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Eyerly-Webb SA, Howley L, Brock CO, Lillegard JB, Fisher J, Reynolds B, Barthel EF, Dion E, Snowise S. Continuous Fetal Cardiac Monitoring During Fetoscopic Myelomeningocele Repair and Relationship to Spectral Doppler Changes. Fetal Diagn Ther 2024:000538122. [PMID: 38643759 DOI: 10.1159/000538122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/21/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION No evidence-based protocols exist for fetal cardiac monitoring during fetoscopic myelomeningocele (fMMC) repair and intraprocedural spectral Doppler data is limited. We determined the feasibility of continuous fetal echocardiography during fMMC repair and correlated Doppler changes with qualitative fetal cardiac function during each phase of fMMC repair. METHODS Patients undergoing fMMC repair had continuous fetal echocardiography interpreted in real-time by pediatric cardiology. Fetal data included fetal heart rate (FHR), qualitative cardiac function, mitral and tricuspid valve inflow waveforms, and umbilical artery (UA), umbilical vein (UV), ductus arteriosus (DA) and ductus venosus (DV) Dopplers. RESULTS UA abnormalities were noted in 14/25 patients, UV abnormalities were observed in two patients, and DV and DA abnormalities were each noted in 4 patients. Qualitative cardiac function was normal for all patients with the exception of one with isolated left ventricular dysfunction during myofascial flap creation, concurrent with an abnormal UA flow pattern. All abnormalities resolved by the first postoperative day. CONCLUSIONS Continuous fetal echocardiography was feasible during all fMMC repairs. Spectral Doppler changes in the UA were common during fMMC procedures but qualitative cardiac dysfunction was rare. Abnormalities in the UV, DV and DA Dopplers, FHR, and cardiac function were less common findings.
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Eyerly-Webb SA, Ylvisaker H, Beh M, Lim FY, Liechty K, Velasco P, Dion E, Snowise S, Lillegard JB, Feltis B. Understanding the Care Journey and Needs of Advanced Fetal Care Center Patients. Perm J 2022; 26:11-20. [DOI: 10.7812/tpp/21.189] [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: 11/30/2022]
Affiliation(s)
| | | | - Megan Beh
- Midwest Fetal Care Center, Minneapolis, MN, USA
| | | | | | | | - Eric Dion
- Midwest Fetal Care Center, Minneapolis, MN, USA
| | | | - Joseph B Lillegard
- Midwest Fetal Care Center, Minneapolis, MN, USA
- Pediatric Surgical Associates, Minneapolis, MN, USA
- Mayo Clinic, Division of General Surgery Research, Rochester, MN, USA
| | - Brad Feltis
- Midwest Fetal Care Center, Minneapolis, MN, USA
- Pediatric Surgical Associates, Minneapolis, MN, USA
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Lillegard JB, Eyerly-Webb SA, Watson DA, Bahtiyar MO, Bennett KA, Emery SP, Fisher AJ, Goldstein RB, Goodnight WH, Lim FY, McCullough LB, Moehrlen U, Moldenhauer JS, Moon-Grady AJ, Ruano R, Skupski DW, Treadwell MC, Tsao K, Wagner AJ, Zaretsky MV. Placental Location in Maternal-Fetal Surgery for Myelomeningocele. Fetal Diagn Ther 2021; 49:117-124. [PMID: 34915495 DOI: 10.1159/000521379] [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] [Received: 08/19/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Uterine incision based on placental location in open maternal-fetal surgery (OMFS) has never been evaluated in regards to maternal or fetal outcomes. OBJECTIVE To investigate whether an anterior placenta was associated with increased rates of intraoperative, perioperative, antepartum, obstetric, or neonatal complications in mothers and babies who underwent OMFS for myelomeningocele (fMMC) closure. METHODS Data from the international multi-center prospective registry of patients who underwent OMFS for fMMC closure (fMMC Consortium Registry, 12/15/2010-7/31/2019) was used to compare fetal and maternal outcomes between anterior and posterior placental locations. RESULTS Placental location for 623 patients was evenly distributed between anterior (51%) or posterior (49%). Intraoperative fetal bradycardia (8.3% vs 3.0%, p=0.005) and performance of fetal resuscitation (3.6% vs 1.0%, p=0.034) occurred more frequently in cases with an anterior placenta when compared to those with a posterior placenta. Obstetric outcomes including membrane separation, placental abruption, and spontaneous rupture of membranes were not different among the two groups. However, thinning of the hysterotomy site (27.7% vs 17.7%, p=0.008) occurred more frequently in cases of anterior placenta. Gestational age at delivery (p=0.583) and length of stay in the neonatal intensive care unit (p=0.655) were similar between the two groups. Fetal incision dehiscence and wound revision were not significantly different between groups. Critical clinical outcomes including fetal demise, perinatal death, and neonatal death were all infrequent occurrences and not associated with placental location. CONCLUSIONS Anterior placental location is associated with increased risk of intraoperative fetal resuscitation and increased thinning at the hysterotomy closure site. Individual institutional experiences may have varied but the aggregate data from the fMMC Consortium did not show a significant impact on the gestational age at delivery or maternal or fetal clinical outcomes.
