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Scott B.J.,Lahey Hospital and Medical Center | Oberheim-Bush N.A.,University of California at San Francisco | Kesari S.,University of California at San Diego
Oncotarget | Year: 2016

Background: There is limited data on the impact of specific patient characteristics, tumor subtypes or treatment interventions on survival in breast cancer LM. Methods: A systematic review was conducted to assess the impact of hormone receptor and HER-2 status on survival in breast cancer LM. A search for clinical studies published between 1/1/2007 and 7/1/2012 and all randomized-controlled trials was performed. Survival data from all studies are reported by study design (prospective trials, retrospective cohort studies, case studies). Results: A total of 36 studies with 851 LM breast cancer subjects were identified. The majority (87%) were treated with intrathecal chemotherapy. Pooled median overall survival ranged from 14.9-18.1 weeks depending on study type. Breast cancer LM survival (15 weeks) was longer than other solid tumor LM 8.3 weeks and lung cancer LM 8.7 weeks, but shorter than LM lymphoma (15.4 versus 24.2 weeks). The impact of hormone receptor and HER-2 status on survival could not be determined. Conclusions: A median overall survival of 15 weeks in prospective studies of breast cancer LM provides a historical comparison for future LM breast cancer trials. Other outcomes including the impact of molecular status on survival could not be determined based on available studies.


