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Cleveland, OH, United States

Robenshtok E.,Sloan Kettering Cancer Center | Robenshtok E.,Endocrinology and Metabolism Institute | Robenshtok E.,Tel Aviv University | Grewal R.K.,Sloan Kettering Cancer Center | And 3 more authors.
Thyroid | Year: 2013

Background: Postsurgical thyrotropin (TSH)-stimulated serum thyroglobulin (Tg) level can be used to predict the likelihood of finding radioactive iodine (RAI) avid metastatic foci on postablation scanning. However, there is little data regarding the predictive value of a nonstimulated postoperative Tg obtained on levothyroxine therapy in patients being considered for recombinant human TSH (rhTSH)-Assisted remnant ablation. Methods: The study included 290 intermediate-risk differentiated thyroid cancer (DTC) patients with a postsurgical nonstimulated Tg<10 ng/mL prior to rhTSH-Assisted remnant ablation. Patients were stratified into four groups based on the postsurgical nonstimulated Tg value: Tg<0.6 ng/mL (n=146), Tg 0.6-0.9 ng/mL (n=76), Tg 1-5 ng/mL (n=51), and Tg>5-10 ng/mL (n=17). RAI avid metastatic foci were identified using post-therapy scanning with SPECT/CT (single photon emission computed tomography). Results: RAI avid metastases were identified in 16% (46/290) of patients, including 12% (17/146) with Tg<0.6 ng/mL, 14% (11/76) with Tg 0.6-0.9 ng/mL, 25% (13/51) with Tg 1-5 ng/mL, and 29% (5/17) with Tg>5-10 ng/mL (p=0.02). While 99% of the RAI avid foci were located in the neck, lung uptake was seen in one patient with Tg<0.6 ng/mL (0.7%, 1/146), one patient with Tg 0.6-0.9 ng/mL (1.3%, 1/76), and 2 patients with Tg>5-10 ng/mL (11%, 2/17 patients). Conclusions: A postoperative nonstimulated Tg<0.6 ng/mL does not exclude identification of RAI avid metastatic foci on postablation SPECT/CT scanning in intermediate-risk DTC patients. Therefore, patient selection for RAI ablation in the intermediate-risk group must be based on an integration of multiple risk factors rather than any single clinicopathologic risk factor. © Copyright 2013, Mary Ann Liebert, Inc. 2013.

Vest A.R.,Tufts Medical Center | Patel P.,Centennial Hospital | Schauer P.R.,Bariatric and Metabolic Institute | Satava M.E.,Quality and Patient Safety Institute | And 4 more authors.
Circulation: Heart Failure | Year: 2016

Background-Obesity is a risk factor for development of left ventricular systolic dysfunction (LVSD) and can complicate LVSD management, especially for individuals in whom cardiac transplantation is indicated. Bariatric surgery is increasingly recognized as a safe and effective intervention to achieve marked weight loss, but experience is limited in the LVSD population. Methods and Results-We retrospectively reviewed patients with obesity and left ventricular ejection fraction (LVEF) <50% who underwent bariatric surgery at a tertiary center 2004 to 2013. An analysis of outcomes and efficacy compared 42 surgical patients with LVSD to 2588 without known LVSD. The LVSD group had greater baseline prevalence of comorbidities and showed a slight excess of early postoperative heart failure and myocardial infarction. However, patients with LVSD achieved good weight loss efficacy (mean decrease 22.6%) and no excess in mortality at 1 year. An overlapping cohort of 38 patients with LVSD had both pre-and postoperative echocardiographic images available for review by 2 blinded readers. Obese nonsurgical controls were matched on age, sex, initial LVEF, and interval between echocardiograms. There was a mean pre-to postoperative LVEF improvement of +5.1% ±8.3 (P=0.0005) for surgical subjects, but not for controls (+3.4%±10.5, P=0.056). Among surgical subjects, 11 patients had an LVEF improvement of >10%, whereas only 6 improved by >10% among nonsurgical controls. Conclusions-At experienced centers, bariatric surgery may be a safe and effective intervention for obese patients with LVSD. Bariatric surgery was associated with an improvement in LVEF, although the magnitude of change was on the cusp of clinical significance. © 2016 American Heart Association, Inc.

