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Mitchell KG, Nelson DB, Corsini EM, Vaporciyan AA, Antonoff MB, Mehran RJ, Rice DC, Roth JA, Sepesi B, Walsh GL, Bhutani MS, Maru DM, Wu CC, Nguyen QN, Ajani JA, Swisher SG, Hofstetter WL. Morbidity following salvage esophagectomy for squamous cell carcinoma: the MD Anderson experience. Dis Esophagus 2020; 33:5532833. [PMID: 31313820 DOI: 10.1093/dote/doz067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/14/2019] [Revised: 06/05/2019] [Accepted: 06/25/2019] [Indexed: 12/11/2022]
Abstract
The survival advantage associated with the addition of surgical therapy in esophageal squamous cell carcinoma (ESCC) patients who demonstrate a complete clinical response to chemoradiotherapy is unclear, and many institutions have adopted an organ-preserving strategy of selective surgery in this population. We sought to characterize our institutional experience of salvage esophagectomy (for failure of definitive bimodality therapy) and planned esophagectomy (as a component of trimodality therapy) by retrospectively analyzing patients with ESCC of the thoracic esophagus and GEJ who underwent esophagectomy following chemoradiotherapy between 2004 and 2016. Of 76 patients who met inclusion criteria, 46.1% (35) underwent salvage esophagectomy. Major postoperative complications (major cardiovascular and pulmonary events, anastomotic leak [grade ≥ 2], and 90-day mortality) were frequent and occurred in 52.6% of the cohort (planned resection: 36.6% [15/41]; salvage esophagectomy: 71.4% [25/35]). Observed rates of 30- and 90-day mortality for the entire cohort were 7.9% (planned: 7.3% [3/41]; salvage: 8.6% [3/35]) and 13.2% (planned: 9.8% [4/41]; salvage: 17.1% [6/35]), respectively. In summary, esophagectomy following chemoradiotherapy for ESCC at our institution has been associated with frequent postoperative morbidity and considerable rates of mortality in both planned and salvage settings. Although a selective approach to surgery may permit organ preservation in many patients with ESCC, these results highlight that salvage esophagectomy for failure of definitive-intent treatment of ESCC may also constitute a difficult clinical undertaking in some cases.
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Affiliation(s)
- K G Mitchell
- Department of Thoracic and Cardiovascular Surgery
| | - D B Nelson
- Department of Thoracic and Cardiovascular Surgery
| | - E M Corsini
- Department of Thoracic and Cardiovascular Surgery
| | | | - M B Antonoff
- Department of Thoracic and Cardiovascular Surgery
| | - R J Mehran
- Department of Thoracic and Cardiovascular Surgery
| | - D C Rice
- Department of Thoracic and Cardiovascular Surgery
| | - J A Roth
- Department of Thoracic and Cardiovascular Surgery
| | - B Sepesi
- Department of Thoracic and Cardiovascular Surgery
| | - G L Walsh
- Department of Thoracic and Cardiovascular Surgery
| | - M S Bhutani
- Department of Gastroenterology Hepatology and Nutrition
| | | | - C C Wu
- Department of Diagnostic Radiology
| | | | - J A Ajani
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - S G Swisher
- Department of Thoracic and Cardiovascular Surgery
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Abstract
BACKGROUND Although diabetic ketoacidosis (DKA) in pregnancy can result in significant adverse consequences for both mother and fetus, the response to treatment, time course of recovery, and perinatal outcomes have not been well studied in pregnancy. OBJECTIVE We examined the precipitating factors, laboratory abnormalities, treatment strategies, and clinical recovery in pregnancies complicated by DKA. STUDY DESIGN This is a retrospective cohort study of pregnancies complicated by DKA between October 1999 and June 2015. The diagnosis was verified by hyperglycemia; anion gap >12 mEq/L, pH <7.3, HCO3 <15 mEq/L; and the presence of ketones. Each episode of DKA was reviewed and subsequent perinatal outcomes analyzed. RESULTS During this period, we identified 33 women with 40 admissions (incidence: 0.2%). The majority of women had type 1 diabetes (67%), and almost all presented with nausea and vomiting (97%). Over half had poor compliance with prescribed insulin. The initial mean blood glucose was 380 mg/dL, within 6 hours, it was <200 mg/dL. By 12 hours, the acidosis had resolved in 90% of patients. CONCLUSION Nausea and vomiting is a prominent presenting feature of DKA in pregnancy. With aggressive insulin and resuscitation, hyperglycemia and acidosis improve rapidly. With current treatment, good perinatal outcomes can be expected.
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Zane LT, Chanda S, Jarnagin K, Nelson DB, Spelman L, Gold LFS. Crisaborole and its potential role in treating atopic dermatitis: overview of early clinical studies. Immunotherapy 2016; 8:853-66. [DOI: 10.2217/imt-2016-0023] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Atopic dermatitis (AD), a chronic, relapsing, inflammatory skin disease that is characterized by intense pruritus and eczematous lesions with up to 90% of patients presenting with mild to moderate disease. Current topical treatments for AD have not changed in over 15 years and are associated with safety concerns. In AD, overactivity of phosphodiesterase 4 (PDE4), leads to inflammation and disease exacerbation. Crisaborole Topical Ointment, 2%, is a novel, nonsteroidal, topical anti-inflammatory PDE4 inhibitor currently being investigated for the treatment of mild to moderate AD. Preliminary studies in children and adults demonstrated favorable efficacy and safety profiles. Crisaborole may represent an anti-inflammatory option that safely minimizes the symptoms and severity of AD and that can be used for both acute and long-term management.
