Timothy P. Kinney
University of Chicago
Network
Latest external collaboration on country level. Dive into details by clicking on the dots.
Publication
Featured researches published by Timothy P. Kinney.
Seminars in Thoracic and Cardiovascular Surgery | 2003
Timothy P. Kinney; Irving Waxman
Gastrointestinal endoscopy has changed in recent years from a largely diagnostic to a highly therapeutic procedure. Technical advances in endoscopic ultrasound as well as new devices designed for endoscopic mucosal resection (EMR) have opened the field to many therapeutic possibilities. Endoscopic resection is technically challenging, and while our colleagues in the Far East have been using such techniques for over a decade, EMR in the West is still in its infancy. The decision to resect a benign esophageal tumor must take several factors into account including whether the patient is symptomatic; characteristics of the particular tumor (including the potential for malignant transformation, risk of bleeding, and obstruction); and the available therapeutic options. Endoscopic resection of benign esophageal tumors is an attractive option as it is a safe and minimally invasive procedure. Its use is limited, however, to smaller tumors arising from the mucosal or submucosal layers. In this article we examine the techniques used in endoscopic mucosal resection and review the literature on this subject.
Digestive Diseases and Sciences | 2005
Timothy P. Kinney; Nina Merel; John Hart; Loren Joseph; Irving Waxman
Prior studies of molecular and genetic derangements in flat and depressed lesions of the colon have revealed lower frequencies in a number of markers commonly present in exophytic lesions. These and other differences suggest that flat lesions are driven by alternative pathways. We reviewed a database of patients who had undergone endoscopic mucosal resection (EMR) for flat and depressed lesions at the University of Chicago from January 2001 to April 2003. Formalin-fixed and paraffin-embedded colonic samples were retrieved from the tissue bank, and five standardized mononucleotide and dinucleotide microsatellite regions were analyzed for instability (MSI) using fluorescently labeled forward primers in nonmultiplex reactions. Sixteen patients were identified with flat or depressed lesions who had adequate tissue specimens available for MSI analysis. Of these specimens, eight were tubular adenomas, three were tubulovillous adenomas, and five were carcinomas in situ. Four of the lesions were microsatellite unstable, each at a single locus, and one lesion showed probable instability at a second locus. Eleven lesions were microsatellite stable. Aberrations in DNA repair mechanisms do not appear to significantly contribute to the molecular derangements underlying sporadic flat or depressed colonic lesions. The molecular bases that underlie the aggressive behavior of sporadic flat and depressed lesions remain to be determined, and further investigation is warranted.
Gastrointestinal Endoscopy | 2005
R. Merino; Timothy P. Kinney; R. Santander; R. Yazigi; Claudio Navarrete; M. Saenz; Roque Sáenz
Inverted Colonic Diverticulum: An Infrequent and Dangerous Endoscopic Finding R. Merino, T. Kinney, R. Santander, R. Yazigi, C. Navarrete, M. Saenz, R. Saenz Background: Inverted Colonic Diverticula (ICD) can be misinterpreted as elevated polypoid lesions, and biopsy or endoscopic resection of these lesions can lead to severe complications. These important lesions are rarely reported in the medical literature and marginally mentioned in classic texts. The aim of this study is to describe the endoscopic characteristics of ICD to avoid misdiagnosis and to report the frequency of these lesions in a large endoscopic series. Materials and Methods: A retrospective analysis was performed of all patients undergoing colonoscopy at our institution between July 2001 and July 2004 using Medicaps 2.0 InfoCYS endoscopic database and selecting patients diagnosed with ICD. Patient characteristics as well as lesion characteristics were recorded, including location, endoscopic characteristics, and the presence of synchronous polypoid lesions.The following endoscopic characteristics were considered in diagnosing ICD: 1) elevated sessile appearance with fine concentric folds surrounding the lesion, 2) mucosal pattern on lesion is similar to surrounding mucosa, 3) umbilicated appearance, 4) found in an area of diverticula, 5) surrounding fine concentric folds enhance with Methylene Blue, and 6) lesion reverts to typical diverticular appearance with direct water infusion, air insufflation, or gentle pressure with biopsy forceps. Results: Among 4508 colonoscopies performed in the selected period, 33 (0.7%) were diagnosed with ICD according to the endoscopic criteria above. Mean patient age was 62.3 years, with 7/9 male/female ratio. 89% of ICD were in an area of multiple colonic diverticula, and 75% were located in the sigmoid colon. One had active bleeding from the inverted diverticulum and was treated with injection therapy. 2 cases required gentle pressure with the biopsy forceps for diagnosis and the remaining were diagnosed according to the other referred endoscopic criteria. No biopsies or resections were performed. There were no complications in this series. Conclusion: ICD is a rare endoscopic finding (0.7%) that is occasionally complicated by local bleeding. Misdiagnosis could be dangerous as these lesions appear similar to sessile polyps, and biopsy or endoscopic resection could lead to serious complications. The endoscopic criteria described should be considered to avoid complications.
The American Journal of Gastroenterology | 2004
Timothy P. Kinney; Irving Waxman
Endoscopic ultrasound (EUS) is well recognized for its ability to accurately stage primary gastrointestinal and pancreatic tumors (T-stage) and detect the presence of lymph nodes (N-stage) that may not be seen using other modalities. EUS has also recently established a role in evaluating mediastinal pathology, including lung cancer staging. Finding prominent lymph nodes in a patient with cancer is worrisome, but any inflammatory processes can give lymph nodes an abnormal appearance, particularly in the mediastinum where histoplasmosis, sarcoid, and other conditions frequently cause lymphatic enlargement. The characteristic features of malignant lymphadenopathy by EUS have long been the subject of discussion and debate. Differentiating between inflammatory and metastatic lymphadenopathy is critical, as this information directly affects therapeutic options and may exclude a patient from surgery (1,2). The prospective study presented by Chen et al., examines the association of various echo findings with malignant lymphadenopathy, compares the accuracy of echo findings alone to EUS-guided fine needle aspiration (EUS-FNA), and reconfirms the utility of this technology in cancer staging.
