Semiautomated Measure of Abdominal Adiposity Using Computed Tomography Scan Analysis.

Background: The obesity epidemic has prompted the need to better understand the impact of adipose tissue on human pathophysiology. However, accurate, efficient, and replicable models of quantifying adiposity have yet to be developed and clinically implemented. We propose a novel semiautomated radiologic method of measuring the visceral fat area (VFA) using computed tomography scan analysis.

Can pancreatic cancer behavior be predicted based on computed tomography measurements of fat and muscle mass?

Unlabelled: Many studies purport that obesity, and specifically visceral fat, impact survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. However, these studies involve crude measures of obesity [eg, body mass index (BMI)] or visceral fat [eg, linear measurements on computed tomographic (CT) scans]. Some studies purport that weight loss and muscle wasting (ie, sarcopenia) presage poor survival in these patients.

The Tumor Suppressive Effects of HPP1 Are Mediated Through JAK-STAT-Interferon Signaling Pathways.

HPP1, a novel tumor suppressive epidermal growth factor (EGF)-like ligand, mediates its effects through signal transducer and activators of transcription (STAT) activation. We previously demonstrated the importance of STAT1 activation for HPP1 function; however the contribution of STAT2 remains unclear. We sought to delineate the components of JAK-STAT-interferon (IFN) signaling specifically associated with HPP1s biological effects.

The impact of pathologic nodal status on survival following neoadjuvant chemoradiation for locally advanced rectal cancer.

Purpose: For patients with locally advanced rectal cancer, the accuracy rates of preneoadjuvant therapy nodal staging and potential nodal downstaging make the prognostic significance of nodal status unclear. We therefore sought to review our experience in order to better understand the impact of clinical and pathologic nodal status upon patient outcomes.

Methods: 174 patients were identified as having undergone neoadjuvant chemoradiation and resection for rectal cancer.

Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation.

Background: The association between body mass index as a measure of obesity and rectal cancer outcomes has been inconsistent. Radiologic measures of visceral adiposity using CT scans have not been well characterized among rectal cancer patients. The objective of this study was to examine quantitative radiologic measures of visceral obesity compared with body mass index in predicting patient outcomes among patients undergoing neoadjuvant chemoradiation and resection for locally advanced rectal cancers.

Causes of dissatisfaction after laparoscopic fundoplication: the impact of new symptoms, recurrent symptoms, and the patient experience.

Background: Although laparoscopic fundoplication effectively alleviates gastroesophageal reflux disease (GERD) in the great majority of patients, some patients remain dissatisfied after the operation. This study was undertaken to report the outcomes of these patients and to determine the causes of dissatisfaction after laparoscopic fundoplication.

Methods: All patients undergoing laparoscopic fundoplication in the authors' series from 1992 to 2010 were evaluated for frequency and severity of symptoms before and after laparoscopic fundoplication, and their experiences were graded from "very satisfying" to "very unsatisfying.

Outcomes after transjugular intrahepatic portosystemic stent shunt: a "bridge" to nowhere.

Background: Transjugular intrahepatic portosystemic stent shunt (TIPS) has become the modality of choice for complicated portal decompression. This study was undertaken to determine outcomes after TIPS and the usefulness of TIPS as a "bridge" to transplantation.

Methods: Patients undergoing TIPS from 2001 to 2010 at a teaching hospital with a transplant program were studied.

Delayed presentation of complete pancreatic ductal transection in children: management of two cases without resection.

Pancreatic ductal injuries in children are rare, and ductal transections presenting in a delayed or subacute fashion are seldom reported. We describe two cases of traumatic pancreatic ductal transection secondary to physical abuse, both of which presented late to medical care. Both were managed successfully without pancreatic resection.

Targeting early deaths following pancreaticoduodenectomy to improve survival.

Introduction: There is increasing focus on disease-specific outcomes. This study was undertaken to analyze early mortality after pancreaticoduodenectomy as part of a strategy to improve long-term outcome.

Methods: One thousand thirty-one patients who underwent pancreaticoduodenectomy from 1992 to 2010 were studied.

Complementary strand microRNAs mediate acquisition of metastatic potential in colonic adenocarcinoma.

Background: Altered expression of specific microRNAs (miRNA) is known to occur during colorectal carcinogenesis. However, little is known about the genome-wide alterations in miRNA expression during the neoplastic progression of primary colorectal cancers.

Methods: Using a miRNA array platform, we evaluated the expression of 668 miRNA in primary colonic adenocarcinomas.

Uncovering the truth about covered stents: is there a difference between covered versus uncovered stents with transjugular intrahepatic portosystemic shunts?

Introduction: Polytetrafluoroethylene (PTFE)-covered transjugular intrahepatic portosystemic shunt (TIPS) stents purportedly provide superior patency. This study was undertaken to determine whether covered stents provide better long-term patency and outcomes after TIPSs.

