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Article ; Online: An Unusual Appearing Esophagus.

Jang, Samuel / Ahn, Joseph C

2021 Volume 162, Issue 6, Page(s) e12–e13

MeSH term(s)	Esophageal Cyst ; Esophagus/diagnostic imaging ; Humans
Language	English
Publishing date	2021-09-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	80112-4
ISSN	1528-0012 ; 0016-5085
ISSN (online)	1528-0012
ISSN	0016-5085
DOI	10.1053/j.gastro.2021.09.031
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Article ; Online: Pulsatile Inferior Vena Cava Contrast Material Reflux in Carcinoid Heart Disease.

Jang, Samuel / Ferrero, Andrea / Foley, Thomas A / Atwell, Thomas D

Radiology. Imaging cancer

2022 Volume 4, Issue 3, Page(s) e220038

MeSH term(s)	Carcinoid Heart Disease/complications ; Carcinoid Heart Disease/diagnostic imaging ; Contrast Media ; Esophagitis, Peptic ; Gastroesophageal Reflux ; Humans ; Vena Cava, Inferior/diagnostic imaging
Chemical Substances	Contrast Media
Language	English
Publishing date	2022-05-23
Publishing country	United States
Document type	Journal Article
ISSN	2638-616X
ISSN (online)	2638-616X
DOI	10.1148/rycan.220038
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Article ; Online: Concomitant Sigmoid Diverticulitis and Periampullary Duodenal Diverticulitis Complicated by Lemmel Syndrome: A Case Report.

Saha, Bibek / Jang, Samuel / Friesen, Joelle N / Kalinoski-DuBose, Victoria / Verma, Anjul / Mundell, William

Journal of investigative medicine high impact case reports

2024 Volume 12, Page(s) 23247096241253342

Abstract: Diverticular disease is a major cause of hospitalizations, especially in the elderly. Although diverticulosis and its complications predominately affect the colon, the formation of diverticula in the small intestine, most commonly in the duodenum, is ... ...

Abstract	Diverticular disease is a major cause of hospitalizations, especially in the elderly. Although diverticulosis and its complications predominately affect the colon, the formation of diverticula in the small intestine, most commonly in the duodenum, is well characterized in the literature. Although small bowel diverticula are typically asymptomatic, and diagnosed incidentally, a complication of periampullary duodenal diverticulum is Lemmel syndrome. Lemmel syndrome is an extremely rare condition whereby periampullary duodenal diverticula, most commonly without diverticulitis, leads to obstruction of the common bile duct due to mass effect and associated complications including acute cholangitis and pancreatitis. Here, we present the first case, to our knowledge, of periampullary duodenal diverticulitis complicated by Lemmel syndrome with concomitant colonic diverticulitis with colovesical fistula. Our case and literature review emphasizes that Lemmel syndrome can present with or without suggestions of obstructive jaundice and can most often be managed conservatively if caught early, except in the setting of emergent complications.
MeSH term(s)	Humans ; Duodenal Diseases/complications ; Tomography, X-Ray Computed ; Male ; Aged ; Intestinal Fistula/complications ; Intestinal Fistula/etiology ; Diverticulitis, Colonic/complications ; Female ; Sigmoid Diseases/complications ; Sigmoid Diseases/etiology ; Diverticulitis/complications
Language	English
Publishing date	2024-04-30
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2710326-2
ISSN	2324-7096 ; 2324-7096
ISSN (online)	2324-7096
ISSN	2324-7096
DOI	10.1177/23247096241253342
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Article ; Online: Wide Provider Variation in Cost for Thyroidectomy: Potential Benefits of Standardizing Practice?

Herring, Brendon / Jang, Samuel / Mayo, A L / Balentine, Courtney J / Aburjania, Zviadi / Chen, Herbert

The Journal of surgical research

2021 Volume 267, Page(s) 9–16

Abstract: Objective(s): Identifying provider variation in surgical costs could control rising healthcare expenditure and deliver cost-effective care. While these efforts have mostly focused on complex and expensive operations, provider-level variation in costs of ...

