Robert J Weil

Geisinger Health System, Danville, Pennsylvania, United States

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Publications (231)1040.43 Total impact

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    ABSTRACT: We review the etiology, investigations, management and outcomes of pituitary tumor apoplexy. Pituitary tumor apoplexy is a clinical syndrome which typically includes the acute onset of headache and/or visual disturbance, cranial nerve palsy and partial or complete endocrine dysfunction. It is associated with either infarction or hemorrhage of a pre-existing pituitary adenoma and is associated with significant morbidity and potential fatality. Not all patients will present with classic signs and symptoms, therefore it is pertinent to appreciate the clinical spectrum in which this condition can present. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Clinical Neuroscience 03/2015; DOI:10.1016/j.jocn.2014.11.023 · 1.32 Impact Factor
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    ABSTRACT: Background Cushing disease (CD) is usually associated with alterations in body mass index. Successful pituitary surgery can result in long term remission with sustained weight loss. We wished to determine rates of body weight changes (in the post-operative period within 6 months) in patients with active CD who underwent transsphenoidal surgery and the relationship of weight loss to remission status Methods Clinical data was obtained from a CD database in addition to the online patient medical record. All patients with biochemically confirmed active CD underwent their first transsphenoidal surgery (TSS) by a single neurosurgeon (RJW) at the Cleveland Clinic between October 2004 and August 2013. None of the patients received glucocorticoids during surgery. Initial remission was defined by nadir cortisol <5 µg/dl, ACTH <5 pg/ml within the immediate post-operative period (72 hrs). Long term remission was defined as 24 hr UFC < ULN (upper limit of normal), and/or sequential midnight salivary cortisols <ULN, and 1mg DST cortisol <1.8 µg/dl. Statistical analyses wer performed using SAS software (Version 9.2;Cary, NC). Results Data was available for 88 patients (F:63,M:25), mean age at presentation was 47 years (range 24-87 years), median follow up 52 months (12-118 months). No significant differences in baseline demographics including pituitary adenoma size (p=0.25) and BMI (p=0.21) were observed between the two groups. 64 had no visible tumor or pituitary microadenoma, 24 were macroadenoma, 74 (84%) patients had initial remission after surgery, during follow up 6 of those with initial remission had recurrence of CS. Those with initial remission had greater mean ± SD weight loss at 3 months (kg:-8.1 ± 11.3 [initial remission, n=59] v 0.8 ± 8.8 [non-remission, n=12], p=0.007) and at 6 months (kg:-14.5 ± 12.1 [initial remission, n=46] v -6.1 ± 12.1 [non-remission, n=12], p=0.045). There was evidence that less weight loss or weight gain at three (p=0.002) and six (p=0.014) months was associated with increased risk of relapse. Conclusions After transsphenoidal surgery for CD, weight loss within the first six months is an additional early clinical indicator associated with initial biochemical remission.
    Endo 2015 The Endocrine Society 97th Annual Meeting and Expo, San Diego Califormia USA; 03/2015
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    ABSTRACT: Cerebrospinal fluid shunt infection is associated with patient morbidity and high cost. We conducted a systematic review of the current evidence of comprehensive surgical protocols or individual interventions designed to reduce shunt infection incidence. A systematic review using PubMed and SCOPUS identified studies evaluating the effect of a particular intervention on shunt infection risk. Systemic prophylactic antibiotic or antibiotic-impregnated shunt efficacy studies were excluded. A total of 7429 articles were screened and 23 articles were included. Eight studies evaluated the effect of comprehensive surgical protocols. Shunt infection was reduced in all studies (absolute risk reduction 2.2-12.3 %). Level of evidence was low (level 4 in seven studies) due to the use of historical controls. Compliance ranged from 24.6 to 74.5 %. Surgical scrub with antiseptic foam and omission of a 5 % chlorhexidine gluconate preoperative hair wash were both associated with increased shunt infection. Twelve studies evaluated the effect of a single intervention. Only antibiotic-impregnated suture, a no-shave policy, and double gloving with glove change prior to shunt handling, were associated with a significant reduction in shunt infection. In a hospital with high methicillin-resistant staphylococcus aureus (MRSA) prevalence, a randomized controlled trial found that perioperative vancomycin rather than cefazolin significantly reduced shunt infection rates. Despite wide variation in compliance rates, the implementation of comprehensive surgical protocols reduced shunt infection in all published studies. Antibiotic-impregnated suture, a no-shave policy, double gloving with glove change prior to device manipulation, and 5 % chlorhexidine hair wash were associated with significant reductions in shunt infection.
