Julian E Losanoff

Wayne State University, Detroit, MI, United States

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Publications (261)611.46 Total impact

  • The American surgeon 03/2012; 78(3):E120-2. · 0.92 Impact Factor
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    ABSTRACT: A 69-year-old male patient underwent excision of hidradenitis suppurativa (HS) affecting both gluteal areas and the perineum. The perineal specimen contained a 1-cm superficially invasive, well-differentiated keratinizing squamous cell carcinoma. The patient was free of recurrence 1 year after surgery. A 66-year-old male patient was diagnosed with massive perineal HS more than 40 years previously. More than 30 abscesses and suppurative sinus tracts were surgically treated over the years. He eventually died of unresectable pelvic squamous carcinoma. Search of the literature and available bibliography revealed 47 retrospective studies of skin carcinoma arising in HS since 1959, including a total of 64 patients together with the two patients treated by our team. Squamous cell carcinoma is a rare but potentially fatal complication of HS. Surgery is the only known treatment method that provides a real chance for cure for both HS and a carcinoma that complicates it. HS must be treated early with complete excision to avoid chronic progression of the disease that can cause cancerous degeneration. A high index of suspicion, early tissue diagnosis, and immediate referral for radical surgery carry the only hope for cure in those whose HS harbors malignancy.
    The American surgeon 11/2011; 77(11):1449-53. · 0.92 Impact Factor
  • Julian E Losanoff, Marc D Basson
    The American surgeon 09/2011; 77(9):E177-8. · 0.92 Impact Factor
  • Julian E Losanoff, Walter A Salwen, Marc D Basson
    The American surgeon 01/2011; 77(1):113-5. · 0.92 Impact Factor
  • Julian E Losanoff, Marc D Basson
    The Journal of thoracic and cardiovascular surgery 12/2010; 140(6):1440-1441. · 3.41 Impact Factor
  • Julian E Losanoff, Marc D Basson
    The American surgeon 06/2010; 76(6):661-2; author reply 662. · 0.92 Impact Factor
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    ABSTRACT: Sciatic hernias are considered the rarest pelvic floor hernias, with a very limited number of published reports worldwide. The condition has received limited attention in the surgical literature. The data reported herein are based on a literature review including MEDLINE and CURRENT CONTENTS computerized database searches. The existing bibliographies on sciatic hernia were explored for articles pertaining to the review. Finally, the Internet was searched for articles not listed in the available medical databases. Sciatic hernia is unusual, and can present the physician with diagnostic and treatment dilemmas. The hernia may present with obscure pelvic pain, intestinal obstruction, life-threatening gluteal sepsis, or as an asymptomatic, reducible mass that distorts the gluteal fold. Small sciatic hernia can remain hidden behind the gluteus maximus muscle. The diagnosis requires imaging studies in such cases. Treatment of sciatic hernia is always surgical and requires prosthetic reinforcement for the best result.
    American journal of surgery 01/2010; 199(1):52-9. · 2.36 Impact Factor
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    ABSTRACT: Idiopathic perforation of the colon is extremely unusual and unexpected, with a very limited number of published reports. The condition's definition depends on the absence of any detectable pathology in the bowel wall that could be responsible for the perforation. A 62-year-old male patient presented with acute thrombosis of the brachial artery. This was successfully treated with an open thrombectomy and systemic anticoagulation, with rapid resolution of the symptoms. During the hospital stay the patient had regular bowel movements and no abdominal complaints. Suddenly he complained of acute abdominal pain. Physical examination and emergency CT scan of the abdomen were consistent with generalized peritonitis. Emergency laparotomy revealed two perforations of the mid-sigmoid colon, each measuring 1.5 x 1.5 cm, and located one in the antimesenteric aspect and one very close to the nutrient vessels. The edges of the perforations showed no inflammatory or necrotic changes. A 2.5 cm streak of macroscopically normal bowel wall was observed between the perforations. The rest of the bowel showed inflamed peritoneum with fibrin as a result of the peritonitis, but was otherwise normal. Sigmoid resection with a Hartmann's pouch was performed and the proximal colon was brought out in the form of an end-colostomy. The abdomen was thoroughly lavaged with warm saline and temporarily closed with plastic sheeting for second-look exploration. Bacteriology