Rizwan Aslam - Academia.edu (original) (raw)

Papers by Rizwan Aslam

Gland Surgery, May 25, 2015

Current advancement in robotic surgery has provided a safe, precise, 3-dimensional (3D) magnified... more Current advancement in robotic surgery has provided a safe, precise, 3-dimensional (3D) magnified dissection for parathyroid surgery without the need for CO2 insufflation, and with a better cosmetic outcome due to an invisible scar in the axillary or retroauricular region. Preoperative imaging studies that assist in the localization of lesions have been key elements in patients' selection for targeted parathyroid surgery.

Radiology, Feb 1, 2008

To prospectively compare the diagnostic performance and time efficiency of both second and concur... more To prospectively compare the diagnostic performance and time efficiency of both second and concurrent computer-aided detection (CAD) reading paradigms for retrospectively obtained computed tomographic (CT) colonography data sets by using consensus reading (three radiologists) of colonoscopic findings as a reference standard. Ethical permission, HIPAA compliance (for U.S. institutions), and patient consent were obtained from all institutions for use of CT colonography data sets in this study. Ten radiologists each read 25 CT colonography data sets (12 men, 13 women; mean age, 61 years) containing 69 polyps (28 were 1-5 mm, 41 were >or=6 mm) by using workstations integrated with CAD software. Reading was randomized to either "second read" CAD (applied only after initial unassisted assessment) or "concurrent read" CAD (applied at the start of assessment). Data sets were reread 6 weeks later by using the opposing paradigm. Polyp sensitivity and reading times were compared by using multilevel logistic and linear regression, respectively. Receiver operating characteristic (ROC) curves were generated. Compared with the unassisted read, odds of improved polyp…

Gland surgery, 2015

Current advancement in robotic surgery has provided a safe, precise, 3-dimensional (3D) magnified... more Current advancement in robotic surgery has provided a safe, precise, 3-dimensional (3D) magnified dissection for parathyroid surgery without the need for CO2 insufflation, and with a better cosmetic outcome due to an invisible scar in the axillary or retroauricular region. Preoperative imaging studies that assist in the localization of lesions have been key elements in patients' selection for targeted parathyroid surgery.

Introduction: Fine needle aspiration cytology (FNA) of thyroid nodules can lead to changes that e... more Introduction: Fine needle aspiration cytology (FNA) of thyroid nodules can lead to changes that extensively replace cytologically confirmed thyroid lesions. These replaced thyroid lesions are called vanishing tumors, and can be challenging to pathologists, endocrinologists and surgeons, rendering the final pathological diagnosis difficult to interpret. We performed a retrospective analysis focusing on the issues that tend to compromise management plans for these vanishing tumors. Study Design: Retrospective review Methods: Data of 609 patients referred to our institution for thyroid surgery were reviewed. Patients with suspicious lesions on neck ultrasound underwent FNA biopsy. We compared FNA cytological and surgical pathological findings to identify patients with vanishing tumors. FNA-induced reactive changes such as cystic degeneration, hemorrhage, calcification, cholesterol crystals, fibrosis and granulation tissue were identified. Results: Seventeen patients (2.7%) were identif...

Annals of Surgical Oncology, 2015

Secondary thyroid cancer is believed to lead to a more aggressive clinical course than primary th... more Secondary thyroid cancer is believed to lead to a more aggressive clinical course than primary thyroid cancer. We aim to examine the difference between primary and secondary thyroid cancer in terms of patient characteristics and perioperative outcomes at the national level. A cross-sectional study utilizing the Nationwide Inpatient Sample database for 2003-2010 was merged with County Health Rankings Data. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to identify adult patients with thyroid cancer. A total of 21,581 discharge records were included. Overall, 16,625 (77.0 %) patients had primary cancer, while the rest (23.0 %) had secondary cancer. Younger (<45 years) and older (>65 years) patients, males, and those of White or Hispanic background were more likely to have secondary cancers (p < 0.05 each). The prevalence of secondary cancer was higher in communities of low health risk (24.0 % vs. 21.1 %; p < 0.024). Secondary cancer was more likely to be managed by total thyroidectomy (odds ratio [OR] 2.40, 95 % CI 2.12-2.73) and to require additional radical neck dissection (OR 12.51, 95 % CI 10.98-14.25). Patients with secondary thyroid cancers were at higher risk of postoperative complications (p < 0.01 each). The cost of secondary cancer management was significantly higher than primary cancer (US$12,449.00 ± 302.07 vs. US$7848.12 ± 149.05; p < 0.001). However, compared with intermediate-volume surgeons, the complication risk was lower for high-volume (OR 0.47, 95 % CI 0.24-0.92; p = 0.026). Secondary thyroid cancer is associated with a higher risk of perioperative complications and higher cost and distinct demographic profile. Patients managed by higher-volume surgeons were less likely to experience disadvantageous outcomes.

