Umut Sarpel, M.D.

Effect of intra-operative fluid volume on peri-operative outcomes after pancreaticoduodenectomy for pancreatic adenocarcinoma
Melis M; Marcon F; Masi A; Sarpel U; Miller G; Moore H; Cohen S; Berman R; Pachter HL; Newman E
2012 Jan;105(1):81-4 L, Journal of surgical oncology
BACKGROUND: Excess use of intravenous fluid can increase post-operative complications. We examined the influence of intra-operative crystalloid (IOC) administration on complications following pancreaticodudenectomy (PD) for pancreatic adenocarcinoma. METHODS: We categorized 188 patients who underwent PD for adenocarcinoma (1990-2009) into two groups: Group I received <6,000 ml and Group II received >/=6,000 ml IOC. Differences between groups in length of stay, overall morbidity, and 30-day mortality were evaluated. RESULTS: There were 86 patients in Group I and 102 in Group II. Group I patients were older and with higher percentage of women, but similar in regards to performance status, ASA score, underlying comorbidities, and administration of neo-adjuvant treatment. Group II patients had longer operations, increased blood loss, and higher rates of intra-operative blood transfusions. There were two post-operative deaths, both in the Group II (P = 0.5). Post-operative overall morbidity was 45.7%, without differences between the two groups (44.2% vs. 47.1%, P = 0.7). Likewise, length of post-operative stay was similar in both groups (13.8 days vs. 14.5 days, P = 0.5). CONCLUSIONS: The volume of IOC increased with duration of surgery, intra-operative blood losses, and intra-operative blood transfusion, but did not correlate with post-operative morbidity. J. Surg. Oncol (c) 2011 Wiley-Liss, Inc
— id: 136611, year: 2012, vol: 105, page: 81, stat: Journal Article,

The Moffitt prognostic model for prediction of survival after pancreaticoduodenectomy
Melis M.; Marcon F.; Masi A.; Sarpel U.; Miller G.; Moore H.; Cohen S.; Berman R.; Pachter H.L.; Newman E.
2011 ;18:S130-S130, Annals of surgical oncology
Background: The AJCC staging for pancreatic cancer is relatively non-discriminatory for prediction of survival after resection. At the Moffitt Cancer Center a prognostic score for patients with localized pancreatic cancer (AJCC <= IIb) has been developed. In the Moffitt Prognostic Index (MPI) patients are grouped in 5 risk categories on the basis of extra-pancreatic tumor extension, degree of differentiation and lymphatic invasion. The aim of this study is to assess the MPI's predictive value in an independent cohort of patients who underwent pancreaticoduodenectomy (PD) at the New York University. Methods From our retrospective pancreatic adenocarcinoma database of 248 patients, we identified and grouped by MPI category patients with AJCC stage <= IIb who underwent PD (1990-2009). Differences between groups were evaluated using ANOVA and chi-squared test. Overall survival (OS) for each group was estimated using the Kaplan-Meier method and compared using the log-rank statistic. Results Among 131 patients with stage Ia-IIb cancer, MPI could be calculated for 126 (96%). Only few patients fell in MPI lower-risk groups 1- 4 (respectively 1, 4, 3, 22), while the majority (96, 76.1%) fell in MPI group 5 (poor prognosis). The 5 groups were similar in demographics, underlying comorbidities, laboratory data, ASA score and ECOG performance status. There were no differences in operative time, blood loss, intra- and post-operative complications, length of stay, 30-day mortality. Pathology revealed more advanced stage in groups 3 to 5 (p=0.001). At mean follow-up of 18 months, there was no difference in median OS across MPI groups (respectively 19, 6, 16, 17, 12 months, p=0.91). Of note, AJCC staging did correlate with median OS (respectively 43, 12, 16, 11 months in stages Ia to IIb, p = 0.004). Conclusions In our experience the MPI performed worse than AJCC staging as a prognostic tool. The clustering of patients in the worst-prognosis group defied the very purpose of prognosis discrimination. Furthermore, in our experience MPI did not correlate with overall survival in patients undergoing DP for earlystage (<= IIb) pancreatic cancer
— id: 127250, year: 2011, vol: 18, page: S130, stat: Journal Article,

