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Epidemiologic investigation of pediatric distal humerus fractures: An American insurance claims database study

World Journal of Orthopedics 2024年第1期15卷 52-60页

作者： Kyle Jay Klahs Jake E Dertinger Grant T Mello Kevin Thapa Alexis B Sandler E'Stephan J Jesus Garcia Nata Parnes Department of Orthopaedic Surgery Texas Tech University Health Sciences-El PasoEl PasoTX 79905United States Medical school California Health Sciences University College of Osteopathic MedicineClovisCA 93611United States Undergraduate school Binghampton UniversityVestalNY 13902United States Department of Orthopaedic Surgery William Beaumont Army Medical CenterFort BlissTX 79918United States Department of Orthopaedic Surgery Carthage Area HospitalCarthageNY 13619United States

BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)*** To evaluate the epidemiology of pediatric distal humerus fractures(SC,LC,and ME)from an American insurance claims *** A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC,LC and ME fractures based on the IBM Truven MarketScan®Commercial and IBM Truven MarketScan Medicare Supplemental *** from 2015 to 2020 were queried for treatments,patient age,sex,length of hospitalization,and *** A total of 1133 SC,154 LC,and 124 ME fractures were *** fractures had the highest percentage of operation at 83%,followed by LC(78%)and ME fractures(41%).Male patients were,on average,older than female patients for both SC and ME *** In the insurance claims databases used,SC fractures were the most reported,followed by LC fractures,and finally ME *** was identified to be a factor for how a pediatric distal humerus fractures,with patients with SC and LC fractures being younger than those with ME *** peak age per injury per sex was similar to reported historic central tendencies,despite reported trends for younger physiologic development.

关键词： Supracondylar humerus fracture Lateral condyle fracture Medial epicondyle fracture Pediatric elbow Truven Epidemiology

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Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm!

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World Journal of Gastroenterology 2020年第9期26卷 984-991页

作者： Mitchell S Cappell Division of Gastroenterology & Hepatology William Beaumont Hospital Oakland University william beaumont school of medicine

BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists,such as surgeons and anesthesiologists,systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic *** gastroenterologists,like any individual,can rarely suffer acute-changes-inmental-status from medical disorders,and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their *** SUMMARIES Among 181767 endoscopies performed by gastroenterologists at william-beaumont-Hospital at Royal-Oak,two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic ***-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps,and absurdly“pressed”endoscopic steering dials to“take”endoscopic photographs;Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum,and wildly turned steering dials and bumped endoscopic tip forcefully against antral *** nurses recognized endoscopists as impaired and informed *** called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies(fulfilling ethical imperative of“physician,firstdo-no-harm”),and go to emergency room for medical *** endoscopists ***-hospital-work-up revealed toxic encephalopathy in both from:case-1-urosepsis and left-ureteral-impacted-nephrolithiasis;and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified *** rapidly recovered with medical *** This rare syndrome(0.0011%of endoscopies)may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy.

关键词： Endoscopy Iatrogenic injury Medical ethics Hippocratic Oath Quality improvement Medical malpractice Morbidity and mortality

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Systematic review of giant gastric lipomas reported since 1980 and report of two new cases in a review of 117110 esophagogastroduodenoscopies

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World Journal of Gastroenterology 2017年第30期23卷 5619-5633页

作者： Mitchell S Cappell Charlton E Stevens Mitual Amin Department of Gastroenterology and Hepatology William Beaumont Hospital Oakland University william beaumont school of medicine San Antonio Military Medical Center Department of Pathology William Beaumont Hospital

To systematically review the syndrome of giant gastric lipomas, report 2 new illustrative *** systematically reviewed using PubMed for publications since 1980 with following medical subject heading/keywords: (“giant lipoma”) AND (“gastric”) OR [(“lipoma”) and (“gastric”) and (“bleeding”)]. Two authors independently reviewed literature, and decided by consensus which articles to incorporate. Computerized review of pathology/endoscopy records at william beaumont Hospitals, Royal Oak and Troy, Michigan, January 2005-December 2015, revealed 2 giant gastric lipomas among 117110 consecutive esophagogastroduodenoscopies (EGDs), which were thoroughly reviewed, including re-review of original endoscopic photographs, radiologic images, and pathologic slides.

