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Baxter NB, Pediyakkal HF, DeShazor-Burnett LJ, Speyer CB, Richburg CE, Howard RA, Rob F, Thumma JR, Telem DA, Ehlers AP. Outcomes of Emergency Parastomal Hernia Repair in Older Adults: A Retrospective Analysis. J Surg Res 2024; 293:596-606. [PMID: 37837814 DOI: 10.1016/j.jss.2023.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/15/2023] [Accepted: 09/06/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Parastomal hernias are common and many are never repaired. Emergency parastomal hernia repair (PHR) is a feared complication following ostomy creation, yet the incidence and long-term outcomes of emergency PHR are unknown. MATERIALS AND METHODS We performed a retrospective analysis of 100% Medicare claims data (2007-2015) to evaluate complications, readmissions, reoperations, hospitalizations, and mortality after emergency PHR. We used logistic regression and Cox proportional hazard models to determine the association of surgical approach, including repair with ostomy reversal, resiting, mesh, minimally invasive approach, or a myofascial flap. Analysis took place between June 2022 and February 2023. RESULTS A total of 6658 patients underwent emergency PHR (mean [standard deviation] age, 75.9 [9.8] y; 4031 female individuals [60.5%]). Overall, 3433 (51.2%) patients underwent primary PHR, 1626 (24.4%) underwent PHR with ostomy resiting, and 1599 (24.0%) underwent PHR with ostomy reversal. In the 30 d after surgery, 4151 (62.3%) patients had complications and 55 (0.83%) underwent reoperation. Compared to local repair, the 30-d odds of complications were lower for patients who underwent ostomy resiting (odds ratio 0.82 [95% confidence interval 0.72-0.93]). Five y after surgery, the cumulative incidence of reoperation was 12.0% and was lowest for patients who underwent PHR with ostomy reversal (hazard ratio 0.15 [95% confidence interval 0.11-0.21]) when compared to local repair. CONCLUSIONS Emergency PHR is associated with significant morbidity. However, technique selection may influence outcomes. Understanding the prognosis of emergency PHR may improve decision-making and patient counseling for patients living with this common disease.
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Affiliation(s)
| | | | | | | | | | - Ryan A Howard
- Department of General Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Farizah Rob
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Jyothi R Thumma
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Dana A Telem
- Department of General Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Anne P Ehlers
- Department of General Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
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Ehlers AP, Rob F, Thumma J, Howard R, Davidson GH, Waljee JF, Dimick JB, Telem DA. Comparative Outcomes of Groin Hernia Repair by Sex Among Medicare Beneficiaries. Ann Surg 2023; 278:e835-e839. [PMID: 36727846 PMCID: PMC10354208 DOI: 10.1097/sla.0000000000005794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the rates of operative recurrence between male and female patients undergoing groin hernia repair. BACKGROUND DATA Groin hernia repair is common but understudied in females. Limited prior work demonstrates worse outcomes among females. METHODS Using Medicare claims, we performed a retrospective cohort study of adult patients who underwent elective groin hernia repair between January 1, 2010 and December 31, 2017. We used a Cox proportional hazards model to evaluate the risk of operative recurrence up to 5 years following the index operation. Secondary outcomes included 30-day complications following surgery. RESULTS Among 118,119 patients, females comprised the minority of patients (n=16,056, 13.6%). Compared with males, female patients were older (74.8 vs. 71.9 y, P <0.01), more often white (89.5% vs. 86.7%, P <0.01), and had a higher prevalence of nearly all measured comorbidities. In the multivariable Cox proportional hazards model, we found that female patients had a significantly lower risk of operative recurrence at 5-year follow-up compared with males (aHR 0.70, 95% CI 0.60-0.82). The estimated cumulative incidence of recurrence was lower among females at all time points: 1 year [0.68% (0.67-0.68) vs. 0.88% (0.88-0.89)], 3 years [1.91% (1.89-1.92) vs. 2.49% (2.47-2.5)], and 5 years [2.85% (2.82-2.88) vs. 3.7% (3.68-3.75)]. We found no significant difference in the 30-day risk of complications. CONCLUSIONS We found that female patients experienced a lower risk of operative hernia recurrence following elective groin hernia repair, which is contrary to what is often reported in the literature. However, the risk of operative recurrence was low overall, indicating excellent surgical outcomes among older adults for this common surgical condition.