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Affiliation(s)
- LT Zane
- Anacor Pharmaceuticals, Inc., 1020 East Meadow Circle, Palo Alto, CA, USA
| | - S Chanda
- Anacor Pharmaceuticals, Inc., 1020 East Meadow Circle, Palo Alto, CA, USA
| | - K Jarnagin
- Anacor Pharmaceuticals, Inc., 1020 East Meadow Circle, Palo Alto, CA, USA
| | - DB Nelson
- Anacor Pharmaceuticals, Inc., 1020 East Meadow Circle, Palo Alto, CA, USA
| | - L Spelman
- Veracity Clinical Research, Queensland, Australia
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Cunningham FG, Nelson DB. Magnesium sulphate: too much of a good thing? BJOG 2015; 123:367. [PMID: 26629674 DOI: 10.1111/1471-0528.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- F G Cunningham
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - D B Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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Nelson DB, Hanlon A, Nachamkin I, Haggerty CL, Mastrogiannis DS, Liu C, Fredricks DN. Early pregnancy changes in bacterial vaginosis-associated bacteria and preterm delivery. Paediatr Perinat Epidemiol 2014; 28:88-96. [PMID: 24405280 PMCID: PMC4031320 DOI: 10.1111/ppe.12106] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND We evaluated the importance of measuring early vaginal levels of eight bacterial vaginosis (BV)-associated bacteria, at two points in pregnancy, and the risk of spontaneous preterm delivery (SPTD) among pregnant women and the subgroup of pregnant women with a history of preterm delivery (PTD). METHODS This prospective cohort study enrolled women at five urban obstetric practices at Temple University Hospital in Philadelphia PA. Women with singleton pregnancies less than 16 weeks gestation self-collected vaginal swabs at two points in pregnancy, prior to 16 weeks gestation and between 20-24 weeks gestation, to measure the presence and level of eight BV-associated bacteria. Women were followed-up for gestational age at delivery via medical records. RESULTS Among women reporting a prior PTD, women with higher levels of Leptotrichia/Sneathia species, BVAB1 and Mobiluncus spp., prior to 16 weeks gestation, were significantly more likely to experience a SPTD. In addition, pregnant women with a prior PTD and increasing levels of Leptotrichia/Sneathia species (aOR: 9.1, 95% CI 1.9, 42.9), BVAB1 (aOR: 16.4, 95% CI 4.3, 62.7) or Megasphaera phylotype 1 (aOR: 6.2, 95% CI 1.9, 20.6), through 24 weeks gestation, were significantly more likely to experience an SPTD. Among the overall group of pregnant women, the levels of BV-associated bacteria were not related to SPTD. CONCLUSION Among the group of women reporting a prior PTD, increasing levels of BVAB1, Leptotrichia/Sneathia species, and Megasphaera phylotype 1, through mid-pregnancy were related to an increased risk of SPTD.
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Affiliation(s)
- DB Nelson
- Department of Obstetrics & Gynecology, Temple University, Philadelphia PA,Department of Public Health, Temple University, Philadelphia PA
| | - A Hanlon
- School of Nursing, University of Pennsylvania
| | - I Nachamkin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia PA
| | - CL Haggerty
- Department of Epidemiology Graduate School of Public Health University of Pittsburgh, Pittsburgh PA
| | - DS Mastrogiannis
- Department of Obstetrics & Gynecology, Temple University, Philadelphia PA
| | - C Liu
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center Seattle WA
| | - DN Fredricks
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center Seattle WA
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Abstract
BACKGROUND AND STUDY AIMS Postpolypectomy bleeding is a rare but serious adverse event. The aim of this study was to identify factors associated with the risk of severe delayed postpolypectomy bleeding. PATIENTS AND METHODS This was a case-control study, comparing cases who developed hematochezia and required medical evaluation 6 hours to 14 days after colonoscopic polypectomy, and control patients who underwent polypectomy without delayed bleeding, and who were selected in approximately a 3 : 1 ratio. The following risk factors were specified a priori: resuming anticoagulation (within 1 week following polypectomy), aspirin use, hypertension, and polyp diameter. RESULTS Of the 4592 patients who underwent colonoscopy with polypectomy, 41 patients (0.9 %) developed delayed postpolypectomy bleeding (cases), and 132 patients were selected as controls. The mean age was 64.3 years for cases and 65.4 years for controls. Cases presented on average 6 days after polypectomy (range 1 - 14 days), and 48 % required blood transfusion (average 4.2 units, range 0 - 17). Two patients required surgery. Anticoagulation was resumed following polypectomy in 34 % of cases compared with 9 % of controls (OR 5.2; 95 % CI 2.2 - 12.5; P < 0.001). For every 1 mm increase in polyp diameter, the risk of hemorrhage increased by 9 % (OR 1.09; 95 % CI 1.0 - 1.2; P = 0.008). Hypertension (OR 1.1) and aspirin use (OR 1.1) did not increase the risk of postpolypectomy bleeding. In exploratory analysis, diabetes (OR 2.5) and coronary artery disease (OR 3.0) were associated with postpolypectomy hemorrhage, but the association was no longer statistically significant once adjusted for the use of anticoagulation. CONCLUSIONS Resuming anticoagulation following polypectomy and polyp diameter were strongly associated with increased risk of severe delayed postpolypectomy bleeding.
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Affiliation(s)
- M S Sawhney
- Section of Gastroenterology Minneapolis Veterans Administration Medical Center, Minneapolis, USA.
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Nelson DB, Bellamy S, Odibo A, Nachamkin I, Ness RB, Allen-Taylor L. Vaginal symptoms and bacterial vaginosis (BV): how useful is self-report? Development of a screening tool for predicting BV status. Epidemiol Infect 2007; 135:1369-75. [PMID: 17274857 PMCID: PMC2870698 DOI: 10.1017/s095026880700787x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Vaginal complaints compel an evaluation of bacterial vaginosis (BV), however, many cases of BV are asymptomatic. We evaluated the sensitivity and specificity of vaginal symptoms in the diagnosis of BV and examined the utility of creating a BV screening tool using clinical, behavioural and demographic characteristics. A total of 1916 pregnant women were included in this analysis. In total, 757 women screened positive for BV and over one third of BV-positive women presented without any lower genital tract symptoms (39.4%). African American race, abnormal vaginal odour, and smoking were independently related to BV positivity. A BV screening tool including these three factors was fairly predictive of BV status with the area under the ROC curve equal to 0.669. This three-item prediction rule may be useful in identifying high- risk pregnant women in need of BV screening and, given the high specificity, accurately identify the group of BV-negative pregnant women.
