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  1. Article ; Online: Effects of ketorolac on complications and postoperative pancreatic fistula in patients undergoing pancreatectomy.

    Sueda, Stefanie / Adkins, Azure / Dehal, Ahmed / Al-Temimi, Mohammed / Chen, Lie H / O'Connor, Victoria / DiFronzo, L Andrew

    HPB : the official journal of the International Hepato Pancreato Biliary Association

    2023  Volume 25, Issue 6, Page(s) 636–643

    Abstract: Background: There are conflicting data on the risk of postoperative pancreatic fistula (POPF) associated with postoperative NSAID use. The primary objective of this multi-center retrospective study was to assess the relationship between ketorolac use ... ...

    Abstract Background: There are conflicting data on the risk of postoperative pancreatic fistula (POPF) associated with postoperative NSAID use. The primary objective of this multi-center retrospective study was to assess the relationship between ketorolac use and POPF. The secondary objective was to assess for effect of ketorolac use on overall complication rate.
    Methods: Retrospective chart review of patients undergoing pancreatectomy from January 1, 2005-January 1, 2016 was performed. Data on patient factors (age, sex, comorbidities, previous surgical history etc.), operative factors (surgical procedure, estimated blood loss, pathology etc.), and outcomes (morbidities, mortality, readmission, POPF) were collected. The cohort was compared based on ketorolac use.
    Results: The study included 464 patients. Ninety-eight (21%) patients received ketorolac during the study period. Ninety-six (21%) patients were diagnosed with POPF within 30 days. There was a significant association between ketorolac use and clinically relevant POPF (21.4 vs. 12.7%) (p = 0.04, 95% CI [1.76, 1.04-2.97]). There was no significant difference in overall morbidity or mortality between the groups.
    Discussion: Though there was no overall increase in morbidity, there was a significant association between POPF and ketorolac use. The use of ketorolac after pancreatectomy should be judicious.
    MeSH term(s) Humans ; Ketorolac/adverse effects ; Pancreas ; Pancreatectomy/adverse effects ; Pancreatectomy/methods ; Pancreatic Fistula/etiology ; Postoperative Complications/etiology ; Retrospective Studies ; Risk Factors ; Male ; Female
    Chemical Substances Ketorolac (YZI5105V0L)
    Language English
    Publishing date 2023-02-10
    Publishing country England
    Document type Multicenter Study ; Journal Article
    ZDB-ID 2131251-5
    ISSN 1477-2574 ; 1365-182X
    ISSN (online) 1477-2574
    ISSN 1365-182X
    DOI 10.1016/j.hpb.2023.02.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 6326: Show issues Location:
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  2. Article ; Online: Peritoneal Lavage Cytology Following Neoadjuvant Chemotherapy for Gastric Adenocarcinoma: Low Yield in Detecting Peritoneal Metastases.

    Young, Stephanie / Ou, Ryan / Dehal, Ahmed / O'Connor, Victoria V / DiFronzo, L Andrew

    The American surgeon

    2020  Volume 88, Issue 6, Page(s) 1084–1089

    Abstract: Background: Peritoneal lavage cytology (PLC) can detect advanced disease in gastric adenocarcinoma (GC); however, routine practice remains controversial. Furthermore, the effect of neoadjuvant chemotherapy (NAC) on cytological detection of ... ...

