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Najafian A, Hathaway B, Gunther S, Solomon JS. Chlorhexidine chemical burn in hand surgery: A case review and recommendations for prevention. Journal of Pediatric Surgery Case Reports 2022. [DOI: 10.1016/j.epsc.2022.102436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Moeckli B, Canner J, Najafian A, Carbunaru S, Cowell N, Atallah C, Paredes E, Chudnovets A, Fang SH. High-resolution anoscopy, is there a benefit in proceeding directly to the operating room? Tech Coloproctol 2021; 25:461-466. [PMID: 33569753 PMCID: PMC8016767 DOI: 10.1007/s10151-021-02416-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/22/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The development of high-resolution anoscopy (HRA) has advanced our ability to detect anal dysplasia. Historically, HRA is performed in a clinical setting and subsequent ablation is performed in the clinical setting or operating room. The aim of this study was to determine the most effective venue for the performance of HRA. METHODS Following institutional review board (IRB) approval, the correlation between anal cytology and HRA performed in the clinic versus in the operating room was evaluated. Data were extracted from our IRB-approved prospective HRA database over the time period of 2013-2017. RESULTS One hundred twenty-eight HRAs were compared (101 in the clinical setting, 27 in the operating room). There was a statistically significant difference in the correlation between anal cytology and HRA pathology for procedures performed in the clinical setting (55% [56/101]) versus those performed in the operating room (82% [22/27]) (p = 0.014). More biopsies were obtained in the operating room than in the clinic setting (3 vs. 1, p < 0.0001). The majority of patients who had HRA in a clinical setting with subsequent HRA in the operating room stated that they preferred to have their HRAs performed in the operating room due to discomfort from the HRA procedure. CONCLUSIONS Detection rates for anal dysplasia on HRA, are significantly higher when performed in the operating room. To prevent discomfort in the clinical setting, patients with high-grade dysplasia on anal pap testing may benefit from proceeding directly to the operating room for concurrent HRA and ablation.
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Affiliation(s)
- B Moeckli
- Department of Surgery, Ravitch Division of Colon and Rectal Surgery, High Resolution Anoscopy Clinic, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA.,Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - J Canner
- Department of Surgery, Ravitch Division of Colon and Rectal Surgery, High Resolution Anoscopy Clinic, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA
| | - A Najafian
- Department of Plastic Surgery, Oregon Health Sciences University, Portland, OR, USA
| | - S Carbunaru
- Northwestern University School of Medicine, Chicago, IL, USA
| | - N Cowell
- Department of Surgery, Ravitch Division of Colon and Rectal Surgery, High Resolution Anoscopy Clinic, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA
| | - C Atallah
- Department of Surgery, Ravitch Division of Colon and Rectal Surgery, High Resolution Anoscopy Clinic, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA
| | - E Paredes
- Department of Surgery, Ravitch Division of Colon and Rectal Surgery, High Resolution Anoscopy Clinic, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA
| | - A Chudnovets
- Department of Surgery, Ravitch Division of Colon and Rectal Surgery, High Resolution Anoscopy Clinic, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA
| | - S H Fang
- Department of Surgery, Ravitch Division of Colon and Rectal Surgery, High Resolution Anoscopy Clinic, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA.
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Sahli Z, Najafian A, Kahan S, Schneider EB, Zeiger MA, Mathur A. One-Hour Postoperative Parathyroid Hormone Levels Do Not Reliably Predict Hypocalcemia After Thyroidectomy. World J Surg 2018; 42:2128-2133. [PMID: 29290070 DOI: 10.1007/s00268-017-4444-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Hypocalcemia is a well-known complication after total thyroidectomy. Studies have indicated that the presence of low postoperative parathyroid hormone (PTH) levels can predict hypocalcemia. However, definitive study designs are lacking. The aim of this study was to determine whether postoperative PTH alone can accurately predict postoperative biochemical hypocalcemia. METHODS Under IRB approval, a prospective study of 218 consecutive patients who underwent total or completion thyroidectomy by two surgeons between June 2014 and June 2016 was performed. Biochemical hypocalcemia was defined as ionized calcium <1.13 mmol/L or serum calcium <8.4 mg/dL at any time postoperatively. Three PTH thresholds, <10, <20 pg/mL, and >50% drop in PTH 1 h postoperatively from baseline were examined. RESULTS Postoperative PTH < 10 pg/mL had a sensitivity of 36.5% (95% CI 27.4-46.3%) and a specificity of 89.2% (95% CI 81.9-94.3%). Postoperative PTH < 20 pg/mL had a sensitivity of 66.4% (95% CI 56.6-75.2%) and a specificity of 67.6% (95% CI 58.0-76.2%). Postoperative PTH decrease >50% had a sensitivity of 63.4% (95% CI 53.2-72.7%) and a specificity of 72.5% (95% CI 62.5-81.0%). Across all PTH thresholds, the false-negative rate was 33.6-63.5% indicating that up to 64% of patients with a normal PTH level could have been discharged without appropriate calcium supplementation. The false-positive rate was 10.8-32.4% indicating that up to 32.4% of patients with low PTH could have been treated with calcium supplementation unnecessarily. CONCLUSION Following total thyroidectomy, PTH levels are unreliable in predicting hypocalcemia. Additional prospective studies are needed to understand the true utility of PTH levels post-thyroidectomy.
