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Gazivoda V, Prioli KM, Li AC, Pizzi L, Laird AM, Beninato T. Which Localizing Strategy is the Most Cost-Effective in Reoperative Primary Hyperparathyroidism? J Surg Res 2024; 296:547-555. [PMID: 38340488 DOI: 10.1016/j.jss.2024.01.015] [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: 06/07/2023] [Revised: 12/03/2023] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION 2%-10% of patients with primary hyperparathyroidism (PHPT) who undergo parathyroidectomy develop persistent/recurrent disease. The aim of this study was to determine which preoperative localization method is most cost-effective in reoperative PHPT. METHODS Clinical decision analytic models comparing cost-effectiveness of localizing studies in reoperative PHPT were constructed using TreeAge Pro. Cost and probability assumptions were varied via Probabilistic Sensitivity Analysis (PSA) to test the robustness of the base case models. RESULTS Base case analysis of model 1 revealed ultrasound (US)-guided fine-needle aspiration with PTH assay as most cost-effective after localizing US. This was confirmed on PSA of model 1. Model 2 showed four-dimensional computed tomography (4D-CT) as most cost-effective after negative US. If not localized by US, on PSA, 4D-CT was the next most cost-effective test. CONCLUSIONS US-guided FNA with PTH is the most cost-effective confirmatory test after US localization. 4D-CT should be considered as the next best test after negative US.
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Affiliation(s)
- Victor Gazivoda
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Katherine M Prioli
- Center for Health Outcomes, Policy & Economics, Rutgers University, Piscataway, New Jersey
| | - Albert C Li
- Section of Vascular and Interventional Radiology, Department of Diagnostic Radiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Laura Pizzi
- Center for Health Outcomes, Policy & Economics, Rutgers University, Piscataway, New Jersey
| | - Amanda M Laird
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Toni Beninato
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
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Manzella A, Kravchenko T, Kheng M, Chao J, Laird AM, Pitt HA, Beninato T. Effects of the COVID-19 pandemic on endocrine operations in the United States. Am J Surg 2024; 228:22-29. [PMID: 37659868 DOI: 10.1016/j.amjsurg.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/13/2023] [Accepted: 08/07/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic disrupted the United States (US) healthcare system. Endocrine operations are predominantly elective and were likely affected. Therefore, our aim was to determine the effect of the pandemic on endocrine operations. STUDY DESIGN The Vizient Clinical Data Base® was examined for cases from 1/2019-12/2022 using ICD10 and CPT codes for thyroid, parathyroid, and adrenal operations. Control chart analysis identified trends in operative volume. Negative binomial regression was utilized to analyze demographic trends. RESULTS Monthly volumes for all operations from 515 hospitals decreased at the beginning of 2020, except for operations for adrenal malignancy. Inpatient operations (Thyroid -17.1%, Parathyroid -20.9%, p < 0.001 for both) experienced more significant and longer lasting disruptions than outpatient operations (Thyroid -2.6%, p = 0.883, Parathyroid -9.1%, p = 0.098). CONCLUSIONS The COVID-19 pandemic disrupted endocrine operations across the US. While all adrenal operations and outpatient thyroid and parathyroid operations have returned to pre-pandemic levels, inpatient operations for thyroid and parathyroid remain decreased.
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Affiliation(s)
- Alexander Manzella
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Timothy Kravchenko
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Marin Kheng
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Joshua Chao
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Amanda M Laird
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Henry A Pitt
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Toni Beninato
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
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Tumati A, Egan CE, Lee-Saxton YJ, Marshall TE, Lee J, Jain K, Heymann JJ, Gokozan H, Azar SA, Schwarz J, Keutgen XM, Laird AM, Beninato T, Zarnegar R, Fahey TJ, Finnerty BM. Clinical utility of a microRNA classifier in cytologically indeterminate thyroid nodules with RAS mutations: A multi-institutional study. Surgery 2024; 175:234-240. [PMID: 37907382 DOI: 10.1016/j.surg.2023.07.042] [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: 02/06/2023] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Molecular testing guides the management of cytologically indeterminate thyroid nodules. We evaluated the real-world clinical benefit of a commercially available thyroid mutation panel plus microRNA risk classifier in classifying RAS-mutated nodules. METHODS We performed a subgroup analysis of the results of molecular testing of Bethesda III/IV nodules using the ThyGenX/ThyGeNEXT-ThyraMIR platform at 3 tertiary-care centers between 2017 and 2021, defining a positive result as 10% or greater risk of malignancy. RESULTS We identified 387 nodules from 375 patients (70.7% female, median age 59.3 years) who underwent testing. Positive nodules (32.3%) were associated with increased surgical intervention (74.4% vs 14.9%, P < .0001) and carcinoma on surgical pathology (46.4% vs 3.4%, P < .0001) compared to negative modules. RAS mutations were the most common mutations, identified in 71 of 380 (18.7%) nodules, and were classified as ThyraMIR- (28 of 71; 39.4%) or ThyraMIR+ (43 of 71; 60.6%). Among RAS-mutated nodules, there was no significant difference in operative rate (P = .2212) or carcinoma diagnosis (P = .6277) between the ThyraMIR+ and ThyraMIR- groups, and the sensitivity, specificity, negative predictive value, and positive predictive value of ThyraMIR were 64.7%, 34.8%, 40.0%, and 59.5%, respectively. CONCLUSION Although testing positive is associated with malignancy in surgical pathology, the ThyraMIR classifier failed to differentiate between benign and malignant RAS-mutated nodules. Diagnostic lobectomy should be considered for RAS-mutated nodules, regardless of microRNA expression status.
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Affiliation(s)
- Abhinay Tumati
- Department of Surgery, Weill Cornell Medicine, New York, NY.