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Affiliation(s)
- Anne P. Ehlers
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | | | - Jyothi Thumma
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Ryan Howard
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | | | - Jennifer F. Waljee
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Justin B. Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Dana A. Telem
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
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Howard R, Rob F, Thumma J, Ehlers A, O’Neill S, Dimick JB, Telem DA. Contemporary Outcomes of Elective Parastomal Hernia Repair in Older Adults. JAMA Surg 2023; 158:394-402. [PMID: 36790773 PMCID: PMC9932944 DOI: 10.1001/jamasurg.2022.7978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/23/2022] [Indexed: 02/16/2023]
Abstract
Importance Parastomal hernia is a challenging complication following ostomy creation; however, the incidence and long-term outcomes after elective parastomal hernia repair are poorly characterized. Objective To describe the incidence and long-term outcomes after elective parastomal hernia repair. Design, Setting, and Participants Using 100% Medicare claims, a retrospective cohort study of adult patients who underwent elective parastomal hernia repair between January 1, 2007, and December 31, 2015, was performed. Logistic regression and Cox proportional hazards models were used to evaluate mortality, complications, readmission, and reoperation after surgery. Analysis took place between February and May 2022. Exposures Parastomal hernia repair without ostomy resiting, parastomal hernia repair with ostomy resiting, and parastomal hernia repair with ostomy reversal. Main Outcomes and Measures Mortality, complications, and readmission within 30 days of surgery and reoperation for recurrence (parastomal or incisional hernia repair) up to 5 years after surgery. Results A total of 17 625 patients underwent elective parastomal hernia repair (mean [SD] age, 73.3 [9.1] years; 10 059 female individuals [57.1%]). Overall, 7315 patients (41.5%) underwent parastomal hernia repair without ostomy resiting, 2744 (15.6%) underwent parastomal hernia repair with ostomy resiting, and 7566 (42.9%) underwent parastomal hernia repair with ostomy reversal. In the 30 days after surgery, 676 patients (3.8%) died, 7088 (40.2%) had a complication, and 1740 (9.9%) were readmitted. The overall adjusted 5-year cumulative incidence of reoperation was 21.1% and was highest for patients who underwent parastomal hernia repair with ostomy resiting (25.3% [95% CI, 25.2%-25.4%]) compared with patients who underwent parastomal hernia repair with ostomy reversal (18.8% [95% CI, 18.7%-18.8%]). Among patients whose ostomy was not reversed, the hazard of repeat parastomal hernia repair was the same for patients whose ostomy was resited vs those whose ostomy was not resited (adjusted hazard ratio, 0.93 [95% CI, 0.81-1.06]). Conclusions and Relevance In this study, more than 1 in 5 patients underwent another parastomal or incisional hernia repair within 5 years of surgery. Although this was lowest for patients who underwent ostomy reversal at their index operation, ostomy resiting was not superior to local repair. Understanding the long-term outcomes of this common elective operation may help inform decision-making between patients and surgeons regarding appropriate operative approach and timing of surgery.
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Affiliation(s)
- Ryan Howard
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Farizah Rob
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Jyothi Thumma
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Anne Ehlers
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
| | - Sean O’Neill
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
| | - Justin B. Dimick
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
- Section Editor, JAMA Surgery
| | - Dana A. Telem
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
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Chen D, Rob F, Mukherjee R, Giordano T, Haymart M, Banerjee M. PSAT241 Variation in the Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features (NIFTP) in the United States. J Endocr Soc 2022. [PMCID: PMC9625492 DOI: 10.1210/jendso/bvac150.1664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The North American Association of Central Cancer Registries (NAACCR) develops and promotes uniform data standards for cancer registries, such as uniform cancer coding, and is used by all central cancer registries in the United States (US) and Canada, including Surveillance, Epidemiology and End Results (SEER). Effective January 1, 2017, the NAACCR modified its coding scheme and noninvasive encapsulated follicular variant of papillary thyroid cancer (EFVPTC) was reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) to reflect the indolent nature and very low risk of adverse outcomes of this thyroid tumor. The diagnostic use of NIFTP was anticipated to impact tens of thousands of patients in the US. Since NIFTP is no longer considered a cancer, as of January 1, 2021, it was no longer a reportable diagnosis in SEER. However, little is known about how the diagnosis of NIFTP was utilized across different regions and patient populations in the US when it was a reportable diagnosis. Methods Data