关键词： Esophagogastroduodenoscopy Lipoma Gastric Giant Melena Upper gastrointestinal bleeding Systematic review

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Acute liver failure secondary to severe systemic disease from fatal hemophagocytic lymphohistiocytosis:Case report and systematic literature review

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World Journal of Hepatology 2018年第9期10卷 629-636页

作者： Mitchell S Cappell Ismail Hader Mitual Amin Division of Gastroenterology and Hepato-logy William Beaumont Hospital Department of medicine Oakland University William Beaumont School of Medicine Department of medicine William Beaumont Hospital Department of Pathology William Beaumont Hospital Department of Pathology Oakland University William Beaumont School of Medicine

AIM To systematically review liver disease associated with hemophagocytic lymphohistiocytosis(HLH),propose reasonable contraindications for liver transplantation for liver failure in HLH,and report an illustrative *** Systematic review according to PRISMA guidelines of hepatic manifestations of HLH using computerizedliterature search via PubMed of articles published since 1980 with keywords("hemophagocytic lymphohistiocytosis" or "HLH") AND("liver" or "hepatic"). Two authors independently performed literature search and incorporated articles into this review by consensus. Illustrative case report presented based on review of medical chart,and expert re-review of endoscopic photographs,radiologic images,and pathologic slides. RESULTS A 47-year-old Caucasian male,was hospitalized with high-grade pyrexia,rash,total bilirubin = 45 g/dL,moderately elevated hepatic transaminases,ferritin of 3300 ng/dL,leukopenia,and profound neutropenia(absolute neutrophil count < 100 cells/mm3). Viral serologies for hepatitis A,B,and C were negative. Abdominal computed tomography scan and magnetic resonance imaging revealed no hepatic or biliary abnormalities. Pathologic analysis of liver biopsy revealed relatively well-preserved hepatic parenchyma without lymphocytic infiltrates or macrophage invasion,except for sparse,focal hepatocyte necrosis. Bone marrow biopsy and aspirate revealed foamy macrophages engulfing mature and precursor erythrocytes,consistent with HLH. Interleukin-2 receptor(CD25) was highly elevated,confirming diagnosis of HLH according to Histiocytic Society criteria. Patient initially improved after high-dose prednisone therapy. Patient was judged not to be a liver transplant candidate despite model for end stage liver disease(MELD) score = 33 because liver failure was secondary to severe systemic disease from HLH,including septic shock,focal centrilobular hepatocyte necrosis from hypotension,bone marrow failure,and explosive immune activation from HLH. The pa

关键词： Hemophagocytic lymphohistiocytosis Acute liver failure Liver injury Liver transplantation Acquired immune hyperactivation Pancytopenia

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Primary biliary cirrhosis: Pathophysiology, clinical presentation and therapy

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World Journal of Hepatology 2015年第7期7卷 926-941页

作者： Treta Purohit Mitchell S Cappell Division of Gastroenterology and Hepatology William Beaumont Hospital Oakland University william beaumont school of medicine

