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7. Continuous Non-invasive finger cuff CareTaker® comparable to invasive intra-arterial pressure in patients undergoing major intra-abdominal surgery

Author

Gratz, Irwin, Deal, Edward, Spitz, Francis, Baruch, Martin, Allen, I Elaine, Seaman, Julia E, Pukenas, Erin, and Jean, Smith

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Cardiovascular, Patient Safety, Bioengineering, Clinical Research, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, Aged, Aged, 80 and over, Arterial Pressure, Blood Pressure Determination, Female, Humans, Male, Middle Aged, Monitoring, Intraoperative, Pilot Projects, CareTaker, Central blood pressure, Finger cuff, Intra-Arterial pressure, Non-Invasive, Medical Physiology, Anesthesiology, Clinical sciences
Abstract

BackgroundDespite increased interest in non-invasive arterial pressure monitoring, the majority of commercially available technologies have failed to satisfy the limits established for the validation of automatic arterial pressure monitoring by the Association for the Advancement of Medical Instrumentation (AAMI). According to the ANSI/AAMI/ISO 81060-2:2013 standards, the group-average accuracy and precision are defined as acceptable if bias is not greater than 5 mmHg and standard deviation is not greater than 8 mmHg. In this study, these standards are used to evaluate the CareTaker® (CT) device, a device measuring continuous non-invasive blood pressure via a pulse contour algorithm called Pulse Decomposition Analysis.MethodsA convenience sample of 24 patients scheduled for major abdominal surgery were consented to participate in this IRB approved pilot study. Each patient was monitored with a radial arterial catheter and CT using a finger cuff applied to the contralateral thumb. Hemodynamic variables were measured and analyzed from both devices for the first thirty minutes of the surgical procedure including the induction of anesthesia. The mean arterial pressure (MAP), systolic and diastolic blood pressures continuously collected from the arterial catheter and CT were compared. Pearson correlation coefficients were calculated between arterial catheter and CT blood pressure measurements, a Bland-Altman analysis, and polar and 4Q plots were created.ResultsThe correlation of systolic, diastolic, and mean arterial pressures were 0.92, 0.86, 0.91, respectively (p

Published
2017

13. Intraperitoneal Photodynamic Therapy Causes a Capillary-Leak Syndrome

Author

Canter, Robert J, Mick, Rosemarie, Kesmodel, Susan B, Raz, Dan J, Spitz, Francis R, Metz, James M, Glatstein, Eli J, Hahn, Stephen M, and Fraker, Douglas L

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Lung, Rare Diseases, Patient Safety, Clinical Research, Cancer, Good Health and Well Being, Adult, Capillary Leak Syndrome, Female, Humans, Infusions, Parenteral, Intensive Care Units, Male, Middle Aged, Peritoneal Neoplasms, Photochemotherapy, Respiration, Artificial, Retrospective Studies, Treatment Outcome, photodynamic therapy, carcinomatosis, sarcomatosis, capillary-leak syndrome, Oncology and Carcinogenesis, Oncology & Carcinogenesis, Oncology and carcinogenesis
Abstract

BackgroundIn patients undergoing intraperitoneal (IP) photodynamic therapy (PDT), the combination of aggressive surgical debulking and light therapy causes an apparent systemic capillary-leak syndrome that necessitates significant intensive care unit (ICU) management after surgery.MethodsFrom May 1997 to May 2001, 65 patients underwent surgical debulking and PDT as part of an ongoing phase II trial for disseminated IP cancer. Perioperative data were reviewed retrospectively, and statistical analyses were performed to determine whether any identifiable factors were associated with the need for mechanical ventilation for longer than 1 day and with the occurrence of postoperative complications.ResultsForty-three women and 22 men (mean age, 49 years) were treated. Operative time averaged 9.8 hours, and mean estimated blood loss was 1450 mL. The mean crystalloid requirement for the first 48 hours after surgery was 29.3 L, and 49 patients required blood products. Twenty-four patients were intubated for longer than 24 hours, with a mean of 8.3 days for those intubated longer than 1 day. The median ICU stay was 4 days. Overall, 110 complications developed in 45 (69%) of the 65 patients. Significant complications included 6 patients with acute respiratory distress syndrome, 28 patients with infectious complications, and 4 patients with anastomotic complications. Statistical analyses revealed that surgery-related factors were significantly associated with these complication outcomes.ConclusionsPatients who undergo surgical debulking and IP PDT develop a significant capillary-leak syndrome after surgery that necessitates massive volume resuscitation, careful ICU monitoring, and, frequently, prolonged ventilatory support.