    Child s Nervous System 02/2015; 31(4). DOI:10.1007/s00381-015-2637-2 · 1.16 Impact Factor
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    ABSTRACT: Premature mortality is a public health concern that can be quantified as years of potential life lost (YPLL). Studying premature mortality from in-hospital mortality can help guide hospital initiatives and resource allocation. This paper identified the diagnosis categories associated with in-hospital deaths that account for the highest YPLL and their trends over time. Retrospective review of the Nationwide Inpatient Sample (NIS), 1988-2010. Using the NIS, YPLL on patients hospitalized in the United States from 1988 to 2010 was calculated. Hospitalizations were categorized by related principal diagnoses using the Healthcare Cost and Utilization Project (HCUP) single-level Clinical Classification Software (CCS) definitions. Between 1988 and 2010, total in-hospital estimated mortality of 20,154,186 people accounted for 198,417,257 YPLL (9.84 YPLL per in-hospital mortality; 8,626,837 estimated annual mean YPLL). The ten highest YPLL diagnosis categories accounted for 51% of the overall YPLL. The liveborn disease category (i.e., in-hospital live births) was the most common principal diagnosis and accounted for the highest YPLL at 1,070,053. The septicemia category accounted for the second highest YPLL at 548,922. The highest in-hospital mortality rate (20.8%) was associated with adult respiratory failure/insufficiency/arrest. The highest estimated in-hospital annual mean deaths occurred in patients with pneumonia at 69,134. For all in-hospital mortality, the inflation adjusted total in-hospital charges per YPLL was highest for acute myocardial infarction at $9292 per YPLL. Using YPLL, a framework has been provided to compare the impact of premature in-hospital mortality from dissimilar diseases. The methodology and results may be used to help guide further investigation of hospital quality initiatives and resource allocation. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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    ABSTRACT: OBJECT The authors assessed the feasibility of intraoperative radiotherapy (IORT) using a portable radiation source to treat newly diagnosed, surgically resected, solitary brain metastasis (BrM). METHODS In a nonrandomized prospective study, 23 patients with histologically confirmed BrM were treated with an Intrabeam device that delivered 14 Gy to a 2-mm depth to the resection cavity during surgery. RESULTS In a 5-year minimum follow-up period, progression-free survival from the time of surgery with simultaneous IORT averaged (± SD) 22 ± 33 months (range 1-96 months), with survival from the time of BrM treatment with surgery+IORT of 30 ± 32 months (range 1-96 months) and overall survival from the time of first cancer diagnosis of 71 ± 64 months (range 4-197 months). For the Graded Prognostic Assessment (GPA), patients with a score of 1.5-2.0 (n = 12) had an average posttreatment survival of 21 ± 26 months (range 1-96 months), those with a score of 2.5-3.0 (n = 7) had an average posttreatment survival of 52 ± 40 months (range 5-94 months), and those with a score of 3.5-4.0 (n = 4) had an average posttreatment survival of 17 ± 12 months (range 4-28 months). A BrM at the treatment site recurred in 7 patients 9 ± 6 months posttreatment, and 5 patients had new but distant BrM 17 ± 3 months after surgery+IORT. Six patients later received whole-brain radiation therapy, 7 patients received radiosurgery, and 2 patients received both treatments. The median Karnofsky Performance Scale scores before and 1 and 3 months after surgery were 80, 90, and 90, respectively; at the time of this writing, 3 patients remain alive with a CNS progression-free survival of > 90 months without additional BrM treatment. CONCLUSIONS The results of this study demonstrate the feasibility of resection combined with IORT at a dose of 14 Gy to a 2-mm peripheral margin to treat a solitary BrM. Local control, distant control, and long-term survival were comparable to those of other commonly used modalities. Surgery combined with IORT seems to be a potential adjunct to patient treatment for CNS involvement by systemic cancer.