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Affiliation(s)
- Joseph B Lillegard
- Midwest Fetal Care Center, Children's Minnesota, Minneapolis, Minnesota, USA
- Division of General Surgery Research, Mayo Clinic, Rochester, Minnesota, USA
- Pediatric Surgical Associates, Minneapolis, Minnesota, USA
| | | | - David A Watson
- Research Design and Analytics, Children's Minnesota, Minneapolis, Minnesota, USA
| | | | | | | | | | - Ruth B Goldstein
- University of California San Francisco, San Francisco, California, USA
| | - William H Goodnight
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Foong-Yen Lim
- Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | | | | | | | | | - Rodrigo Ruano
- University of Texas Health Science Center, Houston, Texas, USA
| | | | | | - KuoJen Tsao
- University of Texas Health Science Center, Houston, Texas, USA
| | - Amy J Wagner
- Children's Hospital of Wisconsin Fetal Concerns Center, Milwaukee, Wisconsin, USA
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Eyerly-Webb SA, Joshi S, Dion E, Snowise S, Lillegard J, Feltis BA. Fetal Non-Ovarian Abdominopelvic Cystic Lesions: A Single-Center Report. Fetal Diagn Ther 2020; 47:955-959. [PMID: 33049734 DOI: 10.1159/000510814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is a paucity of reports describing the clinical course and likely postnatal outcomes of prenatally identified simple cystic abdominopelvic lesions which are not associated with the ovary. OBJECTIVE The aim of this study was to describe the natural history and postnatal outcomes of prenatally discovered abdominopelvic cystic lesions seen at our center. METHODS This study is a retrospective review of all newborns with prenatally discovered non-ovarian simple cystic abdominal or pelvic lesions (September 2012-December 2018). Prenatal solid organ involvement, lesion size, and postnatal clinical outcomes are described. RESULTS Sixty-six patients with 68 cystic lesions were identified; 22 patients with 24 lesions met the defined study criteria and were included. Eleven (46%) resolved prenatally, while 5 (21%) resolved by 18 months of age. Of the 10 lesions associated with an organ, 4 (40%) resolved prenatally. Of the remaining 14 lesions not associated with a solid organ, 7 (50%) resolved prenatally. Seven lesions (29%) required postnatal surgical intervention. Larger maximum prenatal lesions tended toward postnatal surgical intervention (one-way ANOVA: p = 0.072). CONCLUSIONS The majority of simple non-ovarian cystic abdominopelvic lesions at our center resolved in the perinatal period. Due to the low frequency of these lesions at fetal centers, a larger multicenter study based on a consistent monitoring protocol should be undertaken to better describe the resolution patterns of simple non-ovarian cystic lesions for improved prenatal counseling.