Safety of pancreaticoduodenectomy in patients older than 80 years: Risk vs. benefits
Melis M.; Marcon F.; Sarpel U.; Miller G.; Moore H.; Cohen S.; Berman R.; Pachter H.L.; Newman E.
2011 ;18:S101-S101, Annals of surgical oncology
Introduction: Surgery offers the only chance for cure in patients with pancreatic cancer. Currently, pancreaticoduodenectomy can be performed with a mortality of under 5% and a morbidity of 40-50%. Little, however, is known about outcomes of pancreaticoduodenectomy (PD) in octogenarians. This manuscript details outcomes after PD for adenocarcinoma in patients 80 years and older. Methods: From our comprehensive pancreatic adenocarcinoma database of 248 patients, we identified 200 patients who underwent PD (1990-2009). We categorized patients into two groups, according to age at time of surgery: Group I (>= 80 year-old) and Group II (< 80 year-old). The study end-points were length of post-operative stay (LOS), overall morbidity, 30-day mortality, overall survival (OS). Differences between groups were evaluated using t-test or chi-squared test. Survival was compared using Kaplan-Meier analysis and log-rank test. Results: There were 25 patients in group I (mean age 83.1) and 175 patients in Group II (mean age 64.4). Octogenarians had worse ECOG performance status (PS >= 1 in 90% vs. 50.8%, p < 0.01) and ASA score (ASA 3- 4 in 70.8% vs. 47.4%, p < 0.01). The two groups were similar in regard to underlying co-morbidities (including coronary artery disease, COPD, diabetes, chronic renal failure), operative time, rates of portal vein resection, intraoperative complications, blood loss, pathologic AJCC stage, status of resection margins. Octogenarians had longer LOS (20 vs. 13.7 days, p=0.01) and higher overall morbidity (68% vs. 44%, p=0.03). There was a single death in each group (p=0.23). At median follow-up of 13 months older patients had a median OS of 17.3 months compared to 13.1 months in younger patients (p=0.06). Conclusions: Surgical morbidity and LOS are significantly increased in octogenarians. However 30-day mortality was not significantly increased and OS was superior (but not statistically significant) when compared to younger patients. The decision for PD should be individualized and offered to carefully selected octogenarians
— id: 127249, year: 2011, vol: 18, page: S101, stat: Journal Article,

Multiple calcifying fibrous tumors: An incidental finding
Nair, Navya; Chen, Fan; Klimstra, David; Sarpel, Umut
2011 Sep;150(3):568-569, Surgery
— id: 136989, year: 2011, vol: 150, page: 568, stat: Journal Article,

