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Baltimore Highlands, MD, United States

Irani S.,Virginia Mason Medical Center | Baron T.H.,University of North Carolina at Charlotte | Grimm I.S.,University of North Carolina at Charlotte | Khashab M.A.,Johns Hopkins Medical Institute
Gastrointestinal Endoscopy

Background and Aims Nonsurgical techniques for gallbladder drainage are percutaneous, and endoscopic. EUS-guided transmural gallbladder drainage (EUS-GBD) is a relatively new approach, although data are limited. Our aim was to describe the outcome after EUS-GBD with a lumen-apposing metal stent (LAMS). Patients and Methods This was a retrospective review of prospectively collected data on 15 nonsurgical patients who underwent EUS-GBD for various indications. Procedures were performed at 3 tertiary care centers with expertise in the management of complex biliary problems. The main outcome measures were technical and clinical success and adverse events. Results Fifteen patients (8 male, 7 female) with a median age of 74 years (range 42-89) underwent EUS-GBD by using a LAMS to decompress the gallbladder (7 patients calculous cholecystitis, 4 acalculous cholecystitis, 2 patients biliary obstruction, 1 patient gallbladder hydrops, 1 patient symptomatic cholelithiasis). Patients were nonsurgical candidates according to the American Society of Anesthesiologists Physical Status Classification System; findings were class IV or higher in 9 patients and advanced malignancies in 6. Percutaneous transhepatic gallbladder drainage (PT-GBD) was refused by all patients and was further precluded by perihepatic ascites in 3 patients, coagulopathy or need for anticoagulation in 4 patients, and need for internal biliary drainage in 2 patients. Transduodenal access and stenting was achieved in 14 of 15 patients and transgastric stenting was achieved in 1. Technical success was achieved in 14 of 15 patients (93%), whereas clinical success was achieved in all 15 patients with a median follow-up of 160 days. One mild adverse event (postprocedure fever for 3 days) was noted. The limitations of this study are the small select group of patients and retrospective study design. Conclusions EUS-GBD with a LAMS is technically safe and effective for decompressing the gallbladder for cholecystitis and biliary or cystic duct obstruction in patients who are poor surgical candidates. Copyright © 2015 by the American Society for Gastrointestinal Endoscopy. Source

Ziessman H.A.,Johns Hopkins Medical Institute
Journal of Nuclear Medicine

Cholescintigraphy with 99mTc-hepatobiliary radiopharmaceuticals has been an important, clinically useful diagnostic imaging study for almost 4 decades. It continues to be in much clinical demand; however, the indications, methodology, and interpretative criteria have evolved over the years. This review will emphasize state-of-the-art methodology and diagnostic criteria for various clinical indications, including acute cholecystitis, chronic acalculous gallbladder disease, high-grade and partial biliary obstruction, and the postcholecystectomy pain syndrome, including sphincter-of-Oddi dysfunction and biliary atresia. The review will also emphasize the use of diagnostic pharmacologic interventions, particularly sincalide. Copyright © 2014 by the Society of Nuclear Medicine and Molecular Imaging, Inc. Source

Boahene K.,Johns Hopkins Medical Institute
Facial Plastic Surgery

Facial paralysis following acoustic neuroma (AN) resection can be devastating, but timely and strategic intervention can minimize the resulting facial morbidity. A central strategy in reanimating the paralyzed face after AN resection is to restore function of the native facial muscles using available facial nerves or repurposed cranial nerves, mainly the hypoglossal or masseter nerves. The timing of reinnervation is the single most influential factor that determines outcomes in facial reanimation surgery. The rate of recovery of facial function in the first 6 months following AN resection may be used to predict ultimate facial function. Patients who show no signs of recovery in the first 6 months, even when their facial nerves are intact, recover poorly and are candidates for early facial reinnervation. With delay, facial muscles become irreversibly paralyzed. Reanimation in irreversible paralysis requires the transfer of functional muscle units such as the gracilis or the temporalis muscle tendon unit. © 2015 by Thieme Medical Publishers, Inc. Source

Sherman K.E.,University of Cincinnati | Thomas D.,Johns Hopkins Medical Institute | Chung R.T.,Harvard University

In the United States, more than 1.1 million individuals are infected with the human immunodeficiency virus (HIV). These patients exhibit a high frequency of coinfections with other hepatotropic viruses and ongoing fibrosis, leading to cirrhosis and liver-related mortality. Etiologies of liver disease include viral hepatitis coinfections, drug-related hepatotoxicity, fatty liver disease, and direct and indirect effects from HIV infection, including increased bacterial translocation, immune activation, and presence of soluble proteins, that modulate the hepatic cytokine environment. New treatments for hepatitis C virus (HCV) using direct-acting agents appear viable, though issues related to intrinsic toxicities and drug-drug interactions remain. Recent research suggests that acute HCV infection, unrecognized hepatitis D infection, and hepatitis E may all represent emergent areas of concern. Antiretroviral agents, including those used in recent years, may represent risk factors for hepatic injury and portal hypertension. Key issues in the future include systematic implementation of liver disease management and new treatment in HIV-infected populations with concomitant injection drug use, alcohol use, and low socioeconomic status. © 2013 by the American Association for the Study of Liver Diseases. Source

Redett R.J.,Johns Hopkins Medical Institute
Plastic and Reconstructive Surgery

Background: The development of surgical repair of cleft lip-cleft palate closure has been well documented in the literature. However, the contributions of an unlikely pioneer, Harvey Cushing, in the development of cleft lip-cleft palate closure have been to date unknown. Methods: Patient surgical records from 1896 to 1912 at The Johns Hopkins Hospital documenting Harvey Cushing's cases were reviewed. Results: Three cases of Cushing's surgical closure of cleft lip-cleft palate, using a variety of techniques, are described and placed into historical context in the development of cleft lip-cleft palate surgery. Conclusions: Harvey Cushing's contributions to the field of plastic and reconstructive surgery have largely remained unknown. The cases reported here illustrate the early work of this pioneering surgeon in the area of cleft lip-cleft palate surgery. Copyright © 2010 by the American Society of Plastic Surgeons. Source

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