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Affiliation(s)
- Zeyad Sahli
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA
| | - Alireza Najafian
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA
| | - Stacie Kahan
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA
| | - Eric B Schneider
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA
| | - Martha A Zeiger
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA
| | - Aarti Mathur
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA.
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Najafian A, Kahan S, Olson MT, Tufano RP, Zeiger MA. Intraoperative PTH May Not Be Necessary in the Management of Primary Hyperparathyroidism Even with Only One Positive or Only Indeterminate Preoperative Localization Studies. World J Surg 2017; 41:1500-1505. [DOI: 10.1007/s00268-017-3871-4] [Citation(s) in RCA: 10] [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] [Indexed: 10/20/2022]
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Najafian A, Kahan S, Zeiger MA, Olson MT. Unusual findings in thyroid cytology and histology. Diagn Cytopathol 2017; 45:185-190. [PMID: 28160441 DOI: 10.1002/dc.23655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/30/2016] [Revised: 11/24/2016] [Accepted: 12/02/2016] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Although cytology and histopathology of thyroid lesions generally fall into common, well-defined categories, there are uncommon cases with unusual fine needle aspiration (FNA) findings or histology. Herein, we review the prevalence and characteristics of rare thyroid cytology and histopathology findings at a tertiary hospital. METHODS Institutional data from >31,000 patients with a thyroid pathology from 1995 to 2013 were queried. Both cytology and histology were available in 6,693 patients. After exclusion of the common cytological categories detailed by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and common histopathology categories, 90 patients with either an unusual FNA, histopathology, or both were identified. RESULTS A total of 90 cases were included (19: only unusual FNA; 25: only unusual histology; 46: both unusual cytology and histopathology). The positive predictive value of an unusual FNA for discovering an unusual lesion was 71% (95% CI: 58%-81%). The majority (66%) were females and median age was 59 years. On histopathology, 80 (88%) cases were malignant, 72 (90%) of which were initially diagnosed as malignant on FNA. Of the 10 benign lesions, 8 (80%) also had a benign FNA. Patients with unusual malignant lesions were significantly older than those with unusual benign lesions (62 vs. 44 years; P: 0.004). CONCLUSION Unusual cytopathological and histopathological findings in thyroid comprise a varied group of tumors that are individually rare but collectively common. A preoperative FNA with an unusual cytopathology is likely to lead to an unusual histopathological diagnosis; however, its diagnostic accuracy in differentiating benign from malignant is lower than the accuracy of cytopathology of conventional TBSRTC. Diagn. Cytopathol. 2017;45:185-190. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alireza Najafian
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Stacie Kahan
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Martha A Zeiger
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Matthew T Olson
- Division of Cytopathology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
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Najafian A, Noureldine S, Azar F, Atallah C, Trinh G, Schneider EB, Tufano RP, Zeiger MA. RAS Mutations, and RET/PTC and PAX8/PPAR-gamma Chromosomal Rearrangements Are Also Prevalent in Benign Thyroid Lesions: Implications Thereof and A Systematic Review. Thyroid 2017; 27:39-48. [PMID: 27750019 DOI: 10.1089/thy.2016.0348] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Molecular markers associated with thyroid malignancy are increasingly being used as differential diagnostic tools for thyroid nodules. However, little has been reported recently regarding the prevalence of these markers in benign lesions. The literature was systematically reviewed to examine studies that reported on the prevalence of these markers in benign thyroid lesions. METHODS Appropriate studies published between January 1, 2000, and April 30, 2015, and cataloged in PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched for by combining different keywords for "thyroid tumor" with both general and specific keywords for "molecular marker" by using "AND" as the Boolean operator. All studies meeting criteria that reported the prevalence of RAS mutations, and RET/PTC and PAX8/PPAR-gamma chromosomal rearrangements in benign thyroid lesions were included for study. RESULTS A total of 64 articles (including 8162 patients, of whom 42.5% had benign lesions) that met all the study criteria were systematically reviewed and abstracted. Among 35 studies examining RAS mutations, the reported prevalence of RAS mutation in benign lesions ranged from 0% to 48%. In 38 studies examining RET/PTC rearrangements, the prevalence in benign lesions ranged from 0% to 68%. PAX8/PPAR-gamma rearrangements were examined in 27 studies, with the prevalence in benign lesions ranging from 0% to 55%. CONCLUSION The presence of these biomarkers and the tremendous variation in reports of their prevalence in benign lesions suggests the need for caution when including these markers in diagnostic decisions. Further understanding of the importance of these markers, as well as newly discovered markers of thyroid malignancy, may be required in order to avoid overtreatment of patients with benign thyroid tumors.
