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Kassim G, Yzet C, Nair N, Debebe A, Rendon A, Colombel JF, Traboulsi C, Rubin DT, Maroli A, Coppola E, Carvello MM, Ben David N, De Lucia F, Sacchi M, Danese S, Spinelli A, Hirdes MMC, Ten Hove J, Oldenburg B, Cholapranee A, Riter M, Lukin D, Scherl E, Eren E, Sultan KS, Axelrad J, Sachar DB. Long-Term Outcomes of the Excluded Rectum in Crohn's Disease: A Multicenter International Study. Inflamm Bowel Dis 2023; 29:417-422. [PMID: 35522225 DOI: 10.1093/ibd/izac099] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Many patients with Crohn's disease (CD) require fecal diversion. To understand the long-term outcomes, we performed a multicenter review of the experience with retained excluded rectums. METHODS We reviewed the medical records of all CD patients between 1990 and 2014 who had undergone diversionary surgery with retention of the excluded rectum for at least 6 months and who had at least 2 years of postoperative follow-up. RESULTS From all the CD patients in the institutions' databases, there were 197 who met all our inclusion criteria. A total of 92 (46.7%) of 197 patients ultimately underwent subsequent proctectomy, while 105 (53.3%) still had retained rectums at time of last follow-up. Among these 105 patients with retained rectums, 50 (47.6%) underwent reanastomosis, while the other 55 (52.4%) retained excluded rectums. Of these 55 patients whose rectums remained excluded, 20 (36.4%) were symptom-free, but the other 35 (63.6%) were symptomatic. Among the 50 patients who had been reconnected, 28 (56%) were symptom-free, while 22(44%) were symptomatic. From our entire cohort of 197 cases, 149 (75.6%) either ultimately lost their rectums or remained symptomatic with retained rectums, while only 28 (14.2%) of 197, and only 4 (5.9%) of 66 with initial perianal disease, were able to achieve reanastomosis without further problems. Four patients developed anorectal dysplasia or cancer. CONCLUSIONS In this multicenter cohort of patients with CD who had fecal diversion, fewer than 15%, and only 6% with perianal disease, achieved reanastomosis without experiencing disease persistence.
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Affiliation(s)
- Gassan Kassim
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Clara Yzet
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nilendra Nair
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anketse Debebe
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexa Rendon
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean-Frédéric Colombel
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cindy Traboulsi
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| | - Annalisa Maroli
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Elisabetta Coppola
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Michele M Carvello
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Nadat Ben David
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Francesca De Lucia
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Matteo Sacchi
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Meike M C Hirdes
- Division of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joren Ten Hove
- Division of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bas Oldenburg
- Division of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Aurada Cholapranee
- Division of Gastroenterology and Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Maxine Riter
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, NY, USA
| | - Dana Lukin
- Jill Roberts Center for IBD, Weill Cornell Medicine, NY, USA
| | - Ellen Scherl
- Jill Roberts Center for IBD, Weill Cornell Medicine, NY, USA
| | - Esen Eren
- Inflammatory Bowel Disease Center at NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Keith S Sultan
- Division of Gastroenterology and Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jordan Axelrad
- Inflammatory Bowel Disease Center at NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - David B Sachar
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Arca KN, Cai J, Wang F, Kassim G, Hasler WL, Batheja MJ. Migraine and Gastroparesis. Curr Neurol Neurosci Rep 2022; 22:813-821. [PMID: 36370318 DOI: 10.1007/s11910-022-01241-3] [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] [Accepted: 09/30/2022] [Indexed: 11/15/2022]
Abstract
PURPOSEOF REVIEW Migraine is a chronic and disabling disease affecting a significant proportion of the world's population. There is evidence that gastroparesis, a gastrointestinal (GI) dysmotility disorder in which transit of gastric contents is delayed, can occur in the setting of migraine. This article aims to review recent literature on overlap in the pathophysiology and clinical manifestations of migraine and gastroparesis and highlight management considerations when these disorders coexist. RECENT FINDINGS There has been increasing recognition of the importance of the connection between the GI tract and the brain, and mounting evidence for the overlap in the pathophysiology of migraine and gastroparesis specifically. There exists a complex interplay between the central, autonomic, and enteric nervous systems. Studies show that gastroparesis may be present during and between acute migraine attacks necessitating modification of management to optimize outcomes. Gastric dysmotility in the setting of migraine can impact absorption of oral migraine medications and alternate formulations should be considered for some patients. Noninvasive vagus nerve stimulation has been FDA cleared for migraine treatment and is also being studied in gastroparesis. Dysfunction of the autonomic nervous system is a significant feature in the pathophysiology of gut motility and migraine, making treatments that modulate the vagus nerve attractive for future research.
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Affiliation(s)
- Karissa N Arca
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
| | - Jacqueline Cai
- Department of Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Fangfang Wang
- Department of Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Gassan Kassim
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - William L Hasler
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Mashal J Batheja
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Doo FX, Kassim G, Lefton DR, Patterson S, Pham H, Belani P. Rare presentations of COVID-19: PRES-like leukoencephalopathy and carotid thrombosis. Clin Imaging 2021; 69:94-101. [PMID: 32707411 PMCID: PMC7365057 DOI: 10.1016/j.clinimag.2020.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic, and it is increasingly important that physicians recognize and understand its atypical presentations. Neurological symptoms such as anosmia, altered mental status, headache, and myalgias may arise due to direct injury to the nervous system or by indirectly precipitating coagulopathies. We present the first COVID-19 related cases of carotid artery thrombosis and acute PRES-like leukoencephalopathy with multifocal hemorrhage.
