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Schwalbe K, Finelli C, Moon S, Niehaus H, Kondajji A, Tu C, Fathalizadeh A, Kroh M, Allemang M. Endoscopic findings do not predict per-oral pyloromyotomy (POP) response. Surg Endosc 2023; 37:1384-1391. [PMID: 35608698 DOI: 10.1007/s00464-022-09321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Gastroparesis is a life-altering diagnosis caused by the stomach's inability to function in the absence of a mechanical obstruction. The primary causes are idiopathic, diabetic, and postoperative. Our first-line treatment for medical refractory gastroparesis is the endoscopic per-oral pyloromyotomy (POP) procedure. Predicting clinical response cost effectively remains elusive. METHODS All patients who underwent a POP procedure at our institution by a single surgical endoscopist from January 1, 2019 to June 30, 2020 were retrospectively reviewed. All endoscopic data were prospectively collected. The patients were followed by a survey including the Gastroparesis Cardinal Symptom Index (GCSI) and other relevant postoperative measures. The primary endpoint was clinical response defined as ≥ 1.0 decrease in the GCSI from preoperative to the time of survey. Secondary outcome was normalization of the gastric emptying study (GES). RESULTS Our patient population is 85% female and has an average age of 44.8 years. The diagnosis of gastroparesis is 71% iatrogenic, 19% postoperative, and 10% diabetic. On endoscopy, 30% had bile in the stomach and 65% had any degree of pylorospasm. The primary outcome measure of clinical response was 39% at an average of 697 ± 151 days post-POP, but 66% of patients attested to an improvement in their symptoms. Of 68 postoperative gastric emptying studies 50% normalized at an average of 145 ± 98 days. Following univariate and multivariate analyses of preoperative data and endoscopic findings, there were no significant predictors of clinical response. A preoperative GCSI ≥ 2.6 trends toward significance (OR 6.87, p = 0.058). CONCLUSION Endoscopic findings at the time of POP do not correlate with clinical response. The GCSI model currently used to measure clinical response may not accurately capture the full clinical picture. The long-term durability of endoscopic myotomy to treat medical refractory gastroparesis needs to be studied further to improve patient selection.
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Affiliation(s)
- Kathryn Schwalbe
- Cleveland Clinic-South Pointe Hospital, 20000 Harvard Road, Warrensville Heights, OH, 44122, USA.
| | - Caitlin Finelli
- Cleveland Clinic-South Pointe Hospital, 20000 Harvard Road, Warrensville Heights, OH, 44122, USA
| | - Soon Moon
- Cleveland Clinic-South Pointe Hospital, 20000 Harvard Road, Warrensville Heights, OH, 44122, USA
| | - Hannah Niehaus
- Cleveland Clinic-South Pointe Hospital, 20000 Harvard Road, Warrensville Heights, OH, 44122, USA
| | - Abhiram Kondajji
- Cleveland Clinic-South Pointe Hospital, 20000 Harvard Road, Warrensville Heights, OH, 44122, USA
| | - Chao Tu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | | | - Matthew Kroh
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Allemang
- Cleveland Clinic-South Pointe Hospital, 20000 Harvard Road, Warrensville Heights, OH, 44122, USA
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DeRoss A, Fathalizadeh A. Appendicitis management: Is it time for a change? Cleve Clin J Med 2022; 89:309-313. [PMID: 35649567 DOI: 10.3949/ccjm.89a.21012] [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: 11/14/2022]
Affiliation(s)
- Anthony DeRoss
- Section of Pediatric Surgery, Cleveland Clinic, Cleveland, OH
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Kondajji A, Klingler M, Tu C, Kelley R, El-Hayek K, Rodriquez J, Cline M, Fathalizadeh A, Allemang M. Gastroparesis with concomitant gastrointestinal dysmotility is not a contraindication for per-oral pyloromyotomy (POP). Surg Endosc 2022; 36:4226-4232. [PMID: 34642799 DOI: 10.1007/s00464-021-08756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Per-oral pyloromyotomy (POP or G-POEM) provides significant short-term improvements in symptoms and objective emptying for patients with medically refractory gastroparesis, but it is unclear if patients with gastroparesis and co-existing dysmotility (small bowel or colonic delay) also benefit. In this study, we used wireless motility capsule (WMC) data to measure outcomes in patients with isolated gastroparesis (GP) and gastroparesis with co-existing dysmotility (GP + Dys) who underwent POP. METHODS We retrospectively analyzed patients who had POP and completed WMC data during