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Achalasia
Title
Achalasia.
Creator
Oviedo, Rodolfo J., Sofiak, Chase W., Dixon, Bruce M.
Abstract/Description
INTRODUCTION: Achalasia is a condition that occurs when the lower esophageal sphincter (LES) fails to properly relax, combined with slowing/failure of esophageal peristalsis. This is seen clinically by not allowing solids and liquids to pass easily into the stomach. Achalasia is not historically associated with morbid obesity, yet dual treatment of morbid obesity and achalasia is becoming more prominent due to the worldwide obesity epidemic. PRESENTATION OF CASE: Achalasia is typically a...
Show moreINTRODUCTION: Achalasia is a condition that occurs when the lower esophageal sphincter (LES) fails to properly relax, combined with slowing/failure of esophageal peristalsis. This is seen clinically by not allowing solids and liquids to pass easily into the stomach. Achalasia is not historically associated with morbid obesity, yet dual treatment of morbid obesity and achalasia is becoming more prominent due to the worldwide obesity epidemic. PRESENTATION OF CASE: Achalasia is typically a disease that affects non-obese adults over the age of 55, which makes the discussion of this case report unique in that our patient is a 23 year-old woman who successfully underwent per-oral endoscopic myotomy (POEM) in preparation for a future laparoscopic sleeve gastrectomy. There is sparse literature on combining laparoscopic Heller myotomy (LHM) and partial fundoplication versus POEM with either restrictive or malabsorptive minimally invasive bariatric procedures. DISCUSSION: LHM and partial fundoplication have long been considered the gold standard surgical treatment for achalasia by disrupting both the longitudinal and circular muscle layers of the LES. The newer, less invasive, POEM technique will be compared to the gold standard LHM and Dor fundoplication in this uncharacteristically young morbidly obese achalasia patient. The decision to pursue a laparoscopic sleeve gastrectomy over a laparoscopic Roux-en-Y gastric bypass was multifactorial due to the patient's concerns regarding malabsorption of vitamins and nutrients in the event of a future pregnancy. CONCLUSION: The patient has already undergone a POEM procedure, which was chosen to maintain the gastric fundus, cardia, and gastroesophageal junction (GEJ) architecture as opposed to a LHM with Dor fundoplication, which would have altered the anatomy, thus making a concomitant laparoscopic sleeve gastrectomy an unfeasible option. (C) 2016 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
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Date Issued
2016
Identifier
FSU_libsubv1_wos_000384278500002, 10.1016/j.ijscr.2016.06.046
Format
Citation
Caring for Older Adults with the Human Immunodeficiency Virus
Title
Caring for Older Adults with the Human Immunodeficiency Virus.
Creator
Sangarlangkarn, Aroonsiri, Appelbaum, Jonathan S
Abstract/Description
Increasing proportions of older adults are living with the human immunodeficiency virus (HIV). It is estimated that more than 50% of individuals with HIV in the United States are aged 50 and older. Part of this group consists of individuals who have aged with chronic HIV infection, but a large proportion also results from new HIV diagnosis, with approximately 17% of new HIV diagnoses in 2013 occurring in individuals aged 50 and older. Although many of the recommendations on management of HIV...
Show moreIncreasing proportions of older adults are living with the human immunodeficiency virus (HIV). It is estimated that more than 50% of individuals with HIV in the United States are aged 50 and older. Part of this group consists of individuals who have aged with chronic HIV infection, but a large proportion also results from new HIV diagnosis, with approximately 17% of new HIV diagnoses in 2013 occurring in individuals aged 50 and older. Although many of the recommendations on management of HIV infection are not age-specific, individuals with HIV aged 50 and older differ from their younger counterparts in many aspects, including immune response to antiretroviral therapy, multimorbidity, antiretroviral toxicities, and diagnostic considerations. This article outline these differences, offers a strategy on how to care for this unique population, and provides special considerations for problem-based management of individuals with HIV aged 50 and older.
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Date Issued
2016-09-29
Identifier
FSU_libsubv1_scholarship_submission_1483969272, 10.1111/jgs.14584
Format
Citation
Combined DSEK and Transconjunctival Pars Plana Vitrectomy
Title
Combined DSEK and Transconjunctival Pars Plana Vitrectomy.
Creator
Sane, Mona, Shaikh, Naazli, Shaikh, Saad
Abstract/Description
We report here three patients who underwent combined Descemet's stripping with endothelial keratoplasty and transconjunctival pars plana vitrectomy for bullous keratopathy and posterior segment pathology. A surgical technique and case histories are described. Anatomic and visual outcomes of combined Descemet's stripping with endothelial keratoplasty and vitrectomy were excellent. Our experience provides technical guidelines and limitations. The combined minimally invasive techniques allow for...