    Journal of Neurosurgery 01/2015; DOI:10.3171/2014.11.JNS1449 · 3.23 Impact Factor
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    ABSTRACT: Surgery followed by adjuvant radiotherapy is a well-established treatment paradigm for brain metastases. To examine the effect of postsurgical whole-brain radiotherapy (WBRT) or localized radiotherapy (LRT), including stereotactic radiosurgery and intraoperative radiotherapy, on the rate of recurrence both local and distal to the resection site in the treatment of brain metastases. We retrospectively identified patients who underwent surgery for brain metastasis at the Cleveland Clinic between 2004 and 2012. Institutional review board-approved chart review was conducted, and patients who had radiation before surgery, who had nonmetastatic lesions, or who lacked postadjuvant imaging were excluded. The final analysis included 212 patients. One hundred fifty-six patients received WBRT, 37 received stereotactic radiosurgery only, and 19 received intraoperative radiotherapy. One hundred forty-six patients were deceased, of whom 60 (41%) died with no evidence of recurrence. Competing risks methodology was used to test the association between adjuvant modality and progression. Multivariable analysis revealed no significant difference in the rate of recurrence at the resection site (hazard ratio [HR] 1.46, P = .26) or of unresected, radiotherapy-treated lesions (HR 1.70, P = .41) for LRT vs WBRT. Patients treated with LRT had an increased hazard of the development of new lesions (HR 2.41, P < .001) and leptomeningeal disease (HR 2.45, P = .04). Median survival was 16.5 months and was not significantly different between groups. LRT as adjuvant treatment to surgical resection of brain metastases is associated with an increased rate of development of new distant metastases and leptomeningeal disease compared with WBRT, but not with recurrence at the resection site or of unresected lesions treated with radiation. BM, brain metastasisIORT, intraoperative radiotherapyLMD, leptomeningeal diseaseLRT, localized radiotherapySRS, stereotactic radiosurgeryWBRT, whole-brain radiotherapy.
    Neurosurgery 01/2015; DOI:10.1227/NEU.0000000000000626 · 3.03 Impact Factor
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    ABSTRACT: Purpose The Acromegaly Consensus Group recently released updated guidelines for medical management of acromegaly patients. We subjected these guidelines to a cost analysis. Methods We conducted a cost analysis of the recommendations based on published efficacy rates as well as publicly available cost data. The results were compared to findings from a previously reported comparative effectiveness analysis of acromegaly treatments. Using decision tree software, two models were created based on the Acromegaly Consensus Group’s recommendations and the comparative effectiveness analysis. The decision tree for the Consensus Group’s recommendations was subjected to multi-way tornado analysis to identify variables that most impacted the value analysis of the decision tree. Results The value analysis confirmed the Consensus Group’s recommendations of somatostatin analogs as first line therapy for medical management. Our model also demonstrated significant value in using dopamine agonist agents as upfront therapy as well. Sensitivity analysis identified the cost of somatostatin analogs and growth hormone receptor antagonists as having the most significant impact on the cost effectiveness of medical therapies. Conclusion Our analysis confirmed the value of surgery as first-line therapy for patients with surgically accessible lesions. Surgery provides the greatest value for management of patients with acromegaly. However, in accordance with the Acromegaly Consensus Group’s recent recommendations, somatostatin analogs provide the greatest value and should be used as first-line therapy for patients who cannot be managed surgically. At present, the substantial cost is the most significant negative factor in the value of medical therapies for acromegaly.
