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1.
Diseases ; 12(5)2024 May 08.
Article in English | MEDLINE | ID: mdl-38785751

ABSTRACT

BACKGROUND: Appendiceal neuroendocrine tumors (NETs) rank as the third most frequent neoplasm affecting the appendix, originating from enterochromaffin cells. This study aims to evaluate the influence of various prognostic factors on the mortality rates of patients diagnosed with NETs of the appendix. METHODS: Conducted retrospectively, the study involved 3346 patients, utilizing data sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis centered on investigating demographic characteristics, clinical features, overall mortality (OM), and cancer-specific mortality (CSM) among the cohort. Variables showing a p-value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox regression analysis. A Hazard Ratio (HR) > 1 indicated an unfavorable prognosis. RESULTS: In the multivariate analysis, higher OM and CSM were observed in males, older age groups, tumors with distant metastasis, poorly differentiated tumors, and those who underwent chemotherapy. Non-Hispanic Black individuals showed elevated mortality rates. CONCLUSION: Delayed diagnosis may contribute to the increased mortality in this community. Improved access to healthcare and treatment is crucial for addressing these disparities. Larger prospective studies are needed to pinpoint the underlying causes of elevated mortality in non-Hispanic Black populations, and randomized controlled trials (RCTs) are warranted to evaluate therapies for advanced-stage appendix NETs.

2.
Cureus ; 15(2): e35466, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36999100

ABSTRACT

Appendiceal mucocele is an extremely rare pathology accounting for 0.3-0.7% of all appendiceal pathology. It is characterized by appendiceal lumen dilatation by mucinous secretion collection. Though abdominal imaging and tissue Biopsy aids in diagnosis, suspicion should arise when a slight bulge or protrusion is seen on colonoscopy. We present a case of incidental appendiceal bulge found on a routine colonoscopy to evaluate abdominal pain that led to prompt diagnosis and management of appendiceal mucocele.

3.
ACG Case Rep J ; 9(7): e00801, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35919409

ABSTRACT

Clostridioides difficile infection (CDI) is a potentially life-threatening cause of diarrhea that can result in multiple complications. Fulminant CDI that is nonresponsive to antibiotics may require surgical ileostomy or fecal microbiota transplant (FMT). We present a case of a patient with fulminant CDI requiring surgical loop ileostomy who underwent a successful FMT delivered by Foley catheter through the ileostomy with symptom resolution. Delivery of FMT using a foley catheter in a patient with an ileostomy may be safe and effective for patients who are at a higher risk of complications associated with the instillation of FMT through colonoscopy with anesthesia.

5.
Ophthalmic Genet ; 40(4): 362-364, 2019 08.
Article in English | MEDLINE | ID: mdl-31424981

ABSTRACT

Background: Leber congenital amaurosis (LCA) due to RDH12 mutations typically manifests with severe vision loss and panretinal dystrophy. We sought to describe a case of LCA with choroidal neovascularization (CNV) in a 17-year-old patient. Materials and Methods: Case report of a 17-year old with LCA who presented with acute central vision loss of the right eye in the context of a chronic retinal dystrophy. Multimodal retinal imaging including spectral-domain optical coherence tomography and indocyanine green angiography revealed CNV. Results: A 17-year-old boy with previously diagnosed LCA/early-onset retinal dystrophy (EOSRD), with subsequently identified biallelic mutations in RDH12 was found to have type 2 CNV. Patient was treated with intravitreal ranibizumab and exhibited improvement on follow-up exam. Conclusions: Choroidal neovascularization may be a unique occurrence in RDH12-associated retinal dystrophy. Successful treatment of the neovascularization could be accomplished with intravitreal antivasogenic therapy.


Subject(s)
Alcohol Oxidoreductases/genetics , Choroidal Neovascularization/pathology , Mutation , Retinal Degeneration/complications , Adolescent , Angiogenesis Inhibitors/therapeutic use , Choroidal Neovascularization/drug therapy , Choroidal Neovascularization/etiology , Humans , Male , Prognosis , Ranibizumab/therapeutic use
6.
JAMA Ophthalmol ; 137(6): 618-625, 2019 06 01.
Article in English | MEDLINE | ID: mdl-30973595

ABSTRACT

Importance: Systemic blood flow alterations have been described using video nailfold capillaroscopy (NFC) in high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) variants of primary open-angle glaucoma (POAG). To date, no previous studies have explored alterations in nailfold capillary blood flow in exfoliation glaucoma (XFG). Objective: To investigate the measure of peripheral blood flow as a surrogate marker of systemic vascular involvement in patients with XFG, HTG, and NTG, as well as in individuals serving as controls, using NFC. Design, Setting, and Participants: A cross-sectional clinic-based study at the New York Eye and Ear Infirmary of Mount Sinai was conducted from July 6, 2017, to May 18, 2018. A total of 111 participants (30 XFG, 30 NTG, 30 HTG, and 21 controls) received a comprehensive ophthalmic examination to confirm eligibility. Exclusion criteria were the presence of connective tissue disease, uncontrolled diabetes, history of bleeding disorders, and/or history of trauma or surgery to the nondominant hand. Main Outcomes and Measures: Resting capillary blood flow at the nailfold of the fourth digit of the nondominant hand in patients with NTG, HTG, XFG, and controls, using NFC. Results: Two participants were excluded owing to poor nailfold image quality, resulting in 109 participants. Sixty-two participants (57%) were women and 79 (72%) were white. Mean (SD) age of the participants was 67.9 (11.7) years. Mean (SD) resting peripheral capillary blood flow at the nailfold for controls was 70.9 (52.4) picoliters/s (pL/s); HTG, 47.5 (41.9) pL/s; NTG, 40.1 (16.6) pL/s; and XFG, 30.6 (20.0) pL/s. Multivariable analysis of the differences of flow in HTG vs control participants showed values of -18.97 (95% CI, -39.22 to 1.27; P = .07) pL/s, NTG vs controls of -25.17 (95% CI, -45.92 to -4.41; P = .02) pL/s, and XFG vs controls of -28.99 (95% CI, -51.35 to -6.63; P = .01) pL/s. Conclusions and Relevance: Decreased resting peripheral capillary blood flow may occur in patients with XFG and NTG compared with individuals without glaucoma. These findings may contribute to understanding the possible systemic nature of glaucoma.