Methods: Patients with portal hypertension undergoing TIPS at a large teaching hospital from 2001 to 2010 were studied.

Surgical shunting versus transjugular intrahepatic portasystemic shunting for bleeding varices resulting from portal hypertension and cirrhosis: a meta-analysis.

Surgical shunting was the mainstay in treating portal hypertension for years. Recently, transjugular intrahepatic portasystemic shunting (TIPS) has replaced surgical shunting, first as a "bridge" to transplantation and ultimately as first-line therapy for bleeding varices. This study was undertaken to examine evidence from trials comparing TIPS with surgical shunting to reassess the role of surgery in treating portal hypertension.

Access for laparoendoscopic single site surgery.

Laparoscopic surgery is the standard of care for many abdominal and pelvic operations and is widely applied today. LESS (Laparo-Endoscopic Single Site) surgery, originally attempted in the 1990s, is an advanced minimally invasive approach that allows laparoscopic operations to be undertaken through a small (<15 mm) incision in the umbilicus, a preexisting scar. The presence of a preexisting scar allows LESS surgery to be essentially scarless, which is the key benefit to LESS operations.

Pancreaticoduodenectomy for suspected periampullary cancers: the mimes of malignancy.

Background: Pancreaticoduodenectomies are often undertaken with suspicion of malignancy. We undertook this study to determine if and how unnecessary pancreaticoduodenectomies can be avoided.

Methods: Data from patients undergoing pancreaticoduodenectomy were prospectively collected.

Surgery residency training programmes have greater impact on outcomes after pancreaticoduodenectomy than hospital volume or surgeon frequency.

Background: Hospital volume of pancreaticoduodenectomy (PD) and surgeon frequency of PD have been shown to impact outcomes. The impact of surgery residency training programmes after PD is unknown. This study was undertaken to determine the impact of surgery training programmes on outcomes after PD, as well as their importance relative to hospital volume and surgeon frequency of PD.

Survival after pancreaticoduodenectomy is not improved by extending resections to achieve negative margins.

Objective: This study was undertaken to determine the survival benefit of extending resections to obtain microscopically negative margins after positive intraoperative frozen sections.

Summary Background Data: The impact of residual microscopic disease after pancreaticoduodenectomy is currently a point of controversy. It is, however, generally believed that microscopically positive margins negatively impact survival and this may be improved by ultimately achieving negative margins.

Survival and variceal rehemorrhage after shunting support small-diameter prosthetic H-graft portacaval shunt.

This study was undertaken to report variceal rebleeding and survival after small-diameter prosthetic H-graft portacaval shunts (HGPCS) and to compare actual to predicted survival after shunting. Since 1987 we have prospectively followed patients after undergoing HGPCS to treat bleeding varices failing/not amenable to sclerotherapy/banding. One hundred and seventy patients underwent shunting.

Conventional predictors of survival poorly predict and significantly underpredict survival after H-graft portacaval shunts.

Objective: This study was undertaken to evaluate the ability to predict survival after 8 mm prosthetic H-graft portacaval shunts (HGPCS).

Methods: Since 1988, 170 patients have been prospectively followed after HGPCS. Using preshunt data, predictors of survival after shunting [MELD Score, Emory Score, Child Pugh Score, Discriminant Function (DF), and Child Class] were determined and related to actual survival.

H-graft portacaval shunts versus TIPS: ten-year follow-up of a randomized trial with comparison to predicted survivals.

Objective: To report long-term outcome of patients undergoing prosthetic 8-mm H-graft portacaval shunts (HGPCS) or TIPS and to compare actual with predicted survival data.

Methods: A randomized trial comparing TIPS to HGPCS for bleeding varices began in 1993. Predicted survival was determined using MELD (Model for End-stage Liver Disease).

TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial.

Objective: We undertook a prospective randomized clinical trial comparing TIPS to peritoneovenous (PV) shunts in the treatment of medically intractable ascites to establish relative efficacy and morbidity, and thereby superiority, between these shunts.

Methods: Thirty-two patients were prospectively randomized to undergo TIPS or peritoneovenous (Denver) shunts. All patients had failed medical therapy.

Post-shunt resource consumption favors small-diameter prosthetic H-graft portacaval shunt over TIPS for patients with poor hepatic reserve.

Objective: To define the role of surgical shunting for patients with poor hepatic reserve (Child's class C) in the era of TIPS.

Summary Background Data: Most physicians prefer TIPS to surgical shunting for patients with poor hepatic reserve because of anticipated poor long-term survival.

Methods: Sixty-two patients of Child's class C with bleeding varices not amenable to endoscopic sclerotherapy or banding were prospectively randomized to undergo TIPS or 8-mm prosthetic H-graft portacaval shunt (HGPCS) from 1993 to 1999.