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A retrospective cohort study to examine the association between the persistence of abdominal pain after cholecystectomy and ejection fraction on HIDA scan in patients with biliary dyskinesia

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iLIVER 2023年第4期2卷 208-213页

作者： Baldeep Kaur Mann Janpreet Singh Bhandohal ishaan kalha Brian Jean Department of Medicine Kern Medical Center1700 Mount Vernon Ave.BakersfieldCA 93306USA Division of Gastroenterology Department of MedicineKern Medical Center1700 Mount Vernon Ave.BakersfieldCA 93306USA Kern Medical Center 1700 Mount Vernon Ave.BakersfieldCA 93306USA

Background and aims:The persistence of pain in patients who underwent cholecystectomy primarily for biliary dyskinesia has been associated with gall bladder ejection fraction(GBEF)found on hepatobiliary iminodiacetic acid(HIDA)*** is a definitive treatment for cholelithiasis but is questionable in biliary *** the postoperative follow-up,gastroenterologists and surgeons often found that some patients with biliary dyskinesia continue to experience biliary pain even after *** study aims to investigate whether the value of GBEF found on the HIDA scan predicts the persistence of pain after cholecystectomy in patients with biliary dyskinesia(EF<35%on HIDA scan).Methods:It is a retrospective cohort study conducted at Kern Medical by recruiting patients from November 2019 to October 2022 in consecutive *** is a single sample study consisting of post-cholecystectomy biliary dyskinesia patients with dichotomous outcomes,i.e.,persistent typical recurrent epigastric or right upper quadrant pain with/without meals versus no *** primary outcome was the presence of pain 30 days after the *** analysis was performed with some of the bivariate indicators and continuous predictors,which contained fewer missing elements and had more ***:Univariate logistic regression suggested that HIDA GBEF as a continuous variable does not suggest a relationship with pain after surgery(p=0.3951).A ROC analysis suggested a cutoff of HIDA GBEF=16(AUC=0.60,Specificity=0.5455,Sensitivity=0.7333).Conclusion:Our study does not support the relationship between GBEF found on HIDA scan to improved outcomes after the *** larger controlled trials comparing outcomes of the patients with biliary dyskinesia who did and didn't undergo cholecystectomy are needed to look for other factors.

关键词： Post-cholecystectomy syndrome Biliary dyskinesia dyskinesia Gall bladder ejection fraction PCS HIDA Cholecystectomy

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Factors associated with subsequent surgery after septic arthritis of the knee in children

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World Journal of Clinical Pediatrics 2023年第2期12卷 38-44页

作者： Jennifer Marie O’Donnell Ernest Ekunseitan ishaan Swarup Orthopaedic Surgery University of California San FranciscoSan FranciscoCA 94143United States Medical School University of California San FranciscoSan FranciscoCA 94143United States Pediatric Orthopaedic Surgery UCSF Benioff Children’s HospitalOaklandCA 94609United States

BACKGROUND Septic arthritis of the knee in children is a challenging *** debridement is an established treatment,but there is a paucity of literature on long-term *** To determine the rates and factors associated with return to surgery(RTS)and readmission after index surgical debridement for septic arthritis of the knee in *** This is a retrospective cohort study that utilizes data from the Healthcare Cost and Utilization Project(HCUP).We included patients between ages 0 to 18 years that underwent surgical debridement for septic arthritis of the knee between 2005 and *** data included age,gender,race,hospital type and insurance *** data including index admission length of stay(LOS)and Charlson Comorbidity Index(CCI)were available from the HCUP *** statistics were used to summarize the data and univariate and multivariate analyses were *** Nine-hundred thirty-two cases of pediatric septic knee were *** cohort was 62.3%male,with mean age of 9.0(±6.1)*** 46%of patients were white and approximately half had Medicaid ***-six patients(3.6%)required RTS at a minimum of 2 year after index surgery,and 172 patients(18.5%)were readmitted at any *** mean readmission LOS was 11.6(±11.3)*** CCI was associated with RTS(P=0.041).There were no significant associations in age,gender,race,insurance type,or type of hospital to which patients *** analysis showed that both increased CCI(P=0.008)and shorter LOS(P=0.019)were predictive of *** Septic arthritis of the knee is an important condition in *** CCI was associated with RTS at a minimum of 2 years after index *** association was found with age,gender,race,insurance type,or hospital *** LOS and CCI were associated with RTS in multivariate ***,risk of subsequent surgery and readmission after pediatric septic knee arthritis is lo