Primary biliary cirrhosis(PBC) is an autoimmune, slowly progressive, cholestatic, liver disease characterized by a triad of chronic cholestasis, circulating anti-mitochondrial antibodies(AMA), and characteristic liver biopsy findings of nonsuppurative destructive cholangitis and interlobular bile duct destruction. About 10% of PBC patients, however, lack AMA. A variant, called PBC-autoimmune hepatitis(AIH) overlap, is characterized by the above findings of PBC together with findings of elevated serum alanine aminotransferase, elevated serum immunoglobulin G, and circulating anti-smooth muscle antibodies, with liver biopsy demonstrating periportal or periseptal, lymphocytic, piecemeal necrosis. PBC is hypothesized to be related to environmental exposure in genetically vulnerable individuals. It typically occurs in middle-aged females. Prominent clinical features include fatigue, pruritis, jaundice, xanthomas, osteoporosis, and dyslipidemia. The Mayo Risk score is the most widely used and best prognostic system. Ursodeoxycholic acid is the primary therapy. It works partly by reducing the concentration and injury from relatively toxic bile acids. PBC-AIH overlap syndrome is treated with ursodeoxycholic acid and corticosteroids, especially budesonide. Obeticholic acid and fibrate are promising new, but incompletely tested, therapies. Liver transplantation is the definitive therapy for advanced disease, with about 70% 10-year survival after transplantation. Management of pruritis includes local skin care, dermatologist referral, avoiding potential pruritogens, cholestyramine, and possibly opioid antagonists, sertraline, or rifaximin. Management of osteoporosis includes life-style modifications, administration of calcium and vitamin D, and alendronate. Statins are relatively safe to treat the osteopenia associated with PBC. Associated Sjogren's syndrome is treated by artificial tears, cyclosporine ophthalmic emulsion to stimulate tear production; and saliva substitutes, c

关键词： Primary biliary cirrhosis Ursodeoxycholicacid Cirrhosis Liver transplantation Cholestatic liverdisease

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Therapy for alcoholic liver disease

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World Journal of Gastroenterology 2014年第9期20卷 2143-2158页

作者： Maryconi M Jaurigue Mitchell S Cappell Division of Gastroenterology and Hepatology Department of Internal MedicineWilliam Beaumont Hospital Royal Oak MI 48073 United States Oakland University william beaumont school of medicine Royal Oak MI 48073 United States

Alcoholism results in about 2.5 million deaths annually worldwide, representing 4% of all mortality. Although alcoholism is associated with more than 60 diseases, most mortality from alcoholism results from alcoholic liver disease (ALD). ALD includes alcoholic steatosis, alcoholic hepatitis, and alcoholic cirrhosis, in order of increasing severity. Important scoring systems of ALD severity include: Child-Pugh, a semi-quantitative scoring system useful to roughly characterize clinical severity; model for end-stage liver disease, a quantitative, objective scoring system used for prognostication and prioritization for liver transplantation; and discriminant function, used to determine whether to administer corticosteroids for alcoholic hepatitis. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including twelve-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Disulfiram decreases alcohol consumption by causing unpleasant sensations after drinking alcohol from accumulation of acetaldehyde in serum, but disulfiram can be hepatotoxic. Adjunctive pharmacotherapies to reduce alcohol consumption include naltrexone, acamprosate, and baclofen. Nutritional therapy helps reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. Although reduced protein intake was previously recommended for advanced ALD to prevent hepatic encephalopathy, a diet containing 1.2-1.5 g of protein/kg per day is currently recommended to prevent muscle wasting. Corticosteroids are first-line therapy for severe alcoholic hepatitis (discriminant function ≥ 32), but proof of their efficacy in decreasing mortality remains elusive. Pentoxifylline is an alternative therapy. Complications of advanced ALD include ascites, spontaneous bacterial peritonitis, esophageal variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, and portopu

关键词： Alcoholic liver disease Alcoholic steatosis Alcoholic hepatitis Alcoholic cirrhosis Alcoholism Liver disease Corticosteroids Pentoxifylline Liver transplantation

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Limited, local, extracolonic spread of mucinous appendiceal adenocarcinoma after perforation with formation of a malignant appendix-to-sigmoid fistula: Case report and literature review

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World Journal of Gastroenterology 2016年第38期22卷 8624-8630页

作者： Seifeldin Hakim Mitual Amin Mitchell S Cappell Division of Gastro-enterology and Hepatology Department of Internal MedicineWilliam Beaumont Hospital Royal Oak MI 48073 Unites States Department of Pathology William Beaumont Hospital Royal Oak MI 48073 Unites States Oakland University william beaumont school of medicine Royal Oak MI 48073 Unites States