their evaluation of intestinal dysmotility. WMC data were reviewed to identify patients who demonstrated isolated GP or GP + Dys. Each patient's pre-op and post-op Gastroparesis Cardinal Symptom Index (GCSI) and 4-h solid-phase scintigraphy gastric emptying studies (GES) scores were compared to evaluate improvement. RESULTS Of the entire cohort (n = 73), 89% were female with a mean age of 47.0 ± 15.0 years old. Gastroparesis etiologies were divided among idiopathic (54.8%), diabetic (26%), postsurgical (8.2%), autoimmune (5.5%), and multifactorial (5.5%). Forty-one patients (56%) had GP and 32 patients (44%) had GP + Dys. GCSI improved after POP whether the patient had isolated GP (- 12.31, p < 0.001) or GP + Dys (- 9.58, p < 0.001); however, there was no significant difference in total GCSI improvement between the two groups. A subset of patients had postoperative GES available (n = 47). In the isolated GP and GP + Dys cohorts, 15/28 (54%) and 12/19 (63%) patients had normal post-op 4-h GES, respectively, but no statistical difference between the two groups. CONCLUSION Patients with medically refractory gastroparesis with and without concomitant gastrointestinal dysmotility show short-term subjective and objective improvement after POP. Concomitant small bowel or colonic dysmotility should not deter physicians from offering POP in carefully selected patients with gastroparesis.
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Affiliation(s)
- Abhiram Kondajji
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA.
- General Surgery Resident, Cleveland Clinic-South Pointe Hospital, 20000 Harvard Road, Warrensville Height, OH, 44122, USA.
| | - Michael Klingler
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chao Tu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca Kelley
- Dermatology and Plastic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - John Rodriquez
- Digestive Disease and Surgical Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Michael Cline
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alisan Fathalizadeh
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Allemang
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
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Shin TH, Rosinski B, Strong A, Fayazzadeh H, Fathalizadeh A, Rodriguez J, El-Hayek K. Robotic versus laparoscopic median arcuate ligament (MAL) release: a retrospective comparative study. Surg Endosc 2021; 36:5416-5423. [PMID: 34811583 DOI: 10.1007/s00464-021-08877-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Multiple retrospective studies have demonstrated the safety and feasibility of laparoscopic median arcuate ligament division with celiac neurolysis for the definitive management of median arcuate ligament syndrome (MALS). This study queries the clinical equipoise of robotic (RMALR) versus laparoscopic MAL release (LMALR) at a high-volume center. METHODS A retrospective analysis of consecutive 26 RMALR and 24 LMALR between March 2018 and August 2019 by a single surgeon at a quaternary academic institution was completed. Primary endpoint was postoperative decrease in celiac trunk expiratory peak systolic velocities (PSVs) measured by mesenteric duplex ultrasonography. Secondary outcomes included reported improvement in MALS-related clinical symptoms, distribution of first assistant seniority level, and involvement of second assistants in RMALR versus LMALR. RESULTS Mean operative times for LMALR and RMALR were 86 and 134 min, respectively (p < 0.0001). There were no open conversions and mean length of hospital stay was 1 day for both cohorts. Both groups provided an equally effective decrease in postoperative peak systolic velocities (PSVs) (LMALR p = 0.0011; RMALR p = 0.0022; LMALR vs. RMALR p = 0.7772). While RMALR had significantly higher reduction of chronic abdominal pain postoperatively, there were no significant differences in other postoperative symptom relief between groups. However, RMALR patients reported significant relief of postprandial abdominal pain (p < 0.0001) and chronic nausea (p = 0.0002). RMALR had significantly more junior first assistants (p = 0.0001) and less frequently required second assistants compared to LMALR (p = 0.0381). CONCLUSIONS In this study comparing RMALR to LMALR, postoperative chronic abdominal pain relief was significantly less in the former while other outcomes were equivalent. In comparison with LMALR, RMALR cases were associated with more junior first assistants, fewer second assistants, and longer operative times. Both approaches are safe and feasible for well-selected patients in experienced centers.