Future Oncology, 2015

The pre-operative diagnosis of thyroid tumors is determined by gold standard fine needle aspirati... more The pre-operative diagnosis of thyroid tumors is determined by gold standard fine needle aspiration (FNA) biopsy. This has been widely accepted and offers the most cost-effective approach for evaluation of thyroid nodules. However, its diagnostic accuracy can pose a challenging scenario to surgeons. These diagnostic difficulties may subject patients to unnecessary thyroidectomies for benign thyroid nodules. Thus, additional molecular tests are needed to improve the sensitivity and specificity of FNA. The role of molecular markers is being proposed to predict the type and risk of malignancy to abate the need for diagnostic thyroidectomies. This review discusses their utility and validity in pre-operative diagnosis of thyroid nodules and how these markers can enhance the accuracy of FNA cytology.

BACKGROUND: The use of sealing devices has been established for use in thyroid surgery. Recently,... more BACKGROUND: The use of sealing devices has been established for use in thyroid surgery. Recently, a new device, LigaSure™ Small Jaw (LS), utilizes the bipolar energy and was recently approved by FDA to be utilized in thyroid surgery. These novel devices carry a risk of thermal injury to RLN. The new device was advertised to generate less heat than the Harmonic® Focus Scalpel (HS) (60-95oC compared to 250oC for isolated vessel sealing). Interestingly, there is no current literature to support the safety of the use of this new device in thyroid surgeries. The purpose of this study is to assess the efficiency and safety of LS when compared to HS. METHODS: A prospective study was conducted under IRB approved protocol to compare efficacy of LS versus the HS. We evaluated 80 patients who underwent surgery by one single surgeon at a North American academic institution. Matched patients were allocated into two groups according to LS or HS use. All patients underwent vocal cord assessment us...

PURPOSE This is a retrospective study evaluating the bone mineral density (BMD) measurements deri... more PURPOSE This is a retrospective study evaluating the bone mineral density (BMD) measurements derived from CT Colonography (CTC) datasets compared with bone mineral density measurements derived from DEXA in the same patients. METHOD AND MATERIALS Two readers independently calculated BMD and T scores from 35 CTC datasets. All CT scans were performed on a 16 slice MDCT scanner (GE Healthcare) and DEXA measurements were obtained on a Hologic Discovery series A machine. CT bone density analysis was performed on a workstation using a specific bone mineral analysis package (Philips). The bone density measurements were obtained using 3 vertebral bodies from T12 to the L1 level. Density measurements were also obtained from fat and muscle structures to provide an internal reference from which the BMD T score and Z score are calculated. In total we assessed 35 patients of which 30 were males and 5 females, the mean age was 66 (age range 54-79). RESULTS 35 patients were evaluated who underwent ...

PURPOSE To identify computed tomography (CT) findings of portal hypertension that best predict va... more PURPOSE To identify computed tomography (CT) findings of portal hypertension that best predict variceal hemorrhage (VH). METHOD AND MATERIALS We retrospectively identified 28 patients with advanced liver disease who had an outpatient CT scan prior to sustaining a VH and no history of variceal band ligation or suspected hepatocellular carcinoma (HCC). A control group was comprised of similar patients with advanced liver disease (n=56) who underwent a CT and upper endoscopy within 90 days of each other but had no history of VH. Two readers (R1 and R2) independently reviewed each CT scan to evaluate liver nodularity and record findings of portal venous hypertension. RESULTS The three most predictive CT findings for VH were the presence of visible esophageal varices (EV) (OR 73.8 and 25.3 for R1 and R2, respectively, p<0.001 for both), any EV tortuosity (OR ∞ and 17.3, respectively, p<0.001 for both), and the presence of an EV with a diameter > 3 mm (OR 275 and 25.3, respective...