Show moreWe report here three patients who underwent combined Descemet's stripping with endothelial keratoplasty and transconjunctival pars plana vitrectomy for bullous keratopathy and posterior segment pathology. A surgical technique and case histories are described. Anatomic and visual outcomes of combined Descemet's stripping with endothelial keratoplasty and vitrectomy were excellent. Our experience provides technical guidelines and limitations. The combined minimally invasive techniques allow for rapid anatomical recovery and return of function and visual acuity in a single sitting.
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Date Issued
2016
Identifier
FSU_libsubv1_wos_000378284400001, 10.1155/2016/9728035
Format
Citation
Early goal-directed therapy in severe sepsis and septic shock
Title
Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE.
Creator
Nguyen, H. Bryant, Jaehne, Anja Kathrin, Jayaprakash, Namita, Semler, Matthew W., Hegab, Sara, Yataco, Angel Coz, Tatem, Geneva, Salem, Dhafer, Moore, Steven, Boka, Kamran, Gill, Jasreen Kaur, Gardner-Gray, Jayna, Pflaum, Jacqueline, Domecq, Juan Pablo, Hurst, Gina, Belsky, Justin B., Fowkes, Raymond, Elkin, Ronald B., Simpson, Steven Q., Falk, Jay L., Singer, Daniel J., Rivers, Emanuel P.
Abstract/Description
Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar...
Show morePrior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar outcome benefits have been reported in over 70 observational and randomized controlled studies comprising over 70,000 patients. As a result, early goal-directed therapy was largely incorporated into the first 6 hours of sepsis management (resuscitation bundle) adopted by the Surviving Sepsis Campaign and disseminated internationally as the standard of care for early sepsis management. Recently a trio of trials (ProCESS, ARISE, and ProMISe), while reporting an all-time low sepsis mortality, question the continued need for all of the elements of early goal-directed therapy or the need for protocolized care for patients with severe and septic shock. A review of the early hemodynamic pathogenesis, historical development, and definition of early goal-directed therapy, comparing trial conduction methodology and the changing landscape of sepsis mortality, are essential for an appropriate interpretation of these trials and their conclusions.
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Date Issued
2016-07-01
Identifier
FSU_libsubv1_wos_000379790100001, 10.1186/s13054-016-1288-3
Format
Citation
Emergency total proctocolectomy in an uninsured patient with Familial Adenomatous Polyposis Syndrome and acute lower gastrointestinal hemorrhage in a community hospital
Title
Emergency total proctocolectomy in an uninsured patient with Familial Adenomatous Polyposis Syndrome and acute lower gastrointestinal hemorrhage in a community hospital.
Creator
Oviedo, Rodolfo J., Dixon, Bruce M., Sofiak, Chase W.
Abstract/Description
INTRODUCTION: Rectal bleeding is the most common symptom of Familial Adenomatous Polyposis (FAP). This case investigates the efficacy of emergency surgery for FAP with total proctocolectomy end ileostomy for recurrent lower gastrointestinal (GI) hemorrhage in an uninsured patient in a 266-bed community hospital. The optimal treatment for FAP with acute lower GI hemorrhage and hemodynamic compromise unresponsive to conservative management is unclear. PRESENTATION OF CASE: A 41-year-old...
Show moreINTRODUCTION: Rectal bleeding is the most common symptom of Familial Adenomatous Polyposis (FAP). This case investigates the efficacy of emergency surgery for FAP with total proctocolectomy end ileostomy for recurrent lower gastrointestinal (GI) hemorrhage in an uninsured patient in a 266-bed community hospital. The optimal treatment for FAP with acute lower GI hemorrhage and hemodynamic compromise unresponsive to conservative management is unclear. PRESENTATION OF CASE: A 41-year-old uninsured African American man with no past medical or family history presented to the emergency department with hematochezia lasting three days. A clinical diagnosis of FAP made on colonoscopy with biopsies revealed villous and tubulovillous adenomas without dysplasia. After blood products resuscitation, an emergency total proctocolectomy with end ileostomy was performed. A staged ileal J pouch to anal anastomosis and creation of protective loop ileostomy was performed months later after securing state funding. A final loop ileostomy reversal occurred six weeks later. His self reported quality of life is improved. DISCUSSION: Lower GI hemorrhage from FAP unresponsive to blood products may require emergency total proctocolectomy and end ileostomy with a staged ileal J pouch to anal anastomosis, which can be done in a community acute care hospital for an uninsured patient. CONCLUSION: A total proctocolectomy is feasible in the emergency setting in an uninsured patient with lower GI bleeding and FAP. A staged ileal J pouch-anal anastomosis is easier to justify to the hospital compared to a staged completion colectomy with proctectomy. It is essential to monitor the ileo-anal anastomosis with anoscopy. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
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Date Issued
2016
Identifier
FSU_libsubv1_wos_000384278500045, 10.1016/j.ijscr.2016.07.052
Format
Citation
Endonasal (Closed) Rhinoplasty Technique Securing Spreader Grafts With Barbed Suture
Title
Endonasal (Closed) Rhinoplasty Technique Securing Spreader Grafts With Barbed Suture.
