Katherine Facklis

Cedars-Sinai Medical Center, Los Angeles, California, United States

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Publications (4)12.62 Total impact

  • Mark LaSpina · Katherine Facklis · Irving Posalski · Phillip Fleshner
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    ABSTRACT: Despite their anatomic proximity, communication between the colorectum and seminal vesicle is an uncommon event. We describe the first reported case of a fistula between the colon and seminal vesicle as a complication of diverticulitis. This case report is followed by a literature review of other reported cases of fistula formation between the seminal vesicle and the colon.
    No preview · Article · Dec 2006 · Diseases of the Colon & Rectum
  • K. Facklis · P.R. Fleshner
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    ABSTRACT: Colon resection with primary anastomosis in the cause of acute large bowel obstruction is a controversial therapy. Although a primary ileocolonic anastomosis can be performed for right and transverse colon obstruction, left colon obstruction must be treated differently. Single-stage options include primary anastomosis with on-table lavage, subtotal colectomy, and colonic stents and laser. Primary anastomosis with on-table lavage has become a safe treatment option; subtotal colectomy is preferred treatment for cecal perforation or ischemia, synchronous cancer, or younger patients who are at increased risk to develop metachronous cancer. Colonic stents and laser are still in the early phases of use, but seem promising.
    No preview · Article · Jan 2001 · Seminars in Colon [amp ] Rectal Surgery
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    ABSTRACT: Genetic markers have been used to define subgroups of patients within the broad categories of Crohn's disease and ulcerative colitis that may differ in clinical course and response to medical therapy. The tumor necrosis factor microsatellite haplotype a2blc2d4e1 has been found previously to be present in 24 percent of patients with Crohn's disease and only 5 percent of patients with ulcerative colitis. This study examined associations between this microsatellite haplotype and the postoperative clinical course of patients with ulcerative colitis undergoing ileal pouch-anal anastomosis. As part of a large, controlled, prospective study to correlate genetic markers with clinical phenotypes, tumor necrosis factor microsatellite alleles at five loci (a, b, c, d, and e) were determined from genomic DNA by polymerase chain reaction in 32 patients with a clinical and histopathologic diagnosis of ulcerative colitis who underwent ileal pouch-anal anastomosis for medically unresponsive disease. All patients with ileal pouch-anal anastomosis were also studied prospectively for pouch-specific complications. The tumor necrosis factor haplotype a2blc2d4e1 was present in 11 patients. Median follow-up was 19 months. Thirteen patients had a pouch-specific complication (12 pouchitis and 1 pouch-perineal fistula). Six of 11 patients (55 percent) with the haplotype had a pouch-specific complication compared with 7 of the 21 patients (33 percent) who did not possess this haplotype (P = 0.22). Median time from surgery to pouch-specific complication was eight months. Patients with the haplotype had a median time to pouch-specific complication of three months, whereas patients without the haplotype had a median time of 11 months (P = 0.04). In addition, 36 percent of patients with the haplotype had chronic pouch complications vs. only 10 percent of patients without the haplotype (P = 0.05). The Crohn's disease-associated tumor necrosis factor haplotype a2blc2d4e1 may define a subgroup of medically unresponsive patients with ulcerative colitis who are predisposed to a higher incidence of pouch-specific complications after ileal pouch-anal anastomosis.
    No preview · Article · Jun 1999 · Diseases of the Colon & Rectum
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    ABSTRACT: This study was undertaken to compare safety, outcome, and costs of laparoscopic (LS) and open splenectomy (OS) for a variety of hematologic diseases. The records of 137 patients who underwent splenectomy (63 LS and 74 OS) at a large private teaching hospital between March 1991 and April 1996 were reviewed retrospectively. Diagnosis, age, gender, operative time, blood loss, splenic weight, time to resumption of oral diet, postoperative hospital stay, morbidity, mortality, and costs (direct and operative) were analyzed by multivariate statistical analysis. Laparoscopic splenectomy patients had significantly shorter hospitalization and time to resumption of an oral diet (p < 0.01); although operative costs were higher, total direct costs were not. Idiopathic thrombocytopenic purpura patients had earlier resumption of an oral diet after LS, shorter postoperative stay, and comparable OR time. Five patients (7%) were converted, with outcomes similar to OS except for greater operative time and cost. Grade II complications occurred in three LS and four OS patients; Grade III in three OS patients; and Grade IV in two OS patients. There were two major complications of LS and eight of OS, with two deaths. Multivariate analysis showed that operative time and time to resumption of oral intake were significantly related to age, diagnosis, operative technique, and splenic weight. Duration of postoperative hospitalization was related to operative technique, splenic weight, and major complications. Costs (direct and operative) were related to age, splenic weight, and major complications, but not to operative technique. LS results are influenced by splenic weight, disease, and age. Splenic weight appears to be the crucial determinant of operative time and length of hospitalization. LS is a superior treatment for patients with idiopathic thrombocytopenic purpura and patients with small spleens.
    No preview · Article · Aug 1997 · Journal of the American College of Surgeons