6 results on '"Srivastava, Sunita D."'
Search Results
2. Not hepatic infarction: Cold quadrate sign.
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Kuo, Anderson H., Srivastava, Sunita D., Harrington, Samantha G., and Hedgire, Sandeep S.
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UMBILICAL veins , *INFARCTION , *VENA cava superior , *LEG , *VENA cava inferior , *HEPATIC portal system - Abstract
A 50-year-old male presented with bilateral lower extremity plain is found to have a wedge-shape hypodense region in the hepatic quadrate lobe. The hypoenhancement was thought to be a result of systemic-portal venous shunting due to IVC obstruction, a "cold" version of the classically described hot quadrate sign. Follow-up CT confirmed the diagnosis. Venous drainage pathway for both hot and cold quadrate signs is discussed. • The quadrate lobe of the liver (Couinaud segment IVb) is a place of frequent systemic-portal venous shunting. • In hot quadrate lobe sign, early contrast opacification occurs via internal thoracic and umbilical vein flow. • Wash in of non-opacified blood via epigastric and umbilical veins may cause "cold quadrate lobe sign" in IVC obstruction. [ABSTRACT FROM AUTHOR]
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- 2020
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3. Effect of EVAR on International Ruptured AAA Mortality—Sex and Geographic Disparities.
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Png, C. Y. Maximilian, Pendleton, A. Alaska, Altreuther, Martin, Budtz-Lilly, Jacob W., Gunnarsson, Kim, Kan, Chung-Dann, Khashram, Manar, Laine, Matti T., Mani, Kevin, Pederson, Christian C., Srivastava, Sunita D., and Eagleton, Matthew J.
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ENDOVASCULAR aneurysm repair , *ENDOVASCULAR surgery , *ABDOMINAL aortic aneurysms , *MORTALITY , *DEATH rate - Abstract
Background: We sought to investigate the differential impact of EVAR (endovascular aneurysm repair) vis-à-vis OSR (open surgical repair) on ruptured AAA (abdominal aortic aneurysm) mortality by sex and geographically. Methods: We performed a retrospective study of administrative data on EVAR from state statistical agencies, vascular registries, and academic publications, as well as ruptured AAA mortality rates from the World Health Organization for 14 14 states across Australasia, East Asia, Europe, and North America. Results: Between 2011–2016, the proportion of treatment of ruptured AAAs by EVAR increased from 26.1 to 43.8 percent among females, and from 25.7 to 41.2 percent among males, and age-adjusted ruptured AAA mortality rates fell from 12.62 to 9.50 per million among females, and from 34.14 to 26.54 per million among males. The association of EVAR with reduced mortality was more than three times larger (2.2 vis-à-vis 0.6 percent of prevalence per 10 percentage point increase in EVAR) among females than males. The association of EVAR with reduced mortality was substantially larger (1.7 vis-à-vis 1.1 percent of prevalence per 10 percentage point increase in EVAR) among East Asian states than European+ states. Conclusions: The increasing adoption of EVAR coincided with a decrease in ruptured AAA mortality. The relationship between EVAR and mortality was more pronounced among females than males, and in East Asian than European+ states. Sex and ethnic heterogeneity should be further investigated. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Free Vascularized Fibula Graft with Femoral Allograft Sleeve for Lumbar SpineDefects After Spondylectomy of Malignant Tumors.
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Bongers, Michiel E. R., Shin, John H., Srivastava, Sunita D., Morse, Christopher R., Lee, Sang-Gil, and Schwab, Joseph H.
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FIBULA , *LUMBAR vertebrae , *SPINE diseases , *CHORDOMA , *SPINE - Abstract
Case: We present a 65-year-old man with an L4 conventional chordoma. Total en bloc spondylectomy (TES) of the involved vertebral bodies and surrounding soft tissues with reconstruction of the spine using a free vascularized fibula autograft (FVFG) is a proven technique, limiting complications and recurrence. However, graft fracture has occurred only in the lumbar spine in our institutional cases. We used a technique in our patient to ensure extra stability and support, with the addition of a femoral allograft sleeve encasing the FVFG. Conclusions: Our technique for the reconstruction of the lumbar spine after TES of primary malignant spinal disease using a femoral allograft sleeve encasing the FVFG is viable to consider. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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5. Development of machine learning and natural language processing algorithms for preoperative prediction and automated identification of intraoperative vascular injury in anterior lumbar spine surgery.
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Karhade, Aditya V., Bongers, Michiel E.R., Groot, Olivier Q., Cha, Thomas D., Doorly, Terence P., Fogel, Harold A., Hershman, Stuart H., Tobert, Daniel G., Srivastava, Sunita D., Bono, Christopher M., Kang, James D., Harris, Mitchel B., and Schwab, Joseph H.