News Article | February 15, 2017
Site: www.eurekalert.org

WASHINGTON -- In the first successful randomized trial of its kind, researchers have provided preliminary evidence that telephone-based smoking cessation counseling given to smokers shortly after undergoing lung cancer screening can be effective at helping people stop smoking. "We found that at this teachable moment -- a time when smokers are thinking about their health and may be ready to make a change -- offering help makes a difference, and may help save lives," says the study's lead researcher, Kathryn L. Taylor, PhD, a behavioral scientist and a professor of oncology at Georgetown Lombardi Comprehensive Cancer Center. The study, led by researchers at Georgetown Lombardi, was conducted with 92 participants at three centers -- MedStar Georgetown University Hospital in Washington, DC, Hackensack University Medical Center in New Jersey, and Lahey Hospital and Medical Center in Massachusetts. "Millions of current smokers are now eligible for lung cancer screening, so this setting represents an important opportunity to exert a large public health impact on cessation among smokers who are at very high risk for multiple tobacco-related disorders," she says. "This is a great way to engage smokers who have not sought out cessation help." These study findings were so promising that investigators have been funded through NIH to conduct a much larger study of telephone-based cessation counseling. It will enroll 1,300 patients at five medical centers nationwide. Lung cancer screening recommendations issued in 2013 by the U.S. Preventive Services Task Force suggest that people who have smoked long enough to have accumulated a minimum of 30 pack-years (i.e., one pack per day for 30 years, or two packs per day for 15 years, etc.) should have an annual low-dose CT lung cancer screening test. The idea is to intervene early enough that disease spotted on the screening can be effectively treated. In the U.S., lung cancer is the leading cancer killer in both men and women -- almost 160,000 Americans were expected to die from lung cancer in 2016, according to the American Lung Association. Taylor points out that the NIH has said that effective smoking cessation programs should be a part of screening programs, and has funded several groups of researchers to develop effective strategies. In this preliminary study, 92 people about to undergo lung cancer screening agreed to receive either telephone counseling or standard of care (a list of free and low-cost cessation resources). Once participants received their screening results, they were randomized to one of the two groups, each with 46 participants. Each group had an equal number of participants with abnormal screening findings, indicating possible precancerous lesions or chronic obstructive pulmonary disease (COPD). Each group also contained an equal number of participants with minor abnormalities on their screen, as well as those with normal results. None of the participants were diagnosed with lung cancer. Participants in the telephone-counseling group were given their first session after finding out their screening results. Over the next three months, six 10-15 minute sessions were conducted. At the end of the study, a nicotine saliva test was given to participants who said they had quit in order to confirm their abstinence. Researchers found that eight (17 percent) people in the telephone counseling group had verifiably quit, compared to two (4 percent) in the other group. "If this preliminary study is replicated, telephone counseling has the potential to improve cessation in a setting that reaches a large number of hard-to-reach, long-term smokers who are at very high risk for multiple tobacco-related diseases," Taylor says. Charlotte Hagerman, who along with Taylor, offered the telephone counseling to participants, describes the counseling as "a motivational intervention. Everyone acknowledged that smoking is very harmful to their health, but some people thought it was too late to change their fate. Counseling helped them understand that it is not too late." Population-based studies have shown that older smokers who quit can have an increased life expectancy, Taylor says. Hagerman says there were also a number of participants who "were ready to quit, and were very excited to receive the help we were offering. I found this very gratifying, and felt that what we were doing was important and mattered to people," says Hagerman, who was trained as a tobacco treatment specialist for the study. "More than 50 percent of participants said in their first interview that they were not ready to quit, yet some of these people did quit. This finding indicates that it is important to offer the cessation intervention to everyone who undergoes lung cancer screening, and not only those who are already considering quitting. This is exactly what we hope for - to be able to reach the people who are not already planning to quit on their own," says Taylor. In addition to Taylor and Hagerman, co-authors from Georgetown University Medical Center include George Luta, PhD; Paula G. Bellini, MA; and Cassandra Stanton, PhD. David B. Abrams, PhD, and Ray Niaura, PhD, are Georgetown faculty and also affiliated with the Schroeder Institute for Tobacco Research and Policy Studies. Jenna A. Kramer, NP and Eric D. Anderson, MD are from MedStar Georgetown University Hospital in Washington, DC; Shawn Regis, PhD, Andrea McKee, MD, and Brady McKee, MD, are from Lahey Hospital and Medical Center, Burlington, MA; and Harry Harper, MD and Michael Ramsaier, BS are from Hackensack University Medical Center, Hackensack, NJ. The authors report having no personal financial interests related to the study. The study was supported by the Prevent Cancer Foundation and Georgetown Lombardi's NCI Cancer Center Support Grant P30 CA051008. Georgetown Lombardi Comprehensive Cancer Center is designated by the National Cancer Institute as a comprehensive cancer center -- the only cancer center of its kind in the Washington, DC area. A part of Georgetown University Medical Center and MedStar Georgetown University Hospital, Georgetown Lombardi seeks to improve the diagnosis, treatment, and prevention of cancer through innovative basic and clinical research, patient care, community education and outreach, and the training of cancer specialists of the future. Connect with Georgetown Lombardi on Facebook (Facebook.com/GeorgetownLombardi) and Twitter (@LombardiCancer). Georgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health. Connect with GUMC on Facebook (Facebook.com/GUMCUpdate), Twitter (@gumedcenter) and Instagram (@gumedcenter).