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Affiliation(s)
- Florence X Doo
- Mount Sinai Health System, Diagnostic, Molecular and Interventional Radiology, 1000 10th Avenue, Radiology, 4B 25, New York 10019, NY, USA.
| | - Gassan Kassim
- Mount Sinai Health System, Internal Medicine, 1000 10th Ave, New York 10019, NY, USA
| | - Daniel R Lefton
- Mount Sinai Health System, Diagnostic, Molecular and Interventional Radiology, 1000 10th Avenue, Radiology, 4B 25, New York 10019, NY, USA
| | - Shanna Patterson
- Mount Sinai Health System, Neurology, 1000 10th Ave, New York 10019, NY, USA
| | - Hien Pham
- Mount Sinai Health System, Diagnostic, Molecular and Interventional Radiology, 1000 10th Avenue, Radiology, 4B 25, New York 10019, NY, USA
| | - Puneet Belani
- Mount Sinai Health System, Diagnostic, Molecular and Interventional Radiology, 1000 10th Avenue, Radiology, 4B 25, New York 10019, NY, USA
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Fujisaki T, Kassim F, Kassim G, Bandyopadhyay D, Singh V, Kim B. Biventricular takotsubo syndrome with COVID-19 in an Asian male. J Cardiol Cases 2020; 24:6-9. [PMID: 33262862 PMCID: PMC7690273 DOI: 10.1016/j.jccase.2020.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/09/2020] [Accepted: 11/17/2020] [Indexed: 12/25/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has been shown to affect the cardiovascular system, and several cases of takotsubo syndrome (TTS) induced by COVID-19 have been reported. TTS predominantly affects postmenopausal women in western countries, but the prevalence in men is higher in Asian populations. It should be noted that male patients with either TTS or COVID-19 are associated with higher mortality. Despite the higher prevalence of TTS in Asian men, little is known about Asian men with TTS induced by COVID-19. This is a case report of a 60-year-old Asian male with biventricular TTS precipitated by COVID-19. He presented with acute respiratory distress syndrome, cardiogenic shock, and acute kidney injury. He required intubation, multiple vasopressors, and renal replacement therapy. The left ventricular ejection fraction was 15%, but it normalized in 5 weeks. The patient had a prolonged hospital stay in a critical condition, but was eventually discharged alive. The scarce literature about this condition in Asian male populations and the increasing number of COVID-19 cases in Asian countries highlight the rarity and importance of this case. Further studies are warranted to investigate the uneven sex distribution and outcomes of TTS triggered by COVID-19 in an Asian population. <Learning objective: Takotsubo syndrome (TTS) can be provoked by coronavirus disease 2019 (COVID-19). Male sex, right ventricular dysfunction, and COVID-19 as a trigger, are important predicting factors for worse prognosis. It is unknown if there is a significant racial difference in the sex distribution and outcomes for this condition. Further studies are warranted to investigate TTS triggered by COVID-19 in an Asian population.>
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Affiliation(s)
- Tomohiro Fujisaki
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, 1000 10th Avenue, New York, NY, USA
| | - Frida Kassim
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, 1000 10th Avenue, New York, NY, USA
| | - Gassan Kassim
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, 1000 10th Avenue, New York, NY, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Heart and Vascular Institute, Westchester Medical Center, Valhalla, NY, USA
| | - Vasundhara Singh
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, 1000 10th Avenue, New York, NY, USA
| | - Bette Kim
- Cardiomyopathy Program, Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai West, New York, NY, USA
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Klang E, Kassim G, Soffer S, Freeman R, Levin MA, Reich DL. Severe Obesity as an Independent Risk Factor for COVID-19 Mortality in Hospitalized Patients Younger than 50. Obesity (Silver Spring) 2020; 28:1595-1599. [PMID: 32445512 PMCID: PMC7283736 DOI: 10.1002/oby.22913] [Citation(s) in RCA: 196] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) continues to spread, and younger patients are also being critically affected. This study analyzed obesity as an independent risk factor for mortality in hospitalized patients younger than 50. METHODS This study retrospectively analyzed data of patients with COVID-19 who were hospitalized to a large academic hospital system in New York City between March 1, 2020, and May 17, 2020. Data included demographics, comorbidities, BMI, and smoking status. Obesity groups included the following: BMI of 30 to < 40 kg/m2 and BMI ≥ 40 kg/m2 . Multivariable logistic regression models identified variables independently associated with mortality in patients younger and older than 50. RESULTS Overall, 3,406 patients were included; 572 (17.0%) patients were younger than 50. In the younger age group, 60 (10.5%) patients died. In the older age group, 1,076 (38.0%) patients died. For the younger population, BMI ≥ 40 was independently associated with mortality (adjusted odds ratio 5.1; 95% CI: 2.3-11.1). For the older population, BMI ≥ 40 was also independently associated with mortality to a lesser extent (adjusted odds ratio 1.6; 95% CI: 1.2-2.3). CONCLUSIONS This study demonstrates that hospitalized patients younger than 50 with severe obesity are more likely to die of COVID-19. This is particularly relevant in the Western world, where obesity rates are high.
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Affiliation(s)
- Eyal Klang
- Department of Population Health Science and PolicyInstitute for Health Care Delivery ScienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Gassan Kassim
- Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Shelly Soffer
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Robert Freeman
- Department of Population Health Science and PolicyInstitute for Health Care Delivery ScienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Matthew A. Levin
- Department of Anesthesiology, Perioperative and Pain MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - David L. Reich
- Department of Anesthesiology, Perioperative and Pain MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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