Abstract	Objective(s): Identifying provider variation in surgical costs could control rising healthcare expenditure and deliver cost-effective care. While these efforts have mostly focused on complex and expensive operations, provider-level variation in costs of thyroidectomy has not been well examined. Methods: We retrospectively evaluated 921 consecutive total thyroidectomies performed by 14 surgeons at our institution between September 2011 and July 2016. Data were extracted from the Change Healthcare Performance Analytics Program. Results: Mean patient age was 47.4 ± 0.5 y, 81% were females, 64.7% were Caucasians, and 18.8% were outpatients. The number of thyroidectomies performed by the 14 surgeons ranged from 4 to 597 (mean = 66). The mean costs per provider varied widely from $4,293 to $15,529 (P < 0.001). The mean length of stay was 1d ± .03 with wide variation among providers (0-6 d). Providers whose hospital cost exceeded the institutional mean demonstrated significantly higher anesthesia fees and lab costs (P < 0.001). Conclusions: We found substantial variation in hospital cost among providers for thyroidectomy despite practicing in the same academic institution, with some surgeons spending 3x more for the same operation. Implementing institutional standards of practice could reduce variation and the costs of surgical care.
MeSH term(s)	Fees and Charges ; Female ; Health Expenditures ; Hospital Costs ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Surgeons/economics ; Thyroidectomy/economics
Language	English
Publishing date	2021-06-11
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2021.04.040
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Article ; Online: Percutaneous Image-Guided Thermal Ablation of Adrenal Metastasis from Melanoma: A Single-Institution Experience.

Jang, Samuel / Eiken, Patrick W / Atwell, Thomas D / Markovic, Svetomir N / Bancos, Irina / Welch, Brian T

Journal of vascular and interventional radiology : JVIR

2021 Volume 32, Issue 9, Page(s) 1288–1291

Abstract: The outcomes of technically successful image-guided percutaneous thermal ablation of melanoma adrenal metastases involving 11 tumors in 9 consecutive patients over 12 years (2009-2020) were evaluated. All patients had multiple treated metastatic sites, ... ...

Abstract	The outcomes of technically successful image-guided percutaneous thermal ablation of melanoma adrenal metastases involving 11 tumors in 9 consecutive patients over 12 years (2009-2020) were evaluated. All patients had multiple treated metastatic sites, and 44.4% (4/9) had greater than 5 metastatic sites. The mean maximal tumor diameter was 3.6 ± 1.6 cm. The local recurrence-free survival at 1 year was 85.7%. With a median survival of 19.4 months, 66.6% (6/9) of patients died from tumor progression. The 1- and 3-year overall survival rate was 60.0% and 30.0%, respectively. All patients were pretreated with alpha-adrenergic blockade, and 36% (4/11) developed a hypertensive crisis. The median hospital length of stay was 1 day (range, 1-2 days), without any major complications. Thermal ablation of adrenal metastasis from a melanoma provides acceptable local control and a good safety profile.
MeSH term(s)	Adrenal Gland Neoplasms/diagnostic imaging ; Adrenal Gland Neoplasms/surgery ; Catheter Ablation ; Cryosurgery ; Humans ; Melanoma ; Retrospective Studies
Language	English
Publishing date	2021-06-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	1137756-2
ISSN	1535-7732 ; 1051-0443
ISSN (online)	1535-7732
ISSN	1051-0443
DOI	10.1016/j.jvir.2021.06.002
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Article ; Online: Improved CT-based Osteoporosis Assessment with a Fully Automated Deep Learning Tool.

Pickhardt, Perry J / Nguyen, Thang / Perez, Alberto A / Graffy, Peter M / Jang, Samuel / Summers, Ronald M / Garrett, John W

Radiology. Artificial intelligence

2022 Volume 4, Issue 5, Page(s) e220042

Abstract: Purpose: To develop, test, and validate a deep learning (DL) tool that improves upon a previous feature-based CT image processing bone mineral density (BMD) algorithm and compare it against the manual reference standard.: Materials and methods: This ... ...

Abstract	Purpose: To develop, test, and validate a deep learning (DL) tool that improves upon a previous feature-based CT image processing bone mineral density (BMD) algorithm and compare it against the manual reference standard. Materials and methods: This single-center, retrospective, Health Insurance Portability and Accountability Act-compliant study included manual L1 trabecular Hounsfield unit measurements from abdominal CT scans in 11 035 patients (mean age, 58 years ± 12 [SD]; 6311 women) as the reference standard. Automated level selection and L1 trabecular region of interest (ROI) placement were then performed in this CT cohort with both a previously validated feature-based image processing tool and a new DL tool. Overall technical success rates and agreement with the manual reference standard were assessed. Results: The overall success rate of the DL tool in this heterogeneous patient cohort was significantly higher than that of the older image processing BMD algorithm (99.3% vs 89.4%, Conclusion: The new DL BMD tool demonstrated a higher success rate than the older feature-based image processing tool, and its outputs can be targeted for higher specificity or sensitivity for osteoporosis assessment.
Language	English
Publishing date	2022-08-31
Publishing country	United States
Document type	Journal Article
ISSN	2638-6100
ISSN (online)	2638-6100
DOI	10.1148/ryai.220042
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Article ; Online: Lymphatic Mapping Using US Microbubbles before Lymphaticovenous Anastomosis Surgery for Lymphedema.