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Affiliation(s)
- Stephanie A Eyerly-Webb
- Midwest Fetal Care Center, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA,
| | - Shilvi Joshi
- Midwest Fetal Care Center, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Eric Dion
- Midwest Fetal Care Center, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Saul Snowise
- Midwest Fetal Care Center, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Joseph Lillegard
- Midwest Fetal Care Center, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA.,Division of General Surgery Research, Mayo Clinic, Rochester, Minnesota, USA.,Pediatric Surgical Associates, Minneapolis, Minnesota, USA
| | - Brad A Feltis
- Midwest Fetal Care Center, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA.,Pediatric Surgical Associates, Minneapolis, Minnesota, USA
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Subramanian M, Hirschkorn C, Eyerly-Webb SA, Solomon RJ, Hodgman EI, Sanchez RE, Davare DL, Pigneri DA, Kiffin C, Rosenthal AA, Pedraza Taborda FE, Arenas JD, Hennessy SA, Minei JP, Minshall CT, Hranjec T. Clinical Diagnosis of Infection in Surgical Intensive Care Unit: You're Not as Good as You Think! Surg Infect (Larchmt) 2019; 21:122-129. [PMID: 31553271 DOI: 10.1089/sur.2019.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Because of the everincreasing costs and the complexity of institutional medical reimbursement policies, the necessity for extensive laboratory work-up of potentially infected patients has come into question. We hypothesized that intensivists are able to differentiate between infected and non-infected patients clinically, without the need to pan-culture, and are able to identify the location of the infection clinically in order to administer timely and appropriate treatment. Methods: Data collected prospectively on critically ill patients suspected of having an infection in the surgical intensive care unit (SICU) was obtained over a six-month period in a single tertiary academic medical center. Objective evidence of infection derived from laboratory or imaging data was compared with the subjective answers of the three most senior physicians' clinical diagnoses. Results: Thirty-nine critically ill surgical patients received 52 work-ups for suspected infections on the basis of signs and symptoms (e.g., fever, altered mental status). Thirty patients were found to be infected. Clinical diagnosis differentiated infected and non-infected patients with only 61.5% accuracy (sensitivity 60.3%; specificity 64.4%; p = 0.0049). Concordance between physicians was poor (κ = 0.33). Providers were able to predict the infectious source correctly only 60% of the time. Utilization of culture/objective data and SICU antibiotic protocols led to overall 78% appropriate initiation of antibiotics compared with 48% when treatment was based on clinical evaluation alone. Conclusion: Clinical diagnosis of infection is difficult, inaccurate, and unreliable in the absence of culture and sensitivity data. Infection suspected on the basis of signs and symptoms should be confirmed via objective and thorough work-up.
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Affiliation(s)
- Madhu Subramanian
- Division of Burn/Trauma/Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.,Division of Trauma, Surgical Critical Care and Emergency Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Carol Hirschkorn
- Division of Burn/Trauma/Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephanie A Eyerly-Webb
- Division of Trauma/Critical Care, Department of Surgery, Memorial Regional Hospital, Hollywood, Florida
| | - Rachele J Solomon
- Division of Trauma/Critical Care, Department of Surgery, Memorial Regional Hospital, Hollywood, Florida
| | - Erica I Hodgman
- Division of Burn/Trauma/Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Medicine, Pediatric Surgery, University of Tennessee Health Science Center College of Medicine Memphis, Memphis, Tennessee
| | - Rafael E Sanchez
- Division of Trauma/Critical Care, Department of Surgery, Memorial Regional Hospital, Hollywood, Florida
| | - Dafney L Davare
- Division of Trauma/Critical Care, Department of Surgery, Memorial Regional Hospital, Hollywood, Florida
| | - Danielle A Pigneri
- Division of Trauma/Critical Care, Department of Surgery, Memorial Regional Hospital, Hollywood, Florida
| | - Chauniqua Kiffin
- Division of Trauma/Critical Care, Department of Surgery, Memorial Regional Hospital, Hollywood, Florida
| | - Andrew A Rosenthal
- Division of Trauma/Critical Care, Department of Surgery, Memorial Regional Hospital, Hollywood, Florida
| | - Fernando E Pedraza Taborda
- Division of Solid Organ Transplant, Department of Surgery, Memorial Regional Hospital, Hollywood, Florida
| | - Juan D Arenas
- Division of Solid Organ Transplant, Department of Surgery, Memorial Regional Hospital, Hollywood, Florida
| | - Sara A Hennessy
- Division of Burn/Trauma/Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joseph P Minei
- Division of Burn/Trauma/Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christian T Minshall
- Division of Burn/Trauma/Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tjasa Hranjec
- Division of Trauma/Critical Care, Department of Surgery, Memorial Regional Hospital, Hollywood, Florida.,Division of Solid Organ Transplant, Department of Surgery, Memorial Regional Hospital, Hollywood, Florida
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Coombs AV, Eyerly-Webb SA, Solomon RJ, Sanchez R, Lee SK, Carrillo EH, Kiffin C, Rosenthal AA, Whitehouse J, Germain B, Davare DL. Investigating Clinical and Cost Burdens of Law Enforcement–Related K9 Injuries: The Impact of “the Bite” on a Community Hospital. Am Surg 2019. [DOI: 10.1177/000313481908500133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The decision to introduce canines (K9s) to a law enforcement (LE) agency does not typically involve the evaluation of the fiscal or clinical impact on local hospitals. This study compared injury, cost, and care associated with K9s to a common nonlethal force method, the Thomas A Swift Electrical Rifle (TASER), to highlight the cost and resources required to treat both patient types. Patients treated for LE-related K9 and TASER injuries at a Level I community-based trauma center (2011–2016) were evaluated for level of care required (e.g., surgeon/specialist), clinical interventions, proxy medical costs, and length of stay (LOS). Nearly one-third of K9 patients required tertiary-level medical care. The cost of treating the K9-inflicted injuries (n = 75) was almost twice as costly as care for patients subdued with a TASER (n = 80); the K9 patients had significantly (one-tailed t tests) higher medical costs (P = 0.036), required more medical procedures (P = 0.014), and had longer LOS (P = 0.0046) than the TASER patients. Patients with K9 injuries had higher acuity and were significantly more expensive to treat with longer LOS than TASER injuries. LE agencies considering establishing and operating a K9 unit should initiate discussions with their local medical first responders and health-care facilities regarding the capabilities to treat severe K9 injuries to ensure adequate resource allocation.