A 68-year-old man presented with progressive right lower quadrant abdominal pain and tenderness without rebound tenderness, and with constipation during the prior 9 mo. Abdomino-pelvic computed tomography and magnetic resonance imaging demonstrated a dilated appendix forming a fistula to the sigmoid colon. Open laparotomy revealed a bulky abdominal tumor involving appendix, cecum, and sigmoid, and extending up to adjacent viscera, without ascites or peritoneal implants. The abdominal mass was removed en bloc, including resection of sigmoid colon, cecum(with preservation of ileocecal valve), appendix, right vas deferens, testicular vessels, and minimal amounts of anterior abdominal wall; and shaving off of small parts of the walls of the urinary bladder and small bowel. Gross and microscopic pathologic examination revealed an appendix-to-sigmoid malignant fistula secondary to perforation of mucinous adenocarcinoma of the appendix with minimal local spread(stage T4). However, the surgical margins were clear, all 13 resected lymph nodes were cancer-free, and pseudomyxoma peritonei or peritoneal implants were not present. The patient did well during 1 year of follow-up with no clinical or radiologic evidence of local recurrence, metastases, or pseudomyxoma peritonei despite presenting with extensive stage T4 cancer that was debulked without administering chemotherapy, and despite presenting with malignant appendiceal perforation. This case illustrates the non-aggressive biologic behavior of this low-grade malignancy. The fistula may have prevented free spillage of cancerous cells and consequent distant metastases by containing the appendiceal contents largely within the colon.

关键词： Mucinous adenocarcinoma Appendicitis Appendix Malignant fistula Pseudomyxoma peritonei Colon cancer Metastases

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Stricter national standards are required for credentialing of endoscopic-retrograde-cholangiopan-creatography in the United States

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World Journal of Gastroenterology 2019年第27期25卷 3468-3483页

作者： Mitchell S Cappell David M Friedel Division of Gastroenterology and Hepatology William Beaumont HospitalRoyal OakMI 48073United States Oakland University william beaumont school of medicine William Beaumont HospitalMI 48073United States Division of Gastroenterology New York University Winthrop Medical CenterMineolaNY 11501United States

Endoscopic-retrograde-cholangiopancreatography(ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly steeper learning curve than that for other standard gastrointestinal(GI) endoscopies, such as esophagogastroduodenoscopy or colonoscopy, due to greater technical difficulty and higher risk of complications. Yet, GI fellows have limited exposure to ERCP during standard-three-year-GI-fellowships because ERCP is much less frequently performed than esophagogastroduodenoscopy/colonoscopy. This led to adding an optional year of training in therapeutic endoscopy. Yet many graduates from standard three-year-fellowships without advanced training intensely pursue independent/unsupervised ERCP privileges despite inadequate numbers of performed ERCPs and unacceptably low rates of successful selective cannulation of desired(biliary or pancreatic) duct. Hospital credentialing committees have traditionally performed ERCP credentialing, but this practice has led to widespread flouting of recommended guidelines(e.g., planned privileging of applicant with 20% successful cannulation rate, or after performing only 7 ERCPs);and intense politicking of committee members by applicants, their practice groups, and potential competitors. Consequently, some gastroenterologists upon completing standard fellowships train and learn ERCP 'on the job' during independent/unsupervised practice, which can result in bad outcomes: high rates of failed bile duct cannulation. This severe clinical problem is indicated by publication of ≥ 12 ERCP competency studies/guidelines during last 5 years. However, lack of mandatory, quantitative, ERCP credentialing criteria has permitted neglect of recommended guidelines. This work comprehensively reviews literature on ERCP credentialing;reviews rationales for proposed guidelines;reports problems with current system;and proposes novel criteria for competenc

关键词： Endoscopic retrograde cholangiopancreatography Privileges Credentialing Gastroenterology fellowship training Advanced gastrointestinal endoscopy training Certification Standards

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Coronary vasospasm:A narrative review

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World Journal of Cardiology 2021年第9期13卷 456-463页