关键词： Septic arthritis knee Orthopaedic surgery Infection Osteomyelitis Debridement

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Meta-analysis of transanal vs laparoscopic total mesorectal excision of low rectal cancer:Importance of appropriate patient selection

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World Journal of Gastrointestinal Surgery 2022年第12期14卷 1397-1410页

作者： Pratik Bhattacharya ishaan Patel Noureen Fazili Shahab Hajibandeh Shahin Hajibandeh Department of Surgery Sandwell and West Birmingham Hospitals NHS TrustBirmingham B714HJUnited Kingdom Department of Surgery Queen Elizabeth Hospital BirminghamBirmingham B152GWUnited Kingdom Department of Surgery University Hospital of WalesCardiff CF144XWUnited Kingdom Department of Surgery Royal Stoke University HospitalStoke-on-Trent ST46QGUnited Kingdom

BACKGROUND Achieving a clear resection margins for low rectal cancer is technically *** approach to total mesorectal excision(TME)was introduced in order to address the challenges associated with the laparoscopic approach in treating low rectal ***,previous meta-analyses have included mixed population with mid and low rectal tumours when comparing both approaches which has made the interpretation of the real differences between two approaches in treating low rectal cancer *** To investigate the outcomes of transanal TME(TaTME)and laparoscopic TME(LaTME)in patients with low rectal *** A comprehensive systematic review of comparative studies was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses *** and postoperative complications,anastomotic leak,R0 resection,completeness of mesorectal excision,circumferential resection margin(CRM),distal resection margin(DRM),harvested lymph nodes,and operation time were the investigated outcome *** We included twelve comparative studies enrolling 969 patients comparing TaTME(n=969)and LaTME(n=476)in patients with low rectal *** was associated with significantly lower risk of postoperative complications(OR:0.74,P=0.04),anastomotic leak(OR:0.59,P=0.02),and conversion to an open procedure(OR:0.29,P=0.002)in comparison with ***,the rate of R0 resection was significantly higher in the TaTME group(OR:1.96,P=0.03).Nevertheless,TaTME and LaTME were comparable in terms of rate of intraoperative complications(OR:1.87;P=0.23),completeness of mesoractal excision(OR:1.57,P=0.15),harvested lymph nodes(MD:-0.05,P=0.96),DRM(MD:-0.94;P=0.17),CRM(MD:1.08,P=0.17),positive CRM(OR:0.64,P=0.11)and procedure time(MD:-6.99 min,P=0.45).CONCLUSION Our findings indicated that for low rectal tumours,TaTME is associated with better clinical and short term oncological outcomes compared to *** randomised controll

关键词： Total mesorectal excision Laparoscopic Transanal Rectal cancer

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Epidemiology of syndactyly in New York State

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World Journal of Orthopedics 2019年第11期10卷 387-393页

作者： ishaan Swarup Yi Zhang Huong Do Aaron Daluiski Department of Orthopaedic Surgery Hospital for Special SurgeryNew YorkNY 10021United States Healthcare Research Institute Hospital for Special SurgeryNew YorkNY 10021United States

BACKGROUND There is paucity of literature focusing on the incidence and surgical management of syndactyly. In this study, we describe the incidence and rates of surgical management of patients with syndactyly in New York *** To describe the incidence and surgical management of patients with syndactyly using an America’s population-based *** We conducted a retrospective study using the New York State Statewide Planning and Research Cooperative System. All patients with a diagnosis of syndactyly at birth were identified and followed longitudinally to determine yearly incidence as well as demographic and surgical factors. Descriptive statistics and univariate analyses were *** There were 3306 newborns with a syndactyly diagnosis between 1997 and 2014 in New York State. The overall incidence was 0.074% or 7 cases per 10000 live births.A small number of patients underwent surgical correction in New York State(178 patients, 5.4%). Among the surgical patients, most of the operations were performed before the age of two(79%). Approximately 87% of surgeries were performed at teaching hospitals, and 52% of procedures were performed by plastic surgeons. Skin grafting was performed in 15% of cases. Patients having surgery in New York State were more likely to have Medicaid insurance compared to patients not having surgery(P = 0.02).CONCLUSION Syndactyly occurs in approximately 7 per 10000 live births, and the majority of patients undergo surgical correction before age two. There may be severalbarriers to care including the availability of specialized hand surgeons, access to teaching hospitals, and insurance status.

