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Bedi U.S.,Ochsner Clinic
Current Atherosclerosis Reports | Year: 2013

Atherosclerosis is a complex disease associated with aberrant lipoprotein metabolism and leukocyte infiltration into arterial tissue that leads to cardiovascular diseases. Statins have emerged as among the most effective means of reducing the risk of cardiovascular disease in both primary and secondary prevention settings. Statins are the only pharmacological agents that have been consistently shown to have antiatherosclerotic effects. Statins slow atherosclerosis progression and can even induce atherosclerosis regression. Technological advances in imaging modalities to assess atherosclerosis have made possible direct visualization of atherosclerotic plaques and estimation of plaque burden and permit the evaluation of the impact of medical therapies on the natural history of plaque progression. However, owing to several limiting factors as discussed in this review, presently atherosclerotic plaque progression cannot be used as a therapeutic goal for reduction of the risk of cardiovascular disease. In this review we discuss the evidence for the use of imaging modalities in the detection of atherosclerotic plaque regression, the effects of statins on the atherosclerotic process, and the clinical relevance of atherosclerosis regression. © 2012 Springer Science+Business Media New York.


Friedell M.L.,University of Missouri - Kansas City | Vandermeer T.J.,Guthrie Clinic | Cheatham M.L.,Orlando Regional Medical Center | Fuhrman G.M.,Ochsner Clinic | And 3 more authors.
Journal of the American College of Surgeons | Year: 2014

Background Debate exists within the surgical education community about whether 5 years is sufficient time to train a general surgeon, whether graduating chief residents are confident in their skills, why residents choose to do fellowships, and the scope of general surgery practice today. Study Design In May 2013, a 16-question online survey was sent to every general surgery program director in the United States for dissemination to each graduating chief resident (CR). Results Of the 297 surveys returned, 76% of CRs trained at university programs, 81% trained at 5-year programs, and 28% were going directly into general surgery practice. The 77% of CRs who had done >950 cases were significantly more comfortable than those who had done less (p < 0.0001). Only a few CRs were uncomfortable performing a laparoscopic colectomy (7%) or a colonoscopy (6%), and 80% were comfortable being on call at a Level I trauma center. Compared with other procedures, CRs were most uncomfortable with open common bile duct explorations (27%), pancreaticoduodenectomies (38%), hepatic lobectomies (48%), and esophagectomies (60%) (p < 0.00001). Of those going into fellowships, 67% said they truly had an interest in that specialty and only 7% said it was because they were not confident in their surgical skills. Conclusions Current graduates of general surgery residencies appear to be confident in their skills, including care of the trauma patient. Fellowships are being chosen primarily because of an interest in the subspecialty. General surgery residency no longer provides adequate training in esophageal or hepatopancreatobiliary surgery. © 2014 by the American College of Surgeons.


Sessler D.I.,Cleveland Clinic | Sigl J.C.,Covidien | Manberg P.J.,Covidien | Kelley S.D.,Covidien | And 4 more authors.
Anesthesiology | Year: 2010

Background: Hospitals are increasingly required to publicly report outcomes, yet performance is best interpreted in the context of population and procedural risk. We sought to develop a risk-adjustment method using administrative claims data to assess both national-level and hospital-specific performance. Methods: A total of 35,179,507 patient stay records from 2001-2006 Medicare Provider Analysis and Review (MEDPAR) files were randomly divided into development and validation sets. Risk stratification indices (RSIs) for length of stay and mortality endpoints were derived from aggregate risk associated with individual diagnostic and procedure codes. Performance of RSIs were tested prospectively on the validation database, as well as a single institution registry of 103,324 adult surgical patients, and compared with the Charlson comorbidity index, which was designed to predict 1-yr mortality. The primary outcome was the C statistic indicating the discriminatory power of alternative risk-adjustment methods for prediction of outcome measures. Results: A single risk-stratification model predicted 30-day and 1-yr postdischarge mortality; separate risk-stratification models predicted length of stay and in-hospital mortality. The RSIs performed well on the national dataset (C statistics for median length of stay and 30-day mortality were 0.86 and 0.84). They performed significantly better than the Charlson comorbidity index on the Cleveland Clinic registry for all outcomes. The C statistics for the RSIs and Charlson comorbidity index were 0.89 versus 0.60 for median length of stay, 0.98 versus 0.65 for in-hospital mortality, 0.85 versus 0.76 for 30-day mortality, and 0.83 versus 0.77 for 1-yr mortality. Addition of demographic information only slightly improved performance of the RSI. Conclusion: RSI is a broadly applicable and robust system for assessing hospital length of stay and mortality for groups of surgical patients based solely on administrative data. © 2010, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.