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Affiliation(s)
- D B Nelson
- Department of Public Health and Ob/Gyn, Temple University, Philadelphia, PA 19122, USA.
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Bloomfield HE, Nelson DB, van Ryn M, Neil BJ, Koets NJ, Basile JN, Samaha FF, Kaul R, Mehta JL, Bouland D. A trial of education, prompts, and opinion leaders to improve prescription of lipid modifying therapy by primary care physicians for patients with ischemic heart disease. Qual Saf Health Care 2006; 14:258-63. [PMID: 16076789 PMCID: PMC1744060 DOI: 10.1136/qshc.2004.012617] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Recent clinical trials indicate that treatment with lipid modifying therapy improves outcomes in patients with ischemic heart disease (IHD) and low levels of high density lipoprotein (HDL) cholesterol. The results of these trials, however, have not been widely implemented in clinical practice. OBJECTIVES To develop and test an intervention designed to increase the rate of prescription of lipid modifying therapy and to determine the relative effectiveness of three different prompts (progress notes, patient letters, or computer chart reminders). METHODS The study was conducted in 11 US Department of Veterans Affairs Medical Centers. The effect of the intervention on the proportion of eligible patients receiving lipid modifying therapy was compared between five intervention sites and six matched control sites using a controlled before and after study design. Additionally, 92 providers within the intervention clinics were randomized to receive one of the three prompts. Data were analyzed using logistic regression modeling which incorporated terms to account for the clustered nature of the data. RESULTS At the intervention sites the prescription rate increased from 8.3% during the pre-intervention period to 39.1% during the intervention (OR = 6.5, 95% CI 5.2 to 8.2, p<0.0001) but remained unchanged at the control sites. The interaction between group (control v intervention) and time period was highly significant (p<0.0001). The adjusted odds of receiving a prescription during the intervention period was 3.1 times higher at the intervention sites than at the control sites (95% CI 2.1 to 4.7). Overall, there was no significant difference in prescription rates among the three prompt groups. However, there was a significant interaction between prompt group and site, indicating that the efficacy of the prompts differed by site. CONCLUSION An intervention for primary care providers consisting of an educational workshop, opinion leader influence, and prompts substantially increased the prescription rate of lipid modifying therapy.
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Affiliation(s)
- H E Bloomfield
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota, USA.
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Nelson DB, Bellamy S, Nachamkin I, Allen-Taylor L, Wang H. 504: First Trimester Bacterial Vaginosis and Early Pregnancy Loss. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s126c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D B Nelson
- University of Pennsylvania, Philadelphia, PA 19104
| | - S Bellamy
- University of Pennsylvania, Philadelphia, PA 19104
| | - I Nachamkin
- University of Pennsylvania, Philadelphia, PA 19104
| | | | - H Wang
- University of Pennsylvania, Philadelphia, PA 19104
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Freeman EW, Sammel MD, Gracia CR, Kapoor S, Lin H, Liu L, Nelson DB. Follicular phase hormone levels and menstrual bleeding status in the approach to menopause. Fertil Steril 2005; 83:383-92. [PMID: 15705379 DOI: 10.1016/j.fertnstert.2004.06.066] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [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: 03/10/2004] [Revised: 06/29/2004] [Accepted: 06/29/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVE (1) Characterize the relationship between follicular phase hormone levels and menstrual bleeding patterns in the approach to menopause; (2) identify racial differences in hormone levels; (3) determine independent contributions of menstrual status, race, age, BMI, and smoking to hormone levels. DESIGN Randomly identified, population-based cohort, stratified to obtain equal numbers of African American and Caucasian women, prospectively followed for 5 years. SETTING Women in Philadelphia County, PA, identified by random-digit telephone dialing. PARTICIPANT(S) Women aged 35 to 47 years with regular menstrual cycles at enrollment (N = 436). DATA COLLECTION Blood sampling twice in each of 7 assessment periods during days 1-6 of the cycle, menstrual dates identified through structured interview and daily symptom reports, anthropometric measures and standardized questionnaires at each assessment period. MAIN OUTCOME MEASURE(S) Serum levels of follicular E(2), FSH, inhibin B, and LH. RESULT(S) The mean levels of E(2), FSH, inhibin B, and LH were differentially associated with the 5 menstrual status groups defined by changes in bleeding patterns. Significant changes in hormone levels occurred prior to missed menstrual cycles for inhibin B, FSH, and LH. All hormones had a highly significant interaction between menstrual status and BMI. African American women had significantly lower levels of E(2) and LH compared to Caucasian women in univariate analyses. The interaction of race, menstrual status, and BMI was highly significant (P<.001) for E(2), with African American women having lower E(2) levels until postmenopause, when E(2) levels were higher in AA women with BMI > or =25 and BMI > or =30. CONCLUSION(S) Levels of E(2), FSH, LH, and inhibin B are significantly associated with menstrual bleeding patterns in late reproductive age women and differentiate the earliest stages of the menopausal transition. Racial differences in mean levels of E(2) appear strongly mediated by BMI.
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Affiliation(s)
- E W Freeman
- Department of Obstetrics and Gynecology, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, USA.