Named for Co-Founder and Interventional Cardiology Pioneer, Donald Baim, MD, to Honor his Passion, Insight, Innovation and Leadership; Change Reflects Desire for Greater Institutional Diversity, Expansion of Affiliations BOSTON, MA--(Marketwired - October 27, 2016) - The Harvard Clinical Research Institute (HCRI) announced today that it will change its name to the Baim Institute for Clinical Research (Baim Institute), as a reflection of its desire to further expand and diversify its faculty and institutional affiliations. Baim Institute will remain one of the world's most trusted not-for-profit academic research organizations. The new name pays tribute to Dr. Donald S. Baim, a visionary in the field of interventional cardiology, who was a founder of the organization in 1993 and a primary investigator and chief advisor through 2005. Dr. Baim died in 2009 at age 60. "Don dedicated his career to bringing innovative medical technologies forward, and cared deeply about the effective use of new therapeutics," said Laura Mauri, MD, MSc, Professor of Medicine, Harvard Medical School, Physician at the Brigham and Women's Hospital, and Chief Scientific Advisor of the Baim Institute. "He was an inspiration to generations of physician leaders for his ability to couple scientific thought with an unceasing commitment to improve patient care. He embodies the principles on which our Institute was founded and continues to grow." "Dr. Baim's impact is reflected in the Baim Institute's commitment to insight, innovation and leadership in the pursuit of evidence-based medicine that improves lives," said Don Cutlip, MD, Professor of Medicine, Harvard Medical School, Chief, Interventional Cardiology, Cardiac Catheterization Laboratory, Beth Israel Deaconess Medical Center, and Executive Director Clinical Investigations, Baim Institute. "We are fortunate to have had one of the most influential cardiology researchers as our co-founder and mentor." The organization was founded in 1993 as part of Beth Israel Hospital (currently the Beth Israel Deaconess Medical Center), and named the Cardiovascular Data Analysis Center (CDAC). Reflecting CDAC's expanded affiliations with other Harvard teaching hospitals, the organization took the name HCRI in 2000, becoming an independent not-for-profit. The network of institutions collaborating with HCRI grew over the last decade to include Boston University, Brigham and Women's Hospital, Lahey Hospital and Medical Center, and Massachusetts General Hospital. Now the Baim Institute is well-positioned to expand collaborations even further. "The Baim Institute provides a platform for us to build on the values that got us to where we are today," said Spencer Goldsmith, President, Baim Institute. "We will continue to expand our partnerships in ways that will deepen our commitment to advancing human health through creativity in clinical trial design and nimble operations." "The Baim Institute will continue to be a leading academic research organization, guided by our faculty and staff, continuing to serve the needs of research sponsors worldwide with the capabilities we have developed over the past 23 years," said Mr. Goldsmith. About the Baim Institute for Clinical Research The Baim Institute for Clinical Research is a leading, not-for-profit academic research organization that delivers insight, innovation and leadership in today's dynamic research environment. The Baim Institute collaborates with some of the world's most highly respected researchers from renowned institutions to help advance health and quality of life around the world. The Baim Institute has gained notoriety for the design and execution of clinical trials for first-in-class medical devices. Examples of such include trials for the first approved drug-eluting stent, and the first approved transcatheter mitral valve repair device. In addition, we recently sponsored and completed the DAPT study, a large, FDA-mandated study that enrolled over 25,000 subjects, evaluating the use of dual antiplatelet therapy after stent implantation. Since 1993, we have worked on over 450 clinical trials in North America, Europe and Asia. The Baim Institute is based in Boston. More information is at www.BaimInstitute.org.


