taibjee S. Pruritic plaques in a patient with diabetes. Clin Exp Dermatol 2012; 38:315-7. [PMID: 22548289 DOI: 10.1111/j.1365-2230.2012.04369.x] [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: 11/28/2022]
Affiliation(s)
- J Kluk
- Department of Dermatology, Warwick Hospital, South Warwickshire NHS Foundation Trust, Lakin Road, Warwick, UK.
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Simmons EJV, Sanders DSA, Carr RA. Current experience and attitudes to biomedical scientist cut-up: results of an online survey of UK consultant histopathologists. J Clin Pathol 2011; 64:363-6. [DOI: 10.1136/jcp.2011.088955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AimsTo assess the current utilisation of biomedical scientist (BMS) surgical specimen cut-up in the UK and attitudes of consultant histopathologists to the practice.MethodsEmail invitations were sent to all UK consultant histopathologists to participate in an online survey (SurveyMonkey) assessing attitudes to and utilisation of BMS surgical specimen cut-up.Results463 individual replies were received (35% response rate) from 1320 invitations to participate, covering 181 UK histopathology departments. A majority of the respondents were either fully in favour of BMS cut-up (52.7%), or in favour but with some reservation (46.2%). Only five respondents (1.1%) were completely opposed to BMS cut-up. 267 (57.7%) respondents reported that their BMS staff loaded biopsies only. 148 (32%) reported BMS cut-up of more complex benign specimens, and 83 (17.9%) reported BMS handling of orientated skin specimens. Only 39 (8.4%) reported that BMS staff in their departments currently cut-up larger cancer resections.ConclusionsThis survey is representative of current BMS cut-up practice in the UK. The majority of UK consultant histopathologists replying to this survey support BMS cut-up to some degree, but utilisation of BMS cut-up is rather limited and patchy at present. Cost, staffing constraints, perceived quality issues and individual consultant preferences are cited as reasons for limited uptake currently. Recognised benefits of promoting BMS cut-up include better use of consultant time, enhanced team working, BMS job satisfaction and career progression, and better adherence to standard operating procedures.
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Sherley-Dale AC, Carr RA, Gach JE. Flexural reticular pigmentation and pruritic papules in a 33-year-old woman. Clin Exp Dermatol 2011; 36:214-6. [PMID: 21323938 DOI: 10.1111/j.1365-2230.2010.03913.x] [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: 11/28/2022]
Affiliation(s)
- A C Sherley-Dale
- Department of Dermatology, University Hospital, Coventry, UK Department of Pathology, South Warwick Hospital, Warwick, UK.
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Affiliation(s)
- M George
- Department of Dermatology, South Warwickshire General Hospital, West Midlands, UK.
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Affiliation(s)
- J M R Goulding
- Department of Dermatology, Warwick Hospital, Warwick, UK.
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Abstract
Toxic epidermal necrolysis (TEN) is a life-threatening, immune-mediated reaction, characterized by severe cutaneous and mucosal blisters and erosions. It often presents with flu-like symptoms, followed by a maculopapular, urticarial, purpuric or erythema multiforme-like eruption, which then evolves into blisters and sheet-like erosions. Presentation with pustules, however, is not well described in the English literature, and may lead to delayed diagnosis. We present two unusual cases of TEN that initially presented with pustular lesions.
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Affiliation(s)
- J S Hague
- South Warwickshire General Hospitals NHS Trust, Warwick Hospital, Warwick, UK.