was extracted from the US SEER-21 cancer registry (2000-2018). The study cohort comprised of individuals diagnosed with papillary or follicular thyroid cancer (2000-2018), or NIFTP (2017-2018). We examined the annual incidence of thyroid cancer by subtypes and NIFTP. Using data for 2018, we determined the rates of NIFTP for each of the 16 sites included in SEER-21. In addition, we compared the demographics of patients diagnosed with NIFTP to that of patients diagnosed with papillary and follicular thyroid cancer using Chi-square test. Results Between 2010 and 2018, we identified a total of 191,107 cases (182,893 PTC, 7,445 FTC, and 769 NIFTP). Incidence of FVPTC sharply declined from 2015 to 2018, with observed increases in NIFTP and encapsulated PTC/ invasive EFVPTC each accounting for 17% and 10% of the decline in FVPTC, respectively. High heterogeneity was observed in the regional incidence of NIFTP in 2018, with incidence rates ranging from 0.0% (Alaska) to 5.8% (Seattle-Puget Sound). Based on 2018 data, a diagnosis of NIFTP (2.2% of total thyroid cancer cases) was significantly associated with female sex (P=0.001), Black race (P<0.001), and non-Hispanic ethnicity (P<0.001) compared to diagnosis of papillary and follicular thyroid cancer. Conclusion There is marked variation in the use of the NIFTP diagnoses. The recent NAACCR coding change that resulted in NIFTP, a tumor with uncertain malignant potential and for which there is no long-term outcome data available, no longer being a reportable diagnosis will disproportionately affect women and Black patients, and patients who reside in regions with higher rates of NIFTP diagnoses. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
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Rob F, Hugo J, Tivadar S, Boháč P, Gkalpakiotis S, Vargová N, Arenbergerová M, Hercogová J. Compliance, safety concerns and anxiety in patients treated with biologics for psoriasis during the COVID-19 pandemic national lockdown: a multicenter study in the Czech Republic. J Eur Acad Dermatol Venereol 2020; 34:e682-e684. [PMID: 32594549 PMCID: PMC7361878 DOI: 10.1111/jdv.16771] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022]
Affiliation(s)
- F Rob
- Dermatovenereology Department, Second Faculty of Medicine, Na Bulovce Hospital, Charles University, Prague, Czech Republic
| | - J Hugo
- Dermatovenereology Department, Third Faculty of Medicine, Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic
| | - S Tivadar
- Dermatovenereology Department, Third Faculty of Medicine, Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic
| | - P Boháč
- Dermatovenereology Department, Second Faculty of Medicine, Na Bulovce Hospital, Charles University, Prague, Czech Republic
| | - S Gkalpakiotis
- Dermatovenereology Department, Third Faculty of Medicine, Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic
| | - N Vargová
- Dermatovenereology Department, Second Faculty of Medicine, Na Bulovce Hospital, Charles University, Prague, Czech Republic
| | - M Arenbergerová
- Dermatovenereology Department, Third Faculty of Medicine, Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic
| | - J Hercogová
- Dermatovenereology Department, Second Faculty of Medicine, Na Bulovce Hospital, Charles University, Prague, Czech Republic
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Rob F, Klubalová B, Nyčová E, Hercogová J, Unemo M. Gentamicin 240 mg plus azithromycin 2 g vs. ceftriaxone 500 mg plus azithromycin 2 g for treatment of rectal and pharyngeal gonorrhoea: a randomized controlled trial. Clin Microbiol Infect 2019. [PMID: 31419483 DOI: 10.1016/j.cmi.2019.08.004.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim was to evaluate the efficacy and tolerability of gentamicin 240 mg plus azithromycin 2 g for treatment of uncomplicated rectal and pharyngeal gonorrhoea compared to ceftriaxone 500 mg plus azithromycin 2 g, the recommended European first-line gonorrhoea treatment. METHODS A non-inferiority, open-label, single-centre randomized controlled trial was conducted in Prague, Czech Republic. Patients, 18-75 years of age, diagnosed with uncomplicated rectal or pharyngeal gonorrhoea by nucleic acid amplification test (NAAT) were randomized to treatment with gentamicin 240 mg intramuscularly plus azithromycin 2 g orally or ceftriaxone 500 g intramuscularly plus azithromycin 2 g orally. The primary outcome was negative culture and negative NAAT, i.e. 1 week and 3 weeks, respectively, after treatment. RESULTS Both clinical cure and microbiological clearance was achieved by 100% (95% CI 0.95-1.00) of patients in the gentamicin/azithromycin arm (n = 72; 40 rectal, 17 pharyngeal and 15 rectal+pharyngeal infections both localizations) and 100% (95% CI 0.95-1.00) in ceftriaxone/azithromycin arm (n = 71; 38 rectal, 14 pharyngeal and 19 rectal+pharyngeal infections). The absolute difference between the two arms was 0.0% (CI95% -5.1 to 5.1), thus less than the pre-specified margin of 7%. Administration of gentamicin was not more painful than ceftriaxone according to the visual analogue scale (1.8 vs. 3.4; p <0.001). Gastrointestinal adverse events were similar in the ceftriaxone arm (33/71, 46.5%) and the gentamicin arm (29/72, 40.3%), and overall in most (52/62, 83.9%) cases they were mild. CONCLUSIONS Gentamicin 240 mg plus azithromycin 2 g is an effective alternative for treatment of extragenital gonorrhoea.