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Affiliation(s)
- Alireza Najafian
- 1 Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Salem Noureldine
- 2 Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Faris Azar
- 1 Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Chady Atallah
- 1 Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Gina Trinh
- 2 Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Eric B Schneider
- 1 Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Ralph P Tufano
- 2 Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Martha A Zeiger
- 1 Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
- 3 Department of Oncology, The Johns Hopkins University School of Medicine , Baltimore, Maryland
- 4 Department of Cellular and Molecular Medicine, The Johns Hopkins University School of Medicine , Baltimore, Maryland
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Hicks CW, Najafian A, Farber A, Menard MT, Malas MB, Black JH, Abularrage CJ. Below-knee endovascular interventions have better outcomes compared to open bypass for patients with critical limb ischemia. Vasc Med 2016; 22:28-34. [PMID: 27928034 DOI: 10.1177/1358863x16676901] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Both open surgery and endovascular peripheral interventions have been shown to effectively improve outcomes in patients with peripheral artery disease, but minimal data exist comparing outcomes performed at and below the knee. The purpose of this study was to compare outcomes following infrageniculate lower extremity open bypass (LEB) versus peripheral vascular intervention (PVI) in patients with critical limb ischemia. Using data from the 2008-2014 Vascular Quality Initiative, 1-year primary patency, major amputation, and mortality were compared among all patients undergoing LEB versus PVI at or below the knee for rest pain or tissue loss. Overall, 2566 patients were included (LEB=500, PVI=2066). One-year primary patency was significantly worse following LEB (73% vs 81%; p<0.001). One-year major amputation (14% vs 12%; p=0.18) and mortality (4% vs 6%; p=0.15) were similar regardless of revascularization approach. Multivariable analysis adjusting for baseline differences between groups confirmed inferior primary patency following LEB versus PVI (HR 0.74; 95% CI, 0.60-0.90; p=0.004), but no significant differences in 1-year major amputation (HR 1.06; 95% CI, 0.80-1.40; p=0.67) or mortality (HR 0.71; 95% CI, 0.44-1.14; p=0.16). Based on these data, we conclude that endovascular revascularization is a viable treatment approach for critical limb ischemia resulting from infrageniculate arterial occlusive disease.
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Affiliation(s)
- Caitlin W Hicks
- 1 Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Alireza Najafian
- 2 Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Alik Farber
- 3 Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, MA, USA
| | - Matthew T Menard
- 4 Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mahmoud B Malas
- 1 Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - James H Black
- 1 Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Christopher J Abularrage
- 1 Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Hicks CW, Najafian A, Farber A, Menard MT, Malas MB, Black JH, Abularrage CJ. Diabetes does not worsen outcomes following infrageniculate bypass or endovascular intervention for patients with critical limb ischemia. J Vasc Surg 2016; 64:1667-1674.e1. [DOI: 10.1016/j.jvs.2016.07.107] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/06/2016] [Indexed: 11/28/2022]
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Giuliano K, Nagarajan N, Canner J, Najafian A, Wolfgang C, Schneider E, Meyer C, Lennon AM, Johnston FM, Ahuja N. Gastric and small intestine gastrointestinal stromal tumors: Do outcomes differ? J Surg Oncol 2016; 115:351-357. [PMID: 27885685 DOI: 10.1002/jso.24514] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/09/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Previous literature has suggested that small intestine GISTs are more aggressive than gastric GISTs. Our primary objective was to compare the outcomes of gastric and small intestine GISTs in the decade after approval of imatinib for treatment. METHODS The SEER database was queried for cases of gastric and small intestine GIST between the years 2002 and 2012, using the ICD-O-3 histology code 8936. Survival analysis was performed using generalized gamma models for time to cause-specific mortality (CSM). RESULTS CSM was 14.0% for the 3,759 gastric GIST patients and 14.3% for the 1,848 small intestine GIST patients. Five-year survival was 82.2% and 83.3% for gastric and small intestine patients, respectively. The number of diagnosed cases of GIST increased over the course of this study, especially for tumors <5 cm in size and in patients over age 50 years. CONCLUSIONS In this large nation-wide study, we found that patients with gastric and small intestine GISTs had similar outcomes, in contrast to previous reports. The diagnosis of GIST has significantly increased in the last decade, which may reflect the increased recognition of this entity and frequent use of imaging. J. Surg. Oncol. 2017;115:351-357. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Katherine Giuliano
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Neeraja Nagarajan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joseph Canner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alireza Najafian
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher Wolfgang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Schneider
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christian Meyer
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anne Marie Lennon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nita Ahuja
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Orion KC, Najafian A, Ehlert BA, Malas MB, Black JH, Abularrage CJ. Gender Predicts Rupture of Pancreaticoduodenal Artery Aneurysms. Ann Vasc Surg 2016; 36:1-6. [DOI: 10.1016/j.avsg.2016.03.007] [Citation(s) in RCA: 8] [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: 12/09/2015] [Revised: 01/19/2016] [Accepted: 03/03/2016] [Indexed: 11/28/2022]