Mues A.C.,Columbia University | Okhunov Z.,Columbia University | Haramis G.,Columbia University | D'Agostino H.,Louisiana State University Health Sciences Center | And 2 more authors.
Journal of Endourology | Year: 2010

Purpose: We reviewed our experience with laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA) in the management of small renal tumors and compared clinical outcomes, short-term oncologic results, and patient complications. Patients and Methods: A retrospective comparison of two prospectively collected oncologic databases was performed. Ninety patients underwent PCA for 99 lesions and 81 patients underwent an LCA for 97 lesions. Patient characteristics, perioperative data, and tumor characteristics were recorded including age, estimated blood loss, complication rate, tumor size, and tumor pathology. Results: Patients in both the PCA and LCA groups had similar demographic and tumor characteristics. The PCA group had two major complications (2%), and the LCA group had three major complications (3.7%) (P? =? 0.374). In the LCA group, estimated blood loss was associated with tumor location with hilar tumor demonstrating a significantly higher mean blood loss (191? mL) compared with endophytic, mesophytic, and exophytic tumors (70? mL, 71? mL, 73.5? mL), respectively (P? =? 0.05). Malignancies rated in the PCA and LCA groups were 50.5% and 60.0%, respectively (P?


Richardson W.S.,Ochsner Clinic | Fanelli R.D.,Berkshire Medical Center
Surgical Endoscopy and Other Interventional Techniques | Year: 2010

Background: The development and implementation of evidence-based clinical practice guidelines involves many challenges. The Society of the American Gastrointestinal and Endoscopic Surgeons (SAGES) has been at the forefront of guideline development for laparoscopic surgery since 1991, providing its membership with guidelines on the clinical application of procedures and the granting of privileges. The objective of this study was to assess the use of SAGES guidelines by its members. Methods: An electronic survey of SAGES members was conducted via e-mail in August 2007. Members were asked if they used the guidelines, how often, for what purposes and when, and to rank the frequency of use and the usefulness of each of the 26 guidelines. They also were asked to suggest topics for new guideline development and to provide comments. Results: Two hundred thirty-nine SAGES members (4.1%) responded to the survey; 121 (50%) responders used the guidelines. Of these, 95% accessed the guidelines monthly or less often, 58% after hours, 52% during work hours, and 9% while on call. Reasons for guideline use included developing practice protocols (56%) and patient treatment paradigms (51%), creating education and training guidelines for staff privileges (35%), and credentialing new medical staff (25%). The most often used and most useful guidelines included clinical application guidelines on laparoscopic bariatric, antireflux, biliary, and colorectal surgery, laparoscopic appendectomy, and deep vein thrombosis prophylaxis. Some respondents indicated no knowledge of guideline existence and made requests for new guidelines. Conclusions: The results of this survey provided valuable information about current use of SAGES guidelines by its members. The pattern of use highlights the need for interventions that increase member awareness and adoption of these guidelines. Such efforts are currently underway. © 2010 Springer Science+Business Media, LLC.


Continuous echo guidance may add to the safety of neonatal aortic balloon valvuloplasty-carotid access is an alternative route to aortic balloon valvuloplasty in neonates Proof of preferred procedure (surgical or catheter based), procedure setting, and access site remains elusive as the disease is infrequent and single center experience remains small. © 2015 Wiley Periodicals, Inc.


Bailey M.B.,University of Kentucky | Davenport D.L.,University of Kentucky | Vargas H.D.,Ochsner Clinic | Evers B.M.,University of Kentucky | McKenzie S.P.,University of Kentucky
Diseases of the Colon and Rectum | Year: 2014

BACKGROUND: As laparoscopic surgery is applied to colorectal surgery procedures, it becomes imperative to delineate whether there is an operative duration where benefits diminish. OBJECTIVE: The purpose of this work was to determine whether benefits of a laparoscopic right colectomy compared with an open right colectomy are diminished by prolonged operative times. DESIGN: We performed a retrospective analysis comparing outcomes of patients undergoing laparoscopic right and open right colectomy for colon cancer with operative duration of less than and greater than 3 hours. SETTINGS: This study was based on data in the American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS: We queried the database for patients with laparoscopic and open right colectomy with a diagnosis of colorectal cancer between 2005 and 2010. MAIN OUTCOME MEASURES: Patients were stratified by operative technique and duration. Forward multivariable logistic regression analysis was performed for mortality, cerebrovascular/cardiovascular complications, and infectious complications. Predictors of operative time >3 hours in the laparoscopic cohort were identified by logistic regression. RESULTS: Of 4273 patients, operative duration was > 3 hours for 18.4% of patients with a laparoscopic right colectomy and 11.3% with an open right colectomy. There was no benefit of the laparoscopic right colectomy with an operative duration >3 hours over open right colectomy with respect to mortality and cardiopulmonary and cerebrovascular complications. An operative duration >3 hours was an independent risk factor for infectious complications in patients undergoing a laparoscopic right colectomy. LIMITATIONS: This was a retrospective study and not an intention-to-treat analysis. CONCLUSIONS: At an operative duration of =3 hours, laparoscopic right colectomy has higher infectious complications than open right colectomy. Reduced mortality and less cardiopulmonary and cerebrovascular complications seen in the laparoscopic cohort with shorter operative duration were lost with an operative duration >3 hours. In patients at risk for prolonged laparoscopic right colectomy, early conversion to an open technique may be warranted. © The ASCRS 2014.