关键词： Congenital hand anomaly Epidemiology Incidence Syndactyly

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Pediatric firearm-associated fractures:Analysis of management and outcomes

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World Journal of Clinical Pediatrics 2021年第6期10卷 151-158页

作者： Virginia Lieu Laura A Carrillo Nirav K Pandya ishaan Swarup Department of Orthopaedics St.Mary’s Medical CenterSan FranciscoCA 94117United States Medical College of Wisconsin MilwaukeeWI 53226United States Department of Orthopaedics UCSF Benioff Children’s Hospital OaklandOaklandCA 94609United States

BACKGROUND Firearm-associated injuries(FAIs)are among the leading causes of morbidity and mortality in children living in the United *** victims of such injuries survive,but may experience compromised function related to musculoskeletal *** complex firearm-associated fractures(FAFs)often require specialized orthopaedic,vascular,and plastic surgical intervention,there is minimal research describing their management and *** purpose of this study is to describe the epidemiology and presentation of pediatric FAFs,as well as evaluate the management and outcomes of these *** To describe the epidemiology and presentation of pediatric FAFs,as well as evaluate the management and outcomes of these *** A retrospective chart review was performed at a major,pediatric level 1 trauma *** study included patients aged 18 or younger who presented with FAIs between *** data was collected on patients with FAFs including demographic and clinical data such as age,sex,race,payor type,fracture location,injury severity score(ISS),and radiographic and clinical *** management of FAFs was analyzed as well as need for readmission and *** statistics were used to summarize the results and univariate analyses were performed to assess differences between *** Between 2008 and 2018,there were a total of 61 patients who presented with *** this cohort,21 patients(34%)sustained FAFs(25 fractures)with a mean age of 11(Range:10 mo to 18 years old)at the time of *** 52%(n=11)of patients with FAFs were male,76%(n=8 and n=8,respectively)identified as black or other,and 71%(n=15)had government *** were most commonly noted in the upper extremity(n=7)and lower extremity(n=6).In patients with FAFs,the mean ISS at presentation was 11.38(Range:2-38),and 24%of patients(n=5)were classified as having a major *** were no significant differences in age,sex,r

关键词： Firearm Fracture Adolescent Gunshot Injury Pediatric

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Effect of non-steroidal anti-inflammatory drugs on fracture healing in children:A systematic review

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World Journal of Orthopedics 2022年第5期13卷 494-502页

作者： Sarah Stroud Toshali Katyal Alex L Gornitzky ishaan Swarup Department of Orthopaedic Surgery University of CaliforniaSan FranciscoCA 94143United States Department of Orthopaedic Surgery University of CaliforniaSan Francisco Benioff Children’s HospitalCA 94143United States Department of Orthopaedic Surgery University of CaliforniaSan Francisco Benioff Children’s Hospital OaklandOaklandCA 94609United States

BACKGROUND Non-steroidal anti-inflammatory drugs(NSAIDs)are among the most commonly prescribed medications in the United *** they are safe and effective means of analgesia for children with broken bones,there is considerable variation in their clinical use due to persistent concerns about their potentially adverse effect on fracture *** To assess whether NSAID exposure is a risk factor for fracture nonunion in *** We systematically reviewed the literature reporting the effect of NSAIDs on bone *** included all clinical studies that reported on adverse bone healing complications in children with respect to NSAID *** outcomes of interest were delayed union or *** quality was assessed using the Newcastle-Ottawa scale for non-randomized studies.A final table was constructed summarizing the available *** A total of 120 articles were identified and screened,of which 6 articles were included for final *** in children is extremely rare;among the studies included,there were 2011 nonunions among 238822 fractures(0.84%).None of the included studies documented an increased risk of nonunion or delayed bone healing in those children who are treated with NSAIDs in the immediate post-injury or peri-operative time ***,children are likely to take these medications for only a few days after injury or surgery,further decreasing their risk of adverse *** This systematic review suggests that NSAIDS can be safely prescribed to pediatric orthopaedic patients absent other contraindications without concern for increased risk of fracture non-union or delayed bone *** prospective studies are needed focusing on higher risk fractures and elective orthopaedic procedures such as osteotomies and spinal fusion.