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Singh JA, Nelson DB, Nichol KL. HRQOL PREDICTS HEALTH CARE UTILIZATION AND MORTALITY IN VETERANS WITH ARTHRITIS. J Investig Med 2004. [DOI: 10.1097/00042871-200403002-00092] [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: 11/25/2022]
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Singh JA, Nelson DB, Nichol KL. 18 HRQOL PREDICTS HEALTH CARE UTILIZATION AND MORTALITY IN VETERANS WITH ARTHRITIS. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl2-92] [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: 11/04/2022]
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Fink HA, Ensrud KE, Nelson DB, Kerani RP, Schreiner PJ, Zhao Y, Cummings SR, Nevitt MC. Disability after clinical fracture in postmenopausal women with low bone density: the fracture intervention trial (FIT). Osteoporos Int 2003; 14:69-76. [PMID: 12577187 DOI: 10.1007/s00198-002-1314-y] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [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] [Indexed: 11/28/2022]
Abstract
Relatively little is known about outcomes following clinical osteoporotic fractures at nonhip, nonvertebral skeletal sites. To address this issue, we prospectively assessed post-fracture disability at multiple skeletal sites in a population of 909 older (aged 55-81 years), community-dwelling women with low femoral neck bone mineral density who had experienced a fracture while enrolled in the Fracture Intervention Trial (FIT). FIT is a randomized, double-masked, placebo-controlled trial that was designed to determine the effect of alendronate on fracture incidence, and the current study was conducted as a secondary analysis of FIT data. Following incident clinical fractures, FIT participants were followed prospectively for assessment of site-specific, fracture-related disability. Measures of disability were self-reported days hospitalized or confined to bed because of the fracture ('bed days') and days of reduced usual activities because of the fracture ('limited activity days'). Of fracture types evaluated, those of the hip resulted in the highest percentage of subjects with any bed days or limited activity days after fracture (94% with any bed days and 100% with any limited activity days), though the mean number of bed days and limited activity days appeared highest after lumbar vertebral fractures (25.8 mean bed days and 158.5 mean limited activity days). Substantial disability also was reported after fractures of thoracic vertebrae, humerus, distal forearm, ankle and foot. Within fracture types, post-fracture disability was highly variable, ranging from none to more than 6 months.
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Affiliation(s)
- H A Fink
- MD, MPH, VA Medical Center, One Veterans Drive, Box 11G, Minneapolis, MN 55417, USA.
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Abstract
AIMS This study was designed to determine the association between coagulation factors and spontaneous abortion adjusting for sex steroids and to examine the influence of sex hormones on coagulation factors early in pregnancy. METHODS Pregnant women presenting to the emergency department at the Hospital of the University of Pennsylvania were recruited and followed through 22 weeks gestation. Cases were women who experienced a spontaneous abortion (n=29) and controls were women who maintained their pregnancy to 22 weeks gestation (n=89). Participants completed a baseline questionnaire to assess demographic, reproductive, and drug use information. Blood samples measured estradiol, progesterone, fibrinogen, and factor VII antigen. RESULTS Cases of spontaneous abortion had significantly lower levels of estradiol, progesterone, fibrinogen and factor VII antigen compared to controls. The relationship between low levels of fibrinogen and factor VII antigen was diminished adjusting for the sex steroids. Regression analyses found low progesterone was the primary prospective marker for early pregnancy loss among our study population. CONCLUSIONS The relationship between coagulation factors and spontaneous abortion was reduced after adjustment for progesterone suggesting that progesterone mediates the relationship between low levels of coagulation factors and spontaneous abortion. Progesterone seems to be the primary marker for a spontaneous abortion among women seeking emergent care.
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Affiliation(s)
- D B Nelson
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 922 Blockley Hall, 423 Guardian Drive, Philadelphia PA 19104-6021, USA.
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Affiliation(s)
- D B Nelson
- Department of Ophthalmology, Medical College of Georgia, Augusta, GA 30912-3400, USA
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Nelson DB, Barkun AN, Block KP, Burdick JS, Ginsberg GG, Greenwald DA, Kelsey PB, Nakao NL, Slivka A, Smith P, Vakil N. Technology Status Evaluation report. Colonoscopy preparations. May 2001. Gastrointest Endosc 2001. [PMID: 11726878 DOI: 10.1016/s0016-5107(01)70087-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Nelson DB, Barkun AN, Block KP, Burdick JS, Ginsberg GG, Greenwald DA, Kelsey PB, Nakao NL, Slivka A, Smith P, Vakil N. Technology status evaluation report. Transmission of infection by gastrointestinal endoscopy. May 2001. Gastrointest Endosc 2001; 54:824-8. [PMID: 11726877 DOI: 10.1016/s0016-5107(01)70086-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Nelson DB. Effectiveness of colonoscopy in preventing colorectal cancer. Gastroenterology 2001; 121:1522. [PMID: 11729137 DOI: 10.1016/s0016-5085(01)83861-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Nelson DB, Barkun AN, Block KP, Burdick JS, Ginsberg GG, Greenwald DA, Kelsey PB, Nakao NL, Slivka A, Smith P, Vakil N. Technology status evaluation report. Endoscopic hemostatic devices. May 2001. Gastrointest Endosc 2001; 54:833-40. [PMID: 11726879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Nelson DB, Barkun AN, Block KP, Burdick JS, Ginsberg GG, Greenwald DA, Kelsey PB, Nakao NL, Slivka A, Smith P, Vakil N. Technology Status Evaluation report. Colonoscopy preparations. May 2001. Gastrointest Endosc 2001; 54:829-32. [PMID: 11726878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, Overby CS, Aas J, Ryan ME, Bochna GS, Shaw MJ, Snady HW, Erickson RV, Moore JP, Roel JP. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001; 54:425-34. [PMID: 11577302 DOI: 10.1067/mge.2001.117550] [Citation(s) in RCA: 782] [Impact Index Per Article: 34.0] [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: 02/06/2023]
Abstract
BACKGROUND Post-ERCP pancreatitis is poorly understood. The goal of this study was to comprehensively evaluate potential procedure- and patient-related risk factors for post-ERCP pancreatitis over a wide spectrum of centers. METHODS Consecutive ERCP procedures were prospectively studied at 11 centers (6 private, 5 university). Complications were assessed at 30 days by using established consensus criteria. RESULTS Pancreatitis occurred after 131 (6.7%) of 1963 consecutive ERCP procedures (mild 70, moderate 55, severe 6). By univariate analysis, 23 of 32 investigated variables were significant. Multivariate risk factors with adjusted odds ratios (OR) were prior ERCP-induced pancreatitis (OR 5.4), suspected sphincter of Oddi dysfunction (OR 2.6), female gender (OR 2.5), normal serum bilirubin (OR 1.9), absence of chronic pancreatitis (OR 1.9), biliary sphincter balloon dilation (OR 4.5), difficult cannulation (OR 3.4), pancreatic sphincterotomy (OR 3.1), and 1 or more injections of contrast into the pancreatic duct (OR 2.7). Small bile duct diameter, sphincter of Oddi manometry, biliary sphincterotomy, and lower ERCP case volume were not multivariate risk factors for pancreatitis, although endoscopists performing on average more than 2 ERCPs per week had significantly greater success at bile duct cannulation (96.5% versus 91.5%, p = 0.0001). Combinations of patient characteristics including female gender, normal serum bilirubin, recurrent abdominal pain, and previous post-ERCP pancreatitis placed patients at increasingly higher risk of pancreatitis, regardless of whether ERCP was diagnostic, manometric, or therapeutic. CONCLUSIONS Patient-related factors are as important as procedure-related factors in determining risk for post-ERCP pancreatitis. These data emphasize the importance of careful patient selection as well as choice of technique in the avoidance of post-ERCP pancreatitis.