| | - Caitlin E Egan
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/CaitlinEgan18
| | - Yeon J Lee-Saxton
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/YeonJooLeeMD
| | - Teagan E Marshall
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/TeaganEMarshall
| | - Joyce Lee
- Department of Surgery, Weill Cornell Medicine, New York, NY
| | - Kavita Jain
- Department of Surgery, Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY. https://twitter.com/HeymannJonas
| | - Hamza Gokozan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY. https://twitter.com/GokozanMD
| | - Sara Abou Azar
- Department of Surgery, Section of Endocrine Surgery, The University of Chicago Medicine, Chicago, IL. https://twitter.com/SaraAbouAzar
| | - Jason Schwarz
- Department of Surgery, Section of Endocrine Surgery, The University of Chicago Medicine, Chicago, IL
| | - Xavier M Keutgen
- Department of Surgery, Section of Endocrine Surgery, The University of Chicago Medicine, Chicago, IL. https://twitter.com/XKeutgen
| | - Amanda M Laird
- Department of Surgery, Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. https://twitter.com/amlaird
| | - Toni Beninato
- Department of Surgery, Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. https://twitter.com/BeninatoToni
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/RasaZarnegarMD
| | - Thomas J Fahey
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/tjf3endosurg
| | - Brendan M Finnerty
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/FinnertyMD
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Chao JC, Kheng M, Manzella A, Beninato T, Laird AM. Malpractice litigation after thyroid surgery: What factors favor surgeons? Surgery 2024; 175:90-98. [PMID: 37985316 DOI: 10.1016/j.surg.2023.04.071] [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: 02/06/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Litigation impacts physicians financially, reputationally, and professionally. Although thyroid surgery has favorable patient outcomes, litigation persists. We aimed to characterize malpractice claims after thyroidectomy and investigate which factors favor physicians. METHODS We queried the Westlaw legal database using the terms "thyroidectomy" and "medical malpractice" to identify malpractice cases brought against surgeons from 1949 to 2022. We collected and analyzed demographic; clinical; surgical; and legal data, including year, cause for initiating litigation, verdict, state where the lawsuit was brought, and the state's tort reform status. RESULTS Of the 68 cases included, medical negligence was the most common cause of action, followed by failure to provide adequate informed consent. The most common inciting surgical event was recurrent laryngeal nerve injury (n = 34, 50%). Surgeons prevailed more often overall (n = 53, 77.9%) and in 11 (91.7%) of the 12 cases treated at academic institutions. The 3 endocrine surgery fellowship-trained surgeons all prevailed in their cases. Of the 15 cases in which patients prevailed, 12 (80%) of which were decided by a jury, the median damages awarded were $569,668 (interquartile range $341,146-$2,594,050). In the 53 cases won by surgeons, 26 were jury decisions (49.1%). Surgeons prevailed in 87.5% of cases brought in the 24 states with tort reform and in 72.7% in the 44 states without tort reform. CONCLUSION Non-jury cases and operations done at academic institutions appear to favor decisions for the defendant. Although not statistically significant, all endocrine surgery fellowship-trained defendants won. Where tort reforms are in place, surgeons tend to prevail.
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Affiliation(s)
- Joshua C Chao
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
| | - Marin Kheng
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Alexander Manzella
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Toni Beninato
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Amanda M Laird
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Davis CH, Laird AM, Libutti SK. Resistant gastroenteropancreatic neuroendocrine tumors: a definition and guideline to medical and surgical management. Proc AMIA Symp 2023; 37:104-110. [PMID: 38174011 PMCID: PMC10761146 DOI: 10.1080/08998280.2023.2284039] [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: 08/22/2023] [Accepted: 11/07/2023] [Indexed: 01/05/2024] Open
Abstract
Gastroenteropancreatic neuroendocrine tumors (NETs), also historically known as carcinoids, are tumors derived of hormone-secreting enteroendocrine cells. Carcinoids may be found in the esophagus, stomach, small intestine, appendix, colon, rectum, or pancreas. The biologic behavior of carcinoids differs based on their location, with gastric and appendiceal NETs among the least aggressive and small intestinal and pancreatic NETs among the most aggressive. Ultimately, however, biologic behavior is most heavily influenced by tumor grade. The incidence of NETs has increased by 6.4 times over the past 40 years. Surgery remains the mainstay for management of most carcinoids. Medical management, however, is a useful adjunct and/or definitive therapy in patients with symptomatic functional carcinoids, in patients with unresectable or incompletely resected carcinoids, in some cases of recurrent carcinoid, and in postoperative patients to prevent recurrence. Functional tumors with persistent symptoms or progressive metastatic carcinoids despite therapy are called "resistant" tumors. In patients with unresectable disease and/or carcinoid syndrome, an array of medical therapies is available, mainly including somatostatin analogues, molecular-targeted therapy, and peptide receptor radionuclide therapy. Active research is ongoing to identify additional targeted therapies for patients with resistant carcinoids.
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Affiliation(s)
- Catherine H. Davis
- Division of Surgical Oncology, Baylor University Medical Center, Dallas, Texas, USA
- Texas A&M University School of Medicine, Dallas, Texas, USA
| | - Amanda M. Laird
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
| | - Steven K. Libutti
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
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Manzella A, Laird AM, Beninato T. Association of Medicaid expansion of the Affordable Care Act with operations for benign endocrine surgical disease. Am J Surg 2023; 225:679-684. [PMID: 36334948 DOI: 10.1016/j.amjsurg.2022.10.046] [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: 08/04/2022] [Revised: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022]
Abstract
•Background: The Affordable Care Act's Medicaid expansion increased insurance coverage and access to care for endocrine cancers, though impact on benign endocrine disease is unknown. •Methods: Patients undergoing operations for benign thyroid, parathyroid, and adrenal disease were collected from the Vizient® Clinical Data Base from 2009 to 2016 and grouped by state Medicaid expansion status in January 2014. Insurance coverage was analyzed by difference-in-differences analysis, and logistic regression evaluated odds of operation by insurance status. •Results: 134,242 patients were included. Medicaid coverage in expansion states increased for all operations (Adj-DD 5.78%, p < 0.001) with decreases in uninsured and private insurance. Medicaid patients had increased odds of undergoing thyroid operations (OR 1.56, p < 0.001) and decreased odds of parathyroid (OR 0.68, p < 0.001) or adrenal operations (OR 0.70, p < 0.001) versus private insurance. •Conclusion: Medicaid expansion increased insurance coverage for benign endocrine disease, however, barriers remain for Medicaid patients with parathyroid and adrenal disease.
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Affiliation(s)
- Alexander Manzella
- Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, USA.
| | - Amanda M Laird
- Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, USA
| | - Toni Beninato
- Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, USA
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Davis CH, Spinrad M, Beninato T, Laird AM, Grandhi MS, Pitt SC, Pitt HA. Radical antegrade modular pancreatosplenectomy (RAMPS): does adrenalectomy alter outcomes? HPB (Oxford) 2023; 25:311-319. [PMID: 36641327 DOI: 10.1016/j.hpb.2022.12.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/28/2022] [Accepted: 12/09/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Radical antegrade modular pancreatosplenectomy (RAMPS) has oncologic superiority compared to a standard distal pancreatectomy (DP). For tumors invading into the adrenal gland, a posterior RAMPS takes the left adrenal gland en bloc with the pancreas specimen. The aim of this analysis is to determine whether addition of adrenalectomy alters the outcomes of DP. METHODS The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Procedure-Targeted Pancreatectomy database was accessed from 2014 to 2019. Patients with pancreatic ductal adenocarcinoma (PDAC) undergoing posterior RAMPS were compared to patients having a standard DP. 30-day outcomes were analyzed using multivariable regression. RESULTS 3467 PDAC patients underwent DP; 159 (4.6%) also had an adrenalectomy. Posterior RAMPS patients had higher T stage (T3-4 77% vs. 58%, p < 0.01). On multivariable analysis, posterior RAMPS patients had worse perioperative outcomes including more transfusions (OR 2.78, p < 0.01), serious morbidity (OR 1.45, p = 0.04), prolonged hospital stay (OR 1.36, p < 0.05), and less optimal pancreatic surgery (OR 0.61, p < 0.01). CONCLUSION Radical antegrade modular pancreatosplenectomy with adrenalectomy (posterior RAMPS) is associated with worse perioperative outcomes compared to a standard distal pancreatectomy. Improved oncologic outcomes must be weighed against higher perioperative morbidity when selecting patients for this more extensive surgical resection.