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Asemota AO, Alsulaim HA, Alshaikh H, Gani F, Najafian A, Nagarajan N, Canner JK, Schneider EB. Aspiration Pneumonitis in Patients with Acute Traumatic Brain Injury. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Noureldine SI, Najafian A, Aragon Han P, Olson MT, Genther DJ, Schneider EB, Prescott JD, Agrawal N, Mathur A, Zeiger MA, Tufano RP. Evaluation of the Effect of Diagnostic Molecular Testing on the Surgical Decision-Making Process for Patients With Thyroid Nodules. JAMA Otolaryngol Head Neck Surg 2016; 142:676-82. [DOI: 10.1001/jamaoto.2016.0850] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Salem I. Noureldine
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alireza Najafian
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patricia Aragon Han
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew T. Olson
- Division of Cytopathology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dane J. Genther
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric B. Schneider
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason D. Prescott
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishant Agrawal
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aarti Mathur
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martha A. Zeiger
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ralph P. Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Neychev VK, Ghanem M, Blackwood SL, Aragon Han P, Fazeli R, Schneider E, Najafian A, Bloch DC, Bard MC, Klarsfeld JH, Zeiger MA, Lipton RJ. Reply to: Letter to the Editor on the article "Parathyroid surgery can be safely performed in a community hospital by experienced parathyroid surgeons: A retrospective cohort study". Int J Surg 2016; 32:187-8. [PMID: 27321807 DOI: 10.1016/j.ijsu.2016.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Vladimir K Neychev
- Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT, 06810, USA; Department of Surgery, "Alexandrovska" University Multiprofile Hospital, Medical University of Sofia, 1 "Sveti Georgi Sofiyski" Blvd, Sofia, 1431, Bulgaria.
| | - Maher Ghanem
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Stuart L Blackwood
- Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT, 06810, USA
| | - Patricia Aragon Han
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Roghayeh Fazeli
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Eric Schneider
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Alireza Najafian
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Dov C Bloch
- Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT, 06810, USA
| | - Michael C Bard
- Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT, 06810, USA
| | - Jay H Klarsfeld
- Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT, 06810, USA
| | - Martha A Zeiger
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Richard J Lipton
- Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT, 06810, USA
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Ehlert BA, Najafian A, Orion KC, Malas MB, Black JH, Abularrage CJ. Validation of a modified Frailty Index to predict mortality in vascular surgery patients. J Vasc Surg 2016; 63:1595-1601.e2. [DOI: 10.1016/j.jvs.2015.12.023] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/15/2015] [Indexed: 12/21/2022]
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Aragon Han P, Kim HS, Cho S, Fazeli R, Najafian A, Khawaja H, McAlexander M, Dy B, Sorensen M, Aronova A, Sebo TJ, Giordano TJ, Fahey TJ, Thompson GB, Gauger PG, Somervell H, Bishop JA, Eshleman JR, Schneider EB, Witwer KW, Umbricht CB, Zeiger MA. Association of BRAF V600E Mutation and MicroRNA Expression with Central Lymph Node Metastases in Papillary Thyroid Cancer: A Prospective Study from Four Endocrine Surgery Centers. Thyroid 2016; 26:532-42. [PMID: 26950846 PMCID: PMC4827320 DOI: 10.1089/thy.2015.0378] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Studies have demonstrated an association of the BRAF(V600E) mutation and microRNA (miR) expression with aggressive clinicopathologic features in papillary thyroid cancer (PTC). Analysis of BRAF(V600E) mutations with miR expression data may improve perioperative decision making for patients with PTC, specifically in identifying patients harboring central lymph node metastases (CLNM). METHODS Between January 2012 and June 2013, 237 consecutive patients underwent total thyroidectomy and prophylactic central lymph node dissection (CLND) at four endocrine surgery centers. All tumors were tested for the presence of the BRAF(V600E) mutation and miR-21, miR-146b-3p, miR-146b-5p, miR-204, miR-221, miR-222, and miR-375 expression. Bivariate and multivariable analyses were performed to examine associations between molecular markers and aggressive clinicopathologic features of PTC. RESULTS Multivariable logistic regression analysis of all clinicopathologic features found miR-146b-3p and miR-146b-5p to be independent predictors of CLNM, while the presence of BRAF(V600E) almost reached significance. Multivariable logistic regression analysis limited to only predictors available preoperatively (molecular markers, age, sex, and tumor size) found miR-146b-3p, miR-146b-5p, miR-222, and BRAF(V600E) mutation to predict CLNM independently. While BRAF(V600E) was found to be associated with CLNM (48% mutated in node-positive cases vs. 28% mutated in node-negative cases), its positive and negative predictive values (48% and 72%, respectively) limit its clinical utility as a stand-alone marker. In the subgroup analysis focusing on only classical variant of PTC cases (CVPTC), undergoing prophylactic lymph node dissection, multivariable logistic regression analysis found only miR-146b-5p and miR-222 to be independent predictors of CLNM, while BRAF(V600E) was not significantly associated with CLNM. CONCLUSION In the patients undergoing prophylactic CLNDs, miR-146b-3p, miR-146b-5p, and miR-222 were found to be predictive of CLNM preoperatively. However, there was significant overlap in expression of these miRs in the two outcome groups. The BRAF(V600E) mutation, while being a marker of CLNM when considering only preoperative variables among all histological subtypes, is likely not a useful stand-alone marker clinically because the difference between node-positive and node-negative cases was small. Furthermore, it lost significance when examining only CVPTC. Overall, our results speak to the concept and interpretation of statistical significance versus actual applicability of molecular markers, raising questions about their clinical usefulness as individual prognostic markers.