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Affiliation(s)
- Thomas H Shin
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, A-10044195, USA.
| | - Bradley Rosinski
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, A-10044195, USA
| | - Andrew Strong
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, A-10044195, USA
| | - Hana Fayazzadeh
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, A-10044195, USA
| | - Alisan Fathalizadeh
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, A-10044195, USA
| | - John Rodriguez
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, A-10044195, USA
| | - Kevin El-Hayek
- Division of General Surgery, MetroHealth System, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA.,Northeast Ohio College of Medicine, Rootstown, OH, USA
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Fathalizadeh A, Klingler M, Landreneau J, Allemang M, Rodriguez J, Ponsky J, El-Hayek K. Real-time intraoperative functioning lumen imaging probe during endoscopic per-oral pyloromyotomy (pop). Surg Endosc 2021; 36:745-752. [PMID: 33427911 PMCID: PMC8741673 DOI: 10.1007/s00464-020-08237-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/08/2020] [Indexed: 01/12/2023]
Abstract
Background Endoscopic per-oral pyloromyotomy (POP) has emerged as a safe and effective first line option in medically refractory gastroparesis. Determining the appropriate extent of the pyloromyotomy continues to present a challenge as there are no standardized tools for measuring changes in pyloric distensibility during the procedure. The objective of this study was to evaluate the utility of using impedance planimetry with endoscopic functional luminal imaging probe (FLIP) to measure changes in pyloric distensibility after POP, and to compare these changes with improvement in symptoms and objective gastric emptying. Methods Patients with medically refractory gastroparesis underwent POP with FLIP measurements of the pylorus (EndoFLIP®, Medtronic, Fridley MN). FLIP measurements, as well as changes in symptoms measured by the validated gastroparesis cardinal symptom index (GCSI) and scintigraphic gastric emptying studies (GES), were evaluated before and after POP. Results A total of 14 patients underwent measurement with FLIP during POP, 12 of whom had pre- and post-POP measurements. Mean pyloric diameter increased by 1.4 mm, from 13.9 mm to 15.3 mm (p = 0.0012). Mean distensibility index increased from 6.2 mm2/mmHg to 9.1 mm2/mmHg (p = 0.0074). Successful division of the pylorus was achieved in 100% of patients with a mean operative time of 36 min and no perioperative complications. The mean length of stay was 0.7 days (0–3 days). Post-POP mean GCSI score improved from 2.97 to 2.28 at a mean follow-up time of 27 days (p < 0.001). Objective improvement in gastric emptying was observed in 80% of patients with scintigraphic GES, with mean four-hour retention decreasing from 46.3% to 32.4% (p < 0.007). Conclusions FLIP is a safe and feasible tool to provide objective measurements during POP. Larger cohorts with longer follow-up are required to determine if measured improvements in pyloric diameter and distensibility are predictive of sustained improvements in GCSI and GES.