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Affiliation(s)
- Catherine H Davis
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ, USA.
| | - Michael Spinrad
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ, USA
| | - Toni Beninato
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ, USA
| | - Amanda M Laird
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ, USA
| | - Miral S Grandhi
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ, USA
| | - Susan C Pitt
- Division of Endocrine Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Henry A Pitt
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ, USA.
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8
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Collins RA, DiGennaro C, Beninato T, Gartland RM, Chaves N, Broekhuis JM, Reddy L, Lee J, Deimiller A, Alterio MM, Campbell MJ, Lee YJ, Khilnani TK, Stewart LA, O’Brien MA, Alvarado MVY, Zheng F, McAneny D, Liou R, McManus C, Dream SY, Wang TS, Yen TW, Alhefdhi A, Finnerty BM, Fahey TJ, Graves CE, Laird AM, Nehs MA, Drake FT, Lee JA, McHenry CR, James BC, Pasieka JL, Kuo JH, Lubitz CC. Limited disease progression in endocrine surgery patients with treatment delays due to COVID-19. Surgery 2023; 173:93-100. [PMID: 36210185 PMCID: PMC9420726 DOI: 10.1016/j.surg.2022.06.043] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic profoundly impacted the delivery of care and timing of elective surgical procedures. Most endocrine-related operations were considered elective and safe to postpone, providing a unique opportunity to assess clinical outcomes under protracted treatment plans. METHODS American Association of Endocrine Surgeon members were surveyed for participation. A Research Electronic Data Capture survey was developed and distributed to 27 institutions to assess the impact of COVID-19-related delays. The information collected included patient demographics, primary diagnosis, resumption of care, and assessment of disease progression by the surgeon. RESULTS Twelve out of 27 institutions completed the survey (44.4%). Of 850 patients, 74.8% (636) were female; median age was 56 (interquartile range, 44-66) years. Forty percent (34) of patients had not been seen since their original surgical appointment was delayed; 86.2% (733) of patients had a delay in care with women more likely to have a delay (87.6% vs 82.2% of men, χ2 = 3.84, P = .05). Median duration of delay was 70 (interquartile range, 42-118) days. Among patients with a delay in care, primary disease site included thyroid (54.2%), parathyroid (37.2%), adrenal (6.5%), and pancreatic/gastrointestinal neuroendocrine tumors (1.3%). In addition, 4.0% (26) of patients experienced disease progression and 4.1% (24) had a change from the initial operative plan. The duration of delay was not associated with disease progression (P = .96) or a change in operative plan (P = .66). CONCLUSION Although some patients experienced disease progression during COVID-19 delays to endocrine disease-related care, most patients with follow-up did not. Our analysis indicated that temporary delay may be an acceptable course of action in extreme circumstances for most endocrine-related surgical disease.
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Affiliation(s)
- Reagan A. Collins
- Department of Surgery, Massachusetts General Hospital, Boston, MA,Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX,Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Catherine DiGennaro
- Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Toni Beninato
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Natalia Chaves
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jordan M. Broekhuis
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - Lekha Reddy
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jenna Lee
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Maeve M. Alterio
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | | | - Yeon Joo Lee
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Latoya A. Stewart
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Mollie A. O’Brien
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, MA
| | | | - Feibi Zheng
- Department of Surgery, Baylor College of Medicine, Houston, TX
| | - David McAneny
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, MA
| | - Rachel Liou
- Section of Endocrine Surgery, Columbia University, New York, NY
| | | | - Sophie Y. Dream
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Tracy S. Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Tina W. Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Amal Alhefdhi
- Department of General Surgery, Breast and Endocrine Section, King Faisal Specialist Hospital and Research Centre, Al Mathar Ash Shamali, Riyadh, Saudi Arabia
| | - Brendan M. Finnerty
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Thomas J. Fahey
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Amanda M. Laird
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Matthew A. Nehs
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA
| | | | - James A. Lee
- Section of Endocrine Surgery, Columbia University, New York, NY
| | - Christopher R. McHenry
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Benjamin C. James
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - Janice L. Pasieka
- Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jennifer H. Kuo
- Section of Endocrine Surgery, Columbia University, New York, NY
| | - Carrie Cunningham Lubitz
- Department of Surgery, Massachusetts General Hospital, Boston, MA,Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA,Reprint requests: Carrie Cunningham Lubitz, MD, MPH, 55 Fruit Street, Boston, MA 02114
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9
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Greenberg JA, Thiesmeyer JW, Ullmann TM, Egan CE, Valle Reyes F, Moore MD, Ivanov NA, Laird AM, Finnerty BM, Zarnegar R, Fahey TJ, Beninato T. Association of the Affordable Care Act with access to highest-volume centers for patients with thyroid cancer. Surgery 2021; 171:132-139. [PMID: 34489109 DOI: 10.1016/j.surg.2021.04.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/02/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Disparities exist in access to high-volume surgeons, who have better outcomes after thyroidectomy. The association of the Affordable Care Act's Medicaid expansion with access to high-volume thyroid cancer surgery centers remains unclear. METHODS The National Cancer Database was queried for all adult thyroid cancer patients diagnosed from 2010 to 2016. Hospital quartiles (Q1-4) defined by operative volume were generated. Clinicodemographics and adjusted odds ratios for treatment per quartile were analyzed by insurance status. An adjusted difference-in-differences analysis examined the association between implementation of the Affordable Care Act and changes in payer mix by hospital quartile. RESULTS In total, 241,448 patients were included. Medicaid patients were most commonly treated at Q3-Q4 hospitals (Q3 odds ratios 1.05, P = .020, Q4 1.11, P < .001), whereas uninsured patients were most often treated at Q2-Q4 hospitals (Q2 odds ratios 2.82, Q3 2.34, Q4 2.07, P < .001). After expansion, Medicaid patients had lower odds of surgery at Q3-Q4 compared with Q1 hospitals (odds ratios Q3 0.82, P < .001 Q4 0.85, P = .002) in expansion states, but higher odds of treatment at Q3-Q4 hospitals in nonexpansion states (odds ratios Q3 2.23, Q4 1.86, P < .001). Affordable Care Act implementation was associated with increased proportions of Medicaid patients within each quartile in expansion compared with nonexpansion states (Q1 adjusted difference-in-differences 5.36%, Q2 5.29%, Q3 3.68%, Q4 3.26%, P < .001), and a decrease in uninsured patients treated at Q4 hospitals (adjusted difference-in-differences -1.06%, P = .001). CONCLUSIONS Medicaid expansion was associated with an increased proportion of Medicaid patients undergoing thyroidectomy for thyroid cancer in all quartiles, with increased Medicaid access to high-volume centers in expansion compared with nonexpansion states.