    Abstract Background: Peritoneal lavage cytology (PLC) can detect advanced disease in gastric adenocarcinoma (GC); however, routine practice remains controversial. Furthermore, the effect of neoadjuvant chemotherapy (NAC) on cytological detection of carcinomatosis is unknown.
    Methods: Using a 2012-2020 prospective database, we retrospectively reviewed patients with GC who underwent NAC followed by a staging laparoscopic peritoneal lavage with or without biopsy of suspicious peritoneal nodules. PLC results were considered discordant if they did not align with the peritoneal biopsy results. Patients with benign peritoneal cytology (Cyt-) or biopsy results who had postoperative time to carcinomatosis of <6 months were considered to have diagnostic failure of peritoneal lavage.
    Results: Fifty-five patients with GC who underwent NAC followed by staging diagnostic laparoscopy with peritoneal lavage were identified. The majority of the patients in the cohort had Cyt- lavage (89.1%). Of the patients who underwent resection, 76.1% had T3 or greater disease on final pathology and 66% had nodal metastases. In 23 patients (41.8%) who had both peritoneal lavage and biopsy, four cases (17.4%) had discordant results. Diagnostic failure rate was 20% at 6 months and 42.2% at 12 months. The median time to carcinomatosis in patients who were Cyt- or biopsy negative was 7.9 months.
    Conclusion: PLC after NAC has a high diagnostic failure rate and inaccurately predicts carcinomatosis in 20% of patients with GC. Novel methods for identifying cytology positive GC after NAC should also be developed and evaluated, since the risk of peritoneal dissemination is high.
    MeSH term(s) Adenocarcinoma/drug therapy ; Adenocarcinoma/pathology ; Humans ; Laparoscopy/methods ; Neoadjuvant Therapy ; Neoplasm Staging ; Peritoneal Lavage ; Peritoneal Neoplasms/diagnosis ; Peritoneal Neoplasms/pathology ; Peritoneal Neoplasms/therapy ; Prognosis ; Retrospective Studies ; Stomach Neoplasms/drug therapy ; Stomach Neoplasms/surgery
    Language English
    Publishing date 2020-12-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    DOI 10.1177/0003134820984867
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Intraperitoneal and extraperitoneal colonic perforation following diagnostic colonoscopy.

    Dehal, Ahmed / Tessier, Deron J

    JSLS : Journal of the Society of Laparoendoscopic Surgeons

    2014  Volume 18, Issue 1, Page(s) 136–141

    Abstract: Both intraperitoneal and extraperitoneal colonic perforations have been reported after colonoscopy; however, cases with combined types of perforation are rare. We present the case of a 55-year-old man with a history of Crohn disease who complained of ... ...

    Abstract Both intraperitoneal and extraperitoneal colonic perforations have been reported after colonoscopy; however, cases with combined types of perforation are rare. We present the case of a 55-year-old man with a history of Crohn disease who complained of acute abdominal pain after a diagnostic colonoscopy. Abdominal computed tomography scan showed extensive pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, and leftsided pneumothorax. Exploratory laparotomy was performed, and the patient underwent subtotal colectomy and end ileostomy with placement of a left-sided chest drain for the left-sided pneumothorax. The patient was discharged home postoperatively in good condition. As the utility of colonoscopy continues to broaden, its complications will also be more common. Whereas intraperitoneal perforation is a known and not uncommon complication, extraperitoneal perforation is an uncommon complication. Combined intraperitoneal and extraperitoneal perforation is extremely rare, with only a few cases reported in the literature. Early diagnosis and operative management resulted in a satisfactory outcome in this particular case.
    MeSH term(s) Colon, Sigmoid/injuries ; Colonic Diseases/diagnosis ; Colonic Diseases/etiology ; Colonic Diseases/surgery ; Colonoscopy/adverse effects ; Crohn Disease/diagnosis ; Diagnosis, Differential ; Humans ; Intestinal Perforation/diagnosis ; Intestinal Perforation/etiology ; Intestinal Perforation/surgery ; Laparotomy/methods ; Male ; Middle Aged ; Peritoneal Cavity ; Tomography, X-Ray Computed
    Language English
    Publishing date 2014-03-05
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2011211-7
    ISSN 1938-3797 ; 1086-8089
    ISSN (online) 1938-3797
    ISSN 1086-8089
    DOI 10.4293/108680813X13693422521638
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5183: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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    Zs.MO 310: Show issues

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  4. Article ; Online: The power of reflective writing: narrative medicine and medical education.