作者： Jacob Jewulski Sumesh Khanal Khagendra Dahal Foundational Medical Studies Oakland University William Beaumont School of MedicineRochesterMI 48309United States Department of Internal medicine William Beaumont HospitalRoyal OakMI 48073United States Department of Cardiology CHI HealthCreighton University School of MedicineOmahaNE 68118United States

Coronary artery vasospasm(CAVS)plays an important role in acute chest pain syndrome caused by transient and partial or complete occlusion of the coronary *** of the disease remains incompletely understood,with autonomic and endothelial dysfunction thought to play an important *** to the dynamic nature of the disease,its exact prevalence is not entirely clear but is found to be more prevalent in East Asian and female *** smoking remains a prominent risk factor,although CAVS does not follow traditional coronary artery disease risk *** triggers continue to be identified,with recent findings identifying chemotherapeutics,allergens,and inflammatory mediators as playing some role in the exacerbation of *** testing with direct visualization is currently the gold-standard for diagnosis,but non-invasive tests,including the use of biomarkers,are being increasingly studied to aid in the *** of the CAVS is an area of active *** from risk factor modification,calcium channel blockers are currently the first line treatment,with nitrates playing an important adjunct ***-risk patients with life-threatening complications should be considered for implantable cardioverter defibrillator(ICD),although timing criteria for escalated therapy require further *** role of pharmaceuticals targeting oxidative stress remains incompletely understood.

关键词： Coronary artery vasospasm Vasospastic angina Prinzmetal angina Variant angina Coronary artery disease

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Bladder urothelial carcinoma extending to rectal mucosa and presenting with rectal bleeding

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World Journal of Gastrointestinal Endoscopy 2017年第6期9卷 282-295页

作者： Andrew M Aneese Vinayata Manuballa Mitual Amin Mitchell S Cappell Division of Gastroenterology and Hepatology Department of MedicineWilliam Beaumont Hospital Department of Pathology William Beaumont Hospital Oakland University william beaumont school of medicine

An 87-year-old-man with prostate-cancer-stage-T1cGleason-6 treated with radiotherapy in 1996, recurrent prostate cancer treated with leuprolide hormonal therapy in 2009, and bladder-urothelial-carcinoma in situ treated with Bacillus-Calmette-Guerin and adriamycin in 2010, presented in 2015 with painless, bright red blood per rectum coating stools daily for 5 mo. Rectal examination revealed bright red blood per rectum; and a hard, fixed, 2.5 cm × 2.5 cm mass at the normal prostate location. The hemoglobin was 7.6 g/d L(iron saturation = 8.4%,indicating iron-deficiency-anemia). AbdominopelvicCT-angiography revealed focal wall thickening at the bladder neck; a mass containing an air cavity replacing the normal prostate; and adjacent rectal invasion. Colonoscopy demonstrated an ulcerated, oozing, multinodular, friable, 2.5 cm × 2.5 cm mass in anterior rectal wall, at the usual prostate location. Histologic and immunohistochemical analysis of colonoscopic biopsies of the mass revealed poorly-differentiatedcarcinoma of urothelial origin. At visceral angiography, the right-superior-rectal-artery was embolized to achieve hemostasis. The patient subsequently developed multiple new metastases and expired 13 mo postembolization. Comprehensive literature review revealed 16 previously reported cases of rectal involvement from bladder urothelial carcinoma, including 11 cases from direct extension and 5 cases from metastases. Patient age averaged 63.7 ± 9.6 years(all patients male). Rectal involvement was diagnosed on average 13.5 ± 11.8 mo after initial diagnosis of bladder urothelial carcinoma. Symptoms included constipation/gastrointestinal obstruction-6, weight loss-5, diarrhea-3, anorexia-3, pencil thin stools-3, tenesmus-2, anorectal pain-2, and other-5. Rectal examination in 9 patients revealed annular rectal constriction-6, and rectal mass-3. The current patient had the novel presentation of daily bright red blood per rectum coating the stools simulating hemorrhoidal bleed

关键词： Bladder cancer Urothelial Uroepitheilal Transitional cell Rectum penetration Cancer spread Lower gastrointestinal bleeding Colonoscopy

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