Published
2003

14. Supplementary Figure 5 from Targeting HER-2/neu in Early Breast Cancer Development Using Dendritic Cells with Staged Interleukin-12 Burst Secretion

Author

Czerniecki, Brian J., primary, Koski, Gary K., primary, Koldovsky, Ursula, primary, Xu, Shuwen, primary, Cohen, Peter A., primary, Mick, Rosemarie, primary, Nisenbaum, Harvey, primary, Pasha, Terry, primary, Xu, Min, primary, Fox, Kevin R., primary, Weinstein, Susan, primary, Orel, Susan G., primary, Vonderheide, Robert, primary, Coukos, George, primary, DeMichele, Angela, primary, Araujo, Louis, primary, Spitz, Francis R., primary, Rosen, Mark, primary, Levine, Bruce L., primary, June, Carl, primary, and Zhang, Paul J., primary

Published
2023
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15. Supplementary Table 1 from Targeting HER-2/neu in Early Breast Cancer Development Using Dendritic Cells with Staged Interleukin-12 Burst Secretion

Author

Czerniecki, Brian J., primary, Koski, Gary K., primary, Koldovsky, Ursula, primary, Xu, Shuwen, primary, Cohen, Peter A., primary, Mick, Rosemarie, primary, Nisenbaum, Harvey, primary, Pasha, Terry, primary, Xu, Min, primary, Fox, Kevin R., primary, Weinstein, Susan, primary, Orel, Susan G., primary, Vonderheide, Robert, primary, Coukos, George, primary, DeMichele, Angela, primary, Araujo, Louis, primary, Spitz, Francis R., primary, Rosen, Mark, primary, Levine, Bruce L., primary, June, Carl, primary, and Zhang, Paul J., primary

Published
2023
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16. Supplementary Figure 4 from Targeting HER-2/neu in Early Breast Cancer Development Using Dendritic Cells with Staged Interleukin-12 Burst Secretion

Author

Czerniecki, Brian J., primary, Koski, Gary K., primary, Koldovsky, Ursula, primary, Xu, Shuwen, primary, Cohen, Peter A., primary, Mick, Rosemarie, primary, Nisenbaum, Harvey, primary, Pasha, Terry, primary, Xu, Min, primary, Fox, Kevin R., primary, Weinstein, Susan, primary, Orel, Susan G., primary, Vonderheide, Robert, primary, Coukos, George, primary, DeMichele, Angela, primary, Araujo, Louis, primary, Spitz, Francis R., primary, Rosen, Mark, primary, Levine, Bruce L., primary, June, Carl, primary, and Zhang, Paul J., primary

Published
2023
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17. Supplementary Figure 2 from Targeting HER-2/neu in Early Breast Cancer Development Using Dendritic Cells with Staged Interleukin-12 Burst Secretion

Author

Czerniecki, Brian J., primary, Koski, Gary K., primary, Koldovsky, Ursula, primary, Xu, Shuwen, primary, Cohen, Peter A., primary, Mick, Rosemarie, primary, Nisenbaum, Harvey, primary, Pasha, Terry, primary, Xu, Min, primary, Fox, Kevin R., primary, Weinstein, Susan, primary, Orel, Susan G., primary, Vonderheide, Robert, primary, Coukos, George, primary, DeMichele, Angela, primary, Araujo, Louis, primary, Spitz, Francis R., primary, Rosen, Mark, primary, Levine, Bruce L., primary, June, Carl, primary, and Zhang, Paul J., primary

Published
2023
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18. Data from Targeting HER-2/neu in Early Breast Cancer Development Using Dendritic Cells with Staged Interleukin-12 Burst Secretion