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Affiliation(s)
- F Rob
- Dermatovenereology Department, Second Medical Faculty, Charles University, Na Bulovce Hospital, Prague, Czech Republic.
| | - B Klubalová
- Dermatovenereology Department, Second Medical Faculty, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - E Nyčová
- Department of Microbiology, Na Bulovce Hospital, Prague, Czech Republic
| | - J Hercogová
- Dermatovenereology Department, Second Medical Faculty, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - M Unemo
- World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine of Health, Örebro University, Örebro, Sweden
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Rob F, Klubalová B, Nyčová E, Hercogová J, Unemo M. Gentamicin 240 mg plus azithromycin 2 g vs. ceftriaxone 500 mg plus azithromycin 2 g for treatment of rectal and pharyngeal gonorrhoea: a randomized controlled trial. Clin Microbiol Infect 2019; 26:207-212. [PMID: 31419483 DOI: 10.1016/j.cmi.2019.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim was to evaluate the efficacy and tolerability of gentamicin 240 mg plus azithromycin 2 g for treatment of uncomplicated rectal and pharyngeal gonorrhoea compared to ceftriaxone 500 mg plus azithromycin 2 g, the recommended European first-line gonorrhoea treatment. METHODS A non-inferiority, open-label, single-centre randomized controlled trial was conducted in Prague, Czech Republic. Patients, 18-75 years of age, diagnosed with uncomplicated rectal or pharyngeal gonorrhoea by nucleic acid amplification test (NAAT) were randomized to treatment with gentamicin 240 mg intramuscularly plus azithromycin 2 g orally or ceftriaxone 500 g intramuscularly plus azithromycin 2 g orally. The primary outcome was negative culture and negative NAAT, i.e. 1 week and 3 weeks, respectively, after treatment. RESULTS Both clinical cure and microbiological clearance was achieved by 100% (95% CI 0.95-1.00) of patients in the gentamicin/azithromycin arm (n = 72; 40 rectal, 17 pharyngeal and 15 rectal+pharyngeal infections both localizations) and 100% (95% CI 0.95-1.00) in ceftriaxone/azithromycin arm (n = 71; 38 rectal, 14 pharyngeal and 19 rectal+pharyngeal infections). The absolute difference between the two arms was 0.0% (CI95% -5.1 to 5.1), thus less than the pre-specified margin of 7%. Administration of gentamicin was not more painful than ceftriaxone according to the visual analogue scale (1.8 vs. 3.4; p <0.001). Gastrointestinal adverse events were similar in the ceftriaxone arm (33/71, 46.5%) and the gentamicin arm (29/72, 40.3%), and overall in most (52/62, 83.9%) cases they were mild. CONCLUSIONS Gentamicin 240 mg plus azithromycin 2 g is an effective alternative for treatment of extragenital gonorrhoea.
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Affiliation(s)
- F Rob
- Dermatovenereology Department, Second Medical Faculty, Charles University, Na Bulovce Hospital, Prague, Czech Republic.