Jang, Samuel / Lee, Christine U / Hesley, Gina K / Knudsen, John M / Brinkman, Nathan J / Tran, Nho V

Radiology

2022 Volume 304, Issue 1, Page(s) 218–224

Abstract: Background Lymphaticovenous anastomosis (LVA) surgery is an effective surgical treatment of secondary lymphedema in the extremities, but indocyanine green (ICG) fluorescent lymphography, the reference standard for imaging target lymphatic vessels, has ... ...

Abstract	Background Lymphaticovenous anastomosis (LVA) surgery is an effective surgical treatment of secondary lymphedema in the extremities, but indocyanine green (ICG) fluorescent lymphography, the reference standard for imaging target lymphatic vessels, has several limitations. More effective methods are needed for preoperative planning. Purpose To evaluate whether contrast-enhanced US (CEUS) can be used to identify target lymphatic vessels for LVA surgery in patients with secondary upper extremity lymphedema and compare the results with those from ICG fluorescent lymphography. Materials and Methods In this single-center retrospective review, CEUS with intradermal injection of microbubbles was performed in patients before LVA surgery in the upper extremities between October 2019 and September 2021. All patients had secondary upper extremity lymphedema from breast cancer treatment. Technical success rate was defined as lymphatic vessels identified with use of CEUS that led to successful LVAs. Descriptive statistics were used. Results All 11 patients were women (mean age, 56 years ± 8 [SD]). The median number of microbubble injection sites was 11 (range, 8-14). CEUS helped identify lymphatic vessels in all 11 women, including in six women in whom ICG fluorescent lymphography could not be performed or failed to help identify any targets. Thirty-five explorations (median, three per patient; range, two to four) were performed, and 24 LVAs (median, three per patient; range, zero to four) were created. Of the anastomoses, 33% (eight of 24) were mapped with use of both CEUS and ICG fluorescent lymphography, 58% (14 of 24) with CEUS only, and 8% (two of 24) with ICG fluorescent lymphography only. Among the 33 explorations on targets mapped with CEUS, an anastomosis could be made at 22 sites, for a technical success rate of 67%. Seven women had at least one additional LVA created from the use of CEUS. Conclusion Contrast-enhanced US is a promising tool for identifying lymphatic vessels in the upper extremities, especially when indocyanine green fluorescent lymphography fails to depict targets or cannot be used. Published under a CC BY 4.0 license.
MeSH term(s)	Anastomosis, Surgical/methods ; Coloring Agents ; Female ; Humans ; Indocyanine Green ; Lymphatic Vessels/diagnostic imaging ; Lymphatic Vessels/surgery ; Lymphedema/diagnostic imaging ; Lymphedema/surgery ; Lymphography/methods ; Male ; Microbubbles ; Middle Aged ; Tomography, X-Ray Computed
Chemical Substances	Coloring Agents ; Indocyanine Green (IX6J1063HV)
Language	English
Publishing date	2022-04-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	80324-8
ISSN	1527-1315 ; 0033-8419
ISSN (online)	1527-1315
ISSN	0033-8419
DOI	10.1148/radiol.212351
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Article: Lymphatic Mapping with Contrast-enhanced Ultrasound for Lymphaticovenous Anastomosis Surgery: How We Do It.

Jang, Samuel / Bustos, Samyd S / Chen, Austin D / Zheng, Eugene E / Hesley, Gina K / Brinkman, Nathan J / Carter, Jill S / Tran, Nho V / Fahradyan, Vahe / Lee, Christine U

Plastic and reconstructive surgery. Global open

2023 Volume 11, Issue 10, Page(s) e5328

Abstract: Lymphaticovenous anastomosis (LVA) surgery is an effective surgery for the treatment of lymphedema in the extremities. Indocyanine green lymphography is the reference standard for visualizing lymphatics for LVA surgery, but it has several limitations; ... ...