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Affiliation(s)
- Andre V. Coombs
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
- Mount Sinai Medical Center, Miami Beach, Florida
| | | | - Rachele J. Solomon
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Rafael Sanchez
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Seong K. Lee
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Eddy H. Carrillo
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Chauniqua Kiffin
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Andrew A. Rosenthal
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Jill Whitehouse
- Joe DiMaggio Children's Hospital, Pediatric Trauma Services, Hollywood, Florida
| | - Barbara Germain
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Dafney L. Davare
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
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Coombs AV, Eyerly-Webb SA, Solomon RJ, Sanchez R, Lee SK, Carrillo EH, Kiffin C, Rosenthal AA, Whitehouse J, Germain B, Davare DL. Investigating Clinical and Cost Burdens of Law Enforcement-Related K9 Injuries: The Impact of "the Bite" on a Community Hospital. Am Surg 2019; 85:64-70. [PMID: 30760347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The decision to introduce canines (K9s) to a law enforcement (LE) agency does not typically involve the evaluation of the fiscal or clinical impact on local hospitals. This study compared injury, cost, and care associated with K9s to a common nonlethal force method, the Thomas A Swift Electrical Rifle (TASER), to highlight the cost and resources required to treat both patient types. Patients treated for LE-related K9 and TASER injuries at a Level I community-based trauma center (2011-2016) were evaluated for level of care required (e.g., surgeon/specialist), clinical interventions, proxy medical costs, and length of stay (LOS). Nearly one-third of K9 patients required tertiary-level medical care. The cost of treating the K9-inflicted injuries (n = 75) was almost twice as costly as care for patients subdued with a TASER (n = 80); the K9 patients had significantly (one-tailed t tests) higher medical costs (P = 0.036), required more medical procedures (P = 0.014), and had longer LOS (P = 0.0046) than the TASER patients. Patients with K9 injuries had higher acuity and were significantly more expensive to treat with longer LOS than TASER injuries. LE agencies considering establishing and operating a K9 unit should initiate discussions with their local medical first responders and health-care facilities regarding the capabilities to treat severe K9 injuries to ensure adequate resource allocation.
