Schnatz P.F.,Reading Hospital and Medical Center
Obstetrics and Gynecology | Year: 2011
Objective: To estimate whether mammography can be an early, valid tool for predicting the development of coronary heart disease (CHD) in women. Methods: Women presenting for routine mammograms between June and August 2004 were recruited for the study. Baseline data collected included risk factors and family history of heart disease, as well as any cardiac events experienced by the patient. Similar follow-up data were collected during subsequent years, and these patient-completed surveys were correlated with the baseline mammograms screened for breast arterial calcifications. Results: Throughout the 5-year follow-up, CHD was present in 20.8% of women who screened positive for breast arterial calcification and in 5.4% of who screened negative for breast arterial calcification (P<.001). Among women who did not have CHD at baseline, breast arterial calcification-positive women were more likely to develop CHD or a stroke than those who were breast arterial calcification-negative (6.3% compared with 2.3%, P=.003; and 58.3% compared with 13.3%, P<.001), respectively. These results remained significant even when controlling for age. Conclusion: The presence of breast arterial calcifications on mammograms indicates a significantly increased risk of developing CHD or a stroke. These results suggest that breast arterial calcifications should be routinely reported on mammograms and viewed as a marker for the development of CHD. © 2011 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.
Myers S.R.,Reading Hospital and Medical Center |
McGuirl J.,Cognitive Systems Analytics |
Wang J.,Ohio State University
Obesity Surgery | Year: 2013
Background: Roux-en-Y gastric bypass is an effective treatment for severe obesity and obesity-related comorbidities. Presently, gastric bypass is performed most often laparoscopically, although a robotic-assisted procedure is the preferred approach for an increasing number of bariatric surgeons. Methods: This retrospective study compared the results of 100 Roux-en-Y gastric bypass operations using the da Vinci robot and 100 laparoscopic Roux-en-Y gastric bypasses performed laparoscopically. Short-term outcomes were determined by evaluating mortality, length of stay, length of operation, return to the operating room within 90 days of operation, conversions to open procedure, leaks, strictures, transfusions, and hospital readmissions. Results: There was no mortality, pulmonary embolus, or conversion to open procedure in either group. Both the laparoscopic and robotic operative times decreased progressively, although the robotic operation time was longer (mean, 144 versus 87 min, P < 0.001). The length of stay was shorter for the robotic-assisted group (37 versus 52 h, P < 0.001), and 60 % of these patients were discharged after one night's stay (P < 0.001). There were fewer transfusions (P = 0.005) and readmissions (P =.560) in the robotic group. The stricture rate was higher in the first 50 robotic procedures (17 mm gastrotomy) but resolved in the second 50 procedures (21 mm gastrotomy). There was no difference in the rate of leak and return to the operating room between groups (both P > 0.05). Conclusions: These results indicate that Roux-en-Y gastric bypass can be performed safely with robotic assistance, even during the first 100 cases. © 2013 Springer Science+Business Media New York.
Gooneratne N.S.,University of Pennsylvania |
Patel N.P.,University of Pennsylvania |
Patel N.P.,Reading Hospital and Medical Center |
Corcoran A.,University of Pennsylvania
Journal of the American Geriatrics Society | Year: 2010
Chronic obstructive pulmonary disease (COPD) in older adults is a complex disorder with several unique age-related aspects. Underlying changes in pulmonary lung function and poor sensitivity to bronchoconstriction and hypoxia with advancing age can place older adults at greater risk of mortality or other complications from COPD. The establishment of the Global Initiative for Obstructive Lung Disease criteria, which can be effectively applied to older adults, has more rigorously defined the diagnosis and management of COPD. An important component of this approach is the use of spirometry for disease staging, a procedure that can be performed in most older adults. The management of COPD includes smoking cessation, influenza and pneumococcal vaccinations, and the use of short- and long-acting bronchodilators. Unlike with asthma, corticosteroid inhalers represent a third-line option for COPD. Combination therapy is frequently required. When using various inhaler designs, it is important to note that older adults, especially those with more-severe disease, may have inadequate inspiratory force for some dry-powder inhalers, although many older adults find the dry-powder inhalers easier to use than metered-dose inhalers. Other important treatment options include pulmonary rehabilitation, oxygen therapy, noninvasive positive airway pressure, and depression and osteopenia screening. Clinicians caring for older adults with an acute COPD exacerbation should also guard against prognostic pessimism. Although COPD is associated with significant disability, there is a growing range of treatment options to assist patients. © 2010, The American Geriatrics Society.