    Pituitary 01/2015; DOI:10.1007/s11102-014-0626-1 · 2.22 Impact Factor
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    ABSTRACT: A 54-year-old woman presented with bi-temporal hemianopia, palpitations, and diaphoresis. An invasive pituitary macroadenoma was discovered. The patient had biochemical evidence of secondary hyperthyroidism and GH excess; however, she did not appear to be acromegalic. Surgical removal of the pituitary mass revealed a plurihormonal TSH/GH co-secreting pituitary adenoma. TSH-secreting adenomas can co-secrete other hormones including GH, prolactin, and gonadotropins; conversely, co-secretion of TSH from a pituitary adenoma in acromegaly is infrequent. This case highlights an unusual patient with a rare TSH/GH co-secreting pituitary adenoma with absence of the clinical features of acromegaly.Plurihormonality does not always translate into the clinical features of hormonal excess.There appears to be a clinical and immunohistochemical spectrum present in plurihormonal tumors.
    01/2015; 2015:140070. DOI:10.1530/EDM-14-0070
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    ABSTRACT: Premature mortality is a public health concern that can be quantified as years of potential life lost (YPLL). Studying premature mortality can help guide hospital initiatives and resource allocation. We investigated the categories of neurologic and neurosurgical conditions associated with in-hospital deaths that account for the highest YPLL and their trends over time. Using the Nationwide Inpatient Sample (NIS), we calculated YPLL for patients hospitalized in the USA from 1988 to 2011. Hospitalizations were categorized by related neurologic principal diagnoses. An estimated 2,355,673 in-hospital deaths accounted for an estimated 25,598,566 YPLL. The traumatic brain injury (TBI) category accounted for the highest annual mean YPLL at 361,748 (33.9% of total neurologic YPLL). Intracerebral hemorrhage, cerebral ischemia, subarachnoid hemorrhage, and anoxic brain damage completed the group of five diagnoses with the highest YPLL. TBI accounted for 12.1% of all inflation adjusted neurologic hospital charges and 22.4% of inflation adjusted charges among neurologic deaths. The in-hospital mortality rate has been stable or decreasing for all of these diagnoses except TBI, which rose from 5.1% in 1988 to 7.8% in 2011. Using YPLL, we provide a framework to compare the burden of premature in-hospital mortality on patients with neurologic disorders, which may prove useful for informing decisions related to allocation of health resources or research funding. Considering premature mortality alone, increased efforts should be focused on TBI, particularly in and related to the hospital setting.
    Journal of Clinical Neuroscience 11/2014; DOI:10.1016/j.jocn.2014.05.006 · 1.32 Impact Factor
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    ABSTRACT: Retrospective analysis of the Nationwide Inpatient Sample (NIS), 2005-2011.
    Journal of Spinal Disorders & Techniques 10/2014; DOI:10.1097/BSD.0000000000000207 · 1.89 Impact Factor
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    ABSTRACT: Background: The association between clinician- and patient-reported health status measures (HSM) after hemicraniectomy for ischemic stroke is understudied. We compared HSMs to determine how HSM type and follow-up affect the interpretation of outcomes. Methods: We identified patients that underwent hemicraniectomy for ischemic stroke at the Cleveland Clinic (CC) from January 2009 through May 2013. HSMs were obtained from the CC Knowledge Program Data Registry. Outpatient follow-up was divided into "Early" (3 +/- 2 months (standard deviation)) and "Late" (9 +/- 3 months) time periods. Clinician-reported HSMs (National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS)) were compared to patient-reported HSMs (EuroQol quality of life index (EQ-5D), Patient Health Questionnaire-9 (PHQ-9), and the Stroke Impact Scale-16 (SIS-16)). Results: 11 of 32 patients completed all HSMs during both follow-up periods. Clinician-reported median NIHSS scores improved from 12 to 7 (p = 0.003). Median mRS scores demonstrated little improvement from 4 to 3 (p = 0.2). Patient-reported median EQ-5D scores improved from 0.33 to 0.69 (p = 0.03). Among EQ-5D sub-scores, "usual activity" improved from a median score of 3 (extreme problems) to 2 (some problems) (p = 0.008). Median PHQ-9 scores improved from 9 to 1 (p = 0.06) as did SIS-16 scores from 23 to 57 (p = 0.01). EQ-5D and mRS score differences between periods were correlated (r = -0.65, p = 0.03), but only the EQ-5D showed significant improvement over time. Conclusions: Both HSM types, clinician- and patient-reported outcome measures, improved over time. The structure of clinical trials, and, in particular, defining clinical endpoints and framing outcomes, has a profound impact on the interpretation of what a "favorable" outcome means.