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Harrell RM, Eyerly-Webb SA, Golding AC, Edwards CM, Bimston DN. STATISTICAL COMPARISON OF AFIRMA GSC AND AFIRMA GEC OUTCOMES IN A COMMUNITY ENDOCRINE SURGICAL PRACTICE: EARLY FINDINGS. Endocr Pract 2018; 25:161-164. [PMID: 30383497 DOI: 10.4158/ep-2018-0395] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Veracyte Afirma Gene Expression Classifier (GEC) has been the most widely used negative predictive value molecular classifier for indeterminate cytology thyroid nodules since January 2011. To improve the specificity and further reduce unnecessary thyroid surgeries, a second-generation assay (Afirma Genetic Sequence Classifier [GSC]) was released for clinical use in August 2017. We report 11 months of clinical outcomes experience with the GSC and compare them to our 6.5-year experience with the GEC. METHODS We searched our practice registry for FNAB nodules with Afirma results from January 2011through June 2018. GEC versus GSC results were compared overall, in oncocytic and nononcocytic aspirates and by pathologic outcomes. RESULTS GSC identified less indeterminate cytology nodules as suspicious (38.8%; 54/139) when compared to GEC (58.4%; 281/481). There was a decrease of in the percentage of oncocytic fine-needle aspiration thyroid biopsy (FNAB) subjects classified as suspicious in the GSC group, with 86 of 104 oncocytic indeterminates (82.7%) classified as suspicious by GEC and 12 of 34 (35.3%) classified as suspicious by GSC. The surgery rate in patients with oncocytic aspirates fell from 56% in the GEC group to 31% in the GSC-evaluated group (45%). Pathology analysis demonstrated a false-negative percentage for an incomplete surgical group of 9.5% for GEC and 1.2% for GSC. CONCLUSION Our GSC data suggest that the GSC further reduces surgery in indeterminate thyroid nodules by improving the specificity of Afirma technology without compromising sensitivity. A primary determinant for this change is a significant improvement in the specificity of the Afirma GSC test in oncocytic FNAB aspirates. ABBREVIATIONS FNAB = fine-needle aspiration biopsy; GEC = Gene Expression Classifier; GSC = Genetic Sequence Classifier.
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Rosenthal AA, Solomon RJ, Capasso T, Eyerly-Webb SA. Sestamibi Scanning and Intraoperative Parathyroid Hormone Results for Parathyroid Resection in Primary Hyperparathyroidism. Am Surg 2018. [DOI: 10.1177/000313481808400822] [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)
- Andrew A. Rosenthal
- Division of Acute Care Surgery and Trauma Memorial Regional Hospital Hollywood, Florida
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Rosenthal AA, Solomon RJ, Capasso T, Eyerly-Webb SA. Sestamibi Scanning and Intraoperative Parathyroid Hormone Results for Parathyroid Resection in Primary Hyperparathyroidism. Am Surg 2018; 84:e325-e327. [PMID: 30454465] [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: 06/09/2023]
Affiliation(s)
- Andrew A Rosenthal
- Division of Acute Care Surgery and Trauma, Memorial Regional Hospital, Hollywood, Florida, USA
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Dawoud S, Solomon RJ, Eyerly-Webb SA, Abrahams NA, Pedraza F, Arenas JD, Hranjec T. Pyeloduodenal Fistula in Xanthogranulomatous Pyelonephritis: A Series of Two Cases. Perm J 2018; 22:17-150. [PMID: 30005725 DOI: 10.7812/tpp/17-150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Xanthogranulomatous inflammation, characterized by destruction and replacement of tissues with chronic inflammatory cells, including foamy histiocytes and hemosiderin-laden macrophages, is uncommon. In patients with xanthogranulomatous pyelonephritis, inflammation may extend from the kidney to the overlying duodenum, creating a pyeloduodenal fistula that further complicates medical and surgical management. We present two cases with recurrent kidney infections who each ultimately received a nephrectomy and repair of their duodenal fistula.
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Affiliation(s)
- Sara Dawoud
- Medical Student in the College of Osteopathic Medicine at Nova Southeastern University in Fort Lauderdale, FL.
| | - Rachele J Solomon
- Research Coordinator in the Office of Human Research at Memorial Regional Hospital in Hollywood, FL.
| | - Stephanie A Eyerly-Webb
- Research Scholar in the Office of Human Research at Memorial Regional Hospital in Hollywood, FL.
| | - Neil A Abrahams
- Medical Director for Renal Pathology Service in the Division of Anatomic and Clinical Pathology at Memorial Regional Hospital in Hollywood, FL.
| | - Fernando Pedraza
- Medical Director of the Division of Transplant Nephrology at Memorial Regional Hospital in Hollywood, FL.
| | - Juan D Arenas
- Medical Director for the Transplant Institute and the Surgical Director for Adult and Pediatric Kidney Transplant at Memorial Regional Hospital in Hollywood, FL.
| | - Tjasa Hranjec
- Surgeon in the Division of Transplant Surgery and the Division of Acute Care Surgery and Trauma at Memorial Regional Hospital in Hollywood, FL.