    Johna, Samir / Dehal, Ahmed

    The Permanente journal

    2013  Volume 17, Issue 4, Page(s) 84–85

    MeSH term(s) Education, Medical ; Humans ; Narration ; Writing
    Language English
    Publishing date 2013-12-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2062823-7
    ISSN 1552-5775 ; 1552-5775
    ISSN (online) 1552-5775
    ISSN 1552-5775
    DOI 10.7812/TPP/13-043
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Accuracy of nodal staging is influenced by sidedness in colon cancer.

    Dehal, Ahmed N / Nelson, Daniel / Chang, Shu-Ching / Dahel, Akram / Bilchik, Anton J

    Journal of gastrointestinal oncology

    2019  Volume 10, Issue 5, Page(s) 902–909

    Abstract: Background: Adequate lymph node (LN) sampling is critical for accurate nodal staging in colon cancer (CC), particularly for T3N0 disease as current guidelines recommend considering adjuvant chemotherapy when less than 12 LNs are examined. The impact of ... ...

    Abstract Background: Adequate lymph node (LN) sampling is critical for accurate nodal staging in colon cancer (CC), particularly for T3N0 disease as current guidelines recommend considering adjuvant chemotherapy when less than 12 LNs are examined. The impact of sidedness on nodal staging accuracy in patients with T3N0 disease has not been previously studied.
    Methods: Patients with pathologic T3 CC were identified from a prospective multicenter international trial of ultrastaging in CC. The probability of true nodal negativity (TNN) based on the number of LN examined was calculated for right and left CC. These results were then validated in a cohort of patients with similar inclusion criteria selected from the National Cancer Database (NCDB) between 2006 and 2014.
    Results: Three hundred and seventy patients met the inclusion criteria in the trial cohort; 48% were LN-negative. Of 153,945 patients in the NCDB, 57% were LN-negative. The probability of TNN when 12 LNs were examined was 68% for right and 64% for left CC in the trial cohort and 77% and 72% in the NCDB. The number of LNs needed to achieve any given probability of TNN was significantly different between right and left CC in both the trial (P<0.001) and the NCDB (P<0.001).
    Conclusions: In both a prospective multicenter trial and the NCDB, sidedness influences the number of LNs needed to predict nodal negativity in CC. Current guidelines regarding the minimum number of LNs needed to accurately stage patients with T3N0 CC may need to be re-evaluated by taking into consideration the tumor sidedness.
    Language English
    Publishing date 2019-07-20
    Publishing country China
    Document type Journal Article
    ZDB-ID 2594644-4
    ISSN 2219-679X ; 2078-6891
    ISSN (online) 2219-679X
    ISSN 2078-6891
    DOI 10.21037/jgo.2019.08.01
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Primary Epithelial Neuroendocrine Tumors of the Retroperitoneum.

    Dehal, Ahmed / Kim, Sean / Ali, Aamna / Walbolt, Thomas

    The Permanente journal

    2015  Volume 19, Issue 4, Page(s) 71–75

    Abstract: Neuroendocrine tumors are either epithelial or neural in origin. Neuroendocrine tumors of the retroperitoneum are mostly metastatic. Primary epithelial neuroendocrine tumors of the retroperitoneum are exceedingly rare. We describe a case of a ... ...