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Affiliation(s)
- Patricia Aragon Han
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hyun-seok Kim
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Soonweng Cho
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roghayeh Fazeli
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alireza Najafian
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hunain Khawaja
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Melissa McAlexander
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Benzon Dy
- Departments of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Meredith Sorensen
- Division of Endocrine Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Anna Aronova
- Endocrine Surgery Section, Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Thomas J. Sebo
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Thomas J. Giordano
- Departments of Pathology and Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Thomas J. Fahey
- Endocrine Surgery Section, Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | | | - Paul G. Gauger
- Division of Endocrine Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Helina Somervell
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin A. Bishop
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James R. Eshleman
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric B. Schneider
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kenneth W. Witwer
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher B. Umbricht
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martha A. Zeiger
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Najafian A, Selvarajah S, Schneider EB, Malas MB, Ehlert BA, Orion KC, Haider AH, Abularrage CJ. Thirty-day readmission after lower extremity bypass in diabetic patients. J Surg Res 2016. [DOI: 10.1016/j.jss.2015.06.061] [Citation(s) in RCA: 8] [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] [Indexed: 10/23/2022]
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Nagarajan N, Najafian A, Schneider EB, Zeiger MA, Olson MT. Conventional smears versus liquid-based preparations for thyroid fine-needle aspirates: a systematic review and meta-analysis. J Am Soc Cytopathol 2015; 4:253-260. [PMID: 31051762 DOI: 10.1016/j.jasc.2015.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 12/30/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Thyroid fine-needle aspiration has traditionally been prepared using conventional smears (CS). Liquid-based preparations (LBP) have grown in popularity and yet, there is a lack of consensus about which method is superior. This review compared CS and LBP as an intervention in the management of thyroid nodules. MATERIALS AND METHODS Medline, EMBASE, Scopus and ClinicalTrials.gov were searched to locate relevant studies. Observational studies comparing CS and LBP of consecutive thyroid fine-needle aspirations were included. Two reviewers independently screened, extracted, and entered data. Double data extraction included the following outcomes: (1) the proportion of inadequate smears and (2) the proportion of indeterminate smears. Studies were also assessed for risk of bias and heterogeneity. RESULTS From 599 unique studies, title/abstract screening identified 136 studies, and full text screening identified 13 studies. The 13 studies included 24,307 fine-needle aspirations from 19,433 patients and had high clinical, methodological, and statistical heterogeneity with low risk of bias. For CS and LBP, a meta-analysis of 12 studies showed no difference in the proportion of inadequate smears (risk difference: -0.00; 95% confidence interval [CI]: -0.04-0.04); 13 studies showed no difference in the proportion of indeterminate smears (risk difference: -0.02; 95% CI: -0.05-0.01). Sensitivity analysis of studies with low risk of bias had similar results. CONCLUSIONS There is no difference between CS and LBP in the proportion of inadequate and indeterminate smears. Recommendations of one method over the other should be based on cost, feasibility, and accuracy, all of which require further study.
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Affiliation(s)
- Neeraja Nagarajan
- Center for Surgical Trials Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alireza Najafian
- Center for Surgical Trials Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric B Schneider
- Center for Surgical Trials Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martha A Zeiger
- Division of Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew T Olson
- Division of Cytopathology, Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland.
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Kim HS, Wilsbach K, Marti A, Najafian A, Meeker AK, Eshleman JR, Bishop JA, Zeiger M, Umbricht CB. Abstract 4268: DNA copy number variation and driver mutation patterns of follicular thyroid tumors. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-4268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Our previous study using single nucleotide polymorphism (SNP) array identified significant differences in copy number variation (CNV) between tumor subtypes. This study was conducted to extend our previous findings, using both Fluorescent In-Situ Hybridization (FISH) and quantitative PCR (qPCR), and to investigate the possible relationship with major thyroid cancer driver mutations, and their association with aggressive features in follicular thyroid tumors.
