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Frontal Sinus Inverted Papilloma: Surgical Challenges and Outcomes of a Multi-Institutional Cohort
No full textOBJECTIVES: Inverted papilloma (IP) is typically a benign sinonasal tumor with a propensity to recur. The surgical treatment of IP arising from the frontal sinus is complicated by proximity to the orbit and skull base. The objective of this study is to describe the surgical challenges when managing this disease and report treatment outcomes in a multicenter cohort.
METHODS: A retrospective review was performed on frontal sinus IP resected from 1993 to 2023. Demographic and clinicopathologic data, complications, surgical approach, and outcomes were analyzed.
RESULTS: Ninety-eight patients (60 males, 38 females) were identified. Mean age was 59 years, with a median follow-up of 44 months. Histopathologic evaluation identified 13 lesions with carcinoma in situ or invasive carcinoma (13.3%). Bilateral involvement was found in 28 patients (28.6%). Overall, 17 patients (17.3%) had recurrent disease with a median recurrence time of 29.2 months. Fourteen patients (14.3%) underwent staged procedures, with a median time to the second procedure of 7.7 months. Twenty-three patients (23.5%) presented with skull base dehiscence on perioperative imaging. Skull base dehiscence had a significant effect on intraoperative cerebrospinal fluid leak (OR 9.1, 95% CI 3.0-27.4 p \u3c 0.001).
CONCLUSION: Frontal sinus IP is commonly attached at the skull base and associated with skull base dehiscence, CSF leak, and often requires operative repair and staged procedures. Complete tumor removal can be challenging and may necessitate a combined open and endoscopic approach. Careful surgical planning and close follow-up in the postoperative period are essential for disease control.
LEVEL OF EVIDENCE: Level 4
BCL2-Rearrangment-Negative CD23+ Follicle Center Lymphoma and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Rare Case of Biclonal Composite Lymphoma
No full textComposite lymphomas are rare and diagnostically complex, comprising two or more distinct lymphoma subtypes within the same anatomical site and often requiring a comprehensive diagnostic approach. Due to their rarity and varied presentations, further research is needed to better understand their pathogenesis, clonal relationships, and optimal management strategies. This case report highlights an unusual presentation of composite lymphoma involving the coexistence of BCL2-R-negative, CD23-positive follicle center lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL)
A Model for Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 2.0
No full textThe original consensus-based Geriatric Emergency Department (GED) Guidelines, published in 2014, established a framework of core principles for delivering high-quality, age-appropriate emergency care for older adults. In response to significant advances in geriatric emergency medicine research and evolving clinical priorities, we developed the GED Guidelines 2.0 to ensure continued relevance, clinical utility, and evidence-based rigor. This concept paper describes the systematic and iterative process undertaken to update the guidelines, including the formation of multidisciplinary working groups and the application of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Unlike the original GED Guidelines, our approach prioritized methodological transparency, formalized evidence grading, and consensus building grounded in systematic reviews and meta-analyses. We describe the identification, recruitment, and collaboration of multidisciplinary clinical and academic experts working together to improve the care of older adults in the emergency department. Through this multidisciplinary effort, key geriatric domains were selected, priority topics identified, and systematic reviews and meta-analyses conducted to generate a robust evidence base for future guideline and policy development. The GED Guidelines 2.0 represents the first emergency medicine (EM) subspecialty guideline effort to fully adopt the GRADE framework, offering a novel blueprint for future EM guideline development
Effect of Total Psoas Muscle Area and Serum Albumin on Outcomes After Lung Transplantation
No full textBACKGROUND: Sarcopenia of the psoas muscle and hypoalbuminemia indicate poor nutritional status, inflammation, and frailty in lung transplant (LT) candidates, correlating with worse post-transplant outcomes.
METHODS: Retrospective study of LT recipients (2015-2023) examining the association of total psoas muscle area (TPA) and serum albumin with hospital stay, survival, and pulmonary function.
RESULTS: One hundred thirty-two LT recipients (mean age 59.56 ± 10.65 years, BMI 26.73 ± 5.55 kg/m(2), 65% males), 95% underwent bilateral LT. Higher TPA was associated with shorter hospital and ICU stays (p = 0.001). Similarly, higher albumin levels were associated with reduced hospital and ICU stays (p \u3c 0.001). Hospital survivors had higher TPA (17.5 ± 6.1 vs. 14.6 ± 5.2 cm(2), p = 0.02) and higher albumin levels (3.25 ± 0.73 vs. 2.75 ± 0.85 mg/dL, p = 0.01). Long-term survivors had higher TPA (17.8 ± 6.35 vs. 15.9 ± 5.51 cm(2), p = 0.07) and higher albumin levels (3.29 ± 0.75 vs. 2.97 ± 0.78 mg/dL, p = 0.01). On multivariate analysis, albumin and male gender remained independent predictors of hospital and long-term survival. TPA was positively associated with post-transplant pulmonary function based on FVC and FEV1 (p \u3c 0.001), while albumin levels showed no association.