Risk factors for early-onset and late-onset hepatocellular carcinoma in asian immigrants with hepatitis B in the United States
Wan, David W; Tzimas, Demetrios; Smith, Joshua A; Kim, Sunnie; Araujo, James; David, Ramoncito; Lobach, Iryna; Sarpel, Umut
2011 Nov;106(11):1994-2000, American journal of gastroenterology
OBJECTIVES: Routine screening for hepatocellular carcinoma (HCC) is recommended in chronic hepatitis B (HBV) patients with cirrhosis and select non-cirrhotic HBV populations including Asian males ages 40 and older and females ages 50 and older. However, many younger HBV patients develop HCC and there have been few studies examining this group. Additionally, studies of HCC in the Asian immigrant population in the United States have been limited. The objective of this study was to determine the associated risk factors for the development of early-onset (males and females under ages 40 and 50, respectively) and late-onset HCC in immigrants with chronic HBV in the United States. METHODS: Clinical, demographic, and laboratory data were retrospectively collected on all Asian immigrants with HBV at Bellevue Hospital Center from 2003 to 2009. Patients with HCC were identified within this cohort. Features of early-onset and late-onset HCC cases were compared with age-matched HBV controls without HCC. RESULTS: We identified 168 cases of HCC in Asians with HBV. In all, 74% (124/168) of cases were late-onset, and 26% (44/168) were early-onset. When comparing the 124 late-onset HCC cases with 199 age-matched HBV controls, gender (odds ratio (OR)=4.4; P<0.05) and cirrhosis (OR=9.6; P<0.05) or surrogate labs (i.e., platelets, international normalized ratio, total bilirubin, albumin) were found to be associated with HCC development. When comparing the 44 early-onset HCC cases with 432 age-matched HBV controls, family history of HCC (OR=2.7; P<0.05), and smoking history (OR=3.4; P<0.05) were independently associated risk factors in addition to gender (OR=2.7; P<0.05), and cirrhosis (OR=19.5; P<0.05) or surrogate labs. In all, 54.8% of late-onset HCC cases were cirrhotic and 29.5% of early-onset HCC cases were cirrhotic. CONCLUSIONS: HCC occurs in Asian immigrant HBV patients younger than currently recommended screening guidelines. A large majority of these early-onset patients did not have cirrhosis at the time of their HCC diagnosis; therefore, factors other than cirrhosis need to be considered when evaluating HCC risk in young patients. Factors associated with HCC development across all ages include cirrhosis and male gender, while family history and smoking history may identify younger Asian immigrant HBV patients at risk for HCC. Prospective validation, including cost-effectiveness evaluation, is necessary, but our results suggest that younger Asian HBV patients, especially those with a smoking history or family history of HCC, appear to have an increased risk for HCC and should be considered for enrollment in early screening programs regardless of their age
— id: 141069, year: 2011, vol: 106, page: 1994, stat: Journal Article,

Impact of socioeconomic status and sociodemographic factors on melanoma presentation among ethnic minorities
Wich, Lindsay G; Ma, Michelle W; Price, Leah S; Sidash, Stanislav; Berman, Russell S; Pavlick, Anna C; Miller, George; Sarpel, Umut; Goldberg, Judith D; Osman, Iman
2011 Jun;36(3):461-468, Journal of community health
Minority melanoma patients have worse survival. In this study, we evaluated the impact of socioeconomic and demographic factors on minority melanoma patients presenting to two different New York City hospitals (one public and one private) managed by the same multidisciplinary team. Sociodemographic and clinicopathologic characteristics were retrieved for melanoma patients presenting to Bellevue Hospital Center (BHC), a public hospital, and the New York University Cancer Institute (NYUCI), a private cancer center. Socioeconomic data was obtained from the United States Census Bureau database. The Kruskal-Wallis and chi-square tests were used to evaluate the associations between race/ethnicity and continuous and categorical variables (e.g. income, stage at presentation), respectively. Minorities comprised 2% (27/1296) of melanoma patients at the NYUCI compared to 42% (50/119) at BHC. Those presenting to the NYUCI were more likely to have a higher median household income (P = 0.05), a higher educational level (P = 0.04), and an earlier stage at presentation (P = 0.02) than those at BHC. NYUCI patients were predominantly covered by commercial insurance (70%), whereas Medicaid (62%) was common among BHC patients. Only 19% of Hispanic patients at BHC chose English as their preferred language. Our data demonstrate that language and health care system factors affect melanoma presentation in minorities
— id: 138281, year: 2011, vol: 36, page: 461, stat: Journal Article,

Hepatectomy for hepatocellular carcinoma complicated by vasculitis flare
Abdi, Zeinab; Krasnokutsky, Svetlana; Rapkiewicz, Amy; Saxena, Amit; Villanueva, Gerald; Sarpel, Umut
2010 ;2010:841754-841754, HPB surgery
Background. The hepatitis C virus is a major cause of hepatocellular carcinoma. Extrahepatic manifestations of hepatitis C include mixed cryoglobulinemia which can result in ischemic damage to multiple organs. The management of these sequelae in posthepatectomy patients is unclear. Case Report. A 49-year-old male with hepatitis C was found to have a 4 cm hepatocellular carcinoma on surveillance imaging. He underwent portal vein embolization followed by hepatectomy. His postoperative course was complicated by the development of splenic infarcts, small bowel ischemia, skin lesions, and liver damage. Findings of elevated cryocrit and elevated rheumatoid factor suggested the diagnosis of cryoglobulin-related vasculitis. The patient improved on supportive care. Conclusion. Cryoglobulinemia is associated with hepatitis C and may complicate the care of this patient population. The treatment of cryoglobulinemia posthepatectomy patients is complicated by concerns over how medications may affect the regenerating liver. Steroids should be used with caution in this setting. Summary. Brief report of hepatectomy complicated by vasculitis in the context of hepatocellular carcinoma secondary to hepatitis C addresses the management of mixed cryoglobulinemia in post-hepatectomy patients
— id: 112568, year: 2010, vol: 2010, page: 841754, stat: Journal Article,