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Affiliation(s)
- M L Freeman
- Hennepin County Medical Center, University of Minnesota, 701 Park Ave., Minneapolis, MN 55415, USA
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Davis BE, Nelson DB, Sahler OJ, McCurdy FA, Goldberg R, Greenberg LW. Do clerkship experiences affect medical students' attitudes toward chronically ill patients? Acad Med 2001; 76:815-20. [PMID: 11500285 DOI: 10.1097/00001888-200108000-00015] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE To measure changes in medical students' attitudes toward chronically ill patients, and to identify experiences, specifically during clerkships, that contributed to students' attitudes. METHOD A cohort of students from five U.S. medical schools voluntarily participated in three surveys longitudinally administered before and after required clinical rotations. The first two questionnaires were identical and asked for demographic information and pre-matriculation experiences with chronically ill patients. The third was modified to include questions about clinical experiences with chronically ill patients. Responses from the first and third questionnaires were linked for analysis. RESULTS A total of 502 of 695 students (69%) completed both the first and the third questionnaires. Many students (36%) had had pre-matriculation experiences with chronic illness. After clinical training, 25% of the respondents stated that they would seek another career specialty if the incidence of chronically ill patients increased in their chosen field, compared with the 9% who responded so before clinical training (p <.001). While 73% of the students had favorable perceptions toward chronically ill patients, and 91% felt involved in care, significantly fewer students (p <.01) had had positive patient care experiences when working with residents (57%) and attendings (59%). Gender, age, prior experiences, and school site were not associated with attitudinal changes. CONCLUSION Students begin medical school with positive attitudes toward caring for chronically ill patients, but this perception depreciates with clinical experience, which may affect specialty decisions. Contributing factors may include adequate role modeling by residents and attendings and a perceived discrepancy in the quality of care patients receive.
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Affiliation(s)
- B E Davis
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
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Nelson DB, Barkun AN, Block KP, Burdick JS, Ginsberg GG, Greenwald DA, Kelsey PB, Nakao NL, Slivka A, Smith P, Vakil N. Propofol use during gastrointestinal endoscopy. Gastrointest Endosc 2001; 53:876-9. [PMID: 11375623 DOI: 10.1016/s0016-5107(01)70311-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Nelson DB, Block KP, Bosco JJ, Burdick JS, Curtis WD, Faigel DO, Greenwald DA, Kelsey PB, Rajan E, Slivka A, Smith P, VanDam J, Wassef W, Wang KK. Medical device evaluation by the Food and Drug Administration (FDA). Gastrointest Endosc 2001; 53:880-4. [PMID: 11375624 DOI: 10.1016/s0016-5107(01)70312-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
To assess the relationship between hemostatic factors and spontaneous abortion, 134 pregnant women presenting to the emergency department were recruited and followed through 22 weeks' gestation. Cases were women experiencing a spontaneous abortion and controls were women who maintained their pregnancy. Fibrinogen, factor VII antigen, activated protein C-sensitivity ratio (APC-SR), protein S, and plasmin-antiplasmin (PAP) were measured. Cases had lower mean levels of fibrinogen and factor VII antigen compared with controls (3.1 g/L vs. 3.7 g/L and 89% of normal vs. 109% of normal, respectively). Regression analyses found that women with fibrinogen levels below 3.0 g/L had a five-fold increased risk of spontaneous abortion (OR = 5.1, 95% CI: 1.8-14.4) and women with factor VII antigen levels below 94% of normal had a threefold increased risk of spontaneous abortion normal (OR = 3.3, 95% CI: 1.2-8.5). Similar mean levels of APC-SR, protein S, and PAP were found in the two groups.
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Affiliation(s)
- D B Nelson
- Center for Clinical Epidemiology and Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pennsylvania 19104-6021, USA
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Nelson DB. Helicobacter eradication versus prompt endoscopy for dyspepsia. Gastroenterology 2001; 120:1298-9. [PMID: 11266397 DOI: 10.1016/s0016-5085(01)70290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Murphy TV, Gargiullo PM, Massoudi MS, Nelson DB, Jumaan AO, Okoro CA, Zanardi LR, Setia S, Fair E, LeBaron CW, Wharton M, Livengood JR, Livingood JR. Intussusception among infants given an oral rotavirus vaccine. N Engl J Med 2001; 344:564-72. [PMID: 11207352 DOI: 10.1056/nejm200102223440804] [Citation(s) in RCA: 640] [Impact Index Per Article: 27.8] [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: 11/19/2022]
Abstract
BACKGROUND Intussusception is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. Our investigation began on May 27, 1999, after nine cases of infants who had intussusception after receiving the tetravalent rhesus-human reassortant rotavirus vaccine (RRV-TV) were reported to the Vaccine Adverse Event Reporting System. METHODS In 19 states, we assessed the potential association between RRV-TV and intussusception among infants at least 1 but less than 12 months old. Infants hospitalized between November 1, 1998, and June 30, 1999, were identified by systematic reviews of medical and radiologic records. Each infant with intussusception was matched according to age with four healthy control infants who had been born at the same hospital as the infant with intussusception. Information on vaccinations was verified by the provider. RESULTS Data were analyzed for 429 infants with intussusception and 1763 matched controls in a case-control analysis as well as for 432 infants with intussusception in a case-series analysis. Seventy-four of the 429 infants with intussusception (17.2 percent) and 226 of the 1763 controls (12.8 percent) had received RRV-TV (P=0.02). An increased risk of intussusception 3 to 14 days after the first dose of RRV-TV was found in the case-control analysis (adjusted odds ratio, 21.7; 95 percent confidence interval, 9.6 to 48.9). In the case-series analysis, the incidence-rate ratio was 29.4 (95 percent confidence interval, 16.1 to 53.6) for days 3 through 14 after a first dose. There was also an increase in the risk of intussusception after the second dose of the vaccine, but it was smaller than the increase in risk after the first dose. Assuming full implementation of a national program of vaccination with RRV-TV, we estimated that 1 case of intussusception attributable to the vaccine would occur for every 4670 to 9474 infants vaccinated. CONCLUSIONS The strong association between vaccination with RRV-TV and intussusception among otherwise healthy infants supports the existence of a causal relation. Rotavirus vaccines with an improved safety profile are urgently needed.