    Clinical Neurology and Neurosurgery 08/2014; 126C:24-29. DOI:10.1016/j.clineuro.2014.08.007 · 1.25 Impact Factor
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    Endocrine Practice 08/2014; 1(-1):1-7. DOI:10.4158/EP13517.VV · 2.59 Impact Factor
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    ABSTRACT: Studies that have looked at the effect of race on spine surgery outcomes have failed to take into account baseline risk factors for adverse outcomes. We wished to determine the effect of race on outcomes in patients undergoing elective laminectomy or fusion.
    Neurosurgery 08/2014; 61 Suppl 1:206. DOI:10.1227/ · 3.03 Impact Factor
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    ABSTRACT: Background Dural lesions in the anterior skull base may occur secondary to benign or malignant pathology that may be difficult to differentiate on imaging. Detailed clinical evaluation in many cases will narrow the differential diagnosis. In spite of using all the available information, in certain cases the underlying etiology of a lesion remains unclear. Participant We report a rare case of metastatic prostate adenocarcinoma to a meningioma in a 67-year-old-man who presented with progressive confusion and mental status alterations with no prior history of malignancy. Neuroimaging revealed a large anterior skull base lesion. Results The lesion was surgically resected, and histopathology revealed a collision tumor, in which prostate adenocarcinoma was found admixed with a World Health Organization grade I meningioma. Conclusion Anterior dural skull base lesions can be either benign or malignant. Although infrequently reported, a benign-appearing dural-based lesion may be a manifestation of an underlying malignancy, and a thorough clinical, radiologic, and pathologic examination may be necessary, especially in the elderly.
    08/2014; 75(1):e81-3. DOI:10.1055/s-0034-1368150
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    ABSTRACT: Breast cancer brain metastases (BCBM) are challenging complications that respond poorly to systemic therapy. The role of the blood-tumor barrier in limiting BCBM drug delivery and efficacy has been debated. Herein, we determined tissue and serum levels of capecitabine, its prodrug metabolites, and lapatinib in women with BCBM resected via medically indicated craniotomy.
    Neuro-Oncology 07/2014; 17(2). DOI:10.1093/neuonc/nou141 · 5.29 Impact Factor
  • Benjamin P Rosenbaum, Robert J Weil
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    ABSTRACT: Abstract Aneurysmal subarachnoid hemorrhage (SAH) is a common condition treated by neurosurgeons. The inherent variability in the incidence and presentation of ruptured cerebral aneurysms has been investigated in association with seasonality, circadian rhythm, lunar cycle, and climate factors. We aimed to identify an association between solar activity (solar flux and sunspots) and the incidence of aneurysmal SAH, all of which appear to behave in periodic fashions over long time periods. The Nationwide Inpatient Sample (NIS) provided longitudinal, retrospective data on patients hospitalized with SAH in the United States, from 1988 to 2010, who underwent aneurysmal clipping or coiling. Solar activity and SAH incidence data were modeled with the cosinor methodology and a 10-year periodic cycle length. The NIS database contained 32,281 matching hospitalizations from 1988 to 2010. The acrophase (time point in the cycle of highest amplitude) for solar flux and for sunspots were coincident. The acrophase for aneurysmal SAH incidence was out of phase with solar activity determined by non-overlapping 95% confidence intervals (CIs). Aneurysmal SAH incidence peaks appear to be delayed behind solar activity peaks by 64 months (95% CI; 56-73 months) when using a modeled 10-year periodic cycle. Solar activity (solar flux and sunspots) appears to be associated with the incidence of aneurysmal SAH. As solar activity reaches a relative maximum, the incidence of aneurysmal SAH reaches a relative minimum. These observations may help identify future trends in aneurysmal SAH on a population basis. Key Words: Solar flux-Sunspots-Patterns-Nationwide Inpatient Sample-Cerebral aneurysm. Astrobiology 14, xxx-xxx.