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Eyerly-Webb SA, Solomon R, Lee SK, Sanchez R, Carrillo EH, Davare DL, Kiffin C, Rosenthal A. Lightning Burns and Electrical Trauma in a Couple Simultaneously Struck by Lightning. Clin Pract Cases Emerg Med 2018; 1:246-250. [PMID: 29849308 PMCID: PMC5965181 DOI: 10.5811/cpcem.2017.4.33706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 11/11/2022] Open
Abstract
More people are struck and killed by lightning each year in Florida than any other state in the United States. This report discusses a couple that was simultaneously struck by lightning while walking arm-in-arm. Both patients presented with characteristic lightning burns and were admitted for hemodynamic monitoring, serum labs, and observation and were subsequently discharged home. Despite the superficial appearance of lightning burns, serious internal electrical injuries are common. Therefore, lightning strike victims should be admitted and evaluated for cardiac arrhythmias, renal injury, and neurological sequelae.
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Affiliation(s)
| | - Rachele Solomon
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Seong K Lee
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Rafael Sanchez
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Eddy H Carrillo
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Dafney L Davare
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Chauniqua Kiffin
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Andrew Rosenthal
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
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13
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Harrell RM, Eyerly-Webb SA, Pinnar NE, Golding AC, Edwards CM, Bimston DN. COMMUNITY ENDOCRINE SURGICAL EXPERIENCE WITH FALSE-NEGATIVE AFIRMA GEC ® RESULTS: 2011-2017. Endocr Pract 2018; 24:622-627. [PMID: 29688761 DOI: 10.4158/ep-2017-0263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Afirma Gene Expression Classifier® (Afirma GEC) molecular analysis (Veracyte, Inc, San Francisco, CA) is a negative predictive value test developed to reduce the number of thyroidectomies in thyroid nodule patients with indeterminate cytology. GEC technology has reportedly reduced unnecessary thyroid surgery, but few studies have examined Afirma GEC false-negative rates, since usually patients with GEC benign nodules do not undergo surgery for definitive diagnosis. Occasionally, Afirma GEC benign patients require removal of their thyroid nodules for other reasons; this work describes the incidence of malignancy and noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) in this population. METHODS We reviewed our community endocrine surgical practice database for patients who had undergone thyroid surgery from January 2011 through April 2017 despite benign Afirma GEC results. RESULTS Afirma GEC testing was completed for 475 patients during the study period. Surgery was clinically indicated for other reasons in 42 of the 193 patients (22%) with Afirma GEC benign results. Malignancy or NIFTP in the targeted nodule was found in the final histologic evaluation of 14 of the 42 Afirma GEC benign surgical patients. The Afirma GEC false-negative percentage for our incomplete surgical group (FNP-ISG), defined as the surgically proven false negatives divided by the total Afirma GEC benign patients, was 7.3%. CONCLUSION Our high surgical rate in Afirma GEC benign nodules reveals an FNP-ISG of 7.3% in our community endocrine surgical patient population; this value exceeds the 5.7% reported in the multicenter 2012 Afirma GEC validation study. ABBREVIATIONS Afirma GEC = Afirma Gene Expression Classifier; FNA = fine-needle aspiration; FNP = false-negative percentage; FNP-ISG = false-negative percentage for an incomplete surgical group; NIFTP = noninvasive follicular thyroid neoplasms with papillary-like nuclear features.