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Affiliation(s)
- T V Murphy
- Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Abstract
OBJECTIVE The role of Helicobacter pylori in nonulcer dyspepsia is controversial. Speculation has arisen that only strains of H. pylori carrying the CagA virulence factor are important in the development of dyspepsia. The objective of this study was to determine whether nonulcer dyspepsia correlated with CagA-positive H. pylori infection. METHODS A total of 435 healthy blood donors and 102 general medicine clinic respondents completed the Bowel Disease Questionnaire and the PRIME-MD survey, a validated screen for common psychiatric disorders. Subjects were classified as cases of nonulcer dyspepsia if they reported pain in the upper abdomen more than six times in the previous year and denied a past or current history of peptic ulcer disease. Study participants were tested for IgG antibodies to H. pylori and the CagA protein. RESULTS Clinic respondents were more likely than healthy blood donors to meet the case definition for nonulcer dyspepsia (34% vs 13%, p < 0.001), to be seropositive for H. pylori (54% vs 18%, p < 0.001), and to be CagA seropositive (41% vs 10%, p = 0.01). Logistic regression identified CagA seropositivity (p = 0.03), race (p = 0.001), and positive screens for depression (p = 0.007) or somatization (p < 0.001) as variables independently associated with nonulcer dyspepsia. CONCLUSION Infection with a CagA-positive strain of H. pylori is associated with a clinical diagnosis of nonulcer dyspepsia. However, nonulcer dyspepsia was also strongly and independently associated with positive screens for depression or somatization disorder as well as with ethnicity. These potential sources of variance should be considered in the design of future studies evaluating nonulcer dyspepsia.
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Affiliation(s)
- D B Nelson
- Department of Medicine, Minneapolis VA Medical Center and University of Minnesota, 44417, USA
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Nelson DB. Colonoscopy versus double-contrast barium enema. Gastroenterology 2000; 119:1402-3. [PMID: 11054401 DOI: 10.1016/s0016-5085(00)70295-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wang KK, Wassef WY. Technology status evaluation report: endoscopy simulators: May 1999. Gastrointest Endosc 2000; 51:790-2. [PMID: 10840337 DOI: 10.1053/ge.2000.v51.age516790] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Nelson DB, Block KP, Bosco JJ, Burdick JS, Curtis WD, Faigel DO, Greenwald DA, Kelsey PB, Rajan E, Slivka A, Smith P, Wassef W, VanDam J, Wang KK. Technology status evaluation report: ultrathin endoscopes esophagogastroduodenoscopy: March 2000. Gastrointest Endosc 2000; 51:786-9. [PMID: 10840336 DOI: 10.1053/ge.2000.v51.age516786] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Nelson DB, Block KP, Bosco JJ, Burdick JS, Curtis WD, Faigel DO, Greenwald DA, Kelsey PB, Rajan E, Slivka A, Smith P, Wassef W, VanDam J, Wang KK, Barthel J, Affronti JP, Aliperti G, Etemad B, Kocab MA, Kozam ML, Rosen AM, Silverstein BD, Vakil N. Technology status evaluation report: computerized endoscopic medical record systems: November 1999. Gastrointest Endosc 2000; 51:793-6. [PMID: 10840338 DOI: 10.1053/ge.2000.v51.age516793] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Fink HA, Lederle FA, Roth CS, Bowles CA, Nelson DB, Haas MA. The accuracy of physical examination to detect abdominal aortic aneurysm. Arch Intern Med 2000; 160:833-6. [PMID: 10737283 DOI: 10.1001/archinte.160.6.833] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Abdominal palpation during physical examination is an important means of detecting abdominal aortic aneurysm (AAA), but limited information is available on its accuracy. METHODS Two hundred subjects (aged 51-88 years), 99 with and 101 without AAA as determined by previous ultrasound, each underwent physical examination of the abdomen by 2 internists who were blinded to each other's findings and to the ultrasound diagnosis. RESULTS The overall accuracy of abdominal palpation for detecting AAA was as follows: sensitivity, 68% (95% confidence interval [CI], 60%-76%); specificity, 75% (95% CI, 68%-82%); positive likelihood ratio, 2.7 (95% CI, 2.0-3.6); negative likelihood ratio 0.43 (95% CI, 0.33-0.56). Interobserver pair agreement for AAA vs no AAA between the first and second examinations was 77% (kappa = 0.53). Sensitivity increased with AAA diameter, from 61% for AAAs of 3.0 to 3.9 cm, to 69% for AAAs of 4.0 to 4.9 cm, 72% for AAAs of 4.0 cm or larger, and 82% for AAAs of 5.0 cm or larger. Sensitivity in subjects with an abdominal girth less than 100 cm (40-in waistline) was 91% vs 53% for girth of 100 cm or greater (P<.001). When girth was 100 cm or greater and the aorta was palpable, sensitivity was 82%. When girth was less than 100 cm and the AAA was 5.0 cm or larger, sensitivity was 100% (12 examinations). Factors independently associated with correct examination findings included AAA diameter (odds ratio [OR], 1.95 per centimeter increase; 95% CI, 1.06-3.58); abdominal girth (OR, 0.90 per centimeter increase; 95% CI, 0.87-0.94); and the examiner's assessment that the abdomen was not tight (OR, 2.68; 95% CI, 1.17-6.13). CONCLUSIONS Abdominal palpation has only moderate overall sensitivity for detecting AAA, but appears to be highly sensitive for diagnosis of AAAs large enough to warrant elective intervention in patients who do not have a large girth. Abdominal palpation has good sensitivity even in patients with a large girth if the aorta is palpable.
