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Nunez MF, Ortega G, Souza Mota LG, Olufajo OA, Altema DW, Fullum TM, Tran D. Socioeconomic disparities in the complexity of hernias evaluated at Emergency Departments across the United States. Am J Surg 2018; 218:551-559. [PMID: 30587331 DOI: 10.1016/j.amjsurg.2018.11.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 09/27/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hernias represent one of the most common surgical conditions with a high-burden on health expenditures. We examined the impact of socioeconomic-status and complexity of presentation among patients in the Emergency Department (ED). METHODS Retrospective analysis of 2006-2014 data from the Nationwide Emergency Department Sample, identified adult discharges with a diagnosis of inguinal, femoral, and umbilical hernia. Cases were dichotomized: complicated and uncomplicated. Unadjusted and adjusted analyses were used to determine factors that influence ED presentation. RESULTS Among 264,484 patients included, 73% presented as uncomplicated hernias and were evaluated at urban hospitals (86%). Uncomplicated presentation was more likely in Medicaid (OR 1.56 95%CI1.50-1.61) and uninsured (OR 1.73 95%CI 1.67-1.78), but less likely for patients within the third and fourth MHI quartile (OR 0.82 95%CI 0.80-0.84 and OR 0.77 95%CI 0.75-0.79), respectively. CONCLUSION Uninsured, publicly-insured, and low-MHI patients were more likely to present to ED with uncomplicated hernias. This finding might reflect a lack of access to primary surgical care for non-urgent surgical diseases.
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Affiliation(s)
- Maria F Nunez
- Research Centers in Minority Institutions Program, Howard University College of Medicine, 520 W Street NW, Rm 436, Washington, DC, 20059, USA; Clive O. Callender, MD Howard-Harvard Health Sciences Outcomes Research Center, Howard University, 2041 Georgia Avenue, NW, Suite 4B-35, Washington, DC, 20060, USA.
| | - Gezzer Ortega
- Research Centers in Minority Institutions Program, Howard University College of Medicine, 520 W Street NW, Rm 436, Washington, DC, 20059, USA; Clive O. Callender, MD Howard-Harvard Health Sciences Outcomes Research Center, Howard University, 2041 Georgia Avenue, NW, Suite 4B-35, Washington, DC, 20060, USA.
| | - Lucas G Souza Mota
- Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA.
| | - Olubode A Olufajo
- Research Centers in Minority Institutions Program, Howard University College of Medicine, 520 W Street NW, Rm 436, Washington, DC, 20059, USA; Clive O. Callender, MD Howard-Harvard Health Sciences Outcomes Research Center, Howard University, 2041 Georgia Avenue, NW, Suite 4B-35, Washington, DC, 20060, USA.
| | - Derek W Altema
- Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA.
| | - Terrence M Fullum
- Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA; Department of Surgery, Howard University Center for Wellness and Weight Loss Surgery, 2041 Georgia Ave NW, Tower Building 4100B, Washington, DC, 20060, USA.
| | - Daniel Tran
- Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA; Department of Surgery, Howard University Center for Wellness and Weight Loss Surgery, 2041 Georgia Ave NW, Tower Building 4100B, Washington, DC, 20060, USA.
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Aydin N, Sardi A, Milovanov V, Nieroda C, Sittig M, Nunez MF, Jimenez W, Gushchin V. Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Experience of a Peritoneal Surface Malignancy Center. Am Surg 2015; 81:1253-1259. [PMID: 26736164] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon malignancy, which can be difficult to treat. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have evolved as the treatment of choice when complete cytoreduction is to be achieved. This study reports the outcomes of CRS/HIPEC for peritoneal mesothelioma performed in a center for peritoneal surface malignancy. A retrospective analysis of a prospective database of 389 CRS/HIPEC procedures identified 23 patients who underwent CRS/HIPEC for DMPM from 1999 to 2014. Gender, age at diagnosis, age at surgery, previous surgeries, follow-up time, peritoneal cancer index (PCI) score, completeness of cytoreduction (CC), pathology, and overall survival (OS) were analyzed. The univariate analysis was used to determine the prognostic value of age, gender, neoadjuvant chemotherapy, histopathology of the tumor, PCI, CC, and lymph node status on survival. Mean follow-up time from surgery was 31 months (range = 0.5-124). The median PCI score was 28, and 77 per cent had PCI ≥20. CC 0-1 was achieved in 65 per cent of cases. One- and 5-year actuarial OS rates from diagnosis were 86 per cent and 60 per cent, respectively. One- and 5-year actuarial OS from HIPEC was 70 per cent and 64 per cent, respectively. The univariate analysis showed that the CC was the only significant prognostic factor. Patients with DMPM may achieve long-term survival when treated with CRS/HIPEC. The CC is the most significant prognostic factor for long-term survival.
