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Item Incremental Prognostic Value of Echocardiographic Strain and Its Association with Mortality in Cancer Patients(Elsevier, 2015-06) Rhea, Isaac B.; Uppuluri, Sarada; Sawada, Stephen; Schneider, Bryan P.; Feigenbaum, Harvey; Department of Medicine, IU School of MedicineBackground Left ventricular global longitudinal systolic strain (GLS) has been shown to be superior to ejection fraction in detecting subclinical dysfunction in patients with cancer and predicting mortality in patients with cardiovascular disease. Cancer-related fatigue is common in the later stages of neoplastic malignancies and may be indicative of nonovert heart failure. The aim of this study was to determine whether reduced strain by echocardiography was associated with all-cause mortality in a cancer cohort. Methods In this retrospective study, 120 patients with cancer undergoing or scheduled to undergo chemotherapy and with normal ejection fractions (>50%) underwent assessments of GLS. GLS was derived by averaging all speckle-tracking strain segments of the left ventricle. Results Over an average follow-up period of 21.6 ± 13.9 months, 57 of 120 patients died. Univariate predictors of all-cause mortality (P < .10) were Eastern Cooperative Oncology Group performance status, male sex, hematologic malignancy, β-blocker use, and GLS. Multivariate analysis of all significant univariate variables showed that Eastern Cooperative Oncology Group performance status (hazard ratio, 2.12; 95% confidence interval, 1.54–2.92; P < .001), male sex (hazard ratio, 1.93; 95% confidence interval, 1.14–3.27; P = .014), and GLS (hazard ratio, 0.89; 95% confidence interval, 0.81–0.97; P = .012) were significantly and independently associated with mortality. Stepwise analysis of the multivariate associations showed an increase in the global χ2 value after adding GLS (P = .011) to significant clinical variables. Conclusions Eastern Cooperative Oncology Group performance status, male sex, and GLS were significantