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Fresno, CA, United States

Guthrie J.,Community Regional Medical Center
Journal of Diagnostic Medical Sonography | Year: 2012

A novel diagnostic test, named the PREW© score, was formulated to predict the known liver disease status of a purposive sample of 500 patients (304 cases and 196 controls) referred for abdominal sonograms. The score was defined by (P R E)/W, where P = portal vein pressure gradient (mm Hg), R = ratio between the observed mean portal vein diameter in the patient (mm) and the mean diameter in healthy subjects (mm), E = echogenicity of liver parenchyma (ECHO grade scale), and W = hepatic venous waveform (1 = monophasic to 3 = triphasic). Cases with PREW scores >50 were about 480 times more likely than the controls to be diagnosed with cirrhosis/ascites. Cases with PREW scores of 16 to 50 were about 6 to 15 times more likely than the controls to be diagnosed with hepatitis and about 15 to 120 times more likely to be diagnosed with cirrhosis/ascites. It was not possible to clearly discriminate between a diagnosis of hepatitis and cirrhosis/ascites if the PREW score was less than 50. The likelihoods of patients with PREW scores >25 being diagnosed with nonalcoholic fatty liver disease/steatohepatitis (NAFLD/NASH) or gallbladder (GB) disease were not statistically significant. A PREW score greater than 25 identified cases diagnosed with hepatitis/cirrhosis/ascites but eliminated diagnoses of NAFLD/NASH/GB. The clinical implication is that a PREW score >50 may help to facilitate the diagnosis of cirrhosis without confirmation by liver biopsy. © The Author(s) 2012.

Persistent hemodynamically significant patent ductus arteriosus (PDA) in preterm infants may lead to significant morbidity and increased mortality. This report proposes a new composite marker to predict a hemodynamically significant PDA, termed the PDA marker (PDAM) score, which incorporates the diameter of the patent foramen ovale (PFO) in addition to the ratio of the diameter of the left atrium to the diameter of the root of the aorta (LA/Ao) and ratio of the size of the patent ductus arteriosus to the left pulmonary artery (PDA/LPA) diameter. PDA was suspected in 191 infants between 2009 and 2013. Analysis of the data indicated that there was no significant difference between the accuracy of the PDA diameter and the PDAM score as markers of either a hemodynamically significant PDA or a very hemodynamically significant PDA that needed ligation. These data did show that the PDAM score provided slightly higher sensitivity (93.3%) and specificity (75.6%) than the PDA diameter to identify a PDA that needed ligation at the specified cutoff level of PDAM = 5.1. Consequently, clinicians may be more confident using the PDAM score, rather than the PDA diameter alone, when selecting PDA cases for surgical intervention. © The Author(s) 2014.

Balasubramanian V.,Community Regional Medical Center | Naing S.,University of California at San Francisco
Current Opinion in Pulmonary Medicine | Year: 2012

PURPOSE OF REVIEW: This review summarizes the literature on hypogonadism in men with chronic obstructive pulmonary disease (COPD). RECENT FINDINGS: COPD is a systemic disease with effects beyond the lungs. Many prior studies have shown that middle-aged and elderly COPD patients may develop hypogonadism. Prevalence of hypogonadism in men with COPD can range from 22 to 69% and has been associated with several other systemic manifestations including osteoporosis, depression, and muscle weakness. Recent studies have revealed conflicting results with regards to these previous perceptions. The discrepancies in the findings can be mainly attributed to small sample size, differences in patient selection, and inconsistent findings. Testosterone replacement therapy may result in modest improvements in fat-free mass and limb muscle strength but its therapeutic efficacy in COPD patients still remains controversial. SUMMARY: The relationship between hypogonadism and COPD still remains poorly understood. The current literature is at best circumstantial. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Sawant A.C.,Community Regional Medical Center
BMJ case reports | Year: 2012

Benign cystic teratoma of lung is an extremely rare tumour, which was first described in literature by Mohr in 1839. Intrapulmonary teratoma is thought to be a derivative of the third endo-dermal pharyngeal pouch, which is an anlage of the thymus. The authors present a rare case of mature cystic teratoma in a young male involving the right upper lobe of the lung. Diagnosis is often missed and patients are treated for various infectious conditions. Treatment is complete resection for both benign and malignant teratomas and carries excellent prognosis. Benign cystic teratoma, if not excised may cause grave complications like life-threatening haemoptysis or malignant transformation with metastatic disease.

Zachariah B.,James A. Haley Veterans Administration Hospital | Zachariah B.,University of South Florida | Gwede C.K.,University of South Florida | James J.,Statistical Center | And 8 more authors.
Journal of the National Cancer Institute | Year: 2010

Background In anorectal cancer patients, an acute side effect of chemoradiotherapy is gastrointestinal toxicity, which often impedes treatment delivery. Based on previous trials, octreotide acetate is widely recommended for the control of chemotherapy-induced diarrhea. However, the effectiveness of octreotide in preventing or controlling radiation- and chemoradiation-induced diarrhea is not known. Methods A randomized, double-blinded, placebo-controlled trial was designed to determine the efficacy of long-Acting octreotide acetate (LAO) in preventing the onset of acute diarrhea in patients undergoing chemoradiation therapy for rectal or anal cancer. Between 4 and 7 days before the start of radiation therapy, patients received a 30-mg dose of LAO (109 patients) or placebo (106 patients) via intramuscular injection. A second dose was given on day 22 (±3 days) of radiation treatment. A total of 215 patients were included in the final analysis. The primary endpoint was the incidence of grade 2-4 acute diarrhea; secondary endpoints included treatment compliance, medical resource utilization, patient-reported bowel function, and quality of life (QoL). Statistical tests were one- or two-sided, as specified. Results After a median follow-up time of 9.64 months, incidence rates of grades 2-4 acute diarrhea were similar in both groups (49% placebo vs 44% LAO; P = .21). No statistically significant treatment differences in chemotherapy or radiation delivery, medical resource utilization, patient-reported bowel function, or QoL were observed. Conclusion In this study, the prophylactic use of LAO did not prevent the incidence or reduce the severity of diarrhea and had no notable impact on patient-reported bowel function or QoL. © The Author 2010.

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