News Article | February 15, 2017
Site: www.eurekalert.org

A team led by a Stanford University School of Medicine researcher has discovered that shocks from implantable cardioverter defibrillators often trigger a cascade of health tests and interventions, even when the shocks they deliver are not needed. A study describing the team's findings will be published online Feb. 14 in Circulation: Cardiovascular Quality and Outcomes. The lead author is Mintu Turakhia, MD, assistant professor of cardiovascular medicine at Stanford. Each month, more than 10,000 people in the United States with heart conditions get ICD implants. The devices are designed to keep track of heart rate, delivering an electric shock to control life-threatening rapid rhythms, especially those that can cause sudden cardiac arrest. Sometimes, however, the devices can deliver shocks that are unnecessary. In either case, the patients are expected to see their doctors for an evaluation afterward. The study analyzed data from patients who were implanted with ICDs between 2008 and 2010. The health care costs of dealing with shocks from ICDs ranged between about $1,300 and $20,000 per patient for outpatient and inpatient care, regardless of whether the shocks were necessary, the team reports. Unnecessary shocks can occur if there is a problem with the defibrillator system itself -- for example, if a wire breaks, resulting in electrical noise that the system mistakes for an abnormal heart rhythm, or if the implant responds to abnormal heart rhythms that it's not meant to treat. "Sometimes the defibrillator gets tricked, and it misinterprets what the rhythm is," said Matthew Reynolds, MD, a study co-author and cardiac electrophysiologist at the Lahey Hospital and Medical Center in Massachusetts. "You're putting these in to do their job to save patients' lives," said Turakhia, who is also the senior director of research at the Stanford Center for Digital Health and a practicing cardiac electrophysiologist. "But we live in a bit of duality with implantable defibrillators." Interested in trying to understand that contradiction, Turakhia and his colleagues began by tackling the challenge of linking implant data with electronic health records for 10,266 U.S. patients. The team took a freestanding data set of remote monitoring of ICDs and pacemakers and linked it to the patients' clinical information, making it one of the first and largest such studies of its kind, Turakhia said. "That's one of the big innovations here, especially as we start thinking about big data and precision health," Turakhia said. "Linking data across multiple domains -- indirectly and without patient identifiers -- is the wave of the future to understand disease, care and outcomes." In the linked data, the team picked 963 patients who had received an ICD shock more than once. They found that over one-third of administered shocks were inappropriate and nearly half the patients who experienced a shock received some form of health care related to it. But researchers were surprised to find that patients who got a shock were hospitalized one out of seven times. Patients often had to go through procedures like stress tests, cardiac catheterization and echocardiography. "It didn't really matter why the shock occurred," Turakhia said. "The very fact that any shock happened at all triggered all that stuff happening to the patient." These findings indicate that reprogramming the devices so they are smarter and more selective about when to send shocks may help further reduce health care expenditures. At the same time, patients do better if doctors program the ICDs to shock less, or more conservatively, previous studies suggest. "Fortunately, the industry has made many advancements in this area," Turakhia said. "Even older-generation devices can be programmed to be smarter. The quality of care is no longer just an issue of whether an ICD was implanted in appropriate patients but also whether it was programmed in the best way possible." The study was done in patients with ICDs implanted between 2008 and 2010, but because arrhythmia treatment practices have changed since that time, including more recent data might have affected the results of the study, Reynolds said. Further, he said it would be interesting to analyze this in a wider cohort of patients, because patients in the present study were all using defibrillators from a single manufacturer, Medtronic Inc. Looking ahead, Turakhia hopes to use data from remote monitoring devices like defibrillators, as well as insurance claims and electronic health records and even smartphone, genetic and environmental data to take a precision health approach to predicting patient health. "Right now, we're using very limited data relative to what's out there," he said. But by linking all of that data together, it may be possible to predict, for example, the risk of stroke in patients with certain types of arrhythmia, like atrial fibrillation. In addition, with that data, doctors could potentially predict the chance of someone getting admitted to the hospital with heart failure or the prospect of a patient getting a shock over the next month or so. And having that foreknowledge could help doctors intervene with drugs to better manage risks and save lives, Turakhia said. ###Researchers at Hartford Hospital and Medtronic are also co-authors. Turakhia is a consultant to Medtronic and St. Jude Medical Inc. and has received honoraria for speaking for St. Jude Medical; Reynolds is a consultant to Medtronic. The research was funded by Medtronic. Stanford's Department of Medicine also supported the work. The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://med. . The medical school is part of Stanford Medicine, which includes Stanford Health Care and Lucile Packard Children's Hospital Stanford. For information about all three, please visit http://med. .