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Sanders DSA, Yousef A, Carr RA, Murphy P, Taniere P, Glendinning K, Macdonald F, McKeown C. MSI-H 'medullary type' adenocarcinoma complicating ileal Crohn's disease; further molecular insight into Crohn's-related carcinogenesis. Histopathology 2008; 52:519-23. [PMID: 18315608 DOI: 10.1111/j.1365-2559.2008.02942.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Taibjee SM, Gee BC, Sanders DSA, Smith A, Carr RA. Lentigo maligna involving the tumour nests and stroma of a nodular basal cell carcinoma. Br J Dermatol 2007; 157:184-8. [PMID: 17578442 DOI: 10.1111/j.1365-2133.2007.07904.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fan YS, Carr RA, Sanders DSA, Smith AP, Lazar AJF, Calonje E. Characteristic Ber-EP4 and EMA expression in sebaceoma is immunohistochemically distinct from basal cell carcinoma. Histopathology 2007; 51:80-6. [PMID: 17593083 DOI: 10.1111/j.1365-2559.2007.02722.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS There is considerable overlap between the histological features of sebaceoma and basal cell carcinoma (BCC). The distinction between these two tumours is important due to the often more locally aggressive nature of BCC and the association of sebaceoma with the Muir-Torre syndrome. The aim of this study was to describe the immunohistochemical reactivity of the cells in sebaceoma to Ber-EP4 and epithelial membrane antigen (EMA) and investigate the utility of this panel to differentiate sebaceoma from basal cell carcinoma. METHODS AND RESULTS Immunohistochemistry of 25 sebaceomas for Ber-EP4 and EMA revealed unequivocal negative expression of Ber-EP4 in 24 of 25 sebaceomas. A single case exhibited focal weak Ber-EP4 staining, predominantly in mature sebocytes and in < 10% of the tumour cells. EMA was not expressed in the germinative cells of sebaceoma, but was expressed strongly in approximately 50% of mature sebocytes in all cases and highlighted the cytoplasmic vacuoles. We reviewed the immunoreactivity of 51 cases of nodular BCCs and found moderate or strong BerEP4 expression in all cases with never less than 20% of the tumour staining. Expression of EMA was uncommon in BCC (moderate or strong in 8%) and was confined to keratotic or squamoid areas. CONCLUSION The use of Ber-EP4 in combination with EMA, both widely used immunomarkers in histopathology, is a helpful aid in distinguishing sebaceoma from nodular BCC.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Biopsy
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/metabolism
- Carcinoma, Basal Cell/pathology
- Diagnosis, Differential
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Male
- Middle Aged
- Mucin-1/genetics
- Mucin-1/metabolism
- Neoplasms, Adnexal and Skin Appendage/diagnosis
- Neoplasms, Adnexal and Skin Appendage/metabolism
- Neoplasms, Adnexal and Skin Appendage/pathology
- Sebaceous Glands/metabolism
- Sebaceous Glands/pathology
- Skin Neoplasms/diagnosis
- Skin Neoplasms/metabolism
- Skin Neoplasms/pathology
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Affiliation(s)
- Y S Fan
- Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
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Abstract
A successful move towards subspecialised reporting in cellular pathology in the setting of a small to medium-sized district general hospital staffed by five consultant pathologists is described. This move has been facilitated by implementation of a prospective workload allocation system. Perceived benefits in service delivery and career progression are highlighted.
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Affiliation(s)
- D S A Sanders
- Department of Cellular Pathology, Warwick Hospital, Warwick, UK.
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Gietema JA, Hoekstra R, de Vos FYFL, Uges DRA, van der Gaast A, Groen HJM, Loos WJ, Knight RA, Carr RA, Humerickhouse RA, Eskens FALM. A phase I study assessing the safety and pharmacokinetics of the thrombospondin-1-mimetic angiogenesis inhibitor ABT-510 with gemcitabine and cisplatin in patients with solid tumors. Ann Oncol 2006; 17:1320-7. [PMID: 16728485 DOI: 10.1093/annonc/mdl102] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of the study was to determine the safety profile, pharmacokinetics and potential drug interactions of the angiogenesis inhibitor ABT-510 combined with gemcitabine-cisplatin chemotherapy in patients with solid tumors. PATIENTS AND METHODS Patients with advanced solid tumors received gemcitabine 1250 mg/m2 intravenously (i.v.) on days 1 and 8 and cisplatin 80 mg/m2 on day 1 of a 3-week cycle in combination with ABT-510. ABT-510 was administered subcutaneously twice daily at doses of 50 mg or 100 mg. Plasma samples for pharmacokinetics were obtained on days 1 (gemcitabine, cisplatin as single agents), 15 (ABT-510 as single agent) and 22 (gemcitabine, cisplatin and ABT-510 as combination). RESULTS Thirteen patients received ABT-510 as either 50 mg b.i.d. (seven patients) or 100 mg b.i.d. (six patients) in combination with gemcitabine-cisplatin. The most common reported adverse events reflected the known toxicity profile induced by gemcitabine-cisplatin without ABT-510. One episode of hemoptysis occurred in a patient with non-small-cell lung cancer (NSCLC) after 13 days of treatment. No clinically significant pharmacokinetic interactions between ABT-510, gemcitabine and platinum were observed. Three partial responses were observed in 12 evaluable patients (one head and neck cancer, one melanoma and one NSCLC). CONCLUSIONS Combining ABT-510 at doses of 50 mg and 100 mg with gemcitabine-cisplatin is feasible. Pharmacokinetic interactions were not observed and adding ABT-510 does not appear to increase toxicity.
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Affiliation(s)
- J A Gietema
- Department of Medical Oncology, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.