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015

The utility of intraoperative sonography for pancreatic disease has been well described for detec... more The utility of intraoperative sonography for pancreatic disease has been well described for detection and evaluation of neoplastic and inflammatory pancreatic disease.(1-8) Intraoperative sonography can help substantially reduce surgical time as well as decrease potential injury to tissues and major structures. Imaging with sonography literally at the point of care-the surgeon's scalpel-can precisely define the location of pancreatic lesions and their direct relationship with surrounding structures in real time during surgery. This article highlights our experience with intraoperative sonography at multiple institutional sites for both open and laparoscopic surgical procedures. We use intraoperative sonography for a wide range of pancreatic disease to provide accurate localization and staging of disease, provide guidance for enucleation of nonpalpable, nonvisible tumors, and in planning the most direct and least invasive surgical approach, avoiding injury to the pancreatic duct ...

Imaging in Medicine, 2011

PURPOSE/AIM Case material from our Medical Center will be used to illustrate optimization of mult... more PURPOSE/AIM Case material from our Medical Center will be used to illustrate optimization of multi-detector row CT urograms. Identify key imaging features of urothelial disease in a variety of disorders at CT urography Benefits of 3D imaging are emphasized, including volume rendering, virtual cystoscopy and pyeloureteroscopy CONTENT ORGANIZATION 1. Introduction 2. Basic concepts for imaging the urinary tract 3. Imaging techniques: CT-only CT urography a. Three phase CT urography b. Two phase CT urography 4. Case presentations a. Congenital anomalies: renal ectopia, horseshoe kidney, collecting system duplication, aberrant papilla, Fraley syndrome b. Calyceal, renal pelvic and ureteral abnormalities: pyeloureteritis cystica c. Bladder disease: neoplasm vs blood clots, d. Postoperative cases: recurrent TCC, leaks SUMMARY 1. Optimal distention of the urinary tract system during excretory phase is consistently obtained with a combination of oral hydration, intravenous furosemide and scr...

PURPOSE/AIM To demonstrate advantages and limitations of conventional gadolinium-based versus blo... more PURPOSE/AIM To demonstrate advantages and limitations of conventional gadolinium-based versus blood pool contrast material (gadofosveset) for clinical magnetic resonance angiography (MRA) evaluation of blood vessels. To explore techniques to optimize performance of MRA using both conventional and blood pool agents. CONTENT ORGANIZATION Clinical MRA is a powerful tool for the evaluation of abdominopelvic and peripheral vasculature, but suffers some limitations owing to the short intravascular half-life of conventional gadolinium contrast materials, relatively low T1 shortening effects, and high leakage rate into the interstitial space. Several methods, including timing bolus, bolus tracking, repeat dosing, and time resolved imaging may be used to improve MRA results, but each method has tradeoffs. Alternatively, blood pool MR contrast material (gadofosveset) may be utilized to provide most of the benefits of first-pass imaging and also allow steady state imaging of abdominal/lower ex...

PURPOSE/AIM To review the anatomy and etiology of pelvic floor weakness in women. And to evaluate... more PURPOSE/AIM To review the anatomy and etiology of pelvic floor weakness in women. And to evaluate the role of MRI in the assessment of female pelvic floor dysfunction. CONTENT ORGANIZATION Normal Pelvic Anatomy Etiology of Pelvic Floor Dysfunction MRI Techniques and Protocols Assessment of Pelvic Prolapse Review of Surgical Treatment Options SUMMARY Pelvic floor weakness can result in significant morbidity, requiring surgical intervention. MRI, provides superior soft-tissue contrast resolution and allows for dynamic visualization of the pelvic organs and their supporting structures. MRI assessment provides an accurate evaluation of the extent of pelvic organ prolapse. And therefore is essential in identifying patients that would benefit from surgical intervention.

PURPOSE/AIM 1. To review the imaging features of diffuse liver disease 2. To discuss the compleme... more PURPOSE/AIM 1. To review the imaging features of diffuse liver disease 2. To discuss the complementary roles of US, CT, and MR in imaging diffuse liver disease with emphasis on emerging MR sequences, particularly the role of newer contrast agents such as Eovist 3.To describe an algorithmic approach for arriving at a clinically relevant differential diagnosis CONTENT ORGANIZATION 1. Classification and review of diffuse liver disease 2. Discussion of spectrum of imaging findings on US, CT and MR 3. Covered topics will include Steatosis, Hepatitis, Cirrhosis, HCC, Toxic Injury, Infarction, Metastases and Lymphoma, Sarcoid, Wilson Disease, Budd-Chiari, Schistosomiasis, Hemochromatosis, Amyloidosis, Radiation Hepatitis, Storage Diseases 4. Image-rich presentation of cases as unknowns followed by discussion of a problem-solving approach for narrowing the differential SUMMARY 1. Diffuse liver disease is commonly encountered in clinical practice 2. Exhibit will review the pathophysiology an...