Comparison of Early-Onset and Later-Onset Hepatocellular Carcinoma in Asian Patients With Hepatitis B in the United States: the Bellevue Experience
Wan, David W; Kim, Sunnie; Araujo, James L; Tzimas, Demetrios; Smith, Joshua A; David, Ramoncito; Lobach, Iryna; Sarpel, Umut
2010 ;138(5 Suppl 1):S809-S809 #S1884, Gastroenterology
— id: 109863, year: 2010, vol: 138, page: S809, stat: Journal Article,

Adenocarcinoma complicating restorative proctocolectomy for ulcerative colitis with mucosectomy performed by Cavitron Ultrasonic Surgical Aspirator(R)
Branco, B C; Sachar, D B; Heimann, T; Sarpel, U; Harpaz, N; Greenstein, A J
2009 May;11(4):428-429, Colorectal disease
This is a report of adenocarcinoma arising in an ileal pouch after restorative proctocolectomy (RPC) with rectal mucosal stripping performed by Cavitron Ultrasonic Surgical Aspirator (CUSA(R)) for ulcerative colitis. The CUSA(R) was introduced to simplify and optimize ileal pouch-anal anastomosis with mucosectomy and has been shown to shorten the operative time and reduce blood loss. Its use however, may increase the number of pathology specimens made uninterpretable on account of tissue ablation. In the present case, even though preoperative colonoscopy had clearly shown dysplasia, the surgical pathology report could not detect any neoplasia in the specimen; hence, the patient was not surveyed for pouch cancer. Six years later, the patient presented with intestinal obstruction due to cancer. While protocols for universal pouch surveillance remain somewhat controversial, we conclude on the basis of this case and a review of the literature that in RPC with mucosectomy performed by CUSA(R), pouch cancer surveillance is particularly important because remnants of rectal epithelium may have been left behind and tissue ablation may have made the surgical pathology report uninterpretable
— id: 80583, year: 2009, vol: 11, page: 428, stat: Journal Article,

Outcome for patients treated with laparoscopic versus open resection of hepatocellular carcinoma: case-matched analysis
Sarpel, U; Hefti, M M; Wisnievsky, J P; Roayaie, S; Schwartz, M E; Labow, D M
2009 Jun;16(6):1572-1577, Annals of surgical oncology
INTRODUCTION: This is a case-matched analysis of patients undergoing laparoscopic versus open hepatectomy for hepatocellular carcinoma (HCC), with specific regard to margin status and survival. METHODS: Laparoscopic cases were matched with open controls by cirrhosis and tumor size (within 10%). Data were evaluated by logistic regression using the generalized estimating equation method. Mixed linear regression models were used to assess operative duration in the groups. Overall and disease-free survival were compared using a Cox proportional frailty model. RESULTS: Twenty laparoscopic cases were matched to 56 open resections. Thirty patients (39%) developed recurrence and 13 patients (17%) died, including one (1.3%) death within 30 days. There were no significant differences in age, gender, cirrhosis or tumor size. Paired univariate and multivariate analyses showed cases of laparoscopic resection had similar rates of transfusion and positive margins compared with open resection. Operative duration was similar in laparoscopic (mean 161 +/- 37 min) and open (mean 165 +/- 53 min) groups. The adjusted odds of length of stay > or = 6 days was significantly lower in patients with laparoscopic resection [odds ratio (OR) = 0.07, 95% confidence interval (CI) = 0.02-0.27]. Both unadjusted and adjusted analyses showed no significant association between type of resection and overall or disease-free survival. DISCUSSION: Neither margin status, nor recurrence, nor survival was significantly different between the two cohorts. Laparoscopic resection for malignancy is safe, with a similar operative time as open hepatectomy. If tumor location is amenable, laparoscopic resection for HCC is a reasonable alternative to open resection with the added benefits of improved cosmesis and sooner discharge home
— id: 97998, year: 2009, vol: 16, page: 1572, stat: Journal Article,