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Affiliation(s)
- H A Fink
- Department of Medicine and Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, University of Minnesota, 55417, USA
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Nelson DB, Freeman ML, Silvis SE, Cass OW, Yakshe PN, Vennes J, Stahnke LL, Herman M, Hodges J. A randomized, controlled trial of transcutaneous carbon dioxide monitoring during ERCP. Gastrointest Endosc 2000; 51:288-95. [PMID: 10699773 DOI: 10.1016/s0016-5107(00)70357-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [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: 02/08/2023]
Abstract
BACKGROUND Pulse oximetry, used to monitor oxygen saturation during endoscopy, does not directly measure hypoventilation. Study goals were to determine whether transcutaneous carbon dioxide (PtcCO(2)) monitoring during endoscopic retrograde cholangiopancreatography (ERCP) prevents severe hypoventilation and to assess the accuracy of clinical observation and pulse oximetry in detecting hypoventilation. METHODS All patients received intensive clinical and electronic monitoring including pulse oximetry. Supplemental oxygen was administered for pulse oximetry < 90%. Patients were randomized to a treatment arm (group 1) where PtcCO(2) monitoring guided sedation or a control arm (group 2) where PtcCO(2) was recorded but unavailable for guiding sedation. RESULTS Group 1 had significantly fewer episodes of severe carbon dioxide retention (rise in PtcCO(2) >/=40 mm Hg above baseline) than group 2 (0 of 199 versus 5 of 196, respectively, p = 0.03), as well a shorter mean duration of procedure discomfort (8.3% of procedure duration rated as "uncomfortable" versus 11.5%, p = 0.04). Correlations between clinical observation and objective measures of ventilation were poor: level of sedation versus PtcCO(2) (R = 0.3) or pulse oximetry (R = 0.06); slowest respiratory rate versus PtcCO(2) (R = 0.4) or pulse oximetry (R = -0.4). PtcCO(2) rises of greater than 20 mm Hg occurred without oxygen desaturation in 10.7% of patients receiving supplemental oxygen. CONCLUSIONS Carbon dioxide retention during ERCP is not reliably detected by clinical observation or by pulse oximetry in patients receiving supplemental oxygen. The addition of PtcCO(2) monitoring prevents severe carbon dioxide retention more effectively than intensive clinical monitoring and pulse oximetry alone. The clinical relevancy of this observation needs to be determined in an appropriately designed outcome study.
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Affiliation(s)
- D B Nelson
- Veterans Administration Medical Center, Hennepin County Medical Center, University of Minnesota, Minneapolis, USA
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Berke SJ, Cohen AJ, Sturm RT, Caronia RM, Nelson DB. ENDOSCOPIC CYCLOPHOTOCOAGULATION (ECP) AND PHACOEMULSIFICATION IN THE TREATMENT OF MEDICALLY CONTROLLED PRIMARY OPEN-ANGLE GLAUCOMA. J Glaucoma 2000. [DOI: 10.1097/00061198-200002000-00072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Laing K, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wassef WY. ASGE Technology status evaluation report. Automatic endoscope reprocessors. February 1999. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 50:925-7. [PMID: 10644193 DOI: 10.1016/s0016-5107(99)70197-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wassef WY. ASGE technology status evaluation report. Endoscopic retrieval devices. February 1999. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 50:932-4. [PMID: 10644195 DOI: 10.1016/s0016-5107(99)70199-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wang KK, Wassef WY. ASGE technology evaluation report. Endoscopy simulators. May 1999. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 50:935-7. [PMID: 10644196 DOI: 10.1016/s0016-5107(99)70200-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wang KK, Wassef WY. ASGE technology status evaluation report. Biliary stents. Update May 1999. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 50:938-42. [PMID: 10644197 DOI: 10.1016/s0016-5107(99)70201-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wassef WY. ASGE technology status evaluation report. Injection needles. February 1999. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 50:928-31. [PMID: 10644194 DOI: 10.1016/s0016-5107(99)70198-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Abstract
A 53-yr-old man was admitted with new onset of abdominal pain and nonbloody diarrhea 1 month after exposure to the antifungal agent itraconazole. Flexible sigmoidoscopy demonstrated the presence of pseudomembranes, and subsequent evaluation excluded other causes of diarrhea. Disruption of the resident fungal flora of the colon by itraconazole is proposed as the mechanism by which this patient developed pseudomembranous colitis. This association has not previously been reported.