| | - B Klubalová
- Dermatovenereology Department, Second Medical Faculty, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - E Nyčová
- Department of Microbiology, Na Bulovce Hospital, Prague, Czech Republic
| | - J Hercogová
- Dermatovenereology Department, Second Medical Faculty, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - M Unemo
- World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine of Health, Örebro University, Örebro, Sweden
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Rob F, Kašpírková J, Jůzlová K, Pešta M, Hercogová J. Lymphogranuloma venereum with only proximal rectal involvement mimicking inflammatory bowel disease: a potential diagnostic pitfall. J Eur Acad Dermatol Venereol 2016; 31:e264-e265. [PMID: 27862349 DOI: 10.1111/jdv.14050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- F Rob
- Department of Dermatovenereology, Second Faculty of Medicine, Na Bulovce Hospital, Charles University, Prague, Czech Republic
| | - J Kašpírková
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - K Jůzlová
- Department of Dermatovenereology, Second Faculty of Medicine, Na Bulovce Hospital, Charles University, Prague, Czech Republic
| | - M Pešta
- Department of Internal Medicine, Na Bulovce Hospital, Prague, Czech Republic
| | - J Hercogová
- Department of Dermatovenereology, Second Faculty of Medicine, Na Bulovce Hospital, Charles University, Prague, Czech Republic
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Jiráková A, Rob F, Sečníková Z, Koblová K, Džambová M, Rajská L, Göpfertová D, Pellacani G, Malý M, Lotti T, Hercogová J. TOPICAL CORTICOSTEROIDS BUT NOT CALCINEURIN INHIBITORS INDUCED ATROPHY AFTER FOUR WEEKS. J BIOL REG HOMEOS AG 2015; 29:701-706. [PMID: 26403410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Reflectance confocal microscopy (RCM) is a non-invasive, in vivo technique for real-time imaging of the epidermis and superficial dermis at the cellular resolution. We performed a pilot study focusing on the evaluation of the effect of topical corticosteroids and calcineurin inhibitors on the epidermis of patients with atopic dermatitis (AD). The effect was assessed by RCM. A total of 45 patients with AD took part in the study. Patients were selected according to the standardized protocol and divided into two groups. Twenty-three patients used methylprednisolone aceponat topically on the skin with lesions of AD once a day for three months (group A). Twenty-one patients applied topical tacrolimus on the skin with lesions of AD twice a day for three months (B). RCM imaging was performed on the day of intiating the study (T0), then after one (T1), two (T2) and three months (T3). In group A, there was a visible decrease of the stratum corneum and the epidermis thickness which was statistically significant. In comparison, in group B, such changes were not noted and the differences between the groups in time course were statistically significant. In group A, an increase in the percentage of blurred keratinocytes in the stratum spinosum was also recorded, especially between the first (T0) and the second visit (T1). RCM is a useful method for evaluating the changes in epidermis due to the different topical treatment in patients with AD.
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Affiliation(s)
- A Jiráková
- Department of Dermatovenerology 2nd Faculty of Medicine Charles University Bulovka Hospital Prague Czech Republic
| | - F Rob
- Department of Dermatovenerology 2nd Faculty of Medicine Charles University Bulovka Hospital Prague Czech Republic
| | - Z Sečníková
- Department of Dermatovenerology 2nd Faculty of Medicine Charles University Bulovka Hospital Prague Czech Republic
| | - K Koblová
- Department of Dermatovenerology 2nd Faculty of Medicine Charles University Bulovka Hospital Prague Czech Republic
| | - M Džambová
- Department of Dermatovenerology 2nd Faculty of Medicine Charles University Bulovka Hospital Prague Czech Republic
| | - L Rajská
- Department of Dermatovenerology 2nd Faculty of Medicine Charles University Bulovka Hospital Prague Czech Republic
| | - D Göpfertová
- Department of Epidemiology 2nd Faculty of Medicine Charles University Prague Czech Republic
| | - G Pellacani
- Department of Dermatology University of Modena and Reggio Emilia Modena Italy
| | - M Malý
- Department of Biostatistics National Institute of Public Health Prague Czech Republic
| | - T Lotti
- Department of Dermatology and Venereology of the University of Guglielmo Marconi, Rome, Italy
| | - J Hercogová
- Department of Dermatovenerology 2nd Faculty of Medicine Charles University Bulovka Hospital Prague Czech Republic
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Rob F, Kružicová Z, Vaňousová D, Hercogová J. [Condylomata acuminata (genital warts)]. Ceska Gynekol 2014; 79:399-406. [PMID: 25472460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Infection with human papillomavirus is the most common viral sexually transmitted infection that mainly affects younger sexually active population. Genital warts are one of the most common manifestations of this infection. Although not a life-threatening disease, it is difficult to treat and frequent recurrence can traumatize the patient and influence not only his sexual life. Currently there are many treatment possibilities, but none is 100% efficient. Because of the wide range of character manifestation and their different localization is necessary to approach each patient individually. Therefore, there is a major weapon against this disease prevention, a safe sexual behavior and a new vaccination. KEYWORDS condylomata acuminata, HPV infection, diagnostics, prevention, treatment.
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Pasman P, Rob F, Verhoeven JW. Intramolecular charge-transfer absorption and emission resulting from through-bond interaction in bichromophoric molecules. J Am Chem Soc 2002. [DOI: 10.1021/ja00383a023] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rob F, van Ramesdonk H, Verhoeven J, Pandit U, de Boer T. Pyridine-dinucleotide models IV; stereoselective hydride transfer at a bridged pyridinium-ion. Tetrahedron Lett 1980. [DOI: 10.1016/s0040-4039(00)92771-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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