    Astrobiology 06/2014; 14(7). DOI:10.1089/ast.2014.1138 · 2.51 Impact Factor
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    ABSTRACT: Study Design. Retrospective cohort analysis of prospectively-collected clinical data.Objective. To compare outcomes of elective spine fusion and laminectomy when performed by neurological and orthopedic surgeons.Summary of Background Data. The relationship between primary specialty training and outcome of spinal surgery is unknown.Methods. We analyzed the 2006-2012 American College of Surgeons National Surgical Quality Improvement Project database of 50,361 patients, 33,235 (66%) of which were operated on by a neurosurgeon. We eliminated all differences in per- and intraoperative risk factors between surgical specialties by matching 17,126 orthopedic surgery (OS) patients to 17,126 neurosurgery (NS) patients on propensity scores. Regular and conditional logistic regression were used to predict adverse postoperative outcomes in the full sample and matched sample, respectively. The effect of perioperative transfusion on outcomes was further assessed in the matched sample.Results. Diagnosis and procedure were the only factors that were found to be significantly different between surgical subspecialties in the full sample. We found that compared to NS patients, OS patients were more than twice as likely to experience prolonged length of stay (LOS) (odds ratio: 2.6, 95% confidence interval: 2.4-2.8), and significantly more likely to receive a transfusion peri-operatively, have complications, and to require discharge with continued care. After matching, OS patients continued to have slightly higher odds for prolonged LOS, and twice the odds for receiving perioperative transfusion compared to NS patients. Taking into account perioperative transfusion did not eliminate the difference in length of hospital stay between OS and NS patients.Conclusions. Patients operated on by OS have twice the odds for undergoing perioperative transfusion and slightly increased odds for prolonged LOS. Other differences between surgical specialties in 30-day postoperative outcomes were minimal. Analysis of a large, multi-institutional sample of prospectively-collected clinical data suggests that surgeon specialty has limited influence on short-term outcomes after elective spine surgery.
    Spine 06/2014; 39(19). DOI:10.1097/BRS.0000000000000489 · 2.45 Impact Factor
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    ABSTRACT: Objective: We describe a patient with a large, invasive corticotroph adenoma who developed severe hypercortisolism shortly after starting fractionated radiotherapy.Method: We reviewed the patient's clinical course, along with relevant literature for similarly reported cases.Result: A 29-year-old man was referred for radiotherapy for a residual and recurrent, invasive corticotroph adenoma. Prior to the radiotherapy, he had normal urine free cortisol (UFC) 44.7 μg/24 hr with minimal symptoms. Within 2 weeks of radiotherapy, he developed hypertension, ankle edema, and hypokalemia (K 2.8 mEq/L), with markedly elevated UFC 9203 μg/24 hr. The UFC gradually decreased and normalized by the end of radiotherapy. A month later, the patient became adrenal insufficient with a non-detectable 24-hr urine free cortisol. His adrenal function slowly recovered in 3 months. We are aware of only one previous case report of clinically significant hypercortisolism following radiotherapy in Cushing disease.Conclusion: Radiotherapy may result in acute severe hypercortisolism in patients with a large corticotroph adenoma. This uncommon, but clinically significant, acute adverse effect of radiotherapy may suggest that clinical observation and biochemical monitoring during or soon after radiotherapy may be indicated.
    Endocrine Practice 06/2014; 20(9):1-15. DOI:10.4158/EP14064.CR · 2.59 Impact Factor
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    ABSTRACT: Ectopic pituitary adenomas are defined by the presence of adenomatous pituitary tissue outside the sella and distinctly separate from the pituitary gland. Ectopic ACTH-secreting pituitary adenomas (EAPAs) are a rare cause of Cushing's syndrome. Detecting these radiologically can prove difficult, in part, due to their typically small size and unpredictable anatomical location. In ACTH-dependent Cushing's syndrome, if, despite comprehensive testing, the source of excess ACTH remains occult (including negative work up for ectopic ACTH syndrome) thought should be given to the possibility of the patient harboring an EAPA. In most cases, ectopic ACTH pituitary adenomas within the sphenoid sinus will manifest with symptoms of hormonal excess, have an obvious sphenoid sinus mass on pre-operative imaging and will demonstrate resolution of hypercortisolism after surgical excision if located and removed. Twenty cases of EAPAs have been reported in the literature to date. This paper will review the current literature on all previously reported EAPAs within the sphenoid sinus in addition to the current case.
