Publications by authors named "Todd Austin"
Background: Maculopapular cutaneous mastocytosis (MPCM) is a rare disorder characterized by a pathologic accumulation of mast cells in the skin, which may or may not be accompanied by systemic mastocytosis. Diagnosis of MPCM on skin biopsy can be challenging because the findings may be subtle. Although mast cell density in MPCM has been reported, data informing a proposed cutoff for diagnosis and diagnostic criteria are limited.
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- Surgical septal reduction is often considered risky in older adults, but this study evaluates the differences between younger and older patients undergoing septal myectomy for obstructive hypertrophic cardiomyopathy (oHCM).
- The study analyzed 2,663 patients over 21 years and found that older patients (65+) had higher rates of health issues like hypertension and diabetes, yet similar functional limitations when compared to younger counterparts.
- Despite some increased risks, septal myectomy is deemed safe for older patients, with a notable link between left ventricular wall asymmetry and poorer prognosis in this age group.
Article Synopsis
- The study reviews the increasing use of Mohs micrographic surgery with melanocytic immunostains (MMS-I) for treating cutaneous melanoma over a decade.
- It analyzed data from 352 patients, primarily older males, with most tumors classified as early-stage T1a/b and lentigo maligna subtype.
- The findings showed low rates of local recurrence (1.4%) and melanoma-specific deaths (0.9%), indicating that MMS-I is effective for T1a/b melanomas.
Article Synopsis
- The study focuses on differentiating perianal issues caused by hidradenitis suppurativa (HS) and perianal fistulizing inflammatory bowel disease (IBD), as they often present similar symptoms.
- A retrospective review of patient data at the Mayo Clinic identified 15 key clinical features using machine learning to help distinguish between HS and IBD cases.
- Findings revealed significant differences in symptoms, with HS patients showing more skin-related issues and IBD patients experiencing additional gastrointestinal symptoms, which may lead to better diagnosis and treatment strategies.
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- Immune checkpoint inhibitors (ICIs) are revolutionizing cancer treatment but pose risks for severe skin reactions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which need more study.
- This systematic review examined 158 cases to analyze factors related to SJS/TEN in ICI patients to improve risk assessment and clinical management.
- Findings show that SJS/TEN typically occurs in older males, often linked to PD-1 inhibitors, and highlights significant morbidity and mortality risks, though limitations exist in the data reporting and consistency.
Article Synopsis
- The study examines the occurrence of cardiac myxomas in patients with Carney complex (CNC) over a time span from 1970 to 2023, identifying 38 patients in total.
- Out of these, 24 patients (63.1%) developed cardiac myxomas, with a median onset age of 39 years, and more than half (54.1%) experienced recurrences post-surgery.
- The findings highlight the importance of regular echocardiogram monitoring for CNC patients, as surgical removal is crucial for managing these myxomas effectively.
Article Synopsis
- Following the transition to digital pathology for primary diagnosis, dermatology residents showed improved diagnostic accuracy with digital methods compared to traditional light microscopy.
- In a study, residents diagnosed 22 out of 32 cases correctly using digital slides versus 18 out of 32 with light microscopy, with accuracy increasing for those with more training.
- Most residents (85.7%) preferred digital pathology over light microscopy, highlighting the need for training that combines both methods to ensure competency in both areas.*
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- The study analyzed over 148,000 coronary artery bypass grafting (CABG) cases to assess risks associated with clopidogrel (a blood thinner) taken within 5 days prior to surgery.
- It found that patients who had used clopidogrel had slightly higher operative mortality and significantly higher rates of mediastinal reexploration for bleeding and blood product use compared to those who hadn't taken the drug.
- The risks decreased the longer the wait after stopping clopidogrel, reaching similar outcomes for surgeries performed 3 days after the last dose compared to 5 days, suggesting 3 days may be a sufficient waiting period before CABG.
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- Patients with congenital heart disease often require reoperative surgeries, especially for valve issues, and a study tracked 1960 adult patients undergoing repeat surgeries from 1993 to 2022 to analyze outcomes.* -
- Among the 502 patients studied, most underwent surgeries involving multiple valves, with low early mortality rates of 4.2%, particularly for elective operations.* -
- Key factors influencing mortality included patient age, heart function, and the urgency of the surgery, indicating that timely referrals can improve surgical outcomes.*
Background: National cancer reporting-based registry data, although robust, lacks granularity for incidence trends. Expert opinion remains conflicted regarding the possibility of melanoma overdiagnosis in the context of rising incidence without a corresponding rise in mortality.