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Affiliation(s)
- Jacques A Greenberg
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/JacquesGreenbe2
| | - Jessica W Thiesmeyer
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/JessicaThiesme1
| | - Timothy M Ullmann
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/TUllmannMD
| | - Caitlin E Egan
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/CaitlinEgan18
| | | | - Maureen D Moore
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/maureenmooremd
| | - Nikolay A Ivanov
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/n_a_ivanov
| | - Amanda M Laird
- Department of Surgery Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. https://twitter.com/amlaird
| | - Brendan M Finnerty
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/FinnertyMD
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/RasaZarnegarMD
| | - Thomas J Fahey
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/tjf3endosurg
| | - Toni Beninato
- Department of Surgery Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
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10
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Abstract
Gastric and duodenal neuroendocrine tumors (NETs) are increasing in incidence as a result of increased detection and awareness of neuroendocrine tumors as distinct tumor types. The three types of gastric NETs and duodenal NETs have different etiologies and tumor-specific factors, such as grade, location, and hormone-production, and the clinical settings influence management. Options for treatment include removal by local endoscopic resection and surgical resection. Medical therapy is used to treat the inciting condition or as systemic therapy in advanced disease. Although the overall prognosis for most is good, higher grade tumors behave aggressively and have reduced survival.
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Affiliation(s)
- Amanda M Laird
- Section of Endocrine Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ 08903, USA.
| | - Steven K Libutti
- Section of Endocrine Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ 08903, USA
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11
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Beninato T, Laird AM, Graves CE, Drake FT, Alhefdhi A, Lee JA, Kuo JH, Grubbs EG, Wang TS, Pasieka JL, Lubitz CC. Impact of the COVID-19 pandemic on the practice of endocrine surgery. Am J Surg 2021; 223:670-675. [PMID: 34315576 PMCID: PMC8294714 DOI: 10.1016/j.amjsurg.2021.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 12/27/2022]
Abstract
Background This study investigates the impact of the COVID-19 pandemic on endocrine surgeons. Methods A survey on the professional, educational, and clinical impact was sent to active and corresponding members of the American Association of Endocrine Surgeons (AAES) in September 2020. Chi-square and paired t-test were used for analysis. Results 77 surgeons responded (14.8 %). All reported suspension of elective surgeries; 37.7 % were reassigned to other duties during this time. The median number of cases backlogged was 30 (IQR 15–50). Most surgeons reported decreased clinical volume (74.6 %). The use of virtual platforms for clinical and educational purposes increased from pre-COVID-19 levels (all p < 0.001). Use of in-office procedures (p < 0.001) and length of observation prior to discharge for thyroid surgery (p < 0.05) decreased. Conclusion The COVID-19 pandemic led to suspension of operations and decreased practice volume for endocrine surgeons. Surgeons increased use of virtual platforms, decreased in-office procedures, and decreased duration of observation for thyroid surgery in response.
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Affiliation(s)
- Toni Beninato
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ, 08903, USA.
| | - Amanda M Laird
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ, 08903, USA.
| | - Claire E Graves
- University of California Davis, 4501 X Street, Suite 3010, Sacramento, CA, 95817, USA.
| | - F Thurston Drake
- Boston Medical Center, Boston University School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA.
| | - Amal Alhefdhi
- King Faisal Specialist Hospital and Research Centre, Al Mathar Ash Shamali, Riyadh, 11564, Saudi Arabia.
| | - James A Lee
- NewYork Presbyterian Hospital-Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
| | - Jennifer H Kuo
- NewYork Presbyterian Hospital-Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
| | - Elizabeth G Grubbs
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Tracy S Wang
- Medical College of Wisconsin, 8800 West Doyne Avenue, Milwaukee, WI, 53226, USA.
| | - Janice L Pasieka
- Cumming School of Medicine, University of Calgary, 1403 29(th)Street NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Carrie C Lubitz
- Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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12
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Watari J, Vekaria S, Lin Y, Patel M, Kim H, Kang F, Lubitz S, Beninato T, Laird AM. Radiology report language positively influences adrenal incidentaloma guideline adherence. Am J Surg 2021; 223:231-236. [PMID: 34243951 DOI: 10.1016/j.amjsurg.2021.06.015] [Citation(s) in RCA: 8] [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] [Received: 03/28/2021] [Revised: 06/16/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adrenal incidentalomas are common radiographic findings. Guidelines recommend biochemical and radiographic surveillance of adrenal incidentalomas. We investigated if patients were appropriately referred for outpatient evaluation. METHODS Retrospective chart review was performed to identify patients with adrenal masses on imaging between November 7, 2016 and November 7, 2017. Demographic information, medical history, and outpatient referral information was collected. RESULTS 11,723 computed tomography (CT) scans of the chest and/or abdomen/pelvis were performed. 246 patients were noted to have adrenal incidentalomas and met inclusion criteria. The CT report recommended follow-up in 63/246 cases (25.6%). 38/246 (15.4%) patients were referred for evaluation. Age, adrenal nodule size, and type of evaluating provider did not affect referral. A radiology report recommending follow-up was associated with increased referral rate (OR 5.441, 95% CI: 2.491-11.887). CONCLUSION There was low outpatient referral for adrenal incidentalomas. Language in the radiology report significantly influenced referral rates and may be an important resource for improving guideline adherence.
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Affiliation(s)
- Jessica Watari
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA.