Author

Czerniecki, Brian J., primary, Koski, Gary K., primary, Koldovsky, Ursula, primary, Xu, Shuwen, primary, Cohen, Peter A., primary, Mick, Rosemarie, primary, Nisenbaum, Harvey, primary, Pasha, Terry, primary, Xu, Min, primary, Fox, Kevin R., primary, Weinstein, Susan, primary, Orel, Susan G., primary, Vonderheide, Robert, primary, Coukos, George, primary, DeMichele, Angela, primary, Araujo, Louis, primary, Spitz, Francis R., primary, Rosen, Mark, primary, Levine, Bruce L., primary, June, Carl, primary, and Zhang, Paul J., primary

Published
2023
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21. Gastric Neuroendocrine Tumor Treatment and Survival Outcome Depends on Facility Type

Author

Platoff, Rebecca M., Lou, Johanna, Bush, Kathryn, Zhu, Clara, Spitz, Elizabeth, Gaughan, John P., Atabek, Umur, Spitz, Francis, and Hong, Young K

Abstract

Background Gastric neuroendocrine tumors (gNETs) are rare cancers for which surgery may improve survival. We aim to determine if facility type affects treatment and survival outcomes.Methods The NCDB was queried for patients with gNET from 2004-2016 and stratified into Academic/Research Program (ARP), Community Cancer Program (CCP), Comprehensive Community Cancer Program (CCCP), or Integrated Network Cancer Program (INCP). Overall survival along with clinical and demographic features was compared.Results Median survival was improved in patients treated at an academic program: 137.3 months versus 88.0, 96.3, and 100.2 for CCP, CCCP, INCP, respectively (P < .0001). Patients treated at academic centers were more likely to have surgery (64.2% vs 59.1%, 57.5%, 51.4%, P < .0001). After propensity matching for age, race, grade, stage, insurance status, and comorbidity score, survival benefit from treatment at an academic center remained (P = .03), particularly for patients undergoing surgery (P < .0001) and chemotherapy (P = .04).Conclusion Patients with gNET treated at an academic hospital had improved median survival after propensity matching and may benefit from treatment at academic rather than community medical centers.

Published
2023
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26. Strategies for Gene Therapy

Author

Choi, Eugene A., Spitz, Francis R., Pollock, Raphael E., Evans, Douglas B., editor, Pisters, Peter W. T., editor, and Abbruzzese, James L., editor

Published
2002
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30. Hepatocellular-Cholangiocarcinoma Collision Tumors: An Update of Current Management Practices

Author

Goodwin, Brandon, Lou, Johanna, Butchy, Margaret, Wilson, Traeden, Atabek, Umur, Spitz, Francis, and Hong, Young

Abstract

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare form of primary hepatic collision tumor, with an incidence ranging from 0.4 to 14.2%. Given the diagnostic challenges and lack of randomized trials, standardized treatment has yet to be established. We aim to review the literature to summarize the diagnosis, molecular characteristics, current treatment modalities, and challenges for cHCC-CC. A literature review was performed using PubMed. We included studies investigating and describing cHCC-CC, focusing on surgical, medical, and radiologic treatments. Overall prognosis is poor, with a 5-year survival rate under 30%. Minor or major hepatectomy with R0 resection is the only curative treatment; however, recurrence is likely (as high as 50% within 5 years). The role of liver transplantation is also highly debated given the biliary nature of these tumors, with cHCC-CC as a relative contraindication for liver transplantation. Although gemcitabine-based treatments had higher progression-free survival over sorafenib, there is no standard chemotherapy regimen. Treatment with gemcitabine and platinum demonstrates improved disease control rates compared to gemcitabine in conjunction with 5-fluorouracil (78.4% verse 38.5% respectively). Additionally, platinum-containing chemotherapy regimens exhibit a higher overall response rate than non-platinum regimens (21.4% verse 7.0% respectively). These molecular-directed therapies have prolonged survival for HCC, but further investigation needs to be done to assess their utility in patients with cHCC-CC. cHCC-CC is a rare and complex subset of primary hepatic neoplasms with a dismal prognosis and unstandardized treatment options. Further trials need to be performed to investigate systemic chemotherapy and immunotherapy options for patients with unresectable disease.