News Article | February 15, 2017
Site: www.biosciencetechnology.com

A team led by a Stanford University School of Medicine researcher has discovered that shocks from implantable cardioverter defibrillators often trigger a cascade of health tests and interventions, even when the shocks they deliver are not needed. A study describing the team's findings will be published online Feb. 14 in Circulation: Cardiovascular Quality and Outcomes. The lead author is Mintu Turakhia, M.D., assistant professor of cardiovascular medicine at Stanford. Each month, more than 10,000 people in the United States with heart conditions get ICD implants. The devices are designed to keep track of heart rate, delivering an electric shock to control life-threatening rapid rhythms, especially those that can cause sudden cardiac arrest. Sometimes, however, the devices can deliver shocks that are unnecessary. In either case, the patients are expected to see their doctors for an evaluation afterward. The study analyzed data from patients who were implanted with ICDs between 2008 and 2010. The health care costs of dealing with shocks from ICDs ranged between about $1,300 and $20,000 per patient for outpatient and inpatient care, regardless of whether the shocks were necessary, the team reports. Unnecessary shocks can occur if there is a problem with the defibrillator system itself -- for example, if a wire breaks, resulting in electrical noise that the system mistakes for an abnormal heart rhythm, or if the implant responds to abnormal heart rhythms that it's not meant to treat. "Sometimes the defibrillator gets tricked, and it misinterprets what the rhythm is," said Matthew Reynolds, M.D., a study co-author and cardiac electrophysiologist at the Lahey Hospital and Medical Center in Massachusetts. "You're putting these in to do their job to save patients' lives," said Turakhia, who is also the senior director of research at the Stanford Center for Digital Health and a practicing cardiac electrophysiologist. "But we live in a bit of duality with implantable defibrillators." Interested in trying to understand that contradiction, Turakhia and his colleagues began by tackling the challenge of linking implant data with electronic health records for 10,266 U.S. patients. The team took a freestanding data set of remote monitoring of ICDs and pacemakers and linked it to the patients' clinical information, making it one of the first and largest such studies of its kind, Turakhia said. "That's one of the big innovations here, especially as we start thinking about big data and precision health," Turakhia said. "Linking data across multiple domains -- indirectly and without patient identifiers -- is the wave of the future to understand disease, care and outcomes." In the linked data, the team picked 963 patients who had received an ICD shock more than once. They found that over one-third of administered shocks were inappropriate and nearly half the patients who experienced a shock received some form of health care related to it. But researchers were surprised to find that patients who got a shock were hospitalized one out of seven times. Patients often had to go through procedures like stress tests, cardiac catheterization and echocardiography. "It didn't really matter why the shock occurred," Turakhia said. "The very fact that any shock happened at all triggered all that stuff happening to the patient." These findings indicate that reprogramming the devices so they are smarter and more selective about when to send shocks may help further reduce health care expenditures. At the same time, patients do better if doctors program the ICDs to shock less, or more conservatively, previous studies suggest. "Fortunately, the industry has made many advancements in this area," Turakhia said. "Even older-generation devices can be programmed to be smarter. The quality of care is no longer just an issue of whether an ICD was implanted in appropriate patients but also whether it was programmed in the best way possible." The study was done in patients with ICDs implanted between 2008 and 2010, but because arrhythmia treatment practices have changed since that time, including more recent data might have affected the results of the study, Reynolds said. Further, he said it would be interesting to analyze this in a wider cohort of patients, because patients in the present study were all using defibrillators from a single manufacturer, Medtronic Inc. Looking ahead, Turakhia hopes to use data from remote monitoring devices like defibrillators, as well as insurance claims and electronic health records and even smartphone, genetic and environmental data to take a precision health approach to predicting patient health. "Right now, we're using very limited data relative to what's out there," he said. But by linking all of that data together, it may be possible to predict, for example, the risk of stroke in patients with certain types of arrhythmia, like atrial fibrillation. In addition, with that data, doctors could potentially predict the chance of someone getting admitted to the hospital with heart failure or the prospect of a patient getting a shock over the next month or so. And having that foreknowledge could help doctors intervene with drugs to better manage risks and save lives, Turakhia said.