| | - Shivani Vekaria
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Yong Lin
- Biometrics Division, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Manank Patel
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Hyon Kim
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Francis Kang
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA
| | - Sara Lubitz
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Toni Beninato
- Section of Endocrine Surgery, Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Amanda M Laird
- Section of Endocrine Surgery, Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
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13
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Laird AM, Beninato T. Total Thyroidectomy and Low-Risk Thyroid Cancer: Are We Treating the Surgeon or Patient? Ann Surg Oncol 2021; 28:4080-4081. [PMID: 33866474 DOI: 10.1245/s10434-021-09997-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Amanda M Laird
- Division of Surgical Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. .,Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Toni Beninato
- Division of Surgical Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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14
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Beninato T, Laird AM. Is Less More? Adoption of Treatment Guidelines for Low-Risk Papillary Thyroid Cancer. Ann Surg Oncol 2021; 28:3461-3462. [PMID: 33860359 DOI: 10.1245/s10434-021-09996-8] [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: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Toni Beninato
- Department of Surgery, Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Amanda M Laird
- Department of Surgery, Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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15
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Romero-Velez G, Laird AM, Barajas ME, Sierra-Salazar M, Herrera MF, Libutti SK, Parides MK, Pereira X, McAuliffe JC. Outcomes of Adrenalectomy and the Aldosteronoma Resolution Score in the Black and Hispanic Population. World J Surg 2021; 45:1475-1482. [PMID: 33554297 PMCID: PMC8026410 DOI: 10.1007/s00268-021-05967-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
Background Outcomes after adrenalectomy in patients with primary aldosteronism (PA) are variable. The aldosteronoma resolution score (ARS) uses preoperative variables to calculate a score that identifies those patients that are more likely to have resolution of hypertension after adrenalectomy. We aim to determine the efficacy of adrenalectomy and whether the ARS accurately predicts clinical success in a Black and Hispanic population. Methods We reviewed patients who underwent adrenalectomy for PA from 2004 to 2018 at two academic centers treating primarily Hispanic and Black patients. Postoperative outcomes were evaluated based on the primary aldosteronism surgical outcome consensus criterion. Retrospectively, the accuracy of ARS was determined by a receiver operating characteristic curve and the area under the curve (AUC). Results Forty-three Hispanic and 10 Black patients underwent adrenalectomy for PA. Twenty-two patients (41.5%) had complete clinical success. Variables associated with complete clinical success in the univariate analysis were female gender (p = 0.026), younger age (p = 0.001), lower preoperative aldosterone (p = 0.035), lower preoperative systolic blood pressure (p = 0.001), fewer number of preoperative antihypertensive medications (p = 0.007) and a higher ARS (p = 0.003). On multivariate analysis, only fewer number of preoperative antihypertensive medications was independently associated with complete clinical success (p = 0.026). The AUC of the ARS was 0.746. Conclusion The rate of clinical success from adrenalectomy is good for Hispanic and Black patients with PA. Our analysis shows that the ARS is an accurate test of clinical success in Hispanic and Black patients. The ARS may be utilized preoperatively to frame expectations after adrenalectomy in these populations.
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Affiliation(s)
- Gustavo Romero-Velez
- General Surgery, Department of Surgery, Montefiore Medical Center, The Bronx, NY, USA
| | - Amanda M Laird
- Section of Endocrine Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Manuel E Barajas
- Division of Endocrine Surgery, Department of General Surgery, Instituto Nacional de Ciencias Medicas Y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Mauricio Sierra-Salazar
- Division of Endocrine Surgery, Department of General Surgery, Instituto Nacional de Ciencias Medicas Y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Miguel F Herrera
- Division of Endocrine Surgery, Department of General Surgery, Instituto Nacional de Ciencias Medicas Y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | - Michael K Parides
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, The Bronx, NY, USA
| | - Xavier Pereira
- General Surgery, Department of Surgery, Montefiore Medical Center, The Bronx, NY, USA
| | - John C McAuliffe
- Surgical Oncology, Department of Surgery, Montefiore Medical Center, 1865 Eastchester Rd. Suite 2S7, Bronx, NY, 10461, USA.
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16
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Yeung A, Friedmann P, In H, Bloomgarden N, McAuliffe JC, Libutti SK, Laird AM. Evaluation of Adrenal Vein Sampling Use and Outcomes in Patients With Primary Aldosteronism. J Surg Res 2020; 256:673-679. [PMID: 32827833 DOI: 10.1016/j.jss.2020.05.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary aldosteronism (PA) occurs in 10%-20% of patients with resistant hypertension. Guidelines recommend adrenal vein sampling (AVS) to identify patients for surgical management. We evaluate the use of AVS in managing PA to better understand the selection and outcomes of medical versus surgical treatment. METHODS A retrospective review was performed, and patients were divided into those who did (AVS) and did not have AVS (non-AVS). Demographics, aldosterone and renin levels, blood pressure, comorbidities, and antihypertensive medications were recorded. Reasons to defer AVS and medical versus surgical decision-making were examined and groups were compared. RESULTS We included 113 patients; 39.8% (45/113) had AVS, whereas 60.2% (68/113) did not. Groups were similar in age, body mass index, and initial systolic blood pressure (SBP). In patients who underwent AVS, 31 of 45 (68.9%) had unilateral secretion and were referred for surgery, whereas 13 of 45 (28.9%) had bilateral secretion. Of the 31 referred for surgery, 26 underwent laparoscopic adrenalectomy, all cured; four refused surgery; and one counseled toward medical management by their physician. In 68 non-AVS patients, 6 (8.8%) underwent adrenalectomy without sampling and 2 with no clinical improvement. The remaining deferrals were because of normal or bilateral adrenal nodules on imaging (8/68, 11.8%); medical management due to poor surgical candidacy (12/68, 17.6%); patient refusal of intervention (13/68, 19.1%); or reasons not stated (28/68, 41.1%). At the follow-up, patients who underwent AVS had lower median SBP (135.4 mmHg versus 144.7 mmHg, P = 0.0241) and shorter follow-up (17.7 mo versus 54.0 mo, P < 0.0001). Surgically managed patients had biochemical resolution of PA with normalization of potassium levels (3.6 to 4.7mEq/L, P < 0.00001). CONCLUSIONS AVS correctly selects patients for surgical management avoiding unnecessary surgery. However, despite guidelines, AVS is not always pursued as part of PA treatment, potentially excluding surgical candidates.
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Affiliation(s)
- Alyssa Yeung
- Albert Einstein College of Medicine, Bronx, New York.