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Affiliation(s)
- Alisan Fathalizadeh
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Michael Klingler
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joshua Landreneau
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Allemang
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John Rodriguez
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jeffrey Ponsky
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kevin El-Hayek
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.,Division of General Surgery, MetroHealth System, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Aminian A, Fathalizadeh A, Tu C, Butsch WS, Pantalone KM, Griebeler ML, Kashyap SR, Rosenthal RJ, Burguera B, Nissen SE. Association of prior metabolic and bariatric surgery with severity of coronavirus disease 2019 (COVID-19) in patients with obesity. Surg Obes Relat Dis 2020; 17:208-214. [PMID: 33243670 PMCID: PMC7682430 DOI: 10.1016/j.soard.2020.10.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 02/07/2023]
Abstract
Background Obesity is a risk factor for poor clinical outcomes in patients with coronavirus disease 2019 (COVID-19). Objectives To investigate the relationship between prior metabolic surgery and the severity of COVID-19 in patients with severe obesity. Setting Cleveland Clinic Health System in the United States. Methods Among 4365 patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 8, 2020 and July 22, 2020 in the Cleveland Clinic Health System, 33 patients were identified who had a prior history of metabolic surgery. The surgical patients were propensity matched 1:10 to nonsurgical patients to assemble a cohort of control patients (n = 330) with a body mass index (BMI) ≥ 40 kg/m2 at the time of SARS-CoV-2 testing. The primary endpoint was the rate of hospital admission. The exploratory endpoints included admission to the intensive care unit (ICU), need for mechanical ventilation and dialysis during index hospitalization, and mortality. After propensity score matching, outcomes were compared in univariate and multivariate regression models. Results The average BMI of the surgical group was 49.1 ± 8.8 kg/m2 before metabolic surgery and was down to 37.2 ± 7.1 at the time of SARS-CoV-2 testing, compared with the control group’s BMI of 46.7 ± 6.4 kg/m2. In the univariate analysis, 6 (18.2%) patients in the metabolic surgery group and 139 (42.1%) patients in the control group were admitted to the hospital (P = .013). In the multivariate analysis, a prior history of metabolic surgery was associated with a lower hospital admission rate compared with control patients with obesity (odds ratio, 0.31; 95% confidence interval, 0.11−0.88; P = .028). While none of the 4 exploratory outcomes occurred in the metabolic surgery group, 43 (13.0%) patients in the control group required ICU admission (P = .021), 22 (6.7%) required mechanical ventilation, 5 (1.5%) required dialysis, and 8 (2.4%) patients died. Conclusion Prior metabolic surgery with subsequent weight loss and improvement of metabolic abnormalities was associated with lower rates of hospital and ICU admission in patients with obesity who became infected with SARS-CoV-2. Confirmation of these findings will require larger studies. Is there an association between prior metabolic surgery and severity of COVID-19 in patients with obesity? In this matched cohort study of 363 patients with COVID-19 (including 33 patients who underwent metabolic surgery and 330 matched controls with obesity), metabolic surgery was significantly associated with near three times lower odds of hospital admission (odds ratio 0.31, P=0.028). While none of the 4 exploratory outcomes occurred in the metabolic surgery group, 43 (13.0%) patients in the control group required ICU admission (P=0.021), 22 (6.7%) required mechanical ventilation, 5 (1.5%) required dialysis, and 8 (2.4%) patients died. Among patients with obesity, metabolic surgery was significantly associated with a lower risk of hospital and intensive care unit admission.
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Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
| | - Alisan Fathalizadeh
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - W Scott Butsch
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kevin M Pantalone
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marcio L Griebeler
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sangeeta R Kashyap
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - Raul J Rosenthal
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Weston, Florida
| | - Bartolome Burguera
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Hook L, Salami AC, Diaz T, Friend KE, Fathalizadeh A, Joshi ART. The Revised 2017 MSPE: Better, But Not "Outstanding". J Surg Educ 2018; 75:e107-e111. [PMID: 30068491 DOI: 10.1016/j.jsurg.2018.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
AIM The medical student performance evaluation (MSPE) is relied on as an objective summary evaluation by surgical program directors. In 2017, an MSPE task force released recommendations for best practice for their format and content. The purpose of this study was to analyze US medical schools' adherence to these guidelines. METHODS MSPEs from 113 of 147 Liaison committee on Medical Education (LCME)-accredited medical schools were analyzed for measurable attributes such as word counts, transparent clerkship grading, comparative performance data, and statements of professionalism. 2017 MSPEs were compared to a baseline group of 45 MSPEs from 2016 to measure change over time. Measurable attributes were compared using the Fisher exact and Mann Whitney-U tests. A p value < 0.05 was deemed statistically significant. RESULTS We analyzed 113 MSPEs from 2017. The median page count decreased by one from the prior year, with a narrower range of variation. 96% of schools reported a discreet grade in surgery. We observed substantial compliance with the recommendation for a statement of professionalism, noteworthy characteristics, and comparative clerkship data. More schools were observed to report school-wide rankings. There were significant variations in the graphical depiction of student achievement. CONCLUSIONS In response to the 2017 task force guidelines, MSPEs have become more standardized and transparent with regard to medical student evaluation. There is increased (but not ubiquitous) adherence with the recommendation for three noteworthy characteristics and statements of professionalism. Of particular importance to surgical program directors, 95.6% of 2017 MSPEs report a grade in the surgical clerkship and 85.8% include school-wide comparative clerkship performance data. Still, only 69.9% currently report school-wide summative performance data.