Methods
For the validation, we obtained paraffin blocks of all cases with CNVs identified in our prior study (7 samples with Ch12 amplification, and 6 samples with Ch22 deletion), as well as 6 control samples with no CNV, for FISH analysis and qPCR. We used centromeric and distal probes to differentiate partial vs whole chromosome alterations. We then extended the study to characterize the relation between CNV and driver mutations and possible associations with aggressive features in a larger cohort of tumors, consisting of: 35 follicular adenoma (FA), 19 non-aggressive follicular variant papillary thyroid carcinoma (FVPTC), 22 aggressive FVPTC, 16 non-aggressive follicular carcinoma (FC), and 15 aggressive FC.
Results
Our FISH and qPCR results confirmed our earlier CNV results in this expanded sample cohort. Furthermore, FISH indicated that in each case, CNV involved the entire chromosome rather than sub-chromosomal alterations. Ch12 amplification was significantly more prevalent in FA and non-aggressive tumor than aggressive tumor subtypes (p-value <0.01). The HRAS mutation was predominantly detected in aggressive FCs, but the low number of events precluded reaching statistical significance.
Conclusion
Our study suggests that Ch12 amplification is associated with indolent tumors. Since FAs are a common source of inconclusive pre-operative cytopathology, a molecular signature such as Ch12 amplification that identifies follicular tumors with little aggressive potential could be useful. Further independent external testing is warranted.
CNV and RAS pattern across follicular thyroid tumor subtypesChromosome 12 AmplificationChromosome 22 DeletionNRAS mutationHRAS mutationFA40% (14/35)17.1% (6/35)17.1% (6/35)0.3% (1/35)Non-aggressive FVPTC15.8% (3/19)15.8% (3/19)36.8% (7/19)0% (0/19)Aggressive FVPTC4.5% (1/22)22.7% (5/22)18.2% (4/22)0% (0/22)Non-aggressive FC6.3% (1/16)6.3% (1/16)50% (8/16)0% (0/16)Aggressive FC6.7% (1/15)26.7% (4/15)53.3% (8/15)26.7% (4/15)
Citation Format: Hyun-seok Kim, Kathleen Wilsbach, Aurelien Marti, Alireza Najafian, Alan K. Meeker, James R. Eshleman, Justin A. Bishop, Martha Zeiger, Christopher B. Umbricht. DNA copy number variation and driver mutation patterns of follicular thyroid tumors. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4268. doi:10.1158/1538-7445.AM2015-4268
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Ehlert BA, Najafian A, Orion KC, Malas MB, Black JH, Abularrage CJ. RR27. Validation of a Modified Frailty Index to Predict Mortality in Vascular Surgery Patients. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.04.382] [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: 10/23/2022]
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Najafian A, Olson MT, Schneider EB, Zeiger MA. Clinical presentation of patients with a thyroid follicular neoplasm: are there preoperative predictors of malignancy? Ann Surg Oncol 2015; 22:3007-13. [PMID: 25564170 DOI: 10.1245/s10434-014-4324-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Studies examining differences in presentation of patients with benign [follicular adenoma (FA)] and malignant follicular thyroid neoplasms [follicular thyroid carcinoma (FTC) or follicular variant papillary thyroid carcinoma (FVPTC)] include only one or two of these subtypes, and none has considered clinical, cytological, and sonographic features together. We therefore examined presenting clinical features of all benign and malignant follicular neoplasm subtypes in an attempt to identify predictors of malignancy. METHODS Consecutive patients with a surgically resected follicular thyroid neoplasm at a tertiary hospital from 2005 to 2013 were reviewed. Age, gender, symptoms, history, physical findings, nodule size, sonographic, cytologic, and final pathologic results were recorded. Multivariate logistic regression was used to determine variables that contributed to a diagnosis of malignant follicular neoplasm. RESULTS A total of 616 patients (163 males, 453 females) presented with 441 FAs, 17 FTCs, and 158 FVPTCs. On multivariate analysis, male sex [odds ratio (OR) 1.87, p = 0.008], family history of thyroid cancer (OR 5.16, p < 0.001), and history of head and neck radiation (OR 2.01, p = 0.04) were associated with an increased odds of malignancy; age >45 (OR 2.03, p = 0.001), dysphagia (OR 3.48, p = 0.001) or pressure sensation (OR 3.00, p = 003), concomitant hyperthyroidism (OR 4.76, p = 0.01), nodules ≥4 cm (OR 3.68, p < 0.001), and multinodularity on physical examination (OR 1.93, p = 0.004) were associated with an increased odds of a benign lesion. CONCLUSIONS Independent clinical predictors exist that might be helpful in preoperative differentiation of benign and malignant follicular neoplasms. A combination of these predictors with both FNA and molecular results may help us to improve the clinical management of patients with follicular thyroid lesions.