from the intra-abdominal fluid showed mixed abdominal flora and no unusual pathogens. The patient was returned to the operating room on five occasions 24-48 h apart for planned re-explorations and peritoneal irrigations. The abdominal wall was restored on postoperative day 12 once a macroscopically clean peritoneum was noted. The patient was transferred to an acute rehabilitation facility. He is known to be alive and recuperating more than eight months after the surgery. Pathology from the colon revealed an inflamed visceral peritoneum with fibrin and otherwise normal-looking mucosa. There were no diverticula. The edges of each perforation showed no alteration of the muscle or mucosa. Histology from both perforations demonstrated normal intestinal wall architecture, normal mesenteric structures including nutrient vessels and lymphatic tissue, and no specific condition responsible for the perforations. No changes suggestive for ischemia or any other pathology were noted (Figure 1). Idiopathic perforation of the colon is rare. The diagnosis depends on excluding other conditions that can potentially contribute to the condition's occurrence. No pathology that might have caused colonic perforation could be identified in our patient. It could be argued that, based on the preceding
    The Ulster medical journal 01/2010; 79(1):20-1.
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    ABSTRACT: Graft survival following renal retransplantation has been inferior to that following primary allografting, particularly in African Americans (AAs) receiving deceased-donor (DD) kidneys. Among 166 AA DD renal allograft recipients transplanted from July 2001 through July 2007, we compared the outcomes of 26 (16%) receiving a second graft with those of 140 primary cases. All patients received either thymoglobulin (ATG) or an IL-2 receptor antagonist for induction, and were maintained on either tacrolimus or sirolimus + mycophenolate mofetil +/- prednisone. When compared with primary transplants, regrafts received kidneys from older donors, were younger, more sensitized, more likely to receive ATG and to be maintained on prednisone, received more doses of ATG, and were less likely diabetic. There was no difference between primary and retransplant groups in overall patient or graft survival; incidence of acute rejection, CMV infection, BK nephropathy, or new-onset diabetes mellitus; and serum creatinine at 1 year. AA renal allograft recipients can undergo a second DD transplant with intermediate-term outcomes comparable to that of a primary graft, despite the presence of multiple immunologic and non-immunologic high-risk factors, by extending the course of ATG induction and continuing prednisone therapy in the vast majority of cases.
    Surgery 10/2009; 146(4):646-52; discussion 652-3. · 3.37 Impact Factor
  • Julian E Losanoff, Walter A Salwen, Marc D Basson, Edi Levi
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    ABSTRACT: A 64-year-old, otherwise healthy, male patient presented with a malodorous abdominal wall fistula of recent onset. He gave a history of mesh repair of ventral hernia 25 years ago. Computed tomography scan of the abdomen revealed a 15 cm x 15 cm thick-walled cavity inside the abdomen adjacent to bowel loops and the prosthetic mesh. Resection of the mass included a 25-cm segment of small bowel. Histopathology revealed a thick-walled large cavity lined with mucosa, surrounding a large wrinkled sheet of permanent mesh.
    American journal of surgery 10/2009; 199(4):e39-41. · 2.36 Impact Factor
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    ABSTRACT: Sternal osteomyelitis secondary to minor trauma occurs rarely. Only a handful of cases have been reported. A 24-year-old male patient who had history of intravenous drug abuse and recent minor sternal trauma presented with signs and symptoms of sternal infection. Imaging studies suggested osteomyelitis and the patient underwent sternal resection, with a successful outcome. Sternal osteomyelitis should be suspected in immunocompromised patients, including intravenous drug abusers presenting with sternal inflammatory symptoms. Increased awareness, rapid diagnosis, and appropriate empiric antibiotic and radical surgical treatments can successfully manage life-threatening osteomyelitis of the sternum.
    Southern medical journal 09/2009; 102(9):982-4. · 0.92 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 08/2009; 139(6):e127-8. · 3.41 Impact Factor
