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McGinley M.,Loyola University | Morales-Vidal S.,Florida Hospital Tampa | Ruland S.,Loyola University
Frontiers in Neurology | Year: 2016

Autoimmune encephalitis is associated with a wide variety of antibodies and clinical presentations. Voltage-gated potassium channel (VGKC) antibodies are a cause of autoimmune non-paraneoplastic encephalitis characterized by memory impairment, psychiatric symptoms, and seizures. We present a case of VGKC encephalitis likely preceding an ischemic stroke. Reports of autoimmune encephalitis associated with ischemic stroke are rare. Several hypotheses linking these two disease processes are proposed. © 2016 McGinley, Morales-Vidal and Ruland. Source

Stain S.C.,Albany Medical College | Schwarz E.,BSC Management | Shadduck P.P.,Duke Regional Hospital | Shah P.C.,New York University | And 3 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2015

Introduction: The relationship between the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and its industry partners has been longstanding, productive technologically, and beneficial to patient care and education. In order to both maintain this important relationship to honor its responsibility to society for increasing transparency, SAGES established a Conflict of Interest Task Force (CITF) and charged it with identifying and managing potential conflicts of interest (COI) and limiting bias at the SAGES Annual Scientific Meetings. The CITF developed and implemented a comprehensive process for reporting, evaluating, and managing COI in accordance with (and exceeding) Accreditation Council for Continuing Medical Education guidelines. Methods: From 2011 to 2013, all presenters, moderators, and session chairs received proactive and progressively increasing levels of education regarding the CITF rationale and processes and were required to disclose all relationships with commercial interests. Disclosures were reviewed and discussed by multiple layers of reviewers, including moderators, chairs, and CITF committee members with tiered, prescribed actions in a standardized, uniform fashion. Meeting attendees were surveyed anonymously after the annual meeting regarding perceived bias. The CITF database was then analyzed and compared to the reports of perceived bias to determine whether the implementation of this comprehensive process had been effective. Results: In 2011, 68 of 484 presenters (14 %) disclosed relationships with commercial interests. In 2012, 173 of 523 presenters (33.5 %) disclosed relationships, with 49 having prior review (9.4 %), and eight required alteration. In 2013, 190 of 454 presenters disclosed relationships (41.9 %), with 93 presentations receiving prior review (20.4 %), and 20 presentations were altered. From 2008 to 2010, the perceived bias among attendees surveyed was 4.7, 6.2, and 4.4 %; and in 2011–2013, was 2.2, 1.2, and 1.5 %. Conclusion: It is possible to have a surgical meeting that includes participation of speakers that have industry relationships, and minimize perceived bias. © 2014, Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Source

Patel K.,Florida Hospital Tampa | Teta A.,Florida Hospital Tampa | Sukharamwala P.,Florida Hospital Tampa | Thoens J.,Northside Medical Center | And 2 more authors.
International Journal of Surgery | Year: 2014

Background: Postoperative pancreatic fistula formation (POPF) remains one of the most common and detrimental complications following pancreaticojejunostomy (PJ). The aim of this meta-analysis is toanalyze the efficacy of external pancreatic duct stent placement in preventing POPF formation following PJ. Methods: The primary end-point was the incidence of POPF formation following pancreaticoduodenectomy (PD) in the presence and absence of external stent placement. Secondary outcomes examined were the incidence of perioperative mortality, delayed gastric emptying, postoperative wound infection, operative time, blood loss, and length of hospital stay. Results: Four trials were included comprising 416 patients. External pancreatic duct stenting was found to reduce the incidence of both any grade POPF formation (OR 0.37, 95% CI=0.23 to 0.58, p=0.0001) and clinically significant (grade B or C) POPF formation (OR 0.50, 95% CI=0.30 to 0.84, p=0.0009) following PD. The use of an external stent was also found to significantly lessen length of hospital stay (SMD-0.39, 95% CI=-0.63 to-0.15, p=0.001). Conclusions: This analysis has shown that external pancreatic duct stenting is indeed efficacious in the incidence of both any grade as well as clinically significant POPF formation following PD. Length of hospital stay was also found to be significantly less by external duct stenting. © 2014 Surgical Associates Ltd. Source

Toomey P.G.,Florida Hospital Tampa | Teta A.F.,Florida Hospital Tampa | Patel K.D.,Florida Hospital Tampa | Ross S.B.,Florida Hospital Tampa | Rosemurgy A.S.,Florida Hospital Tampa
American Journal of Surgery | Year: 2016

Background High-volume hospitals are purported to provide "best" outcomes. We undertook this study to evaluate the outcomes after pancreaticoduodenectomy when high-volume surgeons relocate to a low-volume hospital (ie, no pancreaticoduodenectomies in >5 years). Methods Outcomes after the last 50 pancreaticoduodenectomies undertaken at a high-volume hospital in 2012 (ie, before relocation) were compared with the outcomes after the first 50 pancreaticoduodenectomies undertaken at a low-volume hospital (ie, after relocation) in 2012 to 2013. Results Patients undergoing pancreaticoduodenectomies at a high-volume vs a low-volume hospital were not different by age or sex. Patients who underwent pancreaticoduodenectomy at the low-volume hospital had shorter operations with less blood loss, spent less time in the intensive care unit, and had shorter length of stay (P <.05 for each); 30-day mortality and 30-day readmission rates were not different. Conclusions The salutary benefits of undertaking pancreaticoduodenectomy at a high-volume hospital are transferred to a low-volume hospital when high-volume surgeons relocate. The "best" results follow high-volume surgeons. © 2016 Elsevier Inc. All rights reserved. Source

Ross S.B.,Florida Hospital Tampa | Luberice K.,Florida Hospital Tampa | Kurian T.J.,Florida Hospital Tampa | Paul H.,Florida Hospital Tampa | Rosemurgy A.S.,Florida Hospital Tampa
American Surgeon | Year: 2013

Initial outcomes suggest laparoendoscopic single-site (LESS) Heller myotomy with anterior fundoplication provides safe, efficacious, and cosmetically superior outcomes relative to conventional laparoscopy. This study was undertaken to define the learning curve of LESS Heller myotomy with anterior fundoplication. One hundred patients underwent LESS Heller myotomy with anterior fundoplication. Symptom frequency and severity were scored using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). Symptom resolution, additional trocars, and complications were compared among patient quartiles. Median data are presented. Preoperative frequency/severity scores were: dysphagia 5 10/8 and regurgitation 5 8/7. Additional trocars were placed in 12 patients (10%), of whom all were in the first two quartiles. Esophagotomy/gastrotomy occurred in three patients. Postoperative complications occurred in 9 per cent. No conversions to "open" operations occurred. Length of stay was 1 day. Postoperative frequency/severity scores were: dysphagia 5 2/0 and regurgitation 5 0/0; scores were less than before myotomy (P < 0.001). There were no apparent scars, except where additional trocars were placed. LESS Heller myotomy with anterior fundoplication well palliates symptoms of achalasia with no apparent scar. Placement of additional trocars only occurred early in the experience. For surgeons proficient with the conventional laparoscopic approach, the learning curve of LESS Heller myotomy with anterior fundoplication is short and safe, because proficiency is quickly attained. © Southeastern Surgical Congress 2013. Source

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