Subject(s)
Exfoliation Syndrome/physiopathology , Glaucoma, Open-Angle/physiopathology , Nails/blood supply , Aged , Aged, 80 and over , Capillaries/physiopathology , Cross-Sectional Studies , Female , Humans , Intraocular Pressure/physiology , Male , Microscopic Angioscopy , Middle Aged , Regional Blood Flow/physiology , Visual Fields/physiology
7.
Invest Ophthalmol Vis Sci ; 60(4): 1244-1253, 2019 03 01.
Article in English | MEDLINE | ID: mdl-30924849

ABSTRACT

Purpose: The purpose of this study was to explore macula vessel density and foveal avascular zone (FAZ) parameters in exfoliation glaucoma (XFG) compared to primary open-angle glaucoma (POAG) using optical coherence tomography angiography (OCTA). Methods: This was a cross-sectional observational study. Twenty-six XFG and 28 POAG patients with comparable visual field defects on Humphrey 24-2 and 10-2 perimetries were recruited. OCTA scans (3 × 3 mm) centered on the fovea were obtained. Built-in software was used to measure superficial capillary plexus (SCP) vessel density at different quadrants of the macula. Custom software was then used to create a full-thickness image. The FAZ was manually delineated, and large vessels were removed. Vessel density in eight concentric rings with increments of 200-µm diameters from the delineated FAZ was measured. FAZ parameters were calculated using the custom software. Results: SCP density was significantly lower in the superior (mean difference [MD] = -4.32, 95% confidence interval [CI] = -7.02, -1.61, P = 0.003) and nasal (MD = -3.00, 95% CI = 05.22, -0.77, P = 0.010) quadrants in XFG versus POAG. SCP vessel density using the concentric ring approach revealed significantly decreased values at all eight rings in XFG versus POAG. In the full-thickness analysis, density was significantly less in the XFG group in all rings except the initial 200 µm. No significant differences existed in FAZ parameters between the groups. Conclusions: Despite the presence of comparable central visual field defects, the macula vessel density was predominately lower in XFG compared with POAG in our sample of patients. Further studies are warranted to investigate the consistency of our results.


Subject(s)
Exfoliation Syndrome/physiopathology , Glaucoma, Open-Angle/physiopathology , Macula Lutea/blood supply , Retinal Vessels/pathology , Aged , Cross-Sectional Studies , Exfoliation Syndrome/diagnostic imaging , Female , Fluorescein Angiography/methods , Fovea Centralis/diagnostic imaging , Fovea Centralis/pathology , Glaucoma, Open-Angle/diagnostic imaging , Humans , Intraocular Pressure/physiology , Macula Lutea/diagnostic imaging , Male , Middle Aged , Prospective Studies , Retinal Vessels/diagnostic imaging , Retrospective Studies , Tomography, Optical Coherence/methods , Visual Field Tests , Visual Fields/physiology
8.
J Foot Ankle Surg ; 50(1): 16-24, 2011.
Article in English | MEDLINE | ID: mdl-21055974

ABSTRACT

Heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia with thrombosis (HITT) syndromes are the result of an adverse reaction to heparin that results in a spectrum of laboratory and end-organ manifestations secondary to thrombosis of both arterial and venous small and large vessels. HITT most often manifests in the extremities as acral ischemia and necrosis, with a spectrum of severity. The lower extremity surgical patient is at risk for deep venous thrombosis, and when exposed to heparin products, is also at risk for the development of a heparin-induced thrombocytopenic syndrome. This article reports on a cohort of patients from a tertiary referral lower extremity reconstruction practice with the HIT/HITT syndromes, with an analysis of the frequency, medical characteristics, clinical settings, lower extremity manifestations, management, and outcomes of patients with HIT/HITT.).


Subject(s)
Anticoagulants/adverse effects , Heparin/adverse effects , Thrombocytopenia/chemically induced , Thrombocytopenia/therapy , Venous Thrombosis/chemically induced , Venous Thrombosis/therapy , Adult , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , Cohort Studies , Combined Modality Therapy , Female , Follow-Up Studies , Heparin/therapeutic use , Humans , Lower Extremity/physiopathology , Male , Middle Aged , Platelet Count , Platelet Function Tests , Retrospective Studies , Risk Assessment , Severity of Illness Index , Survival Rate , Syndrome , Thrombocytopenia/mortality , Thrombocytopenia/physiopathology , Treatment Outcome , Venous Thrombosis/mortality , Venous Thrombosis/physiopathology
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