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3. Detection of Surgical Site Infection Utilizing Automated Feature Generation in Clinical Notes

Author

Shen, Feichen, Larson, David W, Naessens, James M., Habermann, Elizabeth B., Liu, Hongfang, and Sohn, Sunghwan

Subjects
Computer Science - Information Retrieval
Abstract

Postsurgical complications (PSCs) are known as a deviation from the normal postsurgical course and categorized by severity and treatment requirements. Surgical site infection (SSI) is one of major PSCs and the most common healthcare-associated infection, resulting in increased length of hospital stay and cost. In this work, we assessed an automated way to generate lexicon (i.e., keyword features) from clinical narratives using sublanguage analysis with heuristics to detect SSI and evaluated these keywords with medical experts. To further validate our approach, we also conducted decision tree algorithm on cohort using automatically generated keywords. The results show that our framework was able to identify SSI keywords from clinical narratives and to support search-based natural language processing (NLP) approaches by augmenting search queries.

Published
2018
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21. Intensity-modulated radiotherapy for squamous cell carcinoma of the anal canal: Efficacy of a low daily dose to clinically negative regions

Author

Larson David W, Quevedo J, Haddock Michael G, Call Jason A, and Miller Robert C

Subjects
anal cancer, chemotherapy, intensity-modulated radiotherapy, squamous cell carcinoma, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background We aimed to assess outcomes of patients with anal cancer who underwent intensity-modulated radiotherapy (IMRT) and received less than 1.80 Gy/day. Methods We retrospectively reviewed our experience using a low fractional dose (< 1.80 Gy) of IMRT to elective nodal areas for patients receiving chemoradiotherapy for anal cancer. Three-year freedom from any disease relapse and overall survival were estimated using Kaplan-Meier curves. We documented the daily dose that was delivered to clinically uninvolved regions and to areas of gross disease. Incidence of regional failures in high (≥ 1.80 Gy) and low (< 1.80 Gy) daily dose regions was assessed. Results Thirty-four consecutive patients (median age, 59 years) received IMRT from June 2005 through January 2009. Median follow-up duration was 22 months. Twenty-eight patients had T1 or T2 disease and 6 had T3 or T4 disease. Fourteen patients had nodal metastases. Median treatment dose was 50.40 Gy (range, 48.60-57.60 Gy) in 25 to 32 fractions. The range of fractional doses to clinically negative volumes was 1.28 to 1.80 Gy. Seventeen patients (50%) received a fractional dose of less than 1.60 Gy, 13 (38%) received less than 1.50 Gy, and 9 (26%) received less than 1.40 Gy to at least a portion of the clinically negative volume. Three-year freedom from relapse was 80%, and 3-year overall survival was 87%. No patient had treatment failure in the clinically negative volume that received a low daily dose. Conclusions Our data support using doses between 1.50 and 1.80 Gy/day to clinically uninvolved regions.

Published
2011
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23. Perforated Meckel's diverticulum presenting with combined bowel and urinary obstruction and mimicking Crohn's disease: a case report

Author

Wong Banny S, Larson David W, Smyrk Thomas C, and Oxentenko Amy S

Subjects
Medicine
Abstract

Abstract Introduction Meckel's diverticulum is a common congenital anomaly of the gastrointestinal tract, but is an uncommon cause of serious complications in adults. Although cases of patients with hemorrhage, bowel obstruction or perforation associated with Meckel's diverticulum have been reported, there have been no prior reports of patients with combined urinary and bowel obstruction due to abscess formation. Case presentation We describe the case of a 21-year-old man with a history of recurrent papillary thyroid cancer, but no prior abdominal surgeries, who presented with a one-month history of rectal pain and new-onset obstipation with urinary retention. He reported night sweats and weight loss, and had a second-degree relative with known Crohn's disease. A digital rectal examination was notable and revealed marked tenderness with proximal induration. A computed tomography scan of the patient's abdomen revealed a large, complex, circumferential perirectal abscess compressing the rectal lumen and base of the urinary bladder, associated with terminal ileal thickening and an ileocecal fistula. A flexible sigmoidoscopy with an endorectal ultrasound scan displayed a complex abscess with extensive mucosal and surrounding inflammation. An exploratory laparotomy revealed a Meckel's diverticulum with a large perforation at its base, positioned near the ileocecal fistula and immediately superior to the perirectal abscess. The section of small bowel containing the Meckel's diverticulum, the terminal ileum, and the cecum, were all resected, and the abscess was debrided. Conclusions Pre-operative diagnosis of Meckel's diverticulum can be difficult. If the nature of the complication makes ultimate surgical management likely, an early laparoscopic or open exploration should be performed to prevent the morbidity and mortality associated with late complications.