Fleshman J.W.,Baylor University | Beck D.E.,Ochsner Clinic | Hyman N.,University of Vermont | Wexner S.D.,Cleveland Clinic | And 2 more authors.
Diseases of the Colon and Rectum | Year: 2014

BACKGROUND: A large proportion of patients with a colostomy or an ileostomy develop parastomal hernias. The placement of a reinforcing material at the stoma site may reduce parastomal hernia incidence. OBJECTIVE: We aimed to assess the safety and efficacy of stoma reinforcement with sublay placement of noncross- linked porcine-derived acellular dermal matrix at the time of stoma construction. DESIGN: This is a randomized, patient- and third-party assessor-blind, controlled trial. SETTINGS: This study took place in colorectal/general surgery institutions. INTERVENTIONS: Patients were prospectively randomly assigned to undergo standard end-stoma construction with or without porcine-derived acellular dermal matrix reinforcement. PATIENTS: Patients undergoing construction of a permanent stoma were eligible. A total of 113 patients (59 men, 54 women; mean age, 60 years; mean BMI, 25.4 kg/m2) participated: 58 controls and 55 with reinforcement. MAIN OUTCOMES MEASURES: The incidence of parastomal hernia, safety, and stoma-related quality of life were assessed. RESULTS: Intraoperative complications and blood loss were similar between groups. Quality-of-life scores were similar through 24 months of follow-up. At 24 months of follow-up, the incidence of parastomal hernias was similar for both groups (12.2% of the porcine-derived acellular dermal matrix group and 13.2% of controls). LIMITATIONS: Study limitations include the inclusion of ileostomy and colostomy patients, open and laparoscopic techniques, and small numbers of patients at follow-up. CONCLUSIONS: Safety and quality-of-life data from this randomized control trial show similar outcomes in both groups. Prosthetic reinforcement of stomas was safe, but it did not significantly reduce the incidence of parastomal hernia formation. Clinical Trial Registration : Identification no. NCT00771407. © The ASCRS 2014.


Cooper G.M.,University of Washington | Cooper G.M.,HudsonAlpha Institute for Biotechnology | Coe B.P.,University of Washington | Girirajan S.,University of Washington | And 24 more authors.
Nature Genetics | Year: 2011

To understand the genetic heterogeneity underlying developmental delay, we compared copy number variants (CNVs) in 15,767 children with intellectual disability and various congenital defects (cases) to CNVs in 8,329 unaffected adult controls. We estimate that 1/414.2% of disease in these children is caused by CNVs >400 kb. We observed a greater enrichment of CNVs in individuals with craniofacial anomalies and cardiovascular defects compared to those with epilepsy or autism. We identified 59 pathogenic CNVs, including 14 new or previously weakly supported candidates, refined the critical interval for several genomic disorders, such as the 17q21.31 microdeletion syndrome, and identified 940 candidate dosage-sensitive genes. We also developed methods to opportunistically discover small, disruptive CNVs within the large and growing diagnostic array datasets. This evolving CNV morbidity map, combined with exome and genome sequencing, will be critical for deciphering the genetic basis of developmental delay, intellectual disability and autism spectrum disorders. © 2011 Nature America, Inc. All rights reserved.


The International Association of HealthCare Professionals is pleased to welcome Thomas J. Sultenfuss, MD, to their prestigious organization with his upcoming publication in The Leading Physicians of the World. He is a highly-trained and qualified dermatologist with an extensive expertise in all facets of his work. Dr. Thomas J. Sultenfuss has been in practice for more than 39 years, and is currently serving patients within his own private practice in Dunedin, Florida. Dr. Thomas J. Sultenfuss’ career in medicine began in 1977 when he graduated with his Medical Degree from Tulane University in New Orleans, Louisiana. Following his graduation, Dr. Sultenfuss subsequently completed his internship at the Alton Ochsner Clinic in Jefferson, Louisiana which was in turn succeeded by a Dermatology residency at the University of Miami in Jackson. Dr. Sultenfuss holds board certification in Dermatology and has a clinical interest in learning new techniques and methodologies in the field of dermatology. Dr. Sultenfuss has previously taught at the University of South Florida, and is the co-author of A Woman’s Guide to Vitamins, Minerals and Alternative Healing alongside his wife Sherry Wilson Sultenfuss. Dr. Sultenfuss attributes his great success to his love for dermatology, and when he is not assisting patients, he likes to relax by woodworking. Learn more about Dr. Sultenfuss by reading his upcoming publication in The Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics.  Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review.  FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise.  A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life.  For more information about FindaTopDoc, visit http://www.findatopdoc.com

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