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    ABSTRACT: Informed consent is increasingly being standardized. We sought to evaluate variability in the amount and quality of information desired by patients in choosing whether to undergo elective surgical hernia repair, a prototypical low- to moderate-risk common procedure. Consecutive stable outpatients were asked to assume that they were considering hernia repair and interviewed with a standard questionnaire that asked them to rate their interest in learning about the natural history, pathology, and management of inguinal hernia as well as herniorrhaphy complications and postoperative recovery. Ninety-eight consecutive patients exhibited substantial interpersonal variability in their level of interest in receiving information. Although interest in some types of information tended to correlate with interest in other types of information, patients' degree of interest in receiving information about anesthesia during the procedure was independent of other variables. Education and previous exposure to individuals with hernias also affected interest in receiving potentially important information before deciding whether to consent to hernia surgery. Patients may vary with regard to the information they want to receive when deciding whether to consent to an invasive procedure. It may be preferable to individualize the consent process to patients' preferences rather than adhering to standardized content.
    The American surgeon 05/2009; 75(4):296-300. · 0.92 Impact Factor
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    ABSTRACT: The very unusual association between herpes zoster and Ogilvie syndrome has received scant attention in the published literature. This review discusses the published experience since 1950 and attempts to increase clinical awareness about the co-existence of both conditions. An 84-year-old male patient affected by herpes zoster presented with advanced acute colonic pseudo-obstruction and was successfully treated with colonic diversion. Twenty published studies (1950-2008) of 28 patients in whom the two conditions co-existed are reviewed. The review included 22 male and 7 female patients (24%) aged 32-87 years (mean, 61 years). Significant co-morbidities were present in 45% of the patients. The majority of patients were observed and treated conservatively (83%). Two patients died (7%), both suffering from respiratory complications and malignancy. Recognition of the combined syndrome may help to avoid unnecessary surgery. Laparotomy should be reserved as a last resort for when the obstruction cannot be successfully managed by endoscopy. A diverting colostomy can be used to monitor the blood supply and thus provide early warning for an impending abdominal catastrophe.
    Journal of Emergency Medicine 04/2009; 39(5):696-700. · 1.33 Impact Factor
  • J E Losanoff, M D Basson, S A Gruber
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    ABSTRACT: Spontaneous ventral hernia through the rectus abdominis sheath is perhaps the rarest hernia, with eight previously reported cases since 1937. The condition has not been reflected in the popular treatises on hernia. An 83-year-old male patient underwent surgery for intestinal obstruction. A spontaneous Richter's hernia of the small intestine through the posterior rectus abdominis sheath was successfully treated with bowel resection and tissue repair. Hernias of this variety are not well known and thus are rarely suspected. Their successful management is based on accurate emergency diagnosis and surgery, which we recommend as the best chance for a successful outcome.
    Hernia 03/2009; 13(5):555-8. · 1.69 Impact Factor
  • Endoscopy 03/2009; 41 Suppl 2:E45-6. · 5.74 Impact Factor
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    ABSTRACT: The relative importance of donor and recipient risk factors in predicting outcomes in African-American (AA) renal allograft recipients receiving contemporary immunosuppression, including early steroid withdrawal, has not been previously examined. We assessed the impact of 21 risk factors on five primary outcomes in 132 deceased-donor AA renal allograft recipients transplanted from July 2001 to August 2006 with follow-up 6-67 (mean 35 +/- 17) months by univariate and multivariate analysis. Thymoglobulin or basiliximab was given for induction, and mycophenolate mofetil with either tacrolimus or sirolimus (SRL) +/- prednisone for maintenance. Non-compliance accounted for 26% of graft loss (GL) and 19% of acute rejection (AR) episodes, and was more prevalent in patients who were HCV+ and those on prednisone. Delayed graft function remained a significant predictor of GL, but not via increased AR, and donor ethnicity emerged as an important predictor of patient death. De novo use of SRL resulted in increased AR, and only increased recipient age significantly predicted new-onset diabetes mellitus. Our preliminary results suggest the need for improvements in patient education, pre-transplant psychosocial assessment, and late post-transplant psychosocial support and can be utilized to help guide donor/recipient selection and tailor immunosuppressive management to optimize outcomes in this challenging group of patients.