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Affiliation(s)
- Alireza Najafian
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mathur A, Najafian A, Schneider EB, Zeiger MA, Olson MT. Malignancy risk and reproducibility associated with atypia of undetermined significance on thyroid cytology. Surgery 2014; 156:1471-6; discussion1476. [DOI: 10.1016/j.surg.2014.08.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/11/2014] [Indexed: 12/30/2022]
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Costela F, Otero-Millan J, McCamy M, Macknik S, Troncoso X, Najafian A, Martinez S. Characteristics of square-wave jerks in the macaque monkey. J Vis 2014. [DOI: 10.1167/14.10.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Najafian A, Zeiger MA. Role of molecular diagnostic markers in the management of indeterminate and suspicious thyroid nodules. International Journal of Endocrine Oncology 2014. [DOI: 10.2217/ije.13.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Incidental thyroid nodules are commonly found during routine neck examination. Fine needle aspiration (FNA) followed by cytological examination is currently considered as the most reliable method for evaluation of thyroid nodules. However, 10–40% of FNA results are inconclusive, and are reported as indeterminate or suspicious. Approximately 20% of indeterminate or suspicious nodules are malignant. Therefore, there has been an increasing trend in use of molecular markers as an adjunctive measure for more accurate preoperative diagnosis of indeterminate or suspicious nodules. Molecular markers can be used alone or as a part of molecular panels. Although some investigations revealed promising findings regarding the potential use of molecular markers in the management of thyroid nodules, their true impact on management of patients with indeterminate nodules is still unclear.
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Affiliation(s)
- Alireza Najafian
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Martha A Zeiger
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Ghahiri A, Najafian A, Ghasemi M, Najafian A. Comparison study on effectiveness of pentoxifyllin with LD to prevent recurrent endometriosis. Iran J Reprod Med 2012; 10:219-22. [PMID: 25242996 PMCID: PMC4165964] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 04/27/2011] [Accepted: 06/12/2011] [Indexed: 12/03/2022]
Abstract
BACKGROUND About 75% of the symptomatic patients who involved with endometriosis have pelvic pain and dysmenorrhea. Pentoxifyllin is one of the drugs that according to its mechanism could be effective for pain relief of endometriosis which has been used for endometriosis treatment recently. OBJECTIVE We conducted a comparative study for detecting the effect of pentoxifylin (as an immonomodelator) in preventing recurrence endometriotic pain with pentoxifylin plus a combined contraceptive pill with low dose estrogen (LD) and also the LD pill alone. MATERIALS AND METHODS This was a comparative clinical trial on 83 patients with the chief complaint (CC) of pain (dysmenorrheal /or pelvic pain) and with the end diagnosis of endometriosis, in an operative laparoscopy. Patients, dividing to 3 groups, were treated with pentoxifylin, pentoxifylin+LD and LD alone for 10 months. The severity of pain (dismenorhea and/or pelvic pain) was detected by visual analogue scale (VAS) before and after the treatment. The severity of endometriosis in the patients was: I in class I and II in class II and III in class III. The groups were matched for the pain. The number of the patients in group 1, 2 and 3 were 28, 28 and 27 respectively. RESULTS The pain was reduced in the groups of pentoxifylin+LD (p<0.001) and LD alone (p=0.00). The pain relief was not significant in the group of pentoxifylin alone (p=0.136). After treatment, the severity of pain was not significantly different between the LD group and the LD+penthoxyfillin group, but there was difference between these two groups and the group of penthoxyfillin alone. CONCLUSION This study showed that penthoxyfillin actually could not have any effect on the pain relief of endometriosis. It also made it clear that penthoxyfillin could not increase the efficacy of LD when used with this medication.
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Affiliation(s)
- Ataollah Ghahiri
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Aida Najafian
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mojdeh Ghasemi
- Research Office of Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Alireza Najafian
- Research assistant, Isfahan Endocrine and Metabolism Research Center (IEMRC), Isfahan, Iran.
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Mehrabian F, Mohammadizadeh F, Moghtaderi N, Najafian A. Comparison of placental pathology between severe preeclampsia and HELLP syndrome. Arch Gynecol Obstet 2011; 285:175-81. [DOI: 10.1007/s00404-011-1948-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 06/03/2011] [Indexed: 10/18/2022]
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Abstract
Most laboratories use EDTA for anticoagulation of whole blood prior to automated cell counting but due to platelet swelling, mean platelet volume (MPV) values may increase with its use. MPV changes may be less with acid citrate based anticoagulation. As MPV is a marker of platelet function and its precise measurement is important in a number of clinical situations, this study was performed to assess if EDTA and citrate based anticoagulated blood samples can be used interchangeably for MPV measurement. In this cross sectional descriptive study, EDTA and citrate based anticoagulated blood samples of the same patients were assessed by auto-analyzer within 1 h of sampling. In the 61 evaluated patients, there was a close correlation between MPV as measured by EDTA and citrate, but mean MPV measured from EDTA samples was 0.66 fL (9%) more than citrate. There was also a significant negative correlation between platelets count and MPV by both methods. The results of our study reveal that MPV can be measured accurately by both methods of anticoagulation; EDTA and citrate if analysis be performed within 1 h of sampling.