Does Anatomic Versus Nonanatomic Resection Affect Recurrence and Survival in Patients Undergoing Surgery for Colorectal Liver Metastasis?
Sarpel, Umut; Bonavia, Anthony S; Grucela, Alexis; Roayaie, Sasan; Schwartz, Myron E; Labow, Daniel M
2009 Feb;16(2):379-384, Annals of surgical oncology
Anatomic resection of colorectal liver metastases may offer a survival advantage because (1) it removes the hepatic functional unit as a whole and (2) nonanatomic resection has been reported to have a higher incidence of positive margins.A retrospective review was performed of patients undergoing hepatic resection for colorectal liver metastases. 183 patients met inclusion criteria of undergoing either anatomic or nonanatomic resection with the aim of removing all gross disease. Mean age was 61 years (range 31-90 years), 57% were male. 89 patients (49%) underwent nonanatomic resection, the remaining 94 (51%) had anatomic resection. Average duration of inflow occlusion was 10 min. Average length of stay was 7.4 days. There were three deaths, yielding a 1.6% 30-day mortality rate. There was no difference in the incidence of positive margins between types of resection. Recurrence was 27%, 55%, and 59% at 1, 3, and 5 years respectively. Overall survival was 89%, 67%, and 55% at 1, 3, and 5 years, respectively. Type of resection was not associated with significant differences in recurrence or survival even when adjusted for differences in preoperative risk.We conclude that hepatic resection for colorectal metastases can be performed safely and offers select patients with stage IV disease prolonged survival. Resection type should be based on the number and location of tumors, rather than on segmental anatomy. An emphasis on the preservation of hepatic parenchyma may be of increasing importance in the setting of chemotherapy-associated steatohepatitis, and the growing number of patients undergoing repeated metastasectomy
— id: 91425, year: 2009, vol: 16, page: 379, stat: Journal Article,

Adenocarcinoma following ileal pouch-anal anastomosis for ulcerative colitis: Review of 26 cases
Branco, Bernardino C; Sachar, David B; Heimann, Tomas M; Sarpel, Umut; Harpaz, Noam; Greenstein, Adrian J
2008 Dec 9;15(2):295-299, Inflammatory bowel diseases
The occurrence of adenocarcinoma following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) is an infrequent and but potentially lethal complication. We have seen 1 such case among 520 IPAAs performed in our group practice between 1978 and February 2008. We have added this case to a review of 25 previously reported cases of adenocarcinoma of the pouch or outflow tract following IPAA for UC. Our conclusions are 1) that post-IPAA cancer can occur following either mucosectomy or stapled anastomosis; 2) that this malignancy can occur after IPAA performed for UC either with or without neoplasia; and 3) that this complication is seen whether or not the initial cancer or dysplasia had involved the rectum.(Inflamm Bowel Dis 2008)
— id: 91424, year: 2008, vol: 15, page: 295, stat: Journal Article,

Fact and fiction: debunking myths in the US healthcare system
Sarpel, Umut; Vladeck, Bruce C; Divino, Celia M; Klotman, Paul E
2008 Apr;247(4):563-569, Annals of surgery
The United States has the most expensive and complex healthcare system in the world. Despite the magnitude of funds spent on the system, Americans do not achieve the high standards of health seen in other developed countries. The current model of health insurance has failed to deliver efficient and effective healthcare. The administrative costs and lack of buying power that arise out of the existing multipayer system are at the root of the problem. The current system also directly contributes to the rising number of uninsured and underinsured Americans. This lack of insurance leads to poorer health outcomes, and a significant amount of money is lost into the system by paying for these complications. Experience from other countries suggests that tangible improvements can occur with conversion to a single-payer system. However, previous efforts at reform have stalled. There are many myths commonly held true by both patients and physicians. This inscrutability of the US healthcare system may be the major deterrent to its improvement. A discussion of these myths can lead to increased awareness of the inequality of our healthcare system and the possibilities for improvement
— id: 80577, year: 2008, vol: 247, page: 563, stat: Journal Article,