Vyas P.A.,Reading Hospital and Medical Center |
Donato A.A.,Jefferson Medical College
Southern Medical Journal | Year: 2012
Acute pulmonary embolism (PE) is a common clinical condition with presentations that may vary from asymptomatic subsegmental emboli to massive vascular obstruction and shock with high risk of death. Identifying patients at highest risk for death is critical to select those who would benefit most from thrombolytic therapy. New and evolving clinical prediction models, serum tests, and imaging modalities are being used to improve our ability to identify potential thrombolytic candidates. We review the evolution of the present guidelines on the management of PE, specifically regarding the evolving role of thrombolytics; outcomes following thrombolytic therapy, including mortality, hemorrhage, hemodynamic improvement, and prevention of chronic thromboembolic pulmonary hypertension; and our strategy for risk stratification of pulmonary embolism. Copyright © 2012 by The Southern Medical Association.
Donato A.A.,Reading Hospital and Medical Center |
Khoche S.,Reading Hospital and Medical Center |
Santora J.,Reading Hospital and Medical Center
Thrombosis Research | Year: 2010
Introduction: CT Pulmonary Angiography has been shown to be equivalent to Ventilation/ Perfusion scanning in 3-month outcome studies, but it detects more pulmonary emboli. Isolated subsegmental pulmonary emboli are thought to account for some of the increase in diagnosis, but it is not known whether these emboli represent a harbinger for future thromboembolic events. The objective of this study was to determine the 3-month clinical outcomes of a cohort of patients diagnosed with isolated subsegmental pulmonary emboli. Materials and Methods: Review of 10,453 consecutive CTPA radiology reports over 74-month period since the implementation of Multidetector CT Pulmonary Angiography identified a cohort of 93 patients found to have acute pulmonary embolism isolated to subsegmental pulmonary arteries without other evidence of deep venous thrombosis at one institution. The study measured 3-month clinical outcomes (anticoagulation use, recurrence, death, hemorrhage) determined by review of records and telephone interviews with physicians. Results: Seventy-one patients (76%) were treated with anticoagulation and/or IVC filter, while 22 (24%) were observed without therapy. One patient (1/93, 1.05%; 95% CI: 0-6.6%) who was treated with anticoagulants and a vena caval filter had a recurrent subsegmental pulmonary embolus. No patients died of pulmonary embolism. There were 8 hemorrhages, including 5 (5.3%) major hemorrhages without any hemorrhage-related mortality. Conclusions: Patients diagnosed with isolated subsegmental pulmonary emboli have favorable 3-month outcomes. Short-term prognosis for recurrent thromboembolism may be lower than the risk of adverse events with anticoagulation in patients at high risk of hemorrhage. © 2010 Elsevier Ltd.
Le B.H.,Reading Hospital and Medical Center |
Truex R.C.,Spine and Brain Neurosurgery Center
Brain Pathology | Year: 2013
Langerhans cell histiocytosis (LCH), previously referred to as histiocytosis X, is a dendritic cell histiocytic tumor that demonstrates a variable spectrum of organ involvement. Clinical syndromes within this entity include eosinophilic granuloma,Hand-Schuller-Christian disease, Abt-Letterer-Siwe Disease, and Hashimoto-Pritzker disease. Currently, it is classified on the basis of extent, such as unifocal, multifocal, or disseminated disease.LCH typically occurs in childhood and adolescence as solitary osteolytic lesions. When involving the central nervous system, it is usually either a result of extra-axial extension from skull vault epicenters, or is restricted to the hypothalamic-pituitary axis.Discrete intraparenchymal, intra-axial CNS lesions are rare. This report presents a case of an intra-axial LCH in a 29 year-old male who, following this diagnosis, was found to have multiple pulmonary lesions on imaging, attributed to the same disease process. © 2012 The Authors; Brain Pathology © 2012 International Society of Neuropathology.