Robenshtok E.,Sloan Kettering Cancer Center | Robenshtok E.,Endocrinology and Metabolism Institute | Robenshtok E.,Tel Aviv University | Farooki A.,Sloan Kettering Cancer Center | And 2 more authors.
Endocrine | Year: 2014

Bone metastases from differentiated thyroid cancer are generally resistant to radioiodine (RAI) therapy and are associated with poor prognosis. However, in a recent study from our group we noted a small subgroup of patients with RAI-avid bone metastases who had no structural correlate on imaging studies, and had no skeletal complications during follow-up. The purpose of this study was to better define the natural history and outcome of these patients. In a retrospective review of medical records at Memorial Sloan-Kettering Cancer Center, 288 patients were identified with bone metastases from thyroid cancer between 1960 and 2011. Out of this group, 14 patients who had a RAI-avid bone metastasis without structural correlate on CT or MRI were included in the study. After a median follow-up period of 5 years (range 2-14 years) all patients were alive, none had evidence of structural bone metastases, and none had experienced skeletal-related events. The final disease status was: no evidence of disease in 6 patients (43 %), stable biochemical persistence in 2 patients (14 %), stable structural disease in 5 patients (36 %), and one patient with slowly progressive disease. To conclude, RAI-avid bone metastases with no structural correlate on high-resolution imaging studies often resolve following RAI treatment, do not cause skeletal-related complications, and do not have a major prognostic significance. Recognition of this unique type of bone metastases is important as it is not associated with the same poor prognosis and resistance to RAI therapy that is associated with structurally identifiable bone metastases. © 2013 Springer Science+Business Media.

Shiber-Ofer S.,Rabin Medical Center | Shiber-Ofer S.,Tel Aviv University | Shohat Z.,Tel Aviv University | Shohat Z.,Bio statistical Institute | And 2 more authors.
Journal of Clinical Hypertension | Year: 2015

Elevated blood pressure (BP) is reported in many individuals without hypertension presenting to the emergency department (ED). Whether this condition represents a transient state or is predictive for the development of future hypertension is unknown. This observational prospective study investigated patients admitted to an ED without a diagnosis of hypertension in whom BP values were ≥140/90 mm Hg. The primary outcome was development of hypertension during follow-up. Overall, 195 patients were recruited and at the end of follow-up (average 30.14±15.96 months), 142 patients were diagnosed with hypertension (73%). The mean age (50±12.25 vs 48.31±13.9, P=419) and sex distribution (78 men/64 women vs 24 men/20 women, respectively; P=148) were similar in both groups. There were significant differences in systolic and diastolic BP between those who developed hypertension on follow-up and those who did not (177.6 mm Hg±22.6/106.1 mm Hg±16.9 vs 168.6 mm Hg±18/95.2 mm Hg±12.2; P=011 for systolic BP, P<001 for diastolic BP). In multivariate analysis the only significant predictive factor for the development of hypertension was diastolic hypertension recorded in the ED (P=03). Elevated diastolic, but not systolic, BP among patients presenting to the ED is associated with future development of hypertension in previously normotensive individuals. © 2015 Wiley Periodicals, Inc.

Flechner S.M.,Glickman Urological and Kidney Institute | Berber E.,Endocrinology and Metabolism Institute | Askar M.,Cleveland Clinic | Stephany B.,Glickman Urological and Kidney Institute | And 2 more authors.
American Journal of Transplantation | Year: 2010

We report the successful allotransplantation of cryopreserved parathyroid tissue to reverse hypocalcemia in a kidney transplant recipient. A 36-year-old male received a second deceased donor kidney transplant, and 6 weeks later developed severe bilateral leg numbness and weakness, inability to walk, acute pain in the left knee and wrist tetany. His total calcium was 2.6 mg/dL and parathormone level 5 pg/mL (normal 10-60 pg/mL). He underwent allotransplantation of parathyroid tissue cryopreserved for 8 months into his left brachioradialis muscle. Immunosuppression included tacrolimus (target C0 10-12 ng/mL), mycophenolate mofetil and steroids. Within 2 weeks, the left knee pain, leg weakness and numbness resolved, and by 1 month he could walk normally. After a peak at month 2, his parathyroid hormone (PTH) level fell to <10 pg/mL; therefore at month 3 he received a second parathyroid transplant from the same donor. Eight months later (11 months after initial graft) he has a total calcium of 9.3 mg/dL, PTH level 15 pg/mL and is clinically asymptomatic. The amount of parathyroid tissue needed to render a patient normocalcemic is not known. In our case, the need for second transplant suggests that the amount of tissue transferred for an allograft may need to be substantially greater than for an autograft. © 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.

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