关键词： Non-steroidal anti-inflammatory drug Nonunion Complication Pediatric fractures Pain management Bone healing

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Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents

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World Journal of Orthopedics 2021年第12期12卷 1001-1007页

作者： Laura A Carrillo Hao-Hua Wu Aman Chopra Matt Callahan Toshali Katyal ishaan Swarup School of Medicine Medical College of WisconsinMilwaukeeWI 53226United States Department of Orthopaedic Surgery UCSFSan FranciscoCA 94143United States School of Medicine Georgetown University School of MedicineWashington D.C.WA 20007United States

BACKGROUND The national rates of readmission and reoperation after open reduction internal fixation(ORIF)of midshaft clavicle fractures in adolescents is *** To determine rates of and risk factors for readmission and reoperation after ORIF of midshaft clavicle fractures in *** This retrospective study utilized data from the Healthcare Cost and Utilization Project State Inpatient Database for California and Florida and included 11728 patients 10–18 years of age that underwent ORIF of midshaft clavicle fracture between 2005 and *** within ninety days,reoperations within two years,and differences in patient demographic factors were determined through descriptive,univariate,and multivariate *** In total,3.29%(n=11)of patients were readmitted within 90 d to a hospital at an average of 18.91±18 d after discharge,while 15.87%(n=53)of patients underwent a reoperation within two years at an average of 209.53±151 d since the index *** most common reason for readmission was a postoperative infection(n<10).Reasons for reoperation included implant removal(n=49)at an average time of 202.39±138 d after surgery,and revision ORIF(n<10)with an average time of 297±289 d after index *** odds of reoperation were higher for females(P<0.01)and outpatients(P<0.01),while the odds of reoperation were lower for patients who underwent surgery in California(P=0.02).CONCLUSION There is a low rate of readmission and a high rate of reoperation after ORIF for midshaft clavicle fractures in *** are significant differences for reoperation based on patient sex,location,and hospital type.

关键词： Adolescent Clavicle fracture Reoperation Readmission

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Paraspinous hemolymphangioma associated with adolescent scoliosis

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World Journal of Clinical Cases 2015年第6期3卷 514-518页

作者： ishaan Swarup Benjamin T Bjerke-Kroll Matthew E Cunningham Orthopaedic Surgery Hospital for Special Surgery

Lymphangiomas are a group of benign malformations of the lymphatic system, and hemolymphangioma(or hemangiolymphangioma) is a rare congenital malformation of the lymphatic system with vascular involvement. These benign malformations are most commonly diagnosed at an early age, and may be present as a part of an associated syndrome. In this case report, we describe the first case of adolescent scoliosis associated with a large, paraspinous hemolymphangioma. A 15-year-old girl with an incidental finding of a paraspinous hemolymphangioma is presented along with her history, physical exam, radiographic findings, and operative course. The possible pathogenesis, treatment approach, and clinical dilemmas are also discussed. Given the well-known relationship between tumors and scoliosis, a benign paraspinous vascular and lymphatic tumor may be responsible for the presence of scoliosis in a small number of patients.

关键词： Case report Scoliosis Etiology Hemolymphangioma Tumor

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Erratum:Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents

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World Journal of Orthopedics 2023年第6期14卷 502-504页

作者： Laura A Carrillo Hao Hua Wu Matt Callahan Aman Chopra Toshali Katyal ishaan Swarup School of Medicine Medical College of WisconsinMilwaukeeWI 53226United States Department of Orthopaedic Surgery UCSFSan FranciscoCA 94143United States School of Medicine Georgetown UniversityWashingtonDC 20007United States

This is an erratum to an already published *** found an error in the results section and Table ***,we have revised results with n≤10 to be reflected as such,which is consistent with the reporting instructions by the Agency for Healthcare Research and *** note,these changes do not affect our results,and we had previously listed this requirement in the results *** apologize for our unintentional mistake.

关键词： Adolescent Clavicle fracture Reoperation Readmission Correction

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