Masciocchi M.,Reading Hospital and Medical Center |
Wagner B.,Reading Hospital and Medical Center |
Lloyd B.,Reading Hospital and Medical Center
Journal of the American College of Radiology | Year: 2012
Purpose: Solitary pulmonary nodules are a common incidental finding on CT and unnecessary follow-up affects cost, radiation exposure, and patient anxiety. The aim of this study was to evaluate the adherence of one institution's radiologists with published criteria in their follow-up recommendations. Methods: A data set of 3,000 CT scans with the word nodule used in the report history or conclusion from 2008 to 2010 was generated. This pool was increased as each study was traced back to the examination when the pulmonary nodule was first identified. The follow-up recommendation of the radiologist was then classified as "adherent," "incomplete/no recommendation," "earlier than recommended by the criteria," "later than recommended," or a "wider follow-up time frame than recommended." Results: After the implementation of exclusion criteria, 1,432 examinations were satisfactory for classification. The adherence rates of radiologists for nodules followed in up to 4 consecutive examinations were 57%, 48%, 70%, and 79%, respectively. Overmanagement was the most common deviation from the Fleischner criteria, ranging from 15% to 28% of evaluated reports. Conclusions: Radiologists at the authors' hospital do not always adhere to the Fleischner criteria, most often recommending closer follow-up. The possibility of missing a malignancy while it is still treatable, medicolegal concerns, and lack of familiarity with the Fleischner criteria are all potential factors in nonadherence. © 2012 American College of Radiology.
Fagbami O.Y.,Reading Hospital and Medical Center |
Donato A.A.,Reading Hospital and Medical Center |
Donato A.A.,Thomas Jefferson University
Journal of Neurosurgery | Year: 2011
Refractory symptoms in Parkinson disease show good response to deep brain stimulation (DBS). This procedure improves United Parkinson's Disease Rating Scale scores and reduces dyskinesias, whereas speech and swallowing dysfunction typically do not improve and may even worsen. Rarely, DBS can cause idiosyncratic dystonias of muscle groups, including those of the neck and throat. The authors describe a patient experiencing stridor and dysphagia with confirmed pulmonary restriction and aspiration following subthalamic nucleus deep brain stimulator adjustment, with a resolution of symptoms and signs when the stimulator was switched off.
Gulati S.,Reading Hospital and Medical Center |
Donato A.A.,Reading Hospital and Medical Center |
Donato A.A.,Jefferson Medical College
Journal of Thrombosis and Thrombolysis | Year: 2012
A 2010 US report recently detected the presence of levamisole in greater than 77 % of seized cocaine samples. A syndrome of retiform purpura, often involving ears and flanks, with vasculopathy or vasculitis on biopsy, associated with anti-nuclear cytoplasmic antibodies as well as antiphospholipid antibodies, previously associated with therapeutic use of levamisole has now re-emerged, and is associated with cocaine adulterated with levamisole. Patients with this unusual constellation of signs and laboratory findings should be questioned about exposure to cocaine. © 2012 Springer Science+Business Media, LLC.
Schnatz P.F.,Reading Hospital and Medical Center |
Schnatz P.F.,Thomas Jefferson University |
Manson J.E.,Harvard University
Clinical Chemistry | Year: 2014
SUMMARY: Most vitamin D supplementation trials have not demonstrated improvement in CVD, but they have tested relatively low vitamin D doses. Thus, the evidence remains inconclusive, highlighting the need for rigorous randomized trials of higher vitamin D doses with cardiovascular events as prespecified outcomes. While we await the results of ongoing trials, the recommended dietary allowances from the Institute of Medicine remain the best guidepost for nutritional requirements. © 2013 American Association for Clinical Chemistry.