Creator
Bradford, Benjamin D., Asher, Scott A., Ardeshirpour, Farhad
Date Issued
2016-10
Identifier
FSU_libsubv1_wos_000384295300015, 10.1001/jamafacial.2016.0294
Format
Citation
Implementation of the Ten Steps to Successful Breastfeeding Saves Lives
Title
Implementation of the Ten Steps to Successful Breastfeeding Saves Lives.
Creator
Meek, Joan Younger, Noble, Lawrence
Date Issued
2016-10
Identifier
FSU_libsubv1_wos_000385643000005, 10.1001/jamapediatrics.2016.2015
Format
Citation
Medical Concerns in HIV-Positive Aging
Title
Medical Concerns in HIV-Positive Aging.
Creator
Simone, Mark, Appelbaum, Jonathan
Abstract/Description
The management and prognosis of HIV disease has changed dramatically since the introduction of combination HIV antiretroviral therapy in 1996. Thus, the number of older adults with HIV is increasing partly because people with HIV are living longer. At the same time, the rates of new HIV cases in older adults (usually defined as people over the age of 50) are also increasing. Currently, about 25 percent of all patients living with HIV are older than 50, and by 2015 adults older than 50 will...
Show moreThe management and prognosis of HIV disease has changed dramatically since the introduction of combination HIV antiretroviral therapy in 1996. Thus, the number of older adults with HIV is increasing partly because people with HIV are living longer. At the same time, the rates of new HIV cases in older adults (usually defined as people over the age of 50) are also increasing. Currently, about 25 percent of all patients living with HIV are older than 50, and by 2015 adults older than 50 will account for 50 percent of the population living with HIV.1 These trends make understanding the medical challenges of HIV in older adults more important than ever. This article reviews the special issues associated with HIV and AIDS in an older population.
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Date Issued
2009
Identifier
FSU_migr_clinicalsciences_faculty_publications-0001
Format
Citation
Optimal unified combination rule in application of Dempster-Shafer theory to lung cancer radiotherapy dose response outcome analysis
Title
Optimal Unified Combination Rule In Application Of Dempster-shafer Theory To Lung Cancer Radiotherapy Dose Response Outcome Analysis.
Creator
He, Yanyan, Hussaini, M. Yousuff, Gong, Yutao U. T., Xiao, Ying
Abstract/Description
Our previous study demonstrated the application of the Dempster-Shafer theory of evidence to dose/volume/outcome data analysis. Specifically, it provided Yager's rule to fuse data from different institutions pertaining to radiotherapy pneumonitis versus mean lung dose. The present work is a follow-on study that employs the optimal unified combination rule, which optimizes data similarity among independent sources. Specifically, we construct belief and plausibility functions on the lung cancer...
Show moreOur previous study demonstrated the application of the Dempster-Shafer theory of evidence to dose/volume/outcome data analysis. Specifically, it provided Yager's rule to fuse data from different institutions pertaining to radiotherapy pneumonitis versus mean lung dose. The present work is a follow-on study that employs the optimal unified combination rule, which optimizes data similarity among independent sources. Specifically, we construct belief and plausibility functions on the lung cancer radiotherapy dose outcome datasets, and then apply the optimal unified combination rule to obtain combined belief and plausibility, which bound the probabilities of pneumonitis incidence. To estimate the incidence of pneumonitis at any value of mean lung dose, we use the Lyman-Kutcher-Burman (LKB) model to fit the combined belief and plausibility curves. The results show that the optimal unified combination rule yields a narrower uncertainty range (as represented by the belief-plausibility range) than Yager's rule, which is also theoretically proven.
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Date Issued
2016
Identifier
FSU_libsubv1_wos_000368341200002, 10.1120/jacmp.v17i1.5737
Format
Citation