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Dastjerdi MS, Kazemi F, Najafian A, Mohammady M, Aminorroaya A, Amini M. An open-label pilot study of the combination therapy of metformin and fluoxetine for weight reduction. Int J Obes (Lond) 2006; 31:713-7. [PMID: 16969361 DOI: 10.1038/sj.ijo.0803447] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obesity is a very important risk factor for cardiovascular disease, type 2 diabetes mellitus, hypertension, osteoarthritis, fatty liver, metabolic syndrome and respiratory problems. Many weight-reducing drugs cannot be used in obese patients because of numerous complications. Fluoxetine, an antidepressant, and metformin, an antidiabetic drug, reduce weight as their side effect, but the potency of each drug is not always enough. Here, we studied the effects of combination therapy of them for weight reduction in obese women. MATERIALS AND METHODS This study was designed as an open, prospective, controlled clinical trial. Obese and overweight patients referred to obesity clinics were first put under a diet and behavior therapy education program before being invited to this study. The patients who accepted drug therapy were put in the case group. Those who did not accept drug therapy were put in the control group. Fluoxetine, 20 mg daily, and metformin, 500 mg three times daily, were prescribed to the participants. Weight and body mass index (BMI) changes within case and control groups were analyzed by paired t-tests and between groups by t-testing. Side effects were evaluated by interview and questionnaire. SUBJECTS Two hundred and three patients were referred to obesity clinics. Of these, 177 were female with 91 being volunteers for this study. Of this 91, 66 were in the case group and 25 in the control group. RESULTS In a 6.68-month period, a 7.89 kg decrease in weight (9.32%) and a 3.43 U decrease in BMI (10.14%) were observed in participants of the case group that was statistically significant (P<0.0001). The participants of the control group were followed for a mean period of 8.12 months. In this period, the participants of the control group showed a 0.48 kg decrease in weight (0.52%) and a 0.11 U decrease in BMI (0.42%). This was not significant. No serious side effects of the drugs were observed in the case group. CONCLUSION This open-label pilot study of combination therapy of metformin and fluoxetine gave encouraging weight reduction, and these results suggest the need for a randomized double-blind clinical trial comparing the two components and the combination to placebo.
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Affiliation(s)
- M Siavash Dastjerdi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan Endocrine & Metabolism Research Center, Sedigheh Tahereh Medical Research Complex, Isfahan, Iran.
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Siavash Dastjerdi M, Hashemipour M, Rezvanian H, Kazemi F, Najafian A, Mohammady M, Aminorroaya A, Amini M, Kachuei A, Hassan Moaddab M. Iron deficiency in goitrous schoolchildren of Semirom, Iran. Horm Res Paediatr 2006; 66:45-50. [PMID: 16710096 DOI: 10.1159/000093473] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Accepted: 04/08/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Iodine deficiency produces the spectrum of iodine deficiency disorders (IDDs): endemic goiter, hypothyroidism, cretinism, and congenital anomalies. Other factors, including goitrogens and micronutrient deficiencies, may influence the prevalence and severity of IDDs and response to iodine supplementation. This cross-sectional, descriptive study was performed in 2003 on elementary school children of Semirom, a mountainous region of Iran, where goiter was hyper-endemic in 1994, but the goiter prevalence had not decreased as expected many years after salt iodization and iodine injection. Some possible risk factors associated with goiter in that area were evaluated, and the results of iron study are presented here. METHODS 1,869 cases were selected by a multistage cluster sampling procedure. Grade 2 goitrous children were compared with equal number of nongoitrous children for serum iron, ferritin, transferrin, thyroxin, TSH and urine iodine concentrations (UIC). RESULTS 210 children (105 goiter grade 0 and 105 goiter grade 2) entered this sub-study. Of 210 participants, 70 children had low transferrin saturation, 13 had low serum ferritin and 9 children had both problems. There was no significant difference in goiter rate between children with low iron indices and others. There was no significant correlation between serum iron, ferritin or transferrin saturation with other variables including T4, UIC and goiter stage. CONCLUSION The present study reveals that in the area studied, iron deficiency cannot explain the high prevalence of goiter, so other responsible factors should be investigated.
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Affiliation(s)
- Mansour Siavash Dastjerdi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Najafian A, Salimpour R. Medical training in Iran. Pahlavi Med J 1977; 8:271-4. [PMID: 887286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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