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Spader HS, Dean DC, LaFrance WC, Raukar NP, Cosgrove GR, Eyerly-Webb SA, Ellermeier A, Correia S, Deoni SCL, Rogg J. Prospective study of myelin water fraction changes after mild traumatic brain injury in collegiate contact sports. J Neurosurg 2018:1-9. [PMID: 29712487 DOI: 10.3171/2017.12.jns171597] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/05/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVEMild traumatic brain injury (mTBI) in athletes, including concussion, is increasingly being found to have long-term sequelae. Current imaging techniques have not been able to identify early damage caused by mTBI that is predictive of long-term symptoms or chronic traumatic encephalopathy. In this preliminary feasibility study, the authors investigated the use of an emerging magnetic resonance imaging (MRI) technique, multicomponent driven equilibrium single pulse observation of T1 and T2 (mcDESPOT), in visualizing acute and chronic white matter changes after mTBI in collegiate football and rugby players.METHODSThis study was a nonrandomized, nonblinded prospective trial designed to quantify changes in the myelin water fraction (MWF), used as a surrogate MRI measure of myelin content, in a group of male collegiate football and rugby players, classified here as a contact sport player (CSP) cohort, at the time of mTBI diagnosis and 3 months after injury when the acute symptoms of the injury had resolved. In addition, differences in the MWF between the CSP cohort and a control cohort of noncontact sport players (NCSPs) were quantified. T-tests and a threshold-free cluster enhancement (TFCE) statistical analysis technique were used to identify brain structures with significant changes in the MWF between the CSP and NCSP cohorts and between immediately postinjury and follow-up images obtained in the CSP cohort.RESULTSBrain MR images of 12 right-handed male CSPs were analyzed and compared with brain images of 10 right-handed male NCSPs from the same institution. A comparison of CSP and NCSP baseline images using TFCE showed significantly higher MWFs in the bilateral basal ganglia, anterior and posterior corpora callosa, left corticospinal tract, and left anterior and superior temporal lobe (p < 0.05). At the 3-month follow-up examination, images from the CSP cohort still showed significantly higher MWFs than those identified on baseline images from the NCSP cohort in the bilateral basal ganglia, anterior and posterior corpora callosa, and left anterior temporal lobe, and also in the bilateral corticospinal tracts, parahippocampal gyrus, and bilateral juxtapositional (previously known as supplemental motor) areas (p < 0.05). In the CSP cohort, a t-test comparing the MWF at the time of injury and 3 months later showed a significant increase in the overall MWF at follow-up (p < 0.005). These increases were greatest in the bilateral basal ganglia and deep white matter. MWF decreases were seen in more superficial white matter (p < 0.005).CONCLUSIONSIn this preliminary study, MWF was found to be increased in the brains of CSPs compared with the brains of controls, suggesting acute/chronic MWF alterations in CSPs from previous injuries. Increases in the MWF were also demonstrated in the brains of CSPs 3 months after the players sustained an mTBI. The full clinical significance of an increased MWF and whether this reflects axon neuropathology or disorderly remyelination leading to hypermyelination has yet to be determined.
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Affiliation(s)
- Heather S Spader
- 1Division of Pediatric Neurosurgery, Joe DiMaggio Children's Hospital, and
| | - Douglas C Dean
- 2Waisman Center, University of Wisconsin-Madison, Wisconsin
| | - W Curt LaFrance
- 3Division of Neuropsychiatry and Behavioral Neurology.,5Department of Neurology, and
| | | | - G Rees Cosgrove
- 10Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Stephen Correia
- 4Department of Psychiatry and Human Behavior.,9Providence VA Medical Center, Providence; and
| | - Sean C L Deoni
- 11Advanced Baby Imaging Lab, School of Engineering, Brown University; and.,12Department of Pediatrics, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; and
| | - Jeffrey Rogg
- 7Department of Diagnostic Imaging, Rhode Island Hospital
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Rosenthal AA, Solomon RJ, Eyerly-Webb SA, Sanchez R, Lee SK, Kiffin C, Davare DL, Hranjec T, Carrillo EH. Traumatic Epidural Hematoma: Patient Characteristics and Management. Am Surg 2017. [DOI: 10.1177/000313481708301108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew A. Rosenthal
- Memorial Regional Hospital Division of Acute Care Surgery and Trauma Hollywood, Florida
| | - Rachele J. Solomon
- Memorial Regional Hospital Division of Acute Care Surgery and Trauma Hollywood, Florida
| | | | - Rafael Sanchez
- Memorial Regional Hospital Division of Acute Care Surgery and Trauma Hollywood, Florida
| | - Seong K. Lee
- Memorial Regional Hospital Division of Acute Care Surgery and Trauma Hollywood, Florida
| | - Chauniqua Kiffin
- Memorial Regional Hospital Division of Acute Care Surgery and Trauma Hollywood, Florida
| | - Dafney L. Davare
- Memorial Regional Hospital Division of Acute Care Surgery and Trauma Hollywood, Florida
| | - Tjasa Hranjec
- Memorial Regional Hospital Division of Acute Care Surgery and Trauma Hollywood, Florida
| | - Eddy H. Carrillo
- Memorial Regional Hospital Division of Acute Care Surgery and Trauma Hollywood, Florida
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16
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Rosenthal AA, Solomon RJ, Eyerly-Webb SA, Sanchez R, Lee SK, Kiffin C, Davare DL, Hranjec T, Carrillo EH. Traumatic Epidural Hematoma: Patient Characteristics and Management. Am Surg 2017; 83:e438-e440. [PMID: 30401085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Andrew A Rosenthal
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida, USA
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