The role of fibrin sealants in hepatic surgery
Sarpel, Umut; Roayaie, Sasan; Schwartz, Myron E; Labow, Daniel M
2007 ;16:31-36, Surgical technology international
The repair of all tissue disruption begins with hemostasis and tissue sealing. Fibrin sealant is a concentrated mix of the factors required for the body to initiate this process. By applying this mixture directly to the site of injury, clotting and wound healing can be facilitated. Studies have demonstrated that fibrin sealant is effective in controlling bleeding and inducing tissue sealing in many organs. It is particularly useful in hepatobiliary surgery due to the soft nature of liver parenchyma and its propensity to bleed and leak bile. This chapter will discuss the basic science foundation of fibrin sealants and their applications in hepatic surgery
— id: 80569, year: 2007, vol: 16, page: 31, stat: Journal Article,

Liver transplantation for hepatocellular carcinoma
Sarpel, Umut; Schwartz, Myron
2007 Sep;37 Suppl 2:S264-S266, Hepatology research
Hepatocellular carcinoma can only be cured by physical removal or destruction of the tumor before it has spread. This can be accomplished by the ablation of the tumor, surgical resection of the tumor-bearing liver, or by liver transplantation. Ablation and resection can only be performed in patients who will be left with sufficient liver volume to sustain normal hepatic function. Unfortunately, the same disease that caused the HCC also limits the amount of parenchymal loss that can be tolerated by the patient. Liver transplantation is an appealing treatment option because it has the potential to cure patient of both the cancer and the predisposinig liver disease. Excellent survival rates are possible in patients with early HCC who receive a transplant, but dismal results are seen when patients with advanced tumors are transplanted.Wide criteria for transplant allow for more patients to be cured of HCC, but this comes at the expense of a greater overall recurrence rate. The acceptable recurrence rate is not a concrete number, but this is a function of donor organ availability. A 50% cure rate is viewed as an excellent outcome for many accepted cancer operations; however, in the case of transplant for HCC, this would represent a poor use of the scarce donor resource when the same liver offers a 70% 5-year survival rate to a non-HCC patient. These issues and methods retarding tumor progression while on the transplant waiting list are reviewed herein
— id: 80572, year: 2007, vol: 37 Suppl 2, page: S264, stat: Journal Article,

Establishing an international training program for surgical residents
Silverberg, Daniel; Wellner, Rachel; Arora, Shalini; Newell, Philippa; Ozao, Junko; Sarpel, Umut; Torrina, Philip; Wolfeld, Michael; Divino, Celia; Schwartz, Myron; Silver, Lester; Marin, Michael
2007 May-Jun;64(3):143-149, Journal of surgical education
— id: 80571, year: 2007, vol: 64, page: 143, stat: Journal Article,

Reduction of a large incarcerated rectal prolapse by use of an elastic compression wrap
Sarpel, Umut; Jacob, Brian P; Steinhagen, Randolph M
2005 Jun;48(6):1320-1322, Diseases of the colon & rectum
Reduction of a large rectal prolapse may be difficult because of significant edema that collects in the rectal tissues. If reduction is unsuccessful, an emergent laparotomy and internal reduction is required. A wide elastic wrap applied around the prolapsed rectum provides progressive compression, which reduces the amount of edema, allowing subsequent manual reduction. This novel technique is simple, safe, inexpensive, and can easily be performed in the emergency department setting. Manual reduction, by this or other described methods, should be attempted before emergent laparotomy for incarcerated rectal prolapse is performed
— id: 80551, year: 2005, vol: 48, page: 1320, stat: Journal Article,