| | | | - Haejin In
- Surgical Oncology, Department of Surgery, Montefiore Medical Center, Bronx, New York
| | - Noah Bloomgarden
- Endocrinology, Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - John C McAuliffe
- Surgical Oncology, Department of Surgery, Montefiore Medical Center, Bronx, New York
| | | | - Amanda M Laird
- Endocrine Surgery, Rutgers Cancer Institute, New Brunswick, New Jersey
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17
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Bresler A, Mehta V, Schiff BA, Smith RV, Khader S, Ramos‐Rivera G, Lin J, Libutti SK, Laird AM, Ow TJ. Comparison of Bethesda cytopathology classification to surgical pathology across racial‐ethnic groups. Head Neck 2019; 41:2340-2345. [DOI: 10.1002/hed.25707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 12/19/2018] [Accepted: 01/29/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Amishav Bresler
- Department of Otorhinolaryngology‐Head and Neck SurgeryRutgers New Jersey Medical School Newark New Jersey
| | - Vikas Mehta
- Department of Otorhinolaryngology‐Head and Neck SurgeryMontefiore Medical Center/Albert Einstein College of Medicine New York New York
| | - Bradley A. Schiff
- Department of Otorhinolaryngology‐Head and Neck SurgeryMontefiore Medical Center/Albert Einstein College of Medicine New York New York
| | - Richard V. Smith
- Department of Otorhinolaryngology‐Head and Neck SurgeryMontefiore Medical Center/Albert Einstein College of Medicine New York New York
- Department of PathologyMontefiore Medical Center/Albert Einstein College of Medicine New York New York
| | - Samer Khader
- Department of PathologyMontefiore Medical Center/Albert Einstein College of Medicine New York New York
| | - Gloria Ramos‐Rivera
- Department of PathologyMontefiore Medical Center/Albert Einstein College of Medicine New York New York
| | - Juan Lin
- Department of Epidemiology & Population HealthAlbert Einstein College of Medicine New York New York
| | - Steven K. Libutti
- Director, Rutgers Cancer Institute of New Jersey, Vice Chancellor for Cancer Programs, Rutgers Biomedical and Health Sciences, Senior Vice President, Oncology Services, RWJBarnabas HealthProfessor of Surgery, Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey
| | - Amanda M. Laird
- Associate Professor of Surgery, Chief, Section of Endocrine Surgery, Rutgers Cancer Institute of New JerseyAssociate Professor of Surgery, Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey
| | - Thomas J. Ow
- Department of Otorhinolaryngology‐Head and Neck SurgeryMontefiore Medical Center/Albert Einstein College of Medicine New York New York
- Department of PathologyMontefiore Medical Center/Albert Einstein College of Medicine New York New York
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18
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Laird AM, Bliton J, Friedmann P, McAuliffe JC, Libutti SK, In H. Minimally Invasive Surgery for Pancreatic Neuroendocrine Tumors Results in Shorter Length of Stay. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.321] [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: 10/28/2022]
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19
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Wilkinson R, Lotay G, Lennarz A, Ruiz C, Christian G, Akers C, Catford WN, Chen AA, Connolly D, Davids B, Hutcheon DA, Jedrejcic D, Laird AM, Martin L, McNeice E, Riley J, Williams M. Direct Measurement of the Key E_{c.m.}=456 keV Resonance in the Astrophysical ^{19}Ne(p,γ)^{20}Na Reaction and Its Relevance for Explosive Binary Systems. Phys Rev Lett 2017; 119:242701. [PMID: 29286739 DOI: 10.1103/physrevlett.119.242701] [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] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Indexed: 06/07/2023]
Abstract
We have performed a direct measurement of the ^{19}Ne(p,γ)^{20}Na reaction in inverse kinematics using a beam of radioactive ^{19}Ne. The key astrophysical resonance in the ^{19}Ne+p system has been definitely measured for the first time at E_{c.m.}=456_{-2}^{+5} keV with an associated strength of 17_{-5}^{+7} meV. The present results are in agreement with resonance strength upper limits set by previous direct measurements, as well as resonance energies inferred from precision (^{3}He, t) charge exchange reactions. However, both the energy and strength of the 456 keV resonance disagree with a recent indirect study of the ^{19}Ne(d, n)^{20}Na reaction. In particular, the new ^{19}Ne(p,γ)^{20}Na reaction rate is found to be factors of ∼8 and ∼5 lower than the most recent evaluation over the temperature range of oxygen-neon novae and astrophysical x-ray bursts, respectively. Nevertheless, we find that the ^{19}Ne(p,γ)^{20}Na reaction is likely to proceed fast enough to significantly reduce the flux of ^{19}F in nova ejecta and does not create a bottleneck in the breakout from the hot CNO cycles into the rp process.
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Affiliation(s)
- R Wilkinson
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - G Lotay
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
- National Physical Laboratory, Teddington, Middlesex TW11 0LW, United Kingdom
| | - A Lennarz
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - C Ruiz
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G Christian
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843-3366, USA
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843-3366, USA
- Nuclear Solutions Institute, Texas A&M University, College Station, Texas 77843-3366, USA
| | - C Akers
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - W N Catford
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - A A Chen
- Department of Physics and Astronomy, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - D Connolly
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - B Davids
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - D A Hutcheon
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - D Jedrejcic
- Colorado School of Mines, Golden, Colorado 80401, USA
| | - A M Laird
- Department of Physics, The University of York, York YO10 5DD, United Kingdom
| | - L Martin
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - E McNeice
- Department of Physics and Astronomy, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - J Riley
- Department of Physics, The University of York, York YO10 5DD, United Kingdom
| | - M Williams
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
- Department of Physics, The University of York, York YO10 5DD, United Kingdom
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20
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Abstract
Primary hyperparathyroidism is a disease that is caused by excess parathyroid hormone (PTH) secretion from 1 or more of the parathyroid glands. Surgery is the only cure. Traditional surgical management consists of a 4-gland cervical exploration. Development of imaging specific to identification of parathyroid glands and application of the rapid PTH assay to operative management have made more minimal exploration possible. There are distinct advantages and disadvantages of minimally invasive parathyroidectomy (MIP) and bilateral neck exploration (BNE). The advantages of MIP seem to outweigh those of BNE, and MIP has replaced BNE as the operation of choice by many surgeons.
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Affiliation(s)
- Amanda M Laird
- Montefiore Medical Center/Albert Einstein College of Medicine, Greene Medical Arts Pavilion, 3400 Bainbridge Avenue, 4th Floor, Bronx, NY 10467, USA.
| | - Steven K Libutti
- Montefiore Medical Center/Albert Einstein College of Medicine, Greene Medical Arts Pavilion, 3400 Bainbridge Avenue, 4th Floor, Bronx, NY 10467, USA
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21
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Rosenberg AM, Friedmann P, Del Rivero J, Libutti SK, Laird AM. Resection versus expectant management of small incidentally discovered nonfunctional pancreatic neuroendocrine tumors. Surgery 2015; 159:302-9. [PMID: 26547726 DOI: 10.1016/j.surg.2015.10.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/31/2015] [Accepted: 10/14/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sporadic, nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) are diagnosed with increasing frequency. We compared the risk of tumor growth, metastasis, and mortality between patients treated versus those treated expectantly. METHOD A retrospective study of patients seen at our institution with sporadic NF-PNETs, with ≥ 12 months of follow-up. Kaplan-Meier analysis was performed. RESULTS Between 1999 and 2014, 35 patients with an incidentally discovered nonfunctional PNET were identified. Twenty underwent resection and 15 were followed with imaging. In the operative group, 8 had NF-PNETs < 2 cm, while 12 had NF-PNETs ≥ 2 cm. In the nonoperative expectant management by serial imaging group, 10 had NF-PNETs < 2 cm while 5 had NF-PNETs ≥ 2 cm. Small NF-PNETs (<2 cm) in either the operative or nonoperative groups demonstrated no evidence of progression or metastasis (median follow-up of 27.8 months). Morbidity in the operative group was 35% with pancreatic pseudocyst the most common. CONCLUSION Incidentally discovered NF-PNETs < 2 cm in size can be observed safely with serial imaging.
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Affiliation(s)
| | | | - Jaydira Del Rivero
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - Steven K Libutti
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - Amanda M Laird
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY.