Abstract	Lymphaticovenous anastomosis (LVA) surgery is an effective surgery for the treatment of lymphedema in the extremities. Indocyanine green lymphography is the reference standard for visualizing lymphatics for LVA surgery, but it has several limitations; most notably, superficial dermal congestion can mask deeper lymphatic vessels. To overcome the limitations, we add contrast-enhanced ultrasound (CEUS) lymphography. We have previously reported that CEUS lymphography can identify lymphatic vessels for LVA surgery that indocyanine green lymphography does not. Here, we describe how we perform CEUS lymphography, including workflow, technique, and documentation. Before informed consent, the patient must be screened for possible adverse reactions to microbubbles. The procedure involves multiple intradermal injections of the microbubble agent at various sites along the extremity. After each injection, imaging for microbubble uptake by lymphatic vessels is performed using an ultrasound scanner with contrast-specific software. We use sulfur hexafluoride lipid-type A microspheres (Lumason/SonoVue; Bracco Suisse SA), but we are investigating the performance of other Food & Drug Administration-approved microbubble agents for CEUS lymphography. Having a systematic approach to marking the skin can mitigate the hindrance of marking over ultrasound coupling gel. Another benefit of CEUS lymphography is the rapid identification of neighboring veins compatible in size and location for anastomosis. We hold regular scheduled multidisciplinary meetings for coordination of care, discussion of outcomes, quality assurance, and ongoing innovation.
Language	English
Publishing date	2023-10-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000005328
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Article ; Online: Percutaneous Image Guided Cryoablation of Adrenal Metastases From Renal Cell Carcinoma: A Single Institution Review.

Harper, Kelly C / Atwell, Thomas D / Kassmeyer, Blake A / Jang, Samuel / Potretzke, Aaron M / Costello, Brian A / Welch, Tasha L / Boorjian, Stephen A / Welch, Brian T

Urology

2023 Volume 183, Page(s) 141–146

Abstract: Objectives: To assess the safety, technical success, disease progression, and survival associated with percutaneous image-guided cryoablation of renal cell carcinoma metastasis (mRCC) in the adrenal gland.: Methods: Retrospective, single-institution ... ...

Abstract	Objectives: To assess the safety, technical success, disease progression, and survival associated with percutaneous image-guided cryoablation of renal cell carcinoma metastasis (mRCC) in the adrenal gland. Methods: Retrospective, single-institution review of adult patients undergoing percutaneous cryoablation for adrenal mRCC between the years of 2007-2021. Technical parameters, technical success, safety, and survival were analyzed according to standard criteria. Results: Forty-six patients (39 male; mean age 66 ± 8.8 years) with 57 tumors ablated over 51 sessions with a median hospital length of stay of 1 day (range 0-3 days). Forty-four (96%) had primary of clear cell histology. Aim of ablation was curative intent in 39 of 57 tumors (72%) with local tumor control in the remainder. There were 2 (4%) technical failures and technique efficacy was achieved in 52 out of the remaining 55 (95%). There were no Common Terminology Criteria for Adverse Events' immediate complications and 4 of 51 (8%) delayed complications. Twenty-five of 57 (44%) had disease progression anywhere, away from ablation site. One-, 3-, and 5-year recurrence free survival rates were 100%, 89%, and 89% and overall survival was 98%, 85%, and 71%. Fifty-one of 57 (89%) underwent preprocedural alpha blockade with hypertensive crisis in 27 of 56 (54%) available records, of which there were no adverse outcomes. Conclusion: Percutaneous cryoablation of mRCC to the adrenal glands is safe with robust local control, leading to advocacy for its ongoing use in this patient population. Multi-disciplinary management is recommended for successful treatment.
MeSH term(s)	Adult ; Humans ; Male ; Infant ; Carcinoma, Renal Cell/surgery ; Kidney Neoplasms/pathology ; Cryosurgery/methods ; Retrospective Studies ; Treatment Outcome ; Adrenal Gland Neoplasms/etiology ; Disease Progression
Language	English
Publishing date	2023-10-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	192062-5
ISSN	1527-9995 ; 0090-4295
ISSN (online)	1527-9995
ISSN	0090-4295
DOI	10.1016/j.urology.2023.10.001
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Article ; Online: In Reply to Lin and Golden.

Jang, Samuel / Rosenberg, Stephen A / Bradley, Kristin A / Kimple, Randall J

International journal of radiation oncology, biology, physics

2018 Volume 102, Issue 3, Page(s) 672

Language	English
Publishing date	2018-09-21
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2018.06.043
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