Gland Surgery, May 25, 2015

Current advancement in robotic surgery has provided a safe, precise, 3-dimensional (3D) magnified... more Current advancement in robotic surgery has provided a safe, precise, 3-dimensional (3D) magnified dissection for parathyroid surgery without the need for CO2 insufflation, and with a better cosmetic outcome due to an invisible scar in the axillary or retroauricular region. Preoperative imaging studies that assist in the localization of lesions have been key elements in patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; selection for targeted parathyroid surgery.

Radiology, Feb 1, 2008

To prospectively compare the diagnostic performance and time efficiency of both second and concur... more To prospectively compare the diagnostic performance and time efficiency of both second and concurrent computer-aided detection (CAD) reading paradigms for retrospectively obtained computed tomographic (CT) colonography data sets by using consensus reading (three radiologists) of colonoscopic findings as a reference standard. Ethical permission, HIPAA compliance (for U.S. institutions), and patient consent were obtained from all institutions for use of CT colonography data sets in this study. Ten radiologists each read 25 CT colonography data sets (12 men, 13 women; mean age, 61 years) containing 69 polyps (28 were 1-5 mm, 41 were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=6 mm) by using workstations integrated with CAD software. Reading was randomized to either &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;second read&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; CAD (applied only after initial unassisted assessment) or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;concurrent read&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; CAD (applied at the start of assessment). Data sets were reread 6 weeks later by using the opposing paradigm. Polyp sensitivity and reading times were compared by using multilevel logistic and linear regression, respectively. Receiver operating characteristic (ROC) curves were generated. Compared with the unassisted read, odds of improved polyp…

Gland surgery, 2015

Current advancement in robotic surgery has provided a safe, precise, 3-dimensional (3D) magnified... more Current advancement in robotic surgery has provided a safe, precise, 3-dimensional (3D) magnified dissection for parathyroid surgery without the need for CO2 insufflation, and with a better cosmetic outcome due to an invisible scar in the axillary or retroauricular region. Preoperative imaging studies that assist in the localization of lesions have been key elements in patients' selection for targeted parathyroid surgery.

Introduction: Fine needle aspiration cytology (FNA) of thyroid nodules can lead to changes that e... more Introduction: Fine needle aspiration cytology (FNA) of thyroid nodules can lead to changes that extensively replace cytologically confirmed thyroid lesions. These replaced thyroid lesions are called vanishing tumors, and can be challenging to pathologists, endocrinologists and surgeons, rendering the final pathological diagnosis difficult to interpret. We performed a retrospective analysis focusing on the issues that tend to compromise management plans for these vanishing tumors. Study Design: Retrospective review Methods: Data of 609 patients referred to our institution for thyroid surgery were reviewed. Patients with suspicious lesions on neck ultrasound underwent FNA biopsy. We compared FNA cytological and surgical pathological findings to identify patients with vanishing tumors. FNA-induced reactive changes such as cystic degeneration, hemorrhage, calcification, cholesterol crystals, fibrosis and granulation tissue were identified. Results: Seventeen patients (2.7%) were identif...

Annals of Surgical Oncology, 2015

Secondary thyroid cancer is believed to lead to a more aggressive clinical course than primary th... more Secondary thyroid cancer is believed to lead to a more aggressive clinical course than primary thyroid cancer. We aim to examine the difference between primary and secondary thyroid cancer in terms of patient characteristics and perioperative outcomes at the national level. A cross-sectional study utilizing the Nationwide Inpatient Sample database for 2003-2010 was merged with County Health Rankings Data. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to identify adult patients with thyroid cancer. A total of 21,581 discharge records were included. Overall, 16,625 (77.0 %) patients had primary cancer, while the rest (23.0 %) had secondary cancer. Younger (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;45 years) and older (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;65 years) patients, males, and those of White or Hispanic background were more likely to have secondary cancers (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 each). The prevalence of secondary cancer was higher in communities of low health risk (24.0 % vs. 21.1 %; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.024). Secondary cancer was more likely to be managed by total thyroidectomy (odds ratio [OR] 2.40, 95 % CI 2.12-2.73) and to require additional radical neck dissection (OR 12.51, 95 % CI 10.98-14.25). Patients with secondary thyroid cancers were at higher risk of postoperative complications (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01 each). The cost of secondary cancer management was significantly higher than primary cancer (US$12,449.00 ± 302.07 vs. US$7848.12 ± 149.05; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). However, compared with intermediate-volume surgeons, the complication risk was lower for high-volume (OR 0.47, 95 % CI 0.24-0.92; p = 0.026). Secondary thyroid cancer is associated with a higher risk of perioperative complications and higher cost and distinct demographic profile. Patients managed by higher-volume surgeons were less likely to experience disadvantageous outcomes.