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22
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Tomlinson JR, Fallis J, Laird AM, Fox SP, Akers C, Alcorta M, Bentley MA, Christian G, Davids B, Davinson T, Fulton BR, Galinski N, Rojas A, Ruiz C, de Séréville N, Shen M, Shotter AC. Measurement of 23Na(α,p)26Mg at Energies Relevant to 26Al Production in Massive Stars. Phys Rev Lett 2015; 115:052702. [PMID: 26274415 DOI: 10.1103/physrevlett.115.052702] [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] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Indexed: 06/04/2023]
Abstract
26Al is an important radioisotope in astrophysics that provides evidence of ongoing nucleosynthesis in the Galaxy. The 23Na(α, p)26Mg reaction has been identified by a sensitivity study as being one of the most important reactions for the production of 26Al in the convective C/Ne burning shell of massive stars. Owing to large uncertainties in previous experimental data, model calculations are used for the reaction rate of 23Na(α, p)26Mg in this sensitivity study. Current experimental data suggest a reaction rate a factor of ∼40 higher than model calculations. However, a new measurement of this reaction cross section has been made in inverse kinematics in the energy range E(c.m.)=1.28-3.15 MeV at TRIUMF, and found to be in reasonable agreement with the model calculation. A new reaction rate is calculated and tight constraints on the uncertainty in the production of 26Al, due to this reaction, are determined.
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Affiliation(s)
- J R Tomlinson
- The University of York, Heslington, York YO10 5DD, United Kingdom
| | - J Fallis
- TRIUMF, 4004 Westbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - A M Laird
- The University of York, Heslington, York YO10 5DD, United Kingdom
| | - S P Fox
- The University of York, Heslington, York YO10 5DD, United Kingdom
| | - C Akers
- The University of York, Heslington, York YO10 5DD, United Kingdom
- TRIUMF, 4004 Westbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - M Alcorta
- TRIUMF, 4004 Westbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - M A Bentley
- The University of York, Heslington, York YO10 5DD, United Kingdom
| | - G Christian
- TRIUMF, 4004 Westbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - B Davids
- TRIUMF, 4004 Westbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - T Davinson
- School of Physics and Astronomy, The University of Edinburgh, James Clerk Maxwell Building, Mayfield Road, Edinburgh EH9 3FD, United Kingdom
| | - B R Fulton
- The University of York, Heslington, York YO10 5DD, United Kingdom
| | - N Galinski
- TRIUMF, 4004 Westbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - A Rojas
- TRIUMF, 4004 Westbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - C Ruiz
- TRIUMF, 4004 Westbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - N de Séréville
- Institut de Physique Nucléaire d'Orsay, IN2P3-CNRS and Univ Paris-Sud, F-91405 Orsay Cedex, France
| | - M Shen
- TRIUMF, 4004 Westbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - A C Shotter
- School of Physics and Astronomy, The University of Edinburgh, James Clerk Maxwell Building, Mayfield Road, Edinburgh EH9 3FD, United Kingdom
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23
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Akers C, Laird AM, Fulton BR, Ruiz C, Bardayan DW, Buchmann L, Christian G, Davids B, Erikson L, Fallis J, Hager U, Hutcheon D, Martin L, Murphy ASJ, Nelson K, Spyrou A, Stanford C, Ottewell D, Rojas A. Measurement of radiative proton capture on 18F and implications for oxygen-neon novae. Phys Rev Lett 2013; 110:262502. [PMID: 23848867 DOI: 10.1103/physrevlett.110.262502] [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] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Indexed: 06/02/2023]
Abstract
The rate of the 18F(p,γ)19Ne reaction affects the final abundance of the γ-ray observable radioisotope 18F, produced in novae. However, no successful measurement of this reaction exists and the rate used is calculated from incomplete information on the contributing resonances. Of the two resonances thought to play a significant role, one has a radiative width estimated from the assumed analogue state in the mirror nucleus, 19F. The second does not have an analogue state assignment at all, resulting in an arbitrary radiative width being assumed. Here, we report the first successful direct measurement of the 18F(p,γ)^19Ne reaction. The strength of the 665 keV resonance (Ex=7.076 MeV) is found to be over an order of magnitude weaker than currently assumed in nova models. Reaction rate calculations show that this resonance therefore plays no significant role in the destruction of ^{18}F at any astrophysical energy.
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Affiliation(s)
- C Akers
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
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24
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Laird AM, Parikh A, Murphy ASJ, Wimmer K, Chen AA, Deibel CM, Faestermann T, Fox SP, Fulton BR, Hertenberger R, Irvine D, José J, Longland R, Mountford DJ, Sambrook B, Seiler D, Wirth HF. Is γ-ray emission from novae affected by interference effects in the 18F(p,α)15O reaction? Phys Rev Lett 2013; 110:032502. [PMID: 23373915 DOI: 10.1103/physrevlett.110.032502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Indexed: 06/01/2023]
Abstract
The (18)F(p,α)(15)O reaction rate is crucial for constraining model predictions of the γ-ray observable radioisotope (18)F produced in novae. The determination of this rate is challenging due to particular features of the level scheme of the compound nucleus, (19)Ne, which result in interference effects potentially playing a significant role. The dominant uncertainty in this rate arises from interference between J(π)=3/2(+) states near the proton threshold (S(p)=6.411 MeV) and a broad J(π)=3/2(+) state at 665 keV above threshold. This unknown interference term results in up to a factor of 40 uncertainty in the astrophysical S-factor at nova temperatures. Here we report a new measurement of states in this energy region using the (19)F((3)He,t)(19)Ne reaction. In stark contrast to previous assumptions we find at least 3 resonances between the proton threshold and E(cm)=50 keV, all with different angular distributions. None of these are consistent with J(π)=3/2(+) angular distributions. We find that the main uncertainty now arises from the unknown proton width of the 48 keV resonance, not from possible interference effects. Hydrodynamic nova model calculations performed indicate that this unknown width affects (18)F production by at least a factor of two in the model considered.
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Affiliation(s)
- A M Laird
- Department of Physics, University of York, York, United Kingdom.
