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Baltimore Highlands, MD, United States

Gharwan H.,Johns Hopkins Hospital | Yarlagadda L.,Saint Agnes Hospital | Duffy A.,U.S. National Cancer Institute
Case Reports in Oncology

The propensity of colon cancer to metastasize to bones is very low compared to prostate, breast or lung cancer. The reason for this is not yet understood, although an explanation for the osteotropism of certain primaries has been offered by the 'seed and soil' concept, suggesting that the bone microenvironment provides a favorable 'soil' for metastasis and proliferation of some tumor cells ('seeds') [1]. Here, we report an unusual case of colon cancer with metastasis to the finger at initial presentation, and exophytic sclerotic lesions to other bones. The incidence of metastases to fingers/toes (acrometastases) is reported to be only 0.1%, even after including involvement of primary sites other than the colon. The etiology and characteristics of acrometastases are reviewed in this case report. Copyright © 2012 S. Karger AG, Basel. Source

Alderaan K.,Johns Hopkins University | Sekicki V.,Saint Agnes Hospital | Magder L.S.,University of Maryland, Baltimore | Petri M.,Johns Hopkins University
Rheumatology International

Cataract is the most common ocular damage in systemic lupus erythematosus (SLE). We analyzed data from the Hopkins Lupus Cohort longitudinally to identify the factors that predict onset of cataract prior to 60 years of age. The Hopkins Lupus Cohort is a clinical cohort of patients with SLE seen quarterly. This analysis was based on the follow-up experience prior to age 60 of 2,109 SLE patients who had not had a cataract prior to cohort entry. Patients saw their ophthalmologist every 6 months. Cataract was defined by the SLICC/American College of Rheumatology Damage Index. The rate of incident cataract was calculated in subsets of the follow-up defined by patient characteristics and history. Multivariable logistic regression models were fit to identify predictors of cataract while controlling for potential confounding variables. The analysis was based on 11,887 persons-years of follow-up, with median follow-up time of 4.1 years per patient. The incidence of cataract was 13.2/1,000 persons-years. Adjusting for other predictors, a cumulative prednisone dose equivalent to 10 mg/day for 10 years was a strong predictor of cataract (RR = 2.9, P = 0.0010). Disease activity measured by SELENA–SLEDAI (P = 0.0004) and higher systolic blood pressure (P = 0.0003) were associated with cataract. Duration of SLE, diabetes mellitus, smoking, cholesterol, renal involvement, immunological profile and medication history other than prednisone were not associated with cataract. Cataract development in SLE patients is multifactorial with prednisone, systolic blood pressure and disease activity all playing a role. © 2014, Springer-Verlag Berlin Heidelberg. Source

Rothfield K.P.,Saint Agnes Hospital | Rothfield K.P.,University of Maryland, Baltimore | Crowley K.,Saint Agnes Hospital
Surgical Oncology Clinics of North America

This article outlines the anesthetic management of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. This includes a discussion of preoperative evaluation, hemodynamic monitoring, fluid and electrolyte therapy, and temperature management. An understanding of the unique physiologic consequences of this procedure is essential to ensure good outcomes and avoid patient injuries. © 2012 Elsevier Inc. Source

Mackey R.V.,Saint Agnes Hospital | Kowdley G.C.,Saint Agnes Hospital
American Surgeon

There is a paucity of clinical data available on specific treatment in the oncogeriatric population with breast cancer. The purpose of this study was to evaluate treatment patterns and survival outcomes in the elderly to address any disparities at our community hospital. We retrospectively identified a total of 1749 patients diagnosed and treated for breast cancer at our institution between 2001 and 2011. Patient demographics, surgical treatment, stage of disease, tumor characteristics, adjuvant therapy, and 5-year survival data were obtained from tumor registry records. Comparisons between study groups were made using the Pearson χ2 test and Student's t test. We found more favorable prognostic makers among women older than 70 years of age. Of the women with lymph node-positive disease, 84 per cent of those younger than 70 years and 33 per cent in the older than 70 years of age study group received chemotherapy. Adjuvant chemotherapy and radiation therapy were more frequently performed in the younger group. Overall 5-year survival was 90 per cent and 71 per cent for younger than 70 years and older than 70 years groups, respectively. Women older than 70 years of age have more favorable breast cancer characteristics compared with younger women and received less aggressive treatment and experienced a higher mortality rate. Prospective trials are needed to assess the impact of aggressive multimodality therapy in this oncogeriatric population. © 2014, Southeastern Surgical Congress. All rights reserved. Source

Miller A.,Saint Agnes Hospital | Kowdley G.C.,Saint Agnes Hospital
American Surgeon

Reconstruction after mastectomy is an elective procedure. To date many factors have been associated with the choice of operation in these patients including socioeconomic status, insurance, age, comorbidities, and community factors. In an effort to understand the characteristics of patients who undergo reconstruction at our hospital, we performed a retrospective review of patients who received mastectomy at our institution. A total of 354 patients underwent mastectomy from 2006 to 2010 at our hospital. Data from 332 patients undergoing reconstruction within 1 year of mastectomy were then analyzed and χ2 analysis was performed to identify factors significant in the choice of reconstruction. Age younger than 50 years (odds ratio [OR], 3.87), age older than 70 years (OR, 0.09), presence of insurance (OR, 2.89), diabetes (OR, 0.401), hypertension (OR, 0.379), and Medicare (0.182) were found to be significant factors associated with a choice of reconstruction among our patients. When age was corrected for, insurance status was no longer a significant factor in choice of reconstruction. Over 90 per cent of patients underwent implant or tissue expanders for reconstruction. This study reflects the reconstruction choices of patients in our community, city-based hospital. Copyright Southeastern Surgical Congress. All rights reserved. Source

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