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1.
J Gastrointest Surg ; 27(1): 122-130, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36271199

RESUMO

BACKGROUND: Radiomics is an approach to medical imaging that quantifies the features normally translated into visual display. While both radiomic and clinical markers have shown promise in predicting response to neoadjuvant chemoradiation therapy (nCRT) for rectal cancer, the interrelationship is not yet clear. METHODS: A retrospective, single-institution study of patients treated with nCRT for locally advanced rectal cancer was performed. Clinical and radiomic features were extracted from electronic medical record and pre-treatment magnetic resonance imaging, respectively. Machine learning models were created and assessed for complete response and positive treatment effect using the area under the receiver operating curves. RESULTS: Of 131 rectal cancer patients evaluated, 68 (51.9%) were identified to have a positive treatment effect and 35 (26.7%) had a complete response. On univariate analysis, clinical T-stage (OR 0.46, p = 0.02), lymphovascular/perineural invasion (OR 0.11, p = 0.03), and statin use (OR 2.45, p = 0.049) were associated with a complete response. Clinical T-stage (OR 0.37, p = 0.01), lymphovascular/perineural invasion (OR 0.16, p = 0.001), and abnormal carcinoembryonic antigen level (OR 0.28, p = 0.002) were significantly associated with a positive treatment effect. The clinical model was the strongest individual predictor of both positive treatment effect (AUC = 0.64) and complete response (AUC = 0.69). The predictive ability of a positive treatment effect increased by adding tumor and mesorectal radiomic features to the clinical model (AUC = 0.73). CONCLUSIONS: The use of a combined model with both clinical and radiomic features resulted in the strongest predictive capability. With the eventual goal of tailoring treatment to the individual, both clinical and radiologic markers offer insight into identifying patients likely to respond favorably to nCRT.


Assuntos
Terapia Neoadjuvante , Neoplasias Retais , Humanos , Terapia Neoadjuvante/métodos , Resultado do Tratamento , Estudos Retrospectivos , Imageamento por Ressonância Magnética , Neoplasias Retais/terapia , Neoplasias Retais/tratamento farmacológico , Aprendizado de Máquina
2.
Dis Colon Rectum ; 61(6): 713-718, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29664798

RESUMO

BACKGROUND: Restorative proctocolectomy with IPAA improves quality of life in patients with medically refractory ulcerative colitis. Although bowel obstruction is common, pouch volvulus is rare and described only in case reports. Diagnosis can be challenging, resulting in delayed care and heightened morbidity. OBJECTIVE: The purpose of this study was to delineate the symptoms and successful management strategies used in patients with IPAA volvulus that result in pouch salvage. DESIGN: This study was a case series. SETTINGS: The study was conducted at a tertiary referral center for ulcerative colitis in Milwaukee, Wisconsin. PATIENTS: Patients included those with volvulus of the IPAA. MAIN OUTCOME MEASURES: Over the study period (2010-2015), 6 patients were diagnosed with IPAA volvulus. The primary outcomes were symptom manifestation, diagnostic practices, and treatment of pouch volvulus. RESULTS: Six patients with ulcerative colitis were identified with pouch volvulus. The majority (n = 4) underwent a laparoscopic pouch creation and had early symptom manifestation after surgery. Complications preceding volvulus included pouch ulceration (n = 5) and pouchitis (n = 4). The most common presenting symptoms of volvulus were abdominal pain (n = 4) and obstipation (n = 4). Multiple imaging modalities were used, but volvulus was most frequently identified by CT scan. Management was primarily operative (n = 5), composed of excision of the pouch (n = 3), pouch-pexy (n = 1), and detorsion with defect closure (n = 1). Both operative and nonoperative treatment with endoscopic detorsion resulted in low morbidity and improved patient symptoms. LIMITATIONS: This single-institution study is limited by its retrospective design and small number of patients. CONCLUSIONS: IPAA volvulus is a rare and challenging cause of bowel obstruction in ulcerative colitis. Heralding signs and symptoms, such as pouch ulceration and acute obstipation, should initiate a workup for a twisting pouch. Diagnosis, which is multimodal, must occur early to avert necrosis and allow for preservation of a well-functioning pouch. See Video Abstract at http://links.lww.com/DCR/A561.


Assuntos
Colite Ulcerativa/cirurgia , Bolsas Cólicas/efeitos adversos , Volvo Intestinal/cirurgia , Proctocolectomia Restauradora/métodos , Polipose Adenomatosa do Colo/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Bolsas Cólicas/estatística & dados numéricos , Feminino , Humanos , Volvo Intestinal/complicações , Volvo Intestinal/diagnóstico por imagem , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pouchite/etiologia , Proctocolectomia Restauradora/psicologia , Qualidade de Vida , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Wisconsin/epidemiologia , Adulto Jovem
3.
Dysphagia ; 31(4): 587-91, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26753928

RESUMO

Killian-Jamieson diverticulum is a outpouching of the lateral cervical esophageal wall adjacent to the insertion of the recurrent laryngeal to the larynx and is much less common in clinical practice than Zenkers Diverticulum. Surgical management of Killian-Jamieson diverticulum requires open transcervical diverticulectomy due to the proximity of the recurrent laryngeal nerve to the base of the pouch. We present a case of a Killian-Jamieson diverticulum associated with a concurrent large type III paraesophageal hernia causing significant solid-food dysphagia, post-prandial regurgitation of solid foods, and chronic cough managed with open transcervical diverticulectomy and laparoscopic paraesophageal hernia repair with Nissen fundoplication.


Assuntos
Tosse/etiologia , Transtornos de Deglutição/etiologia , Divertículo Esofágico/complicações , Hérnia Hiatal/complicações , Refluxo Laringofaríngeo/etiologia , Divertículo Esofágico/patologia , Esôfago/patologia , Hérnia Hiatal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Laríngeo Recorrente/patologia
4.
Case Rep Gastroenterol ; 5(3): 546-52, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22087087

RESUMO

Fistulas between the luminal gastrointestinal tract and vascular structures can result from a variety of etiologies. While there have been reports of fistulas between the inferior vena cava and the duodenum, we report the first case to our knowledge of a fistula between the jejunum and the inferior vena cava after esophagojejunal anastomosis for recurrent esophageal adenocarcinoma.

5.
J Am Coll Radiol ; 4(11): 776-99, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17964501

RESUMO

Computed tomographic colonography (CTC) was first introduced in the mid-1990s as a minimally invasive technology for colorectal cancer screening. Given its potential to significantly change colorectal cancer screening practices in the United States, it has attracted widespread multidisciplinary interest among radiologists, gastroenterologists, colorectal surgeons, and primary care physicians. Because of its potential for widespread utilization and the potential associated costs, it has also attracted much scrutiny from payers. The authors discuss the coding and reimbursement history of CTC, outline strategies for obtaining local coverage for CTC, and attempt to outline some of the possible future influences on CTC reimbursement.


Assuntos
Centers for Medicare and Medicaid Services, U.S./economia , Colonografia Tomográfica Computadorizada/economia , Planos de Pagamento por Serviço Prestado/economia , Planos de Pagamento por Serviço Prestado/tendências , Previsões , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/tendências , Estados Unidos
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