    Endocrine 06/2014; 47(3). DOI:10.1007/s12020-014-0313-z · 3.53 Impact Factor
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    ABSTRACT: Study Design. Observational retrospective cohort study of prospectively collected database.Objective. To determine whether overweight body mass index (BMI) influences 30-day outcomes of elective spine surgery.Summary of Background Data. Obesity is prevalent in the United States, but its impact on the outcome of elective spine surgery remains controversial.Methods. We used National Surgical Quality Improvement Program, a prospective clinical database with proven validity and reproducibility consisting of 256 perioperative standardized variables from surgical patients at nearly 400 academic and non-academic hospitals nationwide. We identified 49,314 patients who underwent elective fusion, laminectomy or both between 2006 and 2012. We divided patients according to BMI (kg/m) as normal (18.5-24.9), pre-obese (25.0-29.9), obese I (30.0-34.9), obese II (35.0-39.9) and obese III (≥40). Relationship between increased BMI and outcome of surgery measured as prolonged hospitalization, complications, return to the operating room, discharged with continued care, readmission, death was determined using logistic regression before and after propensity score matching.Results. All overweight patients (BMI≥25 kg/m) showed increased odds of an adverse outcome compared to normal patients in unmatched analyses, with maximal effect seen in obese III group. In the propensity-matched sample, obese III patients continued to show increased odds for complications (Odds Ratio, OR, 1.6, 95% confidence interval 1.1-2.3), readmission (2.3, 1.1-4.9), and return to the operating room (1.8, 1.1-3.1).Conclusions. Impact of obesity on elective spine surgery outcome is mediated, at least in part, by comorbidities in patients with BMI between 25.0 and 39.9 kg/m. However, BMI itself is an independent risk factor for adverse outcomes in morbidly obese patients.
    Spine 05/2014; DOI:10.1097/BRS.0000000000000435 · 2.45 Impact Factor

Publication Stats

4k Citations
1,040.43 Total Impact Points


  • 2014–2015
    • Geisinger Health System
      Danville, Pennsylvania, United States
    • Memorial Sloan-Kettering Cancer Center
      New York City, New York, United States
  • 2009–2015
    • Barrow Neurological Institute
      • Department of Neurosurgery
      Phoenix, Arizona, United States
  • 2005–2013
    • Cleveland Clinic
      • • Department of Neurosurgery
      • • Department of Cancer Biology
      Cleveland, Ohio, United States
    • Florida International University
      • Department of Biomedical Engineering
      Miami, FL, United States
  • 2012
    • Texas Neurosurgical Institute
      Plano, Texas, United States
    • Gamma Knife of Spokane
      Spokane, Washington, United States
    • University of Texas MD Anderson Cancer Center
      • Department of NeuroSurgery
      Houston, TX, United States
    • Cancer Research UK Cambridge Institute
      Cambridge, England, United Kingdom
  • 1998–2011
    • National Institutes of Health
      Maryland, United States
  • 2001–2009
    • Vanderbilt University
      • Department of Biomedical Engineering
      Nashville, Michigan, United States
  • 2007
    • University of Texas at San Antonio
      San Antonio, Texas, United States
  • 2006
    • Universität Regensburg
      Ratisbon, Bavaria, Germany
  • 2005–2006
    • Sun Yat-Sen University
      Shengcheng, Guangdong, China
  • 1998–2005
    • Northern Inyo Hospital
      BIH, California, United States
  • 1998–1999
    • National Cancer Institute (USA)
      • Laboratory of Pathology
      Maryland, United States