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Affiliation(s)
- Lauren Hook
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Aitua C Salami
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Tenesha Diaz
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Kara E Friend
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Alisan Fathalizadeh
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Amit R T Joshi
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania.
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Bruns BR, Morris DS, Zielinski M, Mowery NT, Miller PR, Arnold K, Phelan HA, Murry J, Turay D, Fam J, Oh JS, Gunter OL, Enniss T, Love JD, Skarupa D, Benns M, Fathalizadeh A, Leung PS, Carrick MM, Jewett B, Sakran J, O’Meara L, Herrera AV, Chen H, Scalea TM, Diaz JJ. Stapled versus hand-sewn. J Trauma Acute Care Surg 2017; 82:435-443. [DOI: 10.1097/ta.0000000000001354] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karanlik H, Ozgur I, Kilic B, Fathalizadeh A, Sanli Y, Onder S, Saip P, Sen F, Gulluoglu BM. Sentinel lymph node biopsy and aberrant lymphatic drainage in recurrent breast cancer: Findings likely to change treatment decisions. J Surg Oncol 2016; 114:796-802. [PMID: 27778360 DOI: 10.1002/jso.24423] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/14/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES It is not clear whether sentinel lymph node biopsy (SLNB) can be applied to patients with a second breast cancer or recurrence occurring at previously treated breast. The purpose of this study was to assess the feasibility of SLNB procedure in patients with recurrent breast cancer. METHODS Patients with non-metastatic recurrent N0 breast cancer at ipsilateral breast were included. Patients were grouped according to their initial breast, axilla, and overall surgery. Presence of drainage and its pattern as well as SLNB success rate and overall axillary involvement rates were assessed. Findings were compared. RESULTS Out of 75 patients, mean age was 52.5 years and disease-free interval was 82 (9-312) months. Lymphatic drainage was successful in 42 (56%) patients. Drainage positivity was more frequent in patients who were previously treated with SLNB (82.6%) than in patients who underwent axillary lymph node dissection (ALND) (44.2%; P = 0,002). Aberrant lymphatic drainage was detected in 64.3% of drainage positive patients. Success rate of reoperative SLNB was 92.9%. Adjuvant treatment plan was altered in 12 (16%) patients. In 15 patients, negative SLNB prevented axillary dissection. CONCLUSIONS Reoperative SLNB seems to be technically feasible in N0 recurrent breast cancer patients. It may further avoid unnecessary ALND and lead changes in adjuvant treatment plans. J. Surg. Oncol. 2016;114:796-802. © 2016 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hasan Karanlik
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Istanbul, Turkey.