CONCLUSION: In the present study of LT recipients, higher TPA and albumin levels were linked to shorter hospitalization, and albumin independently predicted survival. TPA, but not albumin, was associated with pulmonary function post-transplant
Bilateral Native Nephrectomy as a Successful Treatment for Persistent Polycythemia in a Pediatric Kidney Transplant Recipient: Case Report
No full textINTRODUCTION: Polycythemia, characterized by elevated red blood cell counts, can lead to significant complications, especially in pediatric kidney transplant patients. In rare cases, persistent polycythemia is caused by excessive erythropoietin production from native kidneys post-transplant. We report a unique case in which bilateral native nephrectomy was a successful treatment for persistent polycythemia.
METHODS: We present the case of a 23-year-old male with end-stage kidney disease due to an embolic event from an umbilical artery catheter resulting in bilateral kidney cystic dysplasia. The patient developed polycythemia at 22 months, initially treated with intermittent phlebotomy, which later transitioned to red cell depletion. Despite receiving a living donor kidney transplant at age 15, his hematocrit remained elevated due to continued erythropoietin production from his native kidneys. At age 17, he underwent robotic bilateral native nephrectomies.
RESULTS/IMPORTANT CLINICAL FINDINGS: Following the nephrectomies, the patient\u27s hematocrit was normalized within 2 months. The surgery was complication-free, and the patient no longer required red cell depletion. Five years post-surgery, his hemoglobin and hematocrit remain stable.
CONCLUSIONS: This case demonstrates that persistent polycythemia in pediatric kidney transplant recipients can be successfully treated with bilateral nephrectomies when caused by native kidney erythropoietin production. Surgical removal of native kidneys is a viable solution for refractory cases of post-transplant polycythemia, preventing complications like thromboembolic events and preserving long-term health. A multidisciplinary approach, including urology and nephrology, is essential in managing such complex cases
From Delays to Dialogue, Investigating Team Communication and Patient Safety Culture In an Endoscopy Unit
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1013/thumbnail.jp
Stress Less, Nurse Strong
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1044/thumbnail.jp
Chaos to Control: Nurse-Led Innovation with Agitation Readiness Kits
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1047/thumbnail.jp
Obesity and cancer in america: From declining mortality to emerging challenges
No full textBackground: Obesity is a global epidemic linked to various health issues, including cancer. This study investigates temporal trends in cancer burden among obese individuals in the U.S., emphasizing its long-term public health impact. Understanding these trends is crucial for informing effective public health strategies and resource allocation. Methods: Using the Multiple-Causes of Death database from the CDC WONDER, we retrospectively analyzed annual age-adjusted mortality rates (AAMR) per 100,000 population from 1999 to 2020 in cancer patients with obesity. Joinpoint v5.3 was utilized to assess average annual percent change (AAPC) and annual percent change (APC) across significant trends. Results: Between 1999 and 2020, 14,937,519 deaths were recorded among adults aged 25 and older due to obesity and cancer. The overall AAMR for cancer and obesity-related deaths decreased from 1999 to 2020 with an AAPC of -1.13 (95% CI: -1.27 to -1.06, p \u3c 0.0001). The overall AAMR significantly declined from 1999 to 2018, followed by a non-significant increase until 2020 (APC:1.25, 95% CI: -0.63 to 1.97, p = 0.1332). Across ethnicities, AAMR rose from 2018 to 2020, with the steepest incline among the non-Hispanic (NH) American group or Alaskan native group (APC: 6.10; 95% CI: 0.27 to 10.20, p = 0.040), followed by Hispanics andNHBlack. Cancer and obesity death rates were stable between all U.S. Census Regions. Midwest showed a decline from 1999 to 2018 (APC = -1.0; 95% CI: -1.4 to-0.7, p = 0.004) followed by a steep increase till 2020 (APC = 6.6; 95% CI: 1.3 to 9.4, p = 0.013). Similarly, for the West, a decline till 2018 (APC = -1.0; 95% CI: -1.2 to -1.0, p \u3c 0.0001) followed by a steep increase to 268.5 in 2020 (APC = 5.4; 95% CI: 3.1 to 6.6, p \u3c 0.0001) was recorded. States in the 90th percentile of Cancer and Obesity mortality included West Virginia, Kentucky, Mississippi, Oklahoma, and the District of Columbia, while those in the 10th percentile included Colorado, North Mexico, Arizona, Hawaii, and Utah. Conclusions: This study reveals a complex relationship between obesity and cancer mortality over time, highlighting disparities across demographics and regions. While AAMRs decreased until 2018, the subsequent increase warrants further investigation, especially in light of the COVID-19 pandemic. Further studies are needed to assess the cause-and-effect relationship between obesity and cancer, as well subgroup analysis regarding specific cancer types