Future Oncology, 2015

The pre-operative diagnosis of thyroid tumors is determined by gold standard fine needle aspirati... more The pre-operative diagnosis of thyroid tumors is determined by gold standard fine needle aspiration (FNA) biopsy. This has been widely accepted and offers the most cost-effective approach for evaluation of thyroid nodules. However, its diagnostic accuracy can pose a challenging scenario to surgeons. These diagnostic difficulties may subject patients to unnecessary thyroidectomies for benign thyroid nodules. Thus, additional molecular tests are needed to improve the sensitivity and specificity of FNA. The role of molecular markers is being proposed to predict the type and risk of malignancy to abate the need for diagnostic thyroidectomies. This review discusses their utility and validity in pre-operative diagnosis of thyroid nodules and how these markers can enhance the accuracy of FNA cytology.

BACKGROUND: The use of sealing devices has been established for use in thyroid surgery. Recently,... more BACKGROUND: The use of sealing devices has been established for use in thyroid surgery. Recently, a new device, LigaSure™ Small Jaw (LS), utilizes the bipolar energy and was recently approved by FDA to be utilized in thyroid surgery. These novel devices carry a risk of thermal injury to RLN. The new device was advertised to generate less heat than the Harmonic® Focus Scalpel (HS) (60-95oC compared to 250oC for isolated vessel sealing). Interestingly, there is no current literature to support the safety of the use of this new device in thyroid surgeries. The purpose of this study is to assess the efficiency and safety of LS when compared to HS. METHODS: A prospective study was conducted under IRB approved protocol to compare efficacy of LS versus the HS. We evaluated 80 patients who underwent surgery by one single surgeon at a North American academic institution. Matched patients were allocated into two groups according to LS or HS use. All patients underwent vocal cord assessment us...

PURPOSE This is a retrospective study evaluating the bone mineral density (BMD) measurements deri... more PURPOSE This is a retrospective study evaluating the bone mineral density (BMD) measurements derived from CT Colonography (CTC) datasets compared with bone mineral density measurements derived from DEXA in the same patients. METHOD AND MATERIALS Two readers independently calculated BMD and T scores from 35 CTC datasets. All CT scans were performed on a 16 slice MDCT scanner (GE Healthcare) and DEXA measurements were obtained on a Hologic Discovery series A machine. CT bone density analysis was performed on a workstation using a specific bone mineral analysis package (Philips). The bone density measurements were obtained using 3 vertebral bodies from T12 to the L1 level. Density measurements were also obtained from fat and muscle structures to provide an internal reference from which the BMD T score and Z score are calculated. In total we assessed 35 patients of which 30 were males and 5 females, the mean age was 66 (age range 54-79). RESULTS 35 patients were evaluated who underwent ...

PURPOSE To identify computed tomography (CT) findings of portal hypertension that best predict va... more PURPOSE To identify computed tomography (CT) findings of portal hypertension that best predict variceal hemorrhage (VH). METHOD AND MATERIALS We retrospectively identified 28 patients with advanced liver disease who had an outpatient CT scan prior to sustaining a VH and no history of variceal band ligation or suspected hepatocellular carcinoma (HCC). A control group was comprised of similar patients with advanced liver disease (n=56) who underwent a CT and upper endoscopy within 90 days of each other but had no history of VH. Two readers (R1 and R2) independently reviewed each CT scan to evaluate liver nodularity and record findings of portal venous hypertension. RESULTS The three most predictive CT findings for VH were the presence of visible esophageal varices (EV) (OR 73.8 and 25.3 for R1 and R2, respectively, p<0.001 for both), any EV tortuosity (OR ∞ and 17.3, respectively, p<0.001 for both), and the presence of an EV with a diameter > 3 mm (OR 275 and 25.3, respective...