Objective: To characterize 10- and 50-year trends in melanoma incidence and mortality.
Background: Septal myectomy improves symptoms in the majority of patients with obstructive hypertrophic cardiomyopathy (HCM), but there are limited prospective data on functional outcomes after operation.
Objectives: The authors investigated quality of life measures and prevalence of sexual dysfunction before and after septal myectomy for obstructive HCM.
Methods: Between January 2018 and October 2019, 436 patients underwent transaortic septal myectomy at our clinic.
Article Synopsis
- * Analysis of 50,625 operations showed that higher prior surgery counts (3 or more) significantly increased the risks: operative mortality rates rose from 0.6% for no prior surgeries to 6.3% for six or more.
- * The findings indicate that having three or more prior cardiopulmonary bypass operations is a strong independent risk factor for worse surgical outcomes, suggesting that further studies should focus on improving patient management and outcomes.
The intricate immune mechanisms governing mucosal healing following intestinal damage induced by cytotoxic drugs remain poorly understood. The goal of this study was to investigate the role of lymphotoxin beta receptor (LTβR) signaling in chemotherapy-induced intestinal damage. LTβR deficient mice exhibited heightened body weight loss, exacerbated intestinal pathology, increased proinflammatory cytokine expression, reduced IL-22 expression, and proliferation of intestinal epithelial cells following methotrexate (MTX) treatment.
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- - This study reviews patients who had tricuspid valve (TV) repair during surgery for degenerative mitral valve (MV) disease, focusing on the need for permanent pacemaker (PPM) implantation after the procedure across 404 cases from 2001 to 2022.
- - The findings revealed that 8.7% of patients required PPM implantation post-surgery, primarily due to high-degree AV block, with older age identified as a significant risk factor for this complication.
- - The conclusions suggest that while PPM needs are relatively common after TV repair during MV surgery, careful patient selection and surgical techniques might help to lower the associated risks and improve patient outcomes.
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by ulcerative painful lesions with violaceous undermined borders. Up to 75% of PG cases develop in association with an underlying systemic disease. Monoclonal gammopathy is reportedly a concomitant condition with PG, with studies indicating immunoglobulin (Ig) A gammopathy as the most common.
View Article and Find Full Text PDFBackground: Technology has revolutionized not only direct patient care but also diagnostic care processes. This study evaluates the transition from glass-slide microscopy to digital pathology (DP) at a multisite academic institution, using mixed methods to understand user perceptions of digitization and key productivity metrics of practice change.
Methods: Participants included dermatopathologists, pathology reporting specialists, and clinicians.
Article Synopsis
- Limited data on the outcomes of delayed sternal closure (DSC) in adults with congenital heart disease have been gathered from a review of 159 patients over 30 years.
- Among the 112 patients undergoing DSC, those closed within 4 days had lower early mortality (6.8%) compared to those closed after 4 days (32%), and higher ages and specific medical conditions were linked to worse outcomes.
- Despite the risks, hospital survivors showed no significant difference in late survival between those with brief DSC (≤4 days) and prolonged DSC (>4 days), indicating that a shorter DSC duration may lead to better initial outcomes.
Background: Mohs micrographic surgery with melanocytic immunohistochemistry (MMS-I) is increasingly utilized for special site melanoma treatment. Yet, frequency and risk factors associated with upstaging of all-stage cutaneous melanomas treated with MMS-I remain undefined.
Objective: Determine upstaging frequency and factors associated with tumor upstaging for all-stage melanomas treated with MMS-I.
Background: Transthoracic aortic cross-clamp and endoaortic balloon occlusion have both been shown to have comparable safety profiles for aortic occlusion. Because most surgeons use only one technique, we sought to compare the outcomes when a homogeneous group of surgeons changed their occlusion technique from aortic cross-clamp to balloon occlusion.
Methods: We changed our technique from aortic cross-clamp to balloon occlusion in November 2022.
Outcomes of aortic surgery in patients with Takayasu arteritis.
J Thorac Cardiovasc Surg
February 2024
Objective: To investigate the presentation, aortic involvement, and surgical outcomes in patients with Takayasu arteritis undergoing aortic surgery.
Methods: We queried our surgical database for patients with Takayasu arteritis who underwent aortic surgery from 1994 to 2022.
Results: There were a total of 31 patients with Takayasu arteritis who underwent aortic surgery.