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Tacoma, WA, United States

Brigger M.T.,Naval Medical Center San Diego | Boseley M.E.,Madigan Healthcare System
Current Opinion in Otolaryngology and Head and Neck Surgery | Year: 2012

Purpose of review: The treatment for pediatric tracheal stenosis has evolved over the past 50 years. Open airway reconstruction has traditionally been the treatment of choice for this condition. Numerous recent publications now support the use of endoscopic techniques to both augment and sometimes replace open procedures. Recent findings: During the past 12 months, a significant interest in expanding the role of airway dilation with balloons to manage airway stenoses has emerged. Development of novel airway stents, to include bioabsorbable products, holds promise to decrease the morbidity of stenting procedures. Continued improvement in preoperative imaging, in the form of virtual bronchoscopy, may someday replace airway endoscopy for planning purposes. Additionally, perioperative management strategies and the use of novel adjuvants have been introduced with a goal of improving outcomes in both endoscopic and open techniques through better control of granulation. Ultimately, advances in tissue engineering may provide yet another reconstructive option in the future. Summary: Endoscopic techniques have an increasing role in the management of pediatric subglottic and tracheal stenosis. However, open airway reconstructive procedures are still required in cases of mature scar, high-grade stenosis, and long-segment stenosis. © 2012 Lippincott Williams & Wilkins.

Burney R.O.,Madigan Healthcare System | Giudice L.C.,University of California at San Francisco
Fertility and Sterility | Year: 2012

Originally described over three hundred years ago, endometriosis is classically defined by the presence of endometrial glands and stroma in extrauterine locations. Endometriosis is an inflammatory, estrogen-dependent condition associated with pelvic pain and infertility. This work reviews the disease process from theories regarding origin to the molecular basis for disease sequelae. A thorough understanding of the histopathogenesis and pathophysiology of endometriosis is essential to the development of novel diagnostic and treatment approaches for this debilitating condition. © 2012 by American Society for Reproductive Medicine.

Debarros M.,Madigan Healthcare System | Steele S.R.,Madigan Healthcare System
Clinics in Colon and Rectal Surgery | Year: 2013

The reduction in health-care expenditures and more efficient use of medical resources are now overriding health policy priorities with the two-pronged goal of improving patient outcomes while decreasing overall cost. Current reports show colorectal surgery accounting for 25% of all operative complications and an average length of stay of 8 to 12 days for a standard elective colon resection. To combat this, Kehlet and colleagues introduced a concept of enhanced recovery after surgery (ERAS) or fast-track pathways, with the goal of using current evidence and multimodal therapies to decrease surgical stress, enhance postoperative recovery, and reduce length of stay. The benefits, safety, and cost-effectiveness of fast-track protocols are validated in multiple randomized controlled trials. In this review, the authors focus on the evidence regarding fast-track pathways, use of minimally invasive surgery and its role in fast-track pathways, newer perioperative interventions, and future directions. © 2013 by Thieme Medical Publishers, Inc.

DeBarros M.,Madigan Healthcare System | Steele S.R.,Madigan Healthcare System
Journal of Cancer | Year: 2013

Introduction: The military health system (MHS) a unique setting to analyze implementation programs as well as outcomes for colorectal cancer (CRC). Here we look at the efficacy of different CRC screening methods, attributes and results within the MHS, and current barriers to increase compliance. Materials and Methods: A literature search was conducted utilizing PubMed and the Cochrane library. Key-word combinations included colorectal cancer screening, racial disparity, risk factors, colorectal cancer, screening modalities, and randomized control trials. Directed searches were also performed of embedded references. Results: Despite screening guidelines from several national organizations, extensive barriers to widespread screening remain, especially for minority populations. These barriers are diverse, ranging from education and access problems to personal beliefs. Screening rates in MHS have been reported to be generally higher at 71% compared to national averages of 50-65%. Conclusion: CRC screening can be highly effective at improving detection of both pre-malignant and early cancers. Improved patient education and directed efforts are needed to improve CRC screening both nationally and within the MHS. ©Ivyspring International Publisher.

Burney R.O.,Madigan Healthcare System
Current Opinion in Obstetrics and Gynecology | Year: 2013

PURPOSE OF REVIEW: Endometriosis is a common gynecologic disorder characterized by the displacement of endometrial tissue to ectopic locations. Although predisposition to endometriosis is likely multifactorial, a genetic component is evident. The biochemistry of the disorder is an area of active investigation with translational potential. This review synopsizes recent developments regarding the molecular underpinnings of endometriosis. RECENT FINDINGS: Significant advancements in understanding the molecular hallmarks of endometriosis have occurred in recent years. Inflammation, attenuated progesterone action, and neuroangiogenesis constitute emerging themes in the pathophysiology of endometriosis. SUMMARY: Delineation of the biochemical processes involved in endometriosis has important implications for clinical care. The discovery of a sufficiently sensitive and specific biomarker for the nonsurgical detection of endometriosis promises earlier diagnosis and prevention of deleterious sequelae. Understanding the inflammatory cause, attenuated progesterone action at the level of the endometrium, and neuronal sensitization of endometriotic lesions has facilitated development of novel therapeutic approaches for associated pain and infertility. © 2013 Wolters Kluwer Health / Lippincott Williams & Wilkins.

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