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Carr RA, Sanders DSA, Stores OP, Smew FA, Parkes ME, Ross-Gilbertson V, Chachlani N, Simon J. The Warwick system of prospective workload allocation in cellular pathology--an aid to subspecialisation: a comparison with the Royal College of Pathologists' system. J Clin Pathol 2006; 59:835-9. [PMID: 16524963 PMCID: PMC1860452 DOI: 10.1136/jcp.2005.032615] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 11/04/2022]
Abstract
BACKGROUND Guidelines on staffing and workload for histopathology and cytopathology departments was published by the Royal College of Pathologists (RCPath) in July 2003. In this document, a system is provided whereby the workload of a cellular pathology department and individual pathologists can be assessed with a scoring system based on specialty and complexity of the specimens. A similar, but simplified, system of scoring specimens by specialty was developed in the Warwick District General Hospital. The system was based on the specimen type and suggested clinical diagnosis, so that specimens could be allocated prospectively by the laboratory technical staff to even out workload and support subspecialisation in a department staffed by 4.6 whole-time equivalent consultant pathologists. METHODS The pathologists were asked to indicate their reporting preferences to determine specialist reporting teams. The workload was allocated according to the "prospective" Warwick system (based on specimen type and suggested clinical diagnosis, not affected by final diagnosis or individual pathologist variation in reference to numbers of blocks, sections and special stains examined) for October 2003. The cumulative Warwick score was compared with the "retrospective" RCPath scoring system for each pathologist and between specialties. Four pathologists recorded their time for cut-up and reporting for the month audited. RESULTS The equitable distribution of work between pathologists was ensured by the Warwick allocation and workload system, hence facilitating specialist reporting. Less variation was observed in points reported per hour by the Warwick system (6.3 (range 5.5-6.9)) than by the RCPath system (11.5 (range 9.3-15)). CONCLUSIONS The RCPath system of scoring is inherently complex, is applied retrospectively and is not consistent across subspecialities. The Warwick system is simpler, prospective and can be run by technical staff; it facilitates even workload distribution throughout the day. Subspecialisation within a small-sized or medium-sized department with fair distribution of work between pathologists is also allowed for by this system. Reporting times among pathologists were shown by time and motion studies to be more consistent with Warwick points per hour than with RCPath points per hour.
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Affiliation(s)
- R A Carr
- Warwick Hospital, South Warwickshire Hospitals NHS Trust, Warwick, UK.
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Hoekstra R, de Vos FYFL, Eskens FALM, de Vries EGE, Uges DRA, Knight R, Carr RA, Humerickhouse R, Verweij J, Gietema JA. Phase I study of the thrombospondin-1-mimetic angiogenesis inhibitor ABT-510 with 5-fluorouracil and leucovorin: a safe combination. Eur J Cancer 2006; 42:467-72. [PMID: 16406507 DOI: 10.1016/j.ejca.2005.08.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 08/07/2005] [Accepted: 08/08/2005] [Indexed: 10/25/2022]
Abstract
We performed a phase I study with the thrombospondin-1-mimetic angiogenesis inhibitor ABT-510 combined with 5-fluorouracil and leucovorin (5-FU/LV) to determine safety profile and assess pharmacokinetic interactions. Patients with advanced solid malignancies received LV 20 mg/m(2) followed by 5-FU 425 mg/m(2) both administered intravenously in 15 min daily for 5 days every 4 weeks. ABT-510 was administered subcutaneously twice daily continuously from day 2 onwards. Blood and urine samples for pharmacokinetic analyses were collected at days 1, 5 and 22. Twelve patients received a total of 45 cycles of 5-FU/LV combined with ABT-510. ABT-510 dose levels studied were 50 and 100 mg. The combination was well tolerated, with a toxicity profile comparable to that of 5-FU/LV alone. At the dose levels studied no significant pharmacokinetic interactions were observed. These data indicate that ABT-510 administered twice daily subcutaneously can be safely combined with 5-FU/LV administered daily for 5 days, every 4 weeks.
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Affiliation(s)
- R Hoekstra
- Department of Medical Oncology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Gach JE, Carr RA, Charles-Holmes R, Harris S. Multiple congenital melanocytic naevi presenting with neurofibroma-like lesions complicated by malignant melanoma. Clin Exp Dermatol 2004; 29:473-6. [PMID: 15347327 DOI: 10.1111/j.1365-2230.2004.01562.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 12/01/2022]
Abstract
Giant congenital pigmented naevi and neurofibromatosis (NF-1) may rarely occur together. We report an unusual case where extensive congenital melanocytic naevi were associated with neurofibroma-like lesions that were clinically and histologically confused with neurofibromatosis. The development of malignant melanomas within the pigmented and pendulous lesions representing multiple congenital melanocytic naevi highlights the importance of an accurate diagnosis and a close follow-up of such patients.
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Affiliation(s)
- J E Gach
- Department of Dermatology, Warwick Hospital, Lakin Road, Warwick, CV34 5BW, UK.
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Thomas C, Ogboli MI, Carr RA, Charles-Holmes R. Hypertrophic perianal porokeratosis in association with superficial actinic porokeratosis of the leg. Clin Exp Dermatol 2003; 28:676-7. [PMID: 14616847 DOI: 10.1046/j.1365-2230.2003.01410.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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