Published
2023
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32. What to do When Decompressive Gastrostomies and Jejunostomies are not Options? A Scoping Review of Transesophageal Gastrostomy Tubes for Advanced Malignancies

Author

Zhu, Clara, primary, Platoff, Rebecca, additional, Ghobrial, Gaby, additional, Saddemi, Jackson, additional, Evangelisti, Taylor, additional, Bucher, Emily, additional, Saracco, Benjamin, additional, Adams, Amanda, additional, Kripalani, Simran, additional, Atabek, Umur, additional, Spitz, Francis R., additional, and Hong, Young K., additional

Published
2021
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33. ASO Visual Abstract: What To Do When Decompressive Gastrostomies and Jejunostomies Are Not Options? A Scoping Review of Transesophageal Gastrostomy Tubes for Advanced Malignancies

Author

Zhu, Clara, primary, Platoff, Rebecca, additional, Ghobrial, Gaby, additional, Saddemi, Jackson, additional, Evangelisti, Taylor, additional, Bucher, Emily, additional, Saracco, Benjamin, additional, Adams, Amanda, additional, Kripalani, Simran, additional, Atabek, Umur, additional, Spitz, Francis R., additional, and Hong, Young, additional

Published
2021
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35. Cost-Benefit Analysis of Robotic vs. Laparoscopic Hepatectomy: A Propensity-Matched Retrospective Cohort Study of American College of Surgeons National Surgical Quality Improvement Program Database

Author

Miller, Henry P., Hakim, Abraham, Kellish, Alec, Wozniak, Marisa, Gaughan, John, Sensenig, Richard, Atabek, Umur M., Spitz, Francis R., and Hong, Young K.

Abstract

Background Robotic and laparoscopic hepatectomies having increased utilization as minimally invasive techniques are explored for hepatobiliary malignancies. Although the data on outcomes from these 2 approaches are emerging, the cost-benefit analysis of these approaches remains sparse. This study compares the costs associated with robotic vs. laparoscopic liver resections, taking into account 30-day complications.Methods Using the American College of Surgeons National Surgical Quality Improvement Program database, a propensity-matched cohort of patients with laparoscopic or robotic liver resections between 2014 and 2017 was identified. Costs were assigned to perioperative variables, including operating room (OR) time, length of stay, blood transfusions, and 30-day complications. Cost estimates were obtained from the Centers for Medicare and Medicaid Services billing data (2017), American Hospital Association data (2017), relevant literature, and local institutional cost data.Results In our matched cohort of 454 patients (227 per group), total costs associated with laparoscopic liver resections were estimated at $5.5 M ($24 K per patient) vs. $6.8 M ($29.8 K per patient) for robotic liver resections (21.3% difference, P< .001). The higher cost associated with robotic hepatectomies was related to blood transfusions ($22.0 K vs. $12.1 K, P= .02), length of stay ($2.05 M vs. $1.76 M, P= .046), and OR time ($4.01 M vs. $3.24 M, P< .0001).Discussion Robotic hepatectomies were associated with higher costs compared to laparoscopic hepatectomies. The 2 major contributors to the cost disparity were increased OR time and increased length of stay. Future studies are warranted to analyze high-volume Minimally Invasive Surgery surgeons’ impact in specialty centers on potentially mitigating this current cost disparity.

Published
2022
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38. Cost-Benefit Analysis of Robotic vs. Laparoscopic Hepatectomy: A Propensity-Matched Retrospective Cohort Study of American College of Surgeons National Surgical Quality Improvement Program Database

Author

Miller, Henry P., primary, Hakim, Abraham, additional, Kellish, Alec, additional, Wozniak, Marisa, additional, Gaughan, John, additional, Sensenig, Richard, additional, Atabek, Umur M., additional, Spitz, Francis R., additional, and Hong, Young K., additional

Published
2021
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43. The Role of Neoadjuvant Versus Adjuvant Therapy for Duodenal Adenocarcinoma: A National Cancer Database Propensity Score Matched Analysis

Author

Linden, Kimberly, primary, Melillo, Atlee, additional, Gaughan, John, additional, Obinero, Chioma, additional, Kellish, Alec, additional, Wozniak, Marisa R., additional, Patel, Raj M., additional, Pandya, Vidish, additional, Atabek, Umur, additional, Spitz, Francis, additional, and Hong, Young K., additional

Published
2020
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