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015

The utility of intraoperative sonography for pancreatic disease has been well described for detec... more The utility of intraoperative sonography for pancreatic disease has been well described for detection and evaluation of neoplastic and inflammatory pancreatic disease.(1-8) Intraoperative sonography can help substantially reduce surgical time as well as decrease potential injury to tissues and major structures. Imaging with sonography literally at the point of care-the surgeon's scalpel-can precisely define the location of pancreatic lesions and their direct relationship with surrounding structures in real time during surgery. This article highlights our experience with intraoperative sonography at multiple institutional sites for both open and laparoscopic surgical procedures. We use intraoperative sonography for a wide range of pancreatic disease to provide accurate localization and staging of disease, provide guidance for enucleation of nonpalpable, nonvisible tumors, and in planning the most direct and least invasive surgical approach, avoiding injury to the pancreatic duct ...

Imaging in Medicine, 2011

PURPOSE/AIM Case material from our Medical Center will be used to illustrate optimization of mult... more PURPOSE/AIM Case material from our Medical Center will be used to illustrate optimization of multi-detector row CT urograms. Identify key imaging features of urothelial disease in a variety of disorders at CT urography Benefits of 3D imaging are emphasized, including volume rendering, virtual cystoscopy and pyeloureteroscopy CONTENT ORGANIZATION 1. Introduction 2. Basic concepts for imaging the urinary tract 3. Imaging techniques: CT-only CT urography a. Three phase CT urography b. Two phase CT urography 4. Case presentations a. Congenital anomalies: renal ectopia, horseshoe kidney, collecting system duplication, aberrant papilla, Fraley syndrome b. Calyceal, renal pelvic and ureteral abnormalities: pyeloureteritis cystica c. Bladder disease: neoplasm vs blood clots, d. Postoperative cases: recurrent TCC, leaks SUMMARY 1. Optimal distention of the urinary tract system during excretory phase is consistently obtained with a combination of oral hydration, intravenous furosemide and scr...

PURPOSE/AIM To demonstrate advantages and limitations of conventional gadolinium-based versus blo... more PURPOSE/AIM To demonstrate advantages and limitations of conventional gadolinium-based versus blood pool contrast material (gadofosveset) for clinical magnetic resonance angiography (MRA) evaluation of blood vessels. To explore techniques to optimize performance of MRA using both conventional and blood pool agents. CONTENT ORGANIZATION Clinical MRA is a powerful tool for the evaluation of abdominopelvic and peripheral vasculature, but suffers some limitations owing to the short intravascular half-life of conventional gadolinium contrast materials, relatively low T1 shortening effects, and high leakage rate into the interstitial space. Several methods, including timing bolus, bolus tracking, repeat dosing, and time resolved imaging may be used to improve MRA results, but each method has tradeoffs. Alternatively, blood pool MR contrast material (gadofosveset) may be utilized to provide most of the benefits of first-pass imaging and also allow steady state imaging of abdominal/lower ex...

PURPOSE/AIM To review the anatomy and etiology of pelvic floor weakness in women. And to evaluate... more PURPOSE/AIM To review the anatomy and etiology of pelvic floor weakness in women. And to evaluate the role of MRI in the assessment of female pelvic floor dysfunction. CONTENT ORGANIZATION Normal Pelvic Anatomy Etiology of Pelvic Floor Dysfunction MRI Techniques and Protocols Assessment of Pelvic Prolapse Review of Surgical Treatment Options SUMMARY Pelvic floor weakness can result in significant morbidity, requiring surgical intervention. MRI, provides superior soft-tissue contrast resolution and allows for dynamic visualization of the pelvic organs and their supporting structures. MRI assessment provides an accurate evaluation of the extent of pelvic organ prolapse. And therefore is essential in identifying patients that would benefit from surgical intervention.

PURPOSE/AIM 1. To review the imaging features of diffuse liver disease 2. To discuss the compleme... more PURPOSE/AIM 1. To review the imaging features of diffuse liver disease 2. To discuss the complementary roles of US, CT, and MR in imaging diffuse liver disease with emphasis on emerging MR sequences, particularly the role of newer contrast agents such as Eovist 3.To describe an algorithmic approach for arriving at a clinically relevant differential diagnosis CONTENT ORGANIZATION 1. Classification and review of diffuse liver disease 2. Discussion of spectrum of imaging findings on US, CT and MR 3. Covered topics will include Steatosis, Hepatitis, Cirrhosis, HCC, Toxic Injury, Infarction, Metastases and Lymphoma, Sarcoid, Wilson Disease, Budd-Chiari, Schistosomiasis, Hemochromatosis, Amyloidosis, Radiation Hepatitis, Storage Diseases 4. Image-rich presentation of cases as unknowns followed by discussion of a problem-solving approach for narrowing the differential SUMMARY 1. Diffuse liver disease is commonly encountered in clinical practice 2. Exhibit will review the pathophysiology an...