    Clinical Transplantation 01/2009; 23(4):454-61. · 1.63 Impact Factor
  • Julian E Losanoff, J Michael Millis
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    ABSTRACT: This report describes a liver hemangioma causing obstructive jaundice, an extremely rare condition that has been reported on 3 previous occasions. A hemangioma can compress the major bile ducts and require partial hepatectomy for a successful outcome.
    American journal of surgery 09/2008; 196(3):e3-4. · 2.36 Impact Factor
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    ABSTRACT: Only four centers have reported their results with renal transplantation in human immunodeficiency virus (HIV)+ recipients on highly active antiretroviral therapy, and acute rejection (AR) rates have consistently ranged from 43% to 67%. We examined the outcomes of eight adult HIV+ primary renal allograft recipients with median 15 (range 8-47) months follow-up with multiple other high-risk factors, including African American ethnicity, hepatitis C virus (HCV) positivity, long waiting times, prior sensitization, paucity of live donors, and delayed graft function. Our immunosuppressive protocol consisted of an anti-interleukin-2 receptor antibody for induction, and mycophenolate mofetil, cyclosporin A, and prednisone for maintenance. Initial and 3- to 6-month cyclosporin A trough level targets were 250 to 300 and 225 to 275 ng/mL, respectively, and mycophenolate mofetil dose was adjusted according to 2 to 4 week surveillance and subsequent as needed mycophenolic acid predose concentrations during the first 6 months. Patient and graft survival were 100% and 88%, respectively, with an AR rate of 13% and excellent renal function. No patients developed new-onset diabetes, opportunistic or other serious infections, malignancy, or progression of hepatitis C virus-related liver disease. Excellent suppression of HIV replication with maintenance of CD4 counts was noted in all cases. Our findings suggest that HIV+ patients on highly active antiretroviral therapy can undergo successful renal transplantation with a low incidence of both AR and AIDS-associated and non-AIDS associated infections, despite associated risk factors for poorer outcome. Our encouraging but preliminary results with this protocol will need to be verified in larger numbers of HIV+ renal allograft recipients with longer follow-up.
    Transplantation 07/2008; 86(2):269-74. · 3.78 Impact Factor
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    ABSTRACT: Circulating mitochondrial DNA (mtDNA) affected by mutations have been detected in melanoma, prostate cancer, and digestive neoplasms involving the pancreas, liver, and the colon. We sought to detect such mutations in women with breast cancer to assess if the method could be used to aid in the diagnosis of breast cancer. Blood was collected and mtDNA extracted; 27 samples included 14 patients who had breast cancer and 13 healthy controls. White blood cells and serum were separated. The mitochondrial D-loop region was amplified using PCR followed by automated DNA sequencing. The collected data was analyzed with computer software to detect both polymorphisms and mutations. mtDNA sequencing was successful in 93% of the samples (n=23). No mutations were found in any of the study groups. Polymorphisms were detected in all specimens, three of which had not been previously reported. The method used did not detect mtDNA mutations in the blood of women with breast cancer, but was extremely sensitive in polymorphism detection.
    Breast (Edinburgh, Scotland) 07/2008; 17(5):540-2. · 2.09 Impact Factor

Publication Stats

2k Citations
611.46 Total Impact Points

Institutions

  • 2007–2012
    • Wayne State University
      • • School of Medicine
      • • Department of Surgery
      • • Department of Pathology
      Detroit, MI, United States
    • University of Illinois at Chicago
      • Division of Transplantation
      Chicago, Illinois, United States
  • 2011
    • Michigan State University
      • Department of Surgery
      East Lansing, MI, United States
  • 2005–2007
    • University of Chicago
      • Department of Surgery
      Chicago, IL, United States
  • 2001–2005
    • University of Missouri
      • Department of Surgery
      Columbia, MO, United States
  • 1994–2005
    • Military Medical Academy
      Ulpia Serdica, Sofia-Capital, Bulgaria
  • 2001–2004
    • Palm Drive Hospital
      Sebastopol, California, United States
  • 2002
    • Columbia University
      • Department of Surgery
      New York City, NY, United States
  • 1996–1998
    • International University College
      Khadzhioglu Pazardzhik, Dobrich, Bulgaria