University of, Illinois, United States
University of, Illinois, United States

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Holterman A.-X.,Rush University Medical Center | Holterman A.-X.,University of Illinois Medical Center | Browne A.,Rush University Medical Center | Browne A.,University of Illinois Medical Center | And 7 more authors.
Journal of Pediatric Surgery | Year: 2010

Background and Materials and Methods: The outcome of patients completing 12 months of follow-up in a prospective longitudinal trial of the safety/efficacy of laparoscopic adjustable gastric banding (LAGB) for morbidly obese adolescents aged 14 to 17 years using a Food and Drug Administration Institutional Device Exemption for the use of the LAPBAND was analyzed. Baseline and outcome data were abstracted from a prospective database. Results: Baseline (mean ± SD) body mass index was 50 ± 10 kg/m 2, and excess weight was 178 ± 53 lb in 20 patients. Comorbidities included hypertension (45%), dyslipidemia (80%), insulin resistance (90%), metabolic syndrome (95%), and biopsy-proven nonalcoholic steatohepatitis (88%). At mean (SD) follow-up of 26 (9) months, % excess weight loss was 34% ± 22% (n = 20) and 41% ± 27% (n = 12), and the metabolic syndrome was resolved in 63% and 82% of the patients at 12 and 18 months, respectively. Hypertension normalized in all patients, along with improvement in lipid abnormalities and quality of life scores (P < .05). At 12 months, of the 5 patients with less than 20% excess weight loss, dyslipidemia and metabolic syndrome were resolved in 2 patients. Conclusion: At intermediate follow-up of a LAGB-based obesity treatment program, weight loss led to resolution or improvement of major obesity-related comorbidities in most patients, supporting the efficacy of LAGB as a surgical adjunct to a comprehensive obesity treatment program and its long-term evaluation. © 2010 Elsevier Inc. All rights reserved.


Popa A.M.,University of Illinois at Chicago | Valla K.,University of Illinois Medical Center | Valla K.,Emory University | Radhakrishnan L.,University of Illinois at Chicago | And 3 more authors.
Annals of Pharmacotherapy | Year: 2012

OBJECTIVE: To report the serial development of oral mucositis following infusion of bevacizumab in a young woman with a malignant brain tumor and history of cutaneous psoriasis. CASE SUMMARY: A 29-year-old woman with a history of active cutaneous psoriasis and a malignant glioneuronal tumor was treated with bevacizumab for 2.5 years. With each infusion of bevacizumab, she developed oral mucositis within 36 hours. She received temozolomide as part of concurrent therapy with radiation and as maintenance therapy; it was discontinued after continuous therapy for 1.5 years. Bevacizumab 10 mg/kg was added after 7 cycles of maintenance temozolomide, as the tumor had minimal response and evidence of increased perfusion with angiogenesis on imaging studies. All medication, including temozolomide, was evaluated and eventually discontinued, with the exception of bevacizumab, which remained the drug suspected of causing the mucositis. DISCUSSION: Oral mucositis is a frequent adverse effect of cytotoxic chemotherapy, but has not been reported with bevacizumab. The Naranjo probability scale indicated a probable adverse drug reaction. This likely indicates that bevacizumab is one of many drugs known to induce exacerbation of psoriatic disease. We speculate that oral mucositis developed as bevacizumab-induced generation of proinflammatory cytokines within the vascular endothelium, leading to mucosal damage and ulceration. In addition, interruption of reparative angiogenic pathways with bevacizumab likely contributed to the severity of mucositis. CONCLUSIONS: Clinicians should be aware that bevacizumab can potentially exacerbate psoriatic disease.


Hoff S.R.,Stanford University | Apushkin M.,University of Illinois Medical Center | Pytynia K.B.,Stanford University
Laryngoscope | Year: 2011

Objectives: To discuss the presentation, diagnosis, histopathology, and characteristics of clear cell carcinoma of the larnyx, including squamous and mucoepidermoid variants. Study Design: Case report and review of the literature. Methods: We report the sixth known case of clear cell carcinoma of the larynx, of squamous orgin, in a patient who presented with massive thyroid cartilage destruction and expansion in a short amount of time. We also present a review of the published literature on these lesions. Results: A 68 year old male presented with a rapidly expanding exophytic supraglottic mass with adjacent cartilage destruction. Biopsy was consistent with a stage IV clear cell carcinoma of the larynx, derived from squamous cells. He underwent total laryngectomy with bilateral neck dissections, followed by radiation and chemotherapy. He remains disease free after 12 months. Conclusions: Clear cell carcinoma (CCC) of the larynx is a rare neoplasm, with only nine cases previously reported in the literature. Of these, four were clear cell variants of mucoepidermoid or adenocarcinoma and five were of squamous cell origin. We report a sixth case of CCC of the larynx derived from squamous cells. These tumors are considered highly aggressive, with high rates of recurrence (> 85%) and short overall survival times (mean = 12 months). There is a predilection for the supraglottis, and they tend to present in elderly men, which corresponds to the findings in our patient. Surgery is the treatment of choice, and postoperative radiation/chemotherapy should be considered for this aggressive neoplasm.

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