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SPINAL surgery , *NATURAL language processing , *LUMBAR vertebrae , *MACHINE learning , *NOSOLOGY , *ALGORITHMS - Abstract
Background: Intraoperative vascular injury (VI) may be an unavoidable complication of anterior lumbar spine surgery; however, vascular injury has implications for quality and safety reporting as this intraoperative complication may result in serious bleeding, thrombosis, and postoperative stricture.Purpose: The purpose of this study was to (1) develop machine learning algorithms for preoperative prediction of VI and (2) develop natural language processing (NLP) algorithms for automated surveillance of intraoperative VI from free-text operative notes.Patient Sample: Adult patients, 18 years or age or older, undergoing anterior lumbar spine surgery at two academic and three community medical centers were included in this analysis.Outcome Measures: The primary outcome was unintended VI during anterior lumbar spine surgery.Methods: Manual review of free-text operative notes was used to identify patients who had unintended VI. The available population was split into training and testing cohorts. Five machine learning algorithms were developed for preoperative prediction of VI. An NLP algorithm was trained for automated detection of intraoperative VI from free-text operative notes. Performance of the NLP algorithm was compared to current procedural terminology and international classification of diseases codes.Results: In all, 1035 patients underwent anterior lumbar spine surgery and the rate of intraoperative VI was 7.2% (n=75). Variables used for preoperative prediction of VI were age, male sex, body mass index, diabetes, L4-L5 exposure, and surgery for infection (discitis, osteomyelitis). The best performing machine learning algorithm achieved c-statistic of 0.73 for preoperative prediction of VI (https://sorg-apps.shinyapps.io/lumbar_vascular_injury/). For automated detection of intraoperative VI from free-text notes, the NLP algorithm achieved c-statistic of 0.92. The NLP algorithm identified 18 of the 21 patients (sensitivity 0.86) who had a VI whereas current procedural terminologyand international classification of diseases codes identified 6 of the 21 (sensitivity 0.29) patients. At this threshold, the NLP algorithm had a specificity of 0.93, negative predictive value of 0.99, positive predictive value of 0.51, and F1-score of 0.64.Conclusion: Relying on administrative procedural and diagnosis codes may underestimate the rate of unintended intraoperative VI in anterior lumbar spine surgery. External and prospective validation of the algorithms presented here may improve quality and safety reporting. [ABSTRACT FROM AUTHOR]- Published
- 2021
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6. Outcomes of open and endovascular repair of Kommerell diverticulum.
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Bloom, Jordan P, Attia, Rizwan Q, Sundt, Thoralf M, Cameron, Duke E, Hedgire, Sandeep S, Bhatt, Ami B, Isselbacher, Eric M, Srivastava, Sunita D, Kwolek, Christopher J, Eagleton, Matthew J, Mohebali, Jahan, and Jassar, Arminder S
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ENDOVASCULAR surgery , *DIVERTICULUM , *SUBCLAVIAN artery , *THORACOTOMY , *DEGLUTITION disorders , *LENGTH of stay in hospitals , *AORTA - Abstract
Open in new tab Download slide Open in new tab Download slide OBJECTIVES Kommerell diverticulum (KD) is a rare congenital vascular anomaly often associated with an aberrant subclavian artery (ASCA). Definitive indications for intervention remain unclear. We present open and endovascular (EV) operative outcomes in a large contemporary series and propose a management algorithm. METHODS Between 2004 and 2020, 224 patients presented with ASCA and associated KD to our institution. Of the 43 (19.2%) patients who underwent operative repair, 31 (72.1%) had open surgical (OS) repair via thoracotomy and 12 (27.9%) had EV repair. Univariable and bivariable statistical analyses were conducted stratified by approach. The median follow-up time was 5.4 years (IQR, 2.9–9.7). RESULTS Patients in EV group were older (68 years vs 47 years, P < 0.001) and had larger aneurysms (base diameter 3.2 cm vs 21.5 cm, P = 0.007). All patients with dysphagia lusoria were treated with open surgery (n = 20). Asymptomatic patients with incidentally detected KD (50% vs 16.1%), those with chest or back pain (50% vs 19.4%) and patients who presented with an aortic emergency (25% vs 6.5%) were more likely to be treated endovascularly (P = 0.001). Carotid-to-subclavian bypass was used in 38 (88.4%) patients. There were no operative mortalities. In-hospital mortality was similar between groups (3.2% vs 16.7%, P = 0.121). Mid-term mortality was higher in the EV group [4 (33.8%) vs 0, P < 0.001]. There were 2 (15.4%) postoperative strokes in the EV group. There were no statistically significant differences in other postoperative complications or hospital length of stay between groups. CONCLUSIONS KD can be managed using open or EV approaches with low morbidity and mortality. Treatment strategy should depend on clinical presentation and patient factors. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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