Published
2010
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27. A Curative-Intent Trimodality Approach for Isolated Abdominal Nodal Metastases in Metastatic Colorectal Cancer: Update of a Single-Institutional Experience

Author

Johnson, Benny, primary, Jin, Zhaohui, additional, Haddock, Michael G., additional, Hallemeier, Christopher L., additional, Martenson, James A., additional, Smoot, Rory L., additional, Larson, David W., additional, Dozois, Eric J., additional, Nagorney, David M., additional, and Grothey, Axel, additional

Published
2018
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34. Ranolazine inhibits voltage-gated mechanosensitive sodium channels in human colon circular smooth muscle cells

Author

Neshatian, Leila, primary, Strege, Peter R., additional, Rhee, Poong-Lyul, additional, Kraichely, Robert E., additional, Mazzone, Amelia, additional, Bernard, Cheryl E., additional, Cima, Robert R., additional, Larson, David W., additional, Dozois, Eric J., additional, Kline, Crystal F., additional, Mohler, Peter J., additional, Beyder, Arthur, additional, and Farrugia, Gianrico, additional

Published
2015
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37. Malignancy and Meckel’s diverticulum: A systematic literature review and 14-year experience at a tertiary referral center

Author

van Malderen, Kathleen, Vijayvargiya, Priya, Camilleri, Michael, Larson, David W, and Cima, Robert

Abstract

Background Meckel’s diverticulum is present in about 2% of the population. The literature reports 3.2% incidence of tumors within Meckel’s diverticulum; the tumors are predominantly benign.Objective and methods The purpose of this study was to evaluate malignant tumors in Meckel’s diverticulum through systematic review of the literature and review of electronic medical records including pathology reports over 14 years at the Mayo Clinic, Rochester, USA.Results A literature review over the last 10 years identified 37 citations with 402 patients (median age: 58 years; 68.9% males). The predominant malignancy reported was neuroendocrine tumor 84.6%, followed by gastrointestinal stromal tumor 8.2%, and adenocarcinoma 6%. At the time of diagnosis, 29.5% of patients had metastases. In the Mayo Clinic electronic medical records review, there were 19 patients (5.1% of them surgically removed Meckel’s diverticulum) who had a malignancy associated with Meckel’s diverticulum: 63.2% neuroendocrine tumor, 10.5% gastrointestinal stromal tumor, 5.3% adenocarcinoma, 5.3% pancreatic epithelial neoplasia, and 15.8% metastases from secondary location. Median size of the malignancy was 7 mm, and 17/19 malignancies were coincidental findings. Most neuroendocrine tumors infiltrated the submucosa, while gastrointestinal stromal tumor and adenocarcinoma invaded the serosa. At the time of diagnosis, 33.3% of patients had metastases.Conclusion About 5% of Meckel’s diverticulums resected were associated with malignant tumors, most commonly neuroendocrine tumor, and a significant portion of Meckel’s diverticulum malignancy was metastatic at the time of discovery.

Published
2018
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45. S1184 Cumulative Incidence of and Risk Factors for Major Abdominal Surgery in a Population-Based Cohort of Crohn's Disease

Author

Biroulet, Laurent Peyrin, primary, Loftus, Edward V., additional, Harmsen, William S., additional, Tremaine, William J., additional, Wolff, Bruce G., additional, Pemberton, John H., additional, Dozois, Eric J., additional, Cima, Robert R., additional, Larson, David W., additional, Zinsmeister, Alan R., additional, and Sandborn, William J., additional

Published
2010
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46. 490 Postoperative Complications in a Population-Based Cohort of Crohn's Disease

Author

Biroulet, Laurent Peyrin, primary, Loftus, Edward V., additional, Harmsen, William S., additional, Tremaine, William J., additional, Wolff, Bruce G., additional, Pemberton, John H., additional, Cima, Robert R., additional, Larson, David W., additional, Dozois, Eric J., additional, Zinsmeister, Alan R., additional, and Sandborn, William J., additional

Published
2010
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49. Ano1 is a selective marker of interstitial cells of Cajal in the human and mouse gastrointestinal tract

Author

Gomez-Pinilla, Pedro J., primary, Gibbons, Simon J., additional, Bardsley, Michael R., additional, Lorincz, Andrea, additional, Pozo, Maria J., additional, Pasricha, Pankaj J., additional, de Rijn, Matt Van, additional, West, Robert B., additional, Sarr, Michael G., additional, Kendrick, Michael L., additional, Cima, Robert R., additional, Dozois, Eric J., additional, Larson, David W., additional, Ordog, Tamas, additional, and Farrugia, Gianrico, additional

Published
2009
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