Culler S.D.,Emory University | Kugelmass A.D.,Baystate Health | Brown P.P.,HealthTrust Purchasing Group L.P. | Reynolds M.R.,Lahey Hospital and Medical Center | Simon A.W.,HealthTrust Purchasing Group L.P.
Circulation | Year: 2015

Background-This study reports on the trends in the volume and outcomes of coronary revascularization procedures performed on Medicare beneficiaries between 2008 and 2012. Methods and Results-This retrospective study identifies all Medicare beneficiaries undergoing a coronary revascularization procedure: coronary artery bypass graft surgery or percutaneous coronary intervention (PCI) performed in either the nonadmission or inpatient setting. International Classification of Diseases, 9th Revision, Clinical Modification procedure codes (inpatient setting) and Current Procedural Terminology and Ambulatory Payment Classification codes (nonadmission) were used to identify revascularizations. The study population consists of 2 768 007 records. This study finds that the rapid growth in nonadmission PCIs performed on Medicare beneficiaries (60 405-106 495) has been more than offset by the decrease in PCI admissions (363 384-295 434) during the study period. There also were >18 000 fewer coronary artery bypass graft admissions in 2012 than in 2008. This study finds lower observed mortality rates (3.7%-3.2%) among Medicare beneficiaries undergoing any coronary artery bypass graft surgery and higher observed mortality rates (1.7%-1.9%) for Medicare beneficiaries undergoing any PCI encounter. This study also finds a growth in the number of facilities performing revascularization procedures during the study period: 268 (20.2%) more sites were performing nonadmission PCIs; 136 (8.2%) more sites were performing inpatient PCIs; and 19 (1.6%) more sites were performing coronary artery bypass graft surgery. Conclusions-The total number of revascularization procedures performed on Medicare beneficiaries peaked in 2010 and declined by >4% per year in 2011 and 2012. Observed mortality rates among all Medicare beneficiaries undergoing any coronary revascularization remained between 2.1% and 2.2% annually during the study period. © 2014 American Heart Association, Inc.


Uhlig K.,Tufts Medical Center | Patel K.,Tufts Medical Center | Ip S.,Tufts Medical Center | Kitsios G.D.,Lahey Hospital and Medical Center | Balk E.M.,Tufts Medical Center
Annals of Internal Medicine | Year: 2013

Background: Clinical guidelines recommend that adults with hypertension self-monitor their blood pressure (BP). Purpose: To summarize evidence about the effectiveness of selfmeasured blood pressure (SMBP) monitoring in adults with hypertension. Data Sources: MEDLINE (inception to 8 February 2013) and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (fourth quarter 2012). Study Selection: 52 prospective comparative studies of SMBP monitoring with or without additional support versus usual care or an alternative SMBP monitoring intervention in persons with hypertension. Data Extraction: Data on population, interventions, BP, other outcomes, and study method were extracted. Random-effects model meta-analyses were done. Data Synthesis: For SMBP monitoring alone versus usual care (26 comparisons), moderate-strength evidence supports a lower BP with SMBP monitoring at 6 months (summary net difference, -3.9 mm Hg and-2.4 mm Hg for systolic BP and diastolic BP) but not at 12 months. For SMBP monitoring plus additional support versus usual care (25 comparisons), high-strength evidence supports a lower BP with use of SMBP monitoring, ranging from-3.4 to-8.9 mm Hg for systolic BP and from-1.9 to-4.4 mm Hg for diastolic BP, at 12 months in good-quality studies. For SMBP monitoring plus additional support versus SMBP monitoring alone or with less intense additional support (13 comparisons), low-strength evidence fails to support a difference. Across all comparisons, evidence for clinical outcomes is insufficient. For other surrogate or intermediate outcomes, low-strength evidence fails to show differences. Limitation: Clinical heterogeneity in protocols for SMBP monitoring, additional support, BP targets, and management; follow-up of 1 year or less in most studies, with sparse clinical outcome data. Conclusion: Self-measured BP monitoring with or without additional support lowers BP compared with usual care, but the BP effect beyond 12 months and long-term benefits remain uncertain. Additional support enhances the BP-lowering effect. Primary Funding Source: Agency for Healthcare Research and Quality. © 2013 American College of Physicians.


