Browsing by Subject "Adenoma"
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Item Colon cancer: now a presidential disease(1986-02-06) Krejs, Guenter J.Note: Some information has been redacted in the publicly-available version due to privacy issues. For questions, contact archives@utsouthwestern.edu.Item Safety and Effectiveness of Cecal Retroflexion in Evaluating Proximal Colon: A Case Series(2014-04-11) Geng, Zhuo Zoe; Gupta, Samir; Singal, Amit G.; Agrawal, DeepakBACKGROUND: Cecal retroflexion is a maneuver used by colonoscopists to evaluate the proximal sides of the colonic folds in the right-sided colon. Knowledge is limited regarding cecal retroflexion-associated risk and its effectiveness for increasing neoplasia detection rates in proximal colon. Recently, we encountered a contained perforation caused by cecal retroflexion. To our knowledge, there has been no report on cecal retroflexion-associated complications in the existing literature. OBJECTIVE: We aim to 1) report the case in detail, and characterize cecal retroflexion-related complication rates, and 2) assess whether there is improved neoplasia detection with cecal retroflexion. METHODS: We performed retrospective cohort study of all patients age 18 to 85 years who received colonoscopy by one endoscopist at UT Southwestern Medical Center from 9/1/2006 to 7/31/2012.We excluded patients who received colonoscopies prior to the initiation of cecal retroflexion, had missing colonoscopy reports, or were not found in the electronic medical record system. Our primary outcome is cecal-retroflexion-associated complication rates within 30 days after the procedure; the secondary outcome is cecal-retroflexion-associated neoplasia detection rates. RESULTS: A total of 1,247 patients were included in final analysis. Mean patient age was 57 years; 58.6% of patients were women. Among these patients, 624 (50.0%) received cecal retroflexion during colonoscopy. 1(Case) out of the 624 patients had a cecal retroflexion-related complication, with a complication rate of 1.6 per 1000 cecal retroflexion (95% Cl: 0 to 4.7 per 1000 cecal retroflexion). Of 459 patients underwent screening colonoscopy, 261 (56.9%) had cecal retroflexion. No cecal retroflexion-associated complications were observed with screening colonoscopy. We observed no statistically significant improvement in neoplasia detection rates among individuals who underwent colonoscopy with vs. without documented cecal retroflexion (P>0.05 for all comparisons). CONCLUSION: Cecal retroflexion may be associated with rare but significant complications. Further, the practice does not clearly increase neoplasia detection rates. We postulate that routine implementation of this practice is unlikely to increase neoplasia detection rates substantially, and further, given the small non-significant differences observed in our study, that randomized trials of the practice are unlikely to show clinically significant superiority. We recommend future research explore alternate strategies to improve proximal neoplasia detection.Item Steroid hormone-producing tumors in man(1985-06-27) Freeman, Dale A.Item Surgical Outcomes of Primary Versus Revision Transsphenoidal Resection for Pituitary Adenomas at a High-Volume Center(2017-01-17) Aggarwal, Arjun; Patel, Ankur; Kou, Yann-Fuu; Ryan, Matthew; Barnett, Samuel L.INTRODUCTION: Pituitary adenomas are relatively common tumors managed by skull base surgeons, with a prevalence rate of 16.7% in the general population. Sub-total resection can occur when the tumor is particularly difficult, there is cavernous sinus invasion or there is relative inexperience of the surgical team. The objective of this study was to compare the surgical outcomes of primary transsphenoidal resection (TSR) of pituitary adenomas versus revision surgery of subtotally resected tumors at a high-volume brain tumor center. METHODS: The authors retrospectively reviewed the medical records of 503 consecutive patients who had undergone TSR for a pituitary adenoma at our institution from 2007 to 2015. Two categories of patients were established: 1) those who underwent a primary TSR at our institution and 2) those who underwent a revision TSR at our institution after having underwent a primary TSR at an outside institution. RESULTS: Our current cohort consisted of a total of 250 patients. Of these, 89 underwent a Primary TSR (Category 1), 33 underwent a Revision TSR (Category 2), and 128 were not included due to incomplete information on preliminary survey. Statistical analysis revealed a significant similarity between the surgical outcomes and complications of the two categories of patients. Analyzed data included extent of resection (P = .85), resolution of symptoms (P = .69), length of stay ([LOS] P = .06), chronic diabetes insipidus ([DI] P = 0.13), transient DI (P = 0.18), post-operative CSF leak (P = .10), new hypopituitarism (P = .56), meningitis (P = .29), neural deficit (P = .29), epistaxis (P = .46), and suprasellar hematoma (P = .80). All measurements of surgical outcome and post-operative complications did not meet the level of significance to be considered statistically different. CONCLUSIONS: High-volume centers are able to achieve similar surgical outcomes in revision vs. primary TSR despite the challenges that recurrent or residual disease may present. These results suggest that patients who undergo subtotal resections may benefit from referral to a high-volume center for consideration of a repeat resection before radiation or other adjuvant therapies are initiated.