Complete colorectal duplication
Sarpel, Umut; Le, Maithao N; Morotti, Raffaella A; Dolgin, Stephen E
2005 Feb;200(2):304-305, Journal of the American College of Surgeons
— id: 80550, year: 2005, vol: 200, page: 304, stat: Journal Article,

The incidence of complete androgen insensitivity in girls with inguinal hernias and assessment of screening by vaginal length measurement
Sarpel, Umut; Palmer, Shani K; Dolgin, Stephen E
2005 Jan;40(1):133-136, Journal of pediatric surgery
BACKGROUND/PURPOSE: Complete androgen insensitivity syndrome (CAIS) is a rare disorder; however, surgeons have noted a higher rate in girls with inguinal hernias. A few retrospective studies have estimated the incidence of CAIS to be 0.8% to 2.4% in girls with inguinal hernias. An inexpensive, quick screening method for this population has not been established. Because CAIS is associated with a short vagina, measuring vaginal length could serve this purpose if normal standards were known. The authors endeavored to (1) prospectively confirm the incidence of CAIS, (2) identify normal standards of vaginal length, and (3) assess the usefulness of measuring vaginal length to screen for CAIS in girls with inguinal hernias. METHODS: Vaginal lengths were measured in 270 girls with inguinal hernias at a university hospital from 1991 to 2003. A fallopian tube was identified to exclude CAIS. If CAIS was suspected, gonadal tissue was sampled and karyotyping was performed. Linear regression analysis was performed, and 95% confidence intervals were calculated for individual values. RESULTS: Normal vaginal length for age was established. Three patients were found to have significantly short vaginas: 2 were confirmed to have CAIS, 1 did not (false-positive). One other infant was proved to have CAIS despite having a normal vaginal length (false-negative). The incidence of CAIS in our study was 1.1% (3/270). CONCLUSIONS: This is the largest prospective study of the incidence of CAIS in girls with hernias. The authors found that 1.1% of premenstrual girls with inguinal hernias have this syndrome. The authors also provide standards for normal vaginal length in the pediatric population. Vaginal length increases predictably with age, and some patients with CAIS have significantly shorter vaginas. Vaginal length is not a perfect predictor of this disorder, but can be a useful adjunctive screening tool
— id: 80553, year: 2005, vol: 40, page: 133, stat: Journal Article,

The respiratory advantage of laparoscopic Nissen fundoplication
Powers, Colin J; Levitt, Marc A; Tantoco, Joselito; Rossman, Jon; Sarpel, Umut; Brisseau, Guy; Caty, Michael G; Glick, Philip L
2003 Jun;38(6):886-891, Journal of pediatric surgery
BACKGROUND/PURPOSE: Laparoscopic Nissen fundoplication is replacing the open approach in the treatment of children with gastroesophageal reflux. The postoperative respiratory advantages seem obvious but remain unproven. The authors hypothesized that laparoscopic Nissen fundoplication provides postoperative respiratory advantages in neurologically normal children as well as those with mental retardation or profound neurologic impairment. METHODS: The charts of all laparoscopic Nissen fundoplications over a 4-year period were reviewed. Sixty-one laparoscopic procedures were compared with the most recent 61 consecutive open Nissen fundoplications. The following variables were reviewed: age, weight, gender, preexisting comorbidities, operating time, postoperative pulmonary complications, and length of stay. Categorical data were compared for significance utilizing chi2 cross tabulation. Variables representing numerical data were compared by t test. RESULTS: Although there appeared to be a trend toward sicker patients in the open group, the laparoscopic group showed significantly improved rates of extubation, shorter recovery room stays, shorter durations of chest physiotherapy, fewer intensive care unit admissions, more rapid resumption of baseline feedings, and overall decreased length of stay (P < 0.05). Pulmonary benefits also were noted in the neurologically impaired population when analyzed separately. CONCLUSIONS: Laparoscopic Nissen fundoplication confers a definable benefit with a significant pulmonary advantage in both neurologically normal children and those with neurologic impairment
— id: 80530, year: 2003, vol: 38, page: 886, stat: Journal Article,