| | - Ilker Ozgur
- Department of General Surgery, Acibadem International Hospital, Istanbul, Turkey
| | - Berkay Kilic
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Alisan Fathalizadeh
- Department of General Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Yasemin Sanli
- Department of Nuclear Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Pinar Saip
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Fatma Sen
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Bahadir M Gulluoglu
- Breast Surgery Unit, Department of General Surgery, Marmara University Hospital, Pendik, Istanbul, Turkey
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Parikh N, Drizin G, Dourado C, Randhawa S, Obaid T, Fathalizadeh A, Song G, Jarrar D. 58-Year-Old-Woman With Worsening Shortness of Breath and a Genetic Mutation. Chest 2016. [DOI: 10.1016/j.chest.2016.08.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Randhawa S, Fathalizadeh A, Parikh N, Jarrar D, Kennedy T. Congenital Tracheo-Esophageal Fistula Repaired 31 Years Later. Chest 2016. [DOI: 10.1016/j.chest.2016.08.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Karanlik H, Ozgur I, Simsek S, Fathalizadeh A, Tukenmez M, Sahin D, Dursun M, Kurul S. Can Steroids plus Surgery Become a First-Line Treatment of Idiopathic Granulomatous Mastitis? Breast Care (Basel) 2014; 9:338-42. [PMID: 25759614 PMCID: PMC4322692 DOI: 10.1159/000366437] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 12/15/2022] Open
Abstract
BACKGROUND The aim of this study is to compare the clinical course of idiopathic granulomatous mastitis (IGM) treated with low-dose oral corticosteroid therapy alone as opposed to treatment with low-dose corticosteroid therapy followed by surgery. PATIENTS AND METHODS 37 patients were treated with an approach that consisted of methylprednisolone at a dose of 0.5 mg/kg/day followed by wide excision, and 23 patients were treated with an approach that consisted only of methylprednisolone. The treatment efficacy was compared between the two groups. RESULTS Clinical and radiological regression was reported in all patients with steroid therapy, and the regression rate had a median of 75% (25-100%). No recurrence was observed in patients who were treated with wide surgical excision after steroid therapy during the median follow-up period of 38 (22-78) months. The control group of 23 patients was treated only with steroid therapy, and 7 (30%) of these patients experienced recurrence in the follow-up period (p < 0.001). CONCLUSIONS Steroid therapy was effective in the treatment of IGM by reducing the lesion size and extent. With regard to the current treatment options available for IGM, surgical excision after steroid therapy seems the better treatment option compared to steroid therapy without surgical excision. This treatment sequence reduces the rate of recurrence.
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Affiliation(s)
- Hasan Karanlik
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Turkey
| | | | - Serife Simsek
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Turkey
| | | | - Mustafa Tukenmez
- Department of General Surgery, Istanbul Medical Faculty, Istanbul University, Turkey
| | - Dilek Sahin
- Department of Radiology, Institute of Oncology, Istanbul University, Turkey
| | - Memduh Dursun
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Turkey
| | - Sidika Kurul
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Turkey
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Abstract
BACKGROUND The aim of this study was to identify the axillopectoral muscle anomaly commonly known as Langer's axillary arch, and to understand its importance in surgical procedures of the axilla. PATIENTS AND METHODS Between 2009 and 2011, 758 patients underwent sentinel lymph node biopsy, axillary dissection, or both. Patients with Langer's axillary arch were identified and assessed retrospectively. The decision to cut or preserve the axillary arch was made based on clinical judgment, and patients were followed-up accordingly to monitor for adverse outcomes. RESULTS Of the 758 patients who underwent axillary procedures, 9 (1.2%) were found to have a Langer's axillary arch. In 2 patients the arch was cut, and in 7 patients it was preserved. No adverse outcomes were identified in any of the patients upon follow-up. CONCLUSION Langer's axillary arch is a unique anatomic anomaly of the axillary region that may be problematic due to the potential risks of lymphedema and vascular or nerve compression. It is important for surgeons and radiologists alike to be aware of this anatomic variation in order to properly identify it and respond appropriately based on clinical judgment, and to complete close follow-up of the patient due to the potentially increased risk of adverse outcomes.
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Affiliation(s)
- Hasan Karanlik
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Capa, Turkey
| | - Alisan Fathalizadeh
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Burak Ilhan
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Capa, Turkey
| | - Kursat Serin
- Department of Surgery, Istanbul Medical Faculty, Istanbul University, Capa, Turkey
| | - Sidika Kurul
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Capa, Turkey
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14
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Song Y, Gilbert D, O’Sullivan TN, Yang C, Pan W, Fathalizadeh A, Lu L, Haines DC, Martin PL, Van Dyke T. Carcinoma initiation via RB tumor suppressor inactivation: a versatile approach to epithelial subtype-dependent cancer initiation in diverse tissues. PLoS One 2013; 8:e80459. [PMID: 24312475 PMCID: PMC3846618 DOI: 10.1371/journal.pone.0080459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/03/2013] [Indexed: 01/02/2023] Open
Abstract
Carcinomas arise in a complex microenvironment consisting of multiple distinct epithelial lineages surrounded by a variety of stromal cell types. Understanding cancer etiologies requires evaluating the relationship among cell types during disease initiation and through progression. Genetically engineered mouse (GEM) models facilitate the prospective examination of early oncogenic events, which is not possible in humans. Since most solid tumors harbor aberrations in the RB network, we developed an inducible GEM approach for the establishment and assessment of carcinoma initiation in a diverse range of epithelial tissues and subtypes upon inactivation of RB-mediated tumor suppression (RB-TS). The system allows independent assessment of epithelial subtypes that express either cytokeratins (K) 18 or 19. By Cre-dependent expression of a protein that dominantly inactivates RB and functionally redundant proteins p107 and p130, neoplasia could be initiated in either K18 or K19 expressing cells of numerous tissues. By design, because only a single pathway aberration was engineered, carcinomas developed stochastically only after long latency. Hence, this system, which allows for directed cell type-specific carcinoma initiation, facilitates further definition of events that can progress neoplasms to aggressive cancers via engineered, carcinogen-induced and/or spontaneous evolution.