Gastroenterología y Hepatología | 2008
Roque Sáenz; Timothy P. Kinney; Ricardo Santander; Raúl Yazigi; Claudio Navarrete; Jaquelina Gobelet; Jerome D. Waye
Resumen Introduccion El diverticulo colonico invertido (DCI) tiene una apariencia similar a las lesiones polipoideas elevadas. El objetivo del presente estudio es describir las caracteristicas endoscopicas del DCI a fin de evitar errores en el diagnostico y reportar la frecuencia de estas lesiones. Material y metodo Se realizo un analisis retrospectivo de todos los pacientes que se sometieron a una colonoscopia entre julio de 2001 y julio de 2004, usando una base de datos endoscopicos. Se incluyeron los pacientes con diagnostico de DCI y se analizaron sus caracteristicas. Con respecto al DCI, se registro la localizacion, las caracteristicas endoscopicas y la presencia de polipos colonicos sincronicos. Resultados Entre las 4.508 colonoscopias realizadas, 33 pacientes (0,7%) tuvieron el diagnostico de DCI. La edad promedio de los pacientes fue de 62,3 anos, y hubo un leve predominio del sexo femenino con una relacion 1:1,2. El 89 % de los DCI se localizo en un area de diverticulosis, y el 75% se localizo en el colon sigmoides. Un paciente presento una hemorragia digestiva activa con su origen en el diverticulo invertido y se trato con inyectoterapia. Se describieron las caracteristicas endoscopicas del DCI. No se reportaron complicaciones en esta serie. Conclusiones El DCI es un hallazgo endoscopico raro que puede complicarse por el sangrado local. El error diagnostico puede ser peligroso y su biopsia o reseccion conllevarian graves complicaciones. Los criterios diagnosticos descritos deberian considerarse para evitar la aparicion de complicaciones.
ACP journal club | 2004
Timothy P. Kinney; Irving Waxman
Source Citation Villatoro E, Larvin M, Bassi C. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev. 2004;(2):CD002941. 145...
Gastroenterology | 2010
Kapil Gupta; Timothy P. Kinney; Elizabeth Odstrcil; David R. Bass; Chase R. Herdman; Luis F. Lara; Leon Wolf; Thomas N. Dewar; Manoj K. Mehta; Mohammed S. Anwer; Randall Pellish; J. Kent Hamilton; Daniel E. Polter; K.G. Reddy; Ira M. Hanan; Daniel C. DeMarco
Background: Colonoscopy is considered to be the standard of care for the diagnosis of colorectal cancer. However, population-based studies have reported a subset of patients with cancer who do not undergo colonoscopy. The purpose of this study was to estimate the prevalence and identify the predictors of not having a colonoscopy in the period preceding colorectal cancer diagnosis. Methods: Using the population-based SEER registries, we identified patients aged >= 69 with colorectal cancer diagnosed from 1994-2005. Linked inpatient and outpatientMedicare claimswere used to identify receipt of colonoscopy prior to diagnosis. We divided this group into patients who had did not have colonoscopy within 3 years of diagnosis (Group I) and those who had 1 or more colonoscopies from 6 months prior to 30 days after diagnosis (Group II). Patient, sociodemographic and tumor factors were used to identify predictors of not having colonoscopy in univariate and multivariable logistic regression analysis. Results: We identified 79,032 patients, including 19.6% in Group I and 80.4% in Group II. Among patients in Group I, 31.6% had barium enema, 21.4% had flexible sigmoidoscopy and 57.3% underwent CT scan within 6 months prior to and 30 days after diagnosis. Independent predictors of Group I included age > 85, African American race, non-married, nursing home residence, rural residence, lower comorbidity score, diagnosis before 2000, AJCC Stage II-IV, left sided or rectal tumor site, and emergency presentation. Patients without colonoscopy were also less likely to undergo surgical resection (OR 0.55, CI 0.52-0.59). In a Cox proportional hazards model that adjusted for demographics, stage and treatment, not undergoing colonoscopy was associated with a higher risk of death (HR 1.31, CI 1.28-1.33). Conclusions: In this large, population based analysis, almost 20% of newly diagnosed colorectal cancer patients did not undergo colonoscopy at the time of diagnosis. Although these patients were more likely to be elderly with advanced disease, lack of colonoscopy appears to be an indicator of emergency presentation, less aggressive treatment and poorer prognosis.
Endoscopy | 2006
Vanessa M. Shami; A. Villaverde; Lynne Stearns; K. D. Chi; Timothy P. Kinney; G. B. Rogers; Charles Dye; Irving Waxman
The American Journal of Gastroenterology | 2001
Timothy P. Kinney; Matthew Rawlins; Richard A. Kozarek; David J. Patterson
Gastrointestinal Endoscopy | 2008
Bret T. Petersen; Michel Kahaleh; Richard A. Kozarek; David E. Loren; Kapil Gupta; Thomas E. Kowalski; Martin L. Freeman; Yang K. Chen; Malcolm S. Branch; Steven A. Edmundowicz; Kenneth F. Binmoeller; Todd H. Baron; Michael Gluck; Kamran Ayub; Raj J. Shah; Timothy P. Kinney; William A. Ross; Paul S. Jowell