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Affiliation(s)
- A J Nguyen
- Department of Medicine VA Medical Center and University of Minnesota, Minneapolis, 55417, USA
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Carr-Locke DL, Conn MI, Faigel DO, Laing K, Leung JW, Mills MR, Nelson DB, Tarnasky PR, Waxman I. Technology status evaluation: magnetic resonance cholangiopancreatography: November 1998. From the ASGE. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 49:858-61. [PMID: 10343251 DOI: 10.1016/s0016-5107(99)70318-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Carr-Locke DL, Conn MI, Faigel DO, Laing K, Leung JW, Mills MR, Nelson DB, Smith P, Tarnasky PR, Waxman I. Technology status evaluation: personal protective equipment: November 1998. From the ASGE. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 49:854-7. [PMID: 10343250 DOI: 10.1016/s0016-5107(99)70317-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wassef WY. Technology status evaluation: sheathed endoscopes: November 1998. From the ASGE. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 49:862-4. [PMID: 10343252 DOI: 10.1016/s0016-5107(99)70319-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Freeman ML, Nelson DB, Sherman S, Haber GB, Fennerty MB, DiSario JA, Ryan ME, Kortan PP, Dorsher PJ, Shaw MJ, Herman ME, Cunningham JT, Moore JP, Silverman WB, Imperial JC, Mackie RD, Jamidar PA, Yakshe PN, Logan GM, Pheley AM. Same-day discharge after endoscopic biliary sphincterotomy: observations from a prospective multicenter complication study. The Multicenter Endoscopic Sphincterotomy (MESH) Study Group. Gastrointest Endosc 1999; 49:580-6. [PMID: 10228255 DOI: 10.1016/s0016-5107(99)70385-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [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: 02/08/2023]
Abstract
BACKGROUND Same-day discharge after endoscopic biliary sphincterotomy (ES) is a common clinical practice, but there have been few data to guide appropriate selection of patients. Using a prospective, multicenter database of complications, we examined outcomes after same-day discharge as it was practiced by a variety of endoscopists and evaluated the ability of a multivariate risk factor analysis to predict which patients would require readmission for complications. METHODS A 150-variable database was prospectively collected at time of ES, before discharge and again at 30 days in consecutive patients undergoing ES at 17 centers. Complications were defined by consensus criteria and included all specific adverse events directly or indirectly related to ES requiring more than 1 night of hospitalization. RESULTS Six hundred fourteen (26%) of 2347 patients undergoing ES were discharged on the same day as the procedure, ranging from none at 6 centers to about 50% at 2 centers. After initial observation and release, readmission to the hospital for complications occurred in 35 (5.7%) of 614 same-day discharge patients (20 pancreatitis and 15 other complications, 3 severe). Of the same-day discharge patients, readmission was required for 14 (12.2%) of 115 who had at least one independently significant multivariate risk factor for overall complications (suspected sphincter of Oddi dysfunction, cirrhosis, difficult bile duct cannulation, precut sphincterotomy, or combined percutaneous-endoscopic procedure) versus 21 (4.2%) of 499 without a risk factor (odds ratio 3.1: 95% confidence interval [1.6, 6.3], p < 0.001). Of complications presenting within 24 hours after ES, only 44% presented within the first 2 hours, but 79% presented within 6 hours. CONCLUSIONS Same-day discharge is widely utilized and relatively safe but results in a significant number of readmissions for complications. For patients at higher risk of complications, as indicated by the presence of at least one of five independent predictors, observation for 6 hours or overnight may reduce the need for readmission.
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Affiliation(s)
- M L Freeman
- Hennepin County Medical Center and Minneapolis Veterans Administration Medical Center, MN 55415, USA
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Abstract
BACKGROUND Antibiotic prophylaxis has been recommended for selected patients undergoing esophageal stricture dilation because of a reported high rate of bacteremia. The aim of this study was to determine the rate of bacteremia after esophageal dilatation in a large series and the source of the organisms recovered. METHODS Blood cultures and oral temperatures were obtained before esophageal dilation and at 5 and 30 minutes after dilation. Dilators were cultured immediately before dilation. Procedural data collected included type of dilation, number of passes, and presence of malignancy. RESULTS Of 100 procedures in 86 patients undergoing esophageal dilation, 22 (22%) were associated with a positive post-dilation blood culture. Bacteremia was more frequent with dilation of malignant strictures compared with benign strictures (9 of 17 [52.9%] vs. 13 of 83 [15.7%], respectively, p = 0.002) and with passage of multiple dilators compared with passage of a single dilator (16 of 46 [34.8%] versus 6 of 54 [11.1%], respectively, p = 0.007). Bacterial isolates from 22 positive blood cultures matched those from a dilator in only one episode (4.5%). CONCLUSION The rate of bacteremia after esophageal dilation is 22% and is associated with dilation of malignant strictures or passage of multiple dilators. Organisms cultured from the blood are not transmitted from the dilator.
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Affiliation(s)
- D B Nelson
- Gastroenterology Section, Departments of Medicine and Laboratory Medicine and Pathology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN, USA
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Nelson DB, Ness RB, Peipert JF, Soper DE, Amortegui AJ, Gluck J, Wiesenfeld H, Rice PA. Factors predicting upper genital tract inflammation among women with lower genital tract infection. J Womens Health (Larchmt) 1998; 7:1033-40. [PMID: 9812300 DOI: 10.1089/jwh.1998.7.1033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We sought to identify factors that discriminate between women with a lower genital tract infection and women with a lower genital tract infection and endometritis. This study enrolled women at risk for or having a lower genital tract infection with Chlamydia trachomatis or Neisseria gonorrhoeae and measured behavioral and clinical factors. Women were identified through contact tracing of male partners, presentation with cervicitis, or presentation with symptoms of pelvic inflammatory disease and classified as (1) having a lower genital tract infection without endometritis, (2) having a lower genital tract infection with endometritis, (3) having no lower genital tract infection with endometritis, and (4) having neither a lower genital tract infection nor endometritis. The primary comparison was between women having a lower genital tract infection without endometritis to women having a lower genital tract infection and endometritis. Women with a lower genital tract infection and endometritis were older and reported a history of more sexually transmitted diseases (70.0% vs. 56.7%), abdominal pain (82.2% vs. 60.0%), and use of barrier methods of contraception (28.9% vs. 8.6%) than women with a lower genital tract infection alone. The regression model found that women with a lower genital tract infection and endometritis were 7.1 times (95% CI = 2.2-23.0) more likely to report abdominal pain and 4.6 times (95% CI = 1.5-14.9) more likely to use barrier methods of contraception than women with a lower genital tract infection alone. These results suggest that behavioral factors, in addition to symptoms, can be used to identify women with and without upper genital tract involvement.
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Affiliation(s)
- D B Nelson
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
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Affiliation(s)
- M E Fesenmyer
- Department of Medicine, Minneapolis VA Medical Center, University of Minnesota, USA
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