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Affiliation(s)
- Yurong Song
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, United States of America
| | - Debra Gilbert
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, United States of America
| | - T. Norene O’Sullivan
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, United States of America
| | - Chunyu Yang
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Wenqi Pan
- Department of Cell and Developmental Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Lucy Lu
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, United States of America
| | - Diana C. Haines
- Pathology/Histotechnology Laboratory, SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Philip L. Martin
- Center for Advanced Preclinical Research, SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Terry Van Dyke
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, United States of America
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15
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Song Y, Yang C, Pan W, Fathalizadeh A, Lu L, Gilbert D, O'Sullivan TN, Haines DC, Martin PL, Van Dyke T. Abstract 1577: Subtype dependent carcinoma initiation by Rb tumor suppressor inactivation in multiple epithelial tissues. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-1577] [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: 11/16/2022]
Abstract
Abstract
Carcinomas arise in a complex microenvironment consisting of multiple distinct epithelial lineages surrounded by mesenchymal cells. Of major importance is to understand the relationship among cell types, initiation event, and ultimate cancer outcome. Mouse models facilitate the prospective examination of early oncogenic events, which is not feasible in humans, permitting an analysis of epithelial subtype susceptibility. Since most solid tumors harbor aberrations in the pRb network, we assessed the susceptibility of epithelial subtypes expressing cytokeratin (K) 18 or K19 to the disruption of
Rb tumor suppression (Rb-TS) in vivo. Tumorigenesis could be initiated in either K18- or
K19-expressing cells. However, the susceptibility of epithelial tissues was subtype-dependent. K19 cells were more prone to hyperplasia and neoplasia than
K18 targeted cells. Given that a single genetic event was engineered, a small percentage of animals developed carcinoma/adenocarcinoma, providing the opportunity to define progression events via engineering or spontaneous evolution. To extend our analysis to a specific tissue, we employed a prostate-specific Cre line to target either K18- or K19-expressing prostate epithelial cells. Differential responses observed in the frequency and extent of premalignant hyperplastic lesions strongly supported the notion of cell type-dependent susceptibility to Rb-TS inactivation. Our data suggest that the tumorigenic consequences of a single initiation event are dictated by cellular subtype distinctiveness, underscoring the importance of the tumor cell of origin.
Citation Format: Yurong Song, Chunyu Yang, Wenqi Pan, Alisan Fathalizadeh, Lucy Lu, Debra Gilbert, T. Norene O'Sullivan, Diana C. Haines, Philip L. Martin, Terry Van Dyke. Subtype dependent carcinoma initiation by Rb tumor suppressor inactivation in multiple epithelial tissues. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1577. doi:10.1158/1538-7445.AM2013-1577
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Affiliation(s)
- Yurong Song
- 1Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Chunyu Yang
- 2University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Wenqi Pan
- 2University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Lucy Lu
- 1Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Debra Gilbert
- 1Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | | | | | - Terry Van Dyke
- 1Frederick National Laboratory for Cancer Research, Frederick, MD
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16
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Ozbay I, Kucucuk S, Fayda M, Serarslan B, Kizir A, Oral E, Saglam E, Fathalizadeh A, Kemikler G, Aslay I. PO-400 THE CLINICAL APPLICATIONS OF SURFACE HDR LEIPZIG APPLICATORS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)72366-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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