    Abstract Neuroendocrine tumors are either epithelial or neural in origin. Neuroendocrine tumors of the retroperitoneum are mostly metastatic. Primary epithelial neuroendocrine tumors of the retroperitoneum are exceedingly rare. We describe a case of a retroperitoneal tumor that was discovered incidentally during exploratory laparotomy for small-bowel obstruction. Histopathologic and immunochemical analyses of the biopsied mass were consistent with an epithelial neuroendocrine tumor. The tumor was subsequently removed and final analyses confirmed the initial diagnosis. No evidence of lymph nodes or paraganglia were found within the tumor on histologic examination. Extensive evaluation did not reveal any other primary or metastatic lesions. Therefore, the diagnosis of primary epithelial neuroendocrine tumor of the retroperitoneum was made. The literature is reviewed and discussed. To date, this is only the fifth reported case of primary epithelial retroperitoneal neuroendocrine tumor. Although extremely rare, the possibility of such diagnosis should be included in the differential diagnosis of a retroperitoneal tumor.
    MeSH term(s) Aged ; Female ; Humans ; Intestinal Diseases/pathology ; Necrosis ; Neuroendocrine Tumors/diagnosis ; Neuroendocrine Tumors/pathology ; Retroperitoneal Neoplasms/diagnosis ; Retroperitoneal Neoplasms/pathology
    Language English
    Publishing date 2015-10-30
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 2062823-7
    ISSN 1552-5775 ; 1552-5775
    ISSN (online) 1552-5775
    ISSN 1552-5775
    DOI 10.7812/TPP/15-058
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Cytoreductive surgery and intraperitoneal chemotherapy: an evidence-based review-past, present and future.

    Dehal, Ahmed / Smith, J Joshua / Nash, Garrett M

    Journal of gastrointestinal oncology

    2015  Volume 7, Issue 1, Page(s) 143–157

    Abstract: Peritoneal carcinomatosis (PC) has historically been considered a terminal condition with merely palliative treatment achieving a survival rate measured in months. Cytoreductive surgery (CyRS) and intraperitoneal chemotherapy (IPC) have emerged as ... ...

    Abstract Peritoneal carcinomatosis (PC) has historically been considered a terminal condition with merely palliative treatment achieving a survival rate measured in months. Cytoreductive surgery (CyRS) and intraperitoneal chemotherapy (IPC) have emerged as potentially effective regional treatments with the potential for long-term survival in well-selected patients. The fundamentals of CyRS and IPC are patient selection and complete cytoreduction. Since there is now sufficient evidence for the superiority of CyRS and IPC to systemic chemotherapy alone in a highly select group of patients, surgeons and oncologists should be aware of this modality as a potential benefit for patients with PC. The aim of this report is to highlight cancer-specific evidence in the context of ongoing studies regarding the outcome of this treatment.
    Language English
    Publishing date 2015-09-07
    Publishing country China
    Document type Journal Article ; Review
    ZDB-ID 2594644-4
    ISSN 2219-679X ; 2078-6891
    ISSN (online) 2219-679X
    ISSN 2078-6891
    DOI 10.3978/j.issn.2078-6891.2015.112
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  8. Article ; Online: Risk factors for neck hematoma after thyroid or parathyroid surgery: ten-year analysis of the nationwide inpatient sample database.

    Dehal, Ahmed / Abbas, Ali / Hussain, Farabi / Johna, Samir

    The Permanente journal

    2015  Volume 19, Issue 1, Page(s) 22–28

    Abstract: Context: Postoperative neck hematoma is a well-known complication of thyroid and parathyroid surgery. Better understanding of risk factors for hematoma formation will help define high-risk populations.: Objective: To examine possible risk factors for ...