Palmer D.A.,Lahey Hospital and Medical Center | Buckley J.C.,University of California at San Diego | Zinman L.N.,Lahey Hospital and Medical Center | Vanni A.J.,Lahey Hospital and Medical Center
Journal of Urology | Year: 2015

Purpose: Long segment urethral strictures with a compromised graft bed and poor vascular supply are unfit for standard repair and at high risk for recurrence. We assessed the success of urethral reconstruction in these patients with a ventral buccal mucosa graft and gracilis muscle flap. Materials and Methods: We retrospectively reviewed the records of 1,039 patients who underwent urethroplasty at Lahey Hospital and Medical Center between 1999 and 2014. We identified 20 patients who underwent urethroplasty with a ventral buccal mucosa graft and a gracilis muscle flap graft bed. Stricture recurrence was defined as the inability to pass a 16Fr cystoscope. Results: Mean stricture length was 8.2 cm (range 3.5 to 15). Strictures were located in the posterior urethra with or without involvement of the bulbar urethra in 50% of cases, and in the bulbomembranous urethra in 35%, the bulbar urethra in 10% and the proximal pendulous urethra in 5%. Stricture etiology was radiation therapy in 45% of cases, followed by an idiopathic cause in 20%, trauma in 15%, prostatectomy in 10%, and hypospadias failure and transurethral surgery in 5% each. Nine patients (45%) were previously treated with urethroplasty and 3 (15%) previously underwent UroLume® stent placement. Urethral reconstruction was successful in 16 cases (80%) at a mean followup of 40 months. One of the patients in whom treatment failed had an ileal loop, 2 had a suprapubic tube and urethral dilatation had been done in 1. Mean time to recurrence was 10 months (range 2 to 17). Postoperatively 5 patients (25%) had incontinence requiring an artificial urinary sphincter. Conclusions: Urethroplasty for high risk, long segment urethral strictures can be successfully performed with a ventral buccal mucosa graft and a gracilis muscle flap, avoiding urinary diversion in most patients. © 2015 American Urological Association Education and Research, Inc.


Akoad M.E.,Lahey Hospital and Medical Center | Pomfret E.A.,Lahey Hospital and Medical Center
Clinics in Liver Disease | Year: 2015

With a better understanding of the natural history of hepatocellular carcinoma (HCC) and the improvement in imaging, locoregional therapies, surgical techniques, and postoperative care, patients with HCC are now managed by a multidisciplinary team. Partial hepatic resection can be curative in patients developing HCC in the setting of normal liver parenchyma and in patients with early cirrhosis but well-preserved hepatic synthetic function. Liver transplantation offers the best long-term survival and lowest incidence of tumor recurrence in select patients with HCC and underlying cirrhosis. This article discusses the role of surgical resection and liver transplantation in the management of HCC. © 2015 Elsevier Inc.


Nagpal K.,Lahey Hospital and Medical Center | Bennett N.,Lahey Hospital and Medical Center
Current Urology Reports | Year: 2013

The quality of functional outcome has become increasingly important in view of improvement in prognosis with colorectal cancer patients. Sexual dysfunction remains a common problem after colorectal cancer treatment, despite the good oncologic outcomes achieved by expert surgeons. Although radiotherapy and chemotherapy contribute, surgical nerve damage is the main cause of sexual dysfunction. The autonomic nerves are in close contact with the visceral pelvic fascia that surrounds the mesorectum. The concept of total mesorectal excision (TME) in rectal cancer treatment has led to a substantial improvement of autonomic nerve preservation. In addition, use of laparoscopy has allowed favorable results with regards to sexual function. The present paper describes the anatomy and pathophysiology of autonomic pelvic nerves, prevalence of sexual dysfunction, and the surgical technique of nerve preservation in order to maintain sexual function. © 2013 Springer Science+Business Media New York.

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