Behzad Salari

Clinical characteristics and patterns and predictors of response to therapy in collagenous and lymphocytic colitis

Abstract Background. Collagenous colitis (CC) and lymphocytic colitis (LC) are chronic inflammatory disorders of the colon. There is a paucity of data on differences in etiology, natural history, and treatment response between CC and LC. Methods. Between 2002 and 2013, we identified new diagnoses of CC and LC using the Research Patient Data Registry in a tertiary referral center. We used chi square or Fischer’s exact test and Wilcoxon rank-sum tests to compare the differences in clinical characteristics, treatment types, and response rates between LC and CC. Results: Through 2013, we confirmed 131 patients with a new diagnosis of microscopic colitis (MC) (55 LC, 76 CC). Compared to cases of LC, patients with a diagnosis of CC were more likely to be women (86% vs. 69%, p = 0.03), have elevated erythrocyte sedimentation rate (mean 28 vs. 13 mm/h, p = 0.04), and less likely to be diabetic (5% vs. 18%, p = 0.02). Budesonide was the most effective treatment for both CC and LC (94% and 80%, respectively). However, there were no statistically significant differences in response to various treatments according to the type of MC (all p > 0.10). Older age at the time of diagnosis was associated with better response to bismuth subsalicylate (odds ratio: 1.76; 95% confidence interval: 1.21–2.56 for every 5-year increase) for both CC and LC. Conclusion. Despite differences in the clinical characteristics, response rates to available treatments appeared to be similar in both LC and CC. Older patients may have a better response to bismuth subsalicylate therapy.

Revision neural monitored surgery for recurrent thyroid cancer: Safety and thyroglobulin response.

To evaluate the quantitative biochemical response, recurrence rate, and rate of surgical complications for thyroid cancer revision surgery.

The Biplane Modified Simpson's Method Accurately Estimates Pericardial Effusion Volume: A Comparison with Pericardiocentesis

Pericardial effusion (PE) volume is often assessed semiqualitatively by echocardiography and categorized into minimal, small, moderate, or large. Several methods of echocardiographic quantification have been proposed, but their application is limited either by complexity or inaccuracy. We evaluated the accuracy of PE volume quantification by two‐dimensional transthoracic echocardiogram (2DTTE) and commercially available volume quantification software in patients undergoing pericardiocentesis.

Staged Surgery for Advanced Thyroid Cancers: Safety and Oncologic Outcomes of Neural Monitored Surgery

Objective Thyroidectomy with extensive multicompartment bilateral neck dissections for advanced-stage thyroid cancer may lead to increased risk of complications, including bilateral recurrent laryngeal nerve (RLN) paralysis and hypoparathyroidism. A planned staged approach derived from a detailed preoperative radiographic map is associated with a low complication profile. This study evaluates oncologic results and safety of neural monitored, staged thyroid cancer surgery for management of advanced thyroid cancer. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods With institutional review board approval, 35 consecutive patients with advanced thyroid malignancy and extensive nodal disease managed with staged surgery between January 2004 and May 2013 by the senior author (G.W.R.) were identified, and the oncologic and surgical outcomes were reviewed. Results In total, 37.2% of patients had stage III or IV disease, with extrathyroidal extension in 71.4%, vascular invasion in 51.4%, and RLN invasion in 17% of patients. A total of 34% patients had positive lymph nodes in more than 5 nodal compartments; the average positive lymph node yield was 17, and extranodal extension was present in 51%. Three patients had RLN sacrifice, and there were no other cases of temporary or permanent RLN paralysis; permanent hypoparathyroidism and chyle leak occurred in one patient each. Locoregional recurrence occurred in 5.7% of patients after a 147-week mean follow-up. In patients with papillary thyroid carcinoma, median postoperative nonstimulated and stimulated thyroglobulin levels were 0.2 and 0.75 ng/mL, respectively. Conclusion A neural monitored, staged surgical approach was conducted without significant adverse events in this small sample and represents and effective alternative strategy option to simultaneous bilateral surgery in the management of thyroid cancer with extensive neck metastases.

Serum and tissue endothelin-1 are independent from intima-media thickness of peripheral arteries in patients with chronic kidney disease.

Aim We aimed to study the relationship of peripheral arteries’ atherosclerosis with serum and tissue endothelin-1 in chronic kidney disease patients. Methods Ninety patients were enrolled, including 35 patients with chronic kidney disease (case group), 31 patients with coronary artery diseases who were candidates for coronary artery bypass grafting (positive control group), and 24 living kidney donors (negative control group). Intima-media thickness of the common carotid and femoral arteries was determined by ultrasonography. Serum and tissue endothelin-1 were measured by ELISA method. Results The mean serum and tissue endothelin-1 levels in the donor group were significantly lower than other groups (p < 0.001 for both). The coronary artery bypass grafting group had higher carotid and femoral intima-media thickness than other groups (p < 0.001), and the chronic kidney disease group had higher carotid and femoral intima-media thickness than the donor group (p < 0.001). Regression analysis in all groups did not reveal any correlation between the carotid intima-media thickness/femoral intima-media thickness and the serum/tissue endothelin-1. There was a direct linear correlation between the carotid and femoral intima-media thickness (p < 0.001) in all groups. Conclusions Endothelin-1 level and intima-media thickness were higher in the chronic kidney disease patients and coronary artery bypass grafting candidates, without any correlation between endothelin-1 and peripheral arteries’ intima-media thickness of both groups. Perhaps endothelin-1 rises and remains high upon endothelial damage and initiation of atherosclerosis.

Diabetes and Obesity: The Impact of Their Coincidence on Health and Life

An increasing rate of type 2 diabetes (T2D) and obesity imposes a huge financial drain on healthcare systems. Diabesity describes their close pathophysiological and clinical associations. Both diabetes and obesity are associated with an increased risk of cardiovascular and renal diseases. Multiple factors including biochemical, metabolic, genetic, cultural, and psychosocial conditions contribute to obesity and insulin resistance. The coexistence of obesity and T2D presents a complex therapeutic and management challenge and remains undertreated in primary care. Lifestyle modifications remain the cornerstone of such management. Medical treatment strategies for diabesity should be multifactorial, addressing its multiple metabolic abnormalities. Selection of appropriate therapeutic agents therefore becomes challenging, and long-term monitoring is essential. There is a need for newer anti-diabetic medications with more effective weight-lowering properties. It is hoped that scientific information derived from metabolite-profiling techniques will make it possible to suggest more effective and individualized management for this chronic condition.An increasing rate of type 2 diabetes (T2D) and obesity imposes a huge financial drain on healthcare systems. Diabesity describes their close pathophysiological and clinical associations. Both diabetes and obesity are associated with an increased risk of cardiovascular and renal diseases. Multiple factors including biochemical, metabolic, genetic, cultural, and psychosocial conditions contribute to obesity and insulin resistance. The coexistence of obesity and T2D presents a complex therapeutic and management challenge and remains undertreated in primary care. Lifestyle modifications remain the cornerstone of such management. Medical treatment strategies for diabesity should be multifactorial, addressing its multiple metabolic abnormalities. Selection of appropriate therapeutic agents therefore becomes challenging, and long-term monitoring is essential. There is a need for newer anti-diabetic medications with more effective weight-lowering properties. It is hoped that scientific information derived from metabolite-profiling techniques will make it possible to suggest more effective and individualized management for this chronic condition.