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25
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Siddiqi HK, Yang HY, Laird AM, Fox AC, Doherty GM, Miller BS, Gauger PG. Utility of oral nicardipine and magnesium sulfate infusion during preparation and resection of pheochromocytomas. Surgery 2012; 152:1027-36. [DOI: 10.1016/j.surg.2012.08.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 08/16/2012] [Indexed: 01/23/2023]
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26
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Hughes DT, Laird AM, Miller BS, Gauger PG, Doherty GM. Reoperative Lymph Node Dissection for Recurrent Papillary Thyroid Cancer and Effect on Serum Thyroglobulin. Ann Surg Oncol 2012; 19:2951-7. [DOI: 10.1245/s10434-012-2380-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Indexed: 01/08/2023]
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27
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Laird AM, Gauger PG, Miller BS, Doherty GM. Evaluation of Postoperative Radioactive Iodine Scans in Patients who Underwent Prophylactic Central Lymph Node Dissection. World J Surg 2012; 36:1268-73. [DOI: 10.1007/s00268-012-1431-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [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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28
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Laird AM, Gauger PG, Doherty GM, Miller BS. Paraganglioma: not just an extra-adrenal pheochromocytoma. Langenbecks Arch Surg 2011; 397:247-53. [DOI: 10.1007/s00423-011-0871-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 11/03/2011] [Indexed: 11/29/2022]
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29
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Ruiz C, Parikh A, José J, Buchmann L, Caggiano JA, Chen AA, Clark JA, Crawford H, Davids B, D'Auria JM, Davis C, Deibel C, Erikson L, Fogarty L, Frekers D, Greife U, Hussein A, Hutcheon DA, Huyse M, Jewett C, Laird AM, Lewis R, Mumby-Croft P, Olin A, Ottewell DF, Ouellet CV, Parker P, Pearson J, Ruprecht G, Trinczek M, Vockenhuber C, Wrede C. Measurement of the Ec.m. = 184 keV resonance strength in the 26gAl (p, gamma)27 Si reaction. Phys Rev Lett 2006; 96:252501. [PMID: 16907298 DOI: 10.1103/physrevlett.96.252501] [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] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Indexed: 05/11/2023]
Abstract
The strength of the Ec.m. = 184 keV resonance in the 26gAl(p, gamma)27 reaction has been measured in inverse kinematics using the DRAGON recoil separator at TRIUMF's ISAC facility. We measure a value of omega gamma = 35 +/- 7 microeV and a resonance energy of Ec.m. = 184 +/- 1 keV, consistent with p-wave proton capture into the 7652(3) keV state in 27Si, and discuss the implications of these values for 26GAl nucleosynthesis in typical oxygen-neon white-dwarf novae.
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Affiliation(s)
- C Ruiz
- TRIUMF, Vancouver, BC V6T 2A3, Canada.
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30
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Abstract
INTRODUCTION Recent randomized prospective data suggest that early hyperglycemia is associated with excess mortality in critically ill patients, and tight glucose control leads to improved outcome. This concept has not been carefully examined in trauma patients, and the relationship of early hyperglycemia to mortality from sepsis in this population is unclear. The objective of this study was to determine the relationship different levels of early blood glucose elevation to outcome in a trauma ICU population. METHODS The records of all patients admitted to the ICU over a 2-year period at a Level I trauma center were reviewed for age, injury severity scores (ISS), admission Glasgow Coma Scale (GCS) score, base deficit (BD), blood glucose, and mortality. Three possible cutoffs in defining hyperglycemia were examined (glucose > or =110 mg/dL, > or =150 mg/dL, > or =200 mg/dL) in relation to infection and mortality. Early hyperglycemia was defined as elevated blood glucose on hospital days 1 or 2. Those with diabetes mellitus were excluded. RESULTS From 1/00-12/01, 516 eligible patients were admitted to the ICU after injury. Early hyperglycemia occurred in 483 at the > or =110 mg/dL level, 311 at the > or =150 mg/dL level, and 90 patients at the > or =200 mg/dL level. Univariate logistic regression demonstrated a significant relationship between ISS and subsequent infection(p = 0.02) and a trend toward such a relationship in GCS score, glucose > or =150 mg/dL, and glucose > or =200 mg/dL (p = 0.06, 0.12, and 0.06). A similar analysis for the relationship of these variables to eventual mortality showed a significant correlation with all examined variables except glucose > or =110 mg/dL. Multiple logistic regression to control for the effect of age, ISS, GCS score, and BD found early glucose > or =200 mg/dL to be an independent predictor of both infection and mortality while no such relationship was found with > or = 110 mg/dL or > or =150 mg/dL. CONCLUSIONS Early hyperglycemia as defined by glucose > or =200 mg/dL is associated with significantly higher infection and mortality rates in trauma patients independent of injury characteristics. This was not true at the cutoffs of > or =110 mg/dL or > or =150 mg/dL. These data support the need for a prospective analysis of tight glucose control, keeping serum glucose <200 mg/dL in critically ill trauma patients. However, aggressive maintenance of levels <110 mg/dL as reported by others may not be necessary.
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Affiliation(s)
- Amanda M Laird
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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31
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Bishop S, Azuma RE, Buchmann L, Chen AA, Chatterjee ML, D'Auria JM, Engel S, Gigliotti D, Greife U, Hernanz M, Hunter D, Hussein A, Hutcheon D, Jewett C, José J, King J, Kubono S, Laird AM, Lamey M, Lewis R, Liu W, Michimasa S, Olin A, Ottewell D, Parker PD, Rogers JG, Strieder F, Wrede C. 21Na(p,gamma)22Mg reaction and oxygen-neon novae. Phys Rev Lett 2003; 90:162501. [PMID: 12731972 DOI: 10.1103/physrevlett.90.162501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2002] [Indexed: 05/24/2023]
Abstract
The 21Na(p,gamma)22Mg reaction is expected to play an important role in the nucleosynthesis of 22Na in oxygen-neon novae. The decay of 22Na leads to the emission of a characteristic 1.275 MeV gamma-ray line. This report provides the first direct measurement of the rate of this reaction using a radioactive 21Na beam, and discusses its astrophysical implications. The energy of the important state was measured to be E(c.m.)=205.7+/-0.5 keV with a resonance strength omegagamma=1.03+/-0.16(stat)+/-0.14(sys) meV.
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Affiliation(s)
- S Bishop
- Simon Fraser University, Burnaby, British Columbia, Canada
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32
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Oliveira JM, Lepine-Szily A, Bohlen HG, Ostrowski AN, Lichtenthaler R, Laird AM, Lima GF, Maunoury L, Roussel-Chomaz P, Savajols H, Trinder W, Villari AC. Observation of the 11N ground state. Phys Rev Lett 2000; 84:4056-4059. [PMID: 10990609 DOI: 10.1103/physrevlett.84.4056] [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] [Subscribe] [Scholar Register] [Received: 11/16/1999] [Indexed: 05/23/2023]
Abstract
The ground state of the proton-rich, unbound nucleus 11N was observed, together with six excited states using the multinucleon transfer reaction 10B(14N,13B)11N at 30A MeV incident energy at Grand Accelerateur National d'Ions Lourds. Levels of 11N are observed as well defined resonances in the spectrum of the 13B ejectiles. They are localized at 1.63(5), 2.16(5), 3.06(8), 3.61(5), 4.33(5), 5.98(10), and 6.54(10) MeV above the 10C+p threshold. The ground-state resonance has a mass excess of 24.618(50) MeV; the experimental width is smaller than theoretical predictions.
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Affiliation(s)
- JM Oliveira
- IFUSP-Universidade de Sao Paulo, CP 66318, 05389-970 Sao Paulo, Brazil and CEBES-Centro de Ciencias Exatas, Biologicas e da Saude, Universidade de Sorocaba, Sorocaba, Brazil
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