    Abstract Context: Postoperative neck hematoma is a well-known complication of thyroid and parathyroid surgery. Better understanding of risk factors for hematoma formation will help define high-risk populations.
    Objective: To examine possible risk factors for neck hematoma after thyroid or parathyroid surgery.
    Design: Retrospective analysis of hospital discharge data from the Nationwide Inpatient Sample database.
    Methods: Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedures codes, we identified adults who underwent thyroid or parathyroid surgery and in whom neck hematoma subsequently developed. Information about demographic, clinical, and hospital characteristics was collected. Multivariate regression analyses were used to predict independent risk factors for neck hematoma.
    Results: We identified 147,344 thyroid and parathyroid operations performed nationwide between 2000 and 2009. Overall incidence of postoperative neck hematoma was 1.5% (n = 2210). In multivariate analysis, age 65 years and older (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.4-2.1), male sex (OR = 1.3, 95% CI = 1.2-1.4), African-American race (OR = 1.5, 95% CI = 1.2-1.7), being from the South (OR = 1.3, 95% CI = 1-1.4), comorbidity score of 3 or more (OR = 2, 95% CI = 1.6-2.6), history of alcohol abuse (OR = 2.7, 95% CI = 1.6-2.5), Graves disease (OR = 3, 95% CI = 2.1-4.1), and substernal thyroidectomy (OR = 3.3, 95% CI = 2.8-3.9) were associated with a higher risk of neck hematoma.
    Conclusion: We identified demographic and clinical factors associated with increased risk of neck hematoma after thyroid or parathyroid surgery.
    MeSH term(s) Adolescent ; Adult ; Aged ; Female ; Hematoma/epidemiology ; Hematoma/etiology ; Humans ; Incidence ; Male ; Middle Aged ; Neck ; Parathyroidectomy/adverse effects ; Parathyroidectomy/statistics & numerical data ; Retrospective Studies ; Risk Factors ; Thyroidectomy/adverse effects ; Thyroidectomy/statistics & numerical data ; United States/epidemiology ; Young Adult
    Language English
    Publishing date 2015
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2062823-7
    ISSN 1552-5775 ; 1552-5767
    ISSN (online) 1552-5775
    ISSN 1552-5767
    DOI 10.7812/TPP/14-085
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Performing Omentectomy During Gastrectomy Does Not Improve Survival: a Multi-Center Analysis of 471 Patients with Gastric Adenocarcinoma.

    Young, Stephanie / DiFronzo, L Andrew / Ahuja, Ashim / Keim, Lauren / Papenfuss, Curtis / O'Connor, Victoria / Dehal, Ahmed

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

    2020  Volume 24, Issue 12, Page(s) 2856–2858

    Language English
    Publishing date 2020-08-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2012365-6
    ISSN 1873-4626 ; 1934-3213 ; 1091-255X
    ISSN (online) 1873-4626 ; 1934-3213
    ISSN 1091-255X
    DOI 10.1007/s11605-020-04772-7
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5207: Show issues Location:
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    Zs.MO 354: Show issues

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  10. Article ; Online: Cutaneous Metastasis of Rectal Cancer: A Case Report and Literature Review.

    Dehal, Ahmed / Patel, Sunal / Kim, Sean / Shapera, Emanuel / Hussain, Farabi

    The Permanente journal

    2016  Volume 20, Issue 1, Page(s) 74–78

    Abstract: Cutaneous metastasis of rectal cancer is rare. It typically indicates widespread disease and poor prognosis. We report an exceedingly rare case of rectal cancer with metastasis to the skin and review the literature on cutaneous metastasis of rectal ... ...

    Abstract Cutaneous metastasis of rectal cancer is rare. It typically indicates widespread disease and poor prognosis. We report an exceedingly rare case of rectal cancer with metastasis to the skin and review the literature on cutaneous metastasis of rectal cancer. A 47-year-old man presented with stage IV unresectable adenocarcinoma of the rectum and received palliative chemoradiation for local pain control. About a year later he developed extensive skin lesions involving the genital area, bilateral groin, and perineum. Biopsy specimen showed mucinous adenocarcinoma compatible with rectal origin. Palliative treatment with radiation therapy was initiated. The patient responded well to treatment and is still alive more than a year after diagnosis of cutaneous metastasis. Surgeons should maintain strong suspicion of cutaneous metastases when patients with rectal cancer have new or evolving skin lesions.
    MeSH term(s) Adenocarcinoma/radiotherapy ; Aged ; Biopsy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis/diagnostic imaging ; Neoplasm Metastasis/radiotherapy ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/pathology ; Rectal Neoplasms/radiotherapy
    Language English
    Publishing date 2016
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 2062823-7
    ISSN 1552-5775 ; 1552-5767
    ISSN (online) 1552-5775
    ISSN 1552-5767
    DOI 10.7812/TPP/15-078
    Database MEDical Literature Analysis and Retrieval System OnLINE

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