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Affiliation(s)
- Nail Aydin
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland, USA
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Aydin N, Sardi A, Milovanov V, Nieroda C, Sittig M, Nunez MF, Jimenez W, Gushchin V. Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Experience of a Peritoneal Surface Malignancy Center. Am Surg 2015. [DOI: 10.1177/000313481508101228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon malignancy, which can be difficult to treat. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have evolved as the treatment of choice when complete cytoreduction is to be achieved. This study reports the outcomes of CRS/HIPEC for peritoneal mesothelioma performed in a center for peritoneal surface malignancy. A retrospective analysis of a prospective database of 389 CRS/ HIPEC procedures identified 23 patients who underwent CRS/HIPEC for DMPM from 1999 to 2014. Gender, age at diagnosis, age at surgery, previous surgeries, follow-up time, peritoneal cancer index (PCI) score, completeness of cytoreduction (CC), pathology, and overall survival (OS) were analyzed. The univariate analysis was used to determine the prognostic value of age, gender, neoadjuvant chemotherapy, histopathology of the tumor, PCI, CC, and lymph node status on survival. Mean follow-up time from surgery was 31 months (range = 0.5–124). The median PCI score was 28, and 77 per cent had PCI ≥20. CC 0–1 was achieved in 65 per cent of cases. One- and 5-year actuarial OS rates from diagnosis were 86 per cent and 60 per cent, respectively. One- and 5-year actuarial OS from HIPEC was 70 per cent and 64 per cent, respectively. The univariate analysis showed that the CC was the only significant prognostic factor. Patients with DMPM may achieve long-term survival when treated with CRS/HIPEC. The CC is the most significant prognostic factor for long-term survival.
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Affiliation(s)
- Nail Aydin
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Armando Sardi
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Vladimir Milovanov
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Carol Nieroda
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Michelle Sittig
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Maria F. Nunez
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - William Jimenez
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Vadim Gushchin
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
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Nunez MF, Sardi A, Jimenez W, Nieroda C, Sittig M, MacDonald R, Aydin N, Milovanov V, Gushchin V. Port-Site Metastases is an Independent Prognostic Factor in Patients with Peritoneal Carcinomatosis. Ann Surg Oncol 2014; 22:1267-73. [DOI: 10.1245/s10434-014-4136-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Indexed: 02/06/2023]
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Nunez MF, Sardi A, Nieroda C, Jimenez W, Sittig M, MacDonald R, Aydin N, Milovanov V, Gushchin V. Morbidity of the Abdominal Wall Resection and Reconstruction After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC). Ann Surg Oncol 2014; 22:1658-63. [DOI: 10.1245/s10434-014-4075-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Indexed: 01/07/2023]
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Ji AJ, Nunez MF, Machacek D, Ferguson JE, Iossi MF, Kao PC, Landers JP. Separation of urinary estrogens by micellar electrokinetic chromatography. J Chromatogr B Biomed Appl 1995; 669:15-26. [PMID: 7581880 DOI: 10.1016/0378-4347(95)00143-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Urinary estrogen levels are important for monitoring the normal pregnancy process as well as for the diagnosis of reproductive diseases. 17 beta-Estradiol and estrone are maintained at very low concentrations in urine and, therefore, are difficult to determine using standard chromatography with UV detection. In the present study, we describe a potential method for the determination of urinary estrogens (estrone, estradiol and estriol) using a solid-phase extraction and rapid capillary electrophoretic (CE) separations. Micellar electrokinetic chromatographic (MEKC) analysis was optimized by evaluating the number of surfactants in a 5 mM borate-5 mM phosphate separation buffer, of which sodium cholate (75-90 mM) was found to be optimal. Changing the hydrophobic character of the separation buffer with organic additives had a significant effect on the resolution of the three estrogens and an internal standard (d-equilenin). The addition of an organic additive (20% acetonitrile) was found to be necessary for the resolution of all components of the mixture. Substitution with 20% methanol provided a similar separation with better resolution but at the cost of increased analysis time. Analysis of two extracted urine samples from 18-weeks and 21-weeks pregnant women showed that, with the present technology, CE can provide adequate resolution and superior speed, but the sensitivity limits attainable with the existing technology may limit its utility to the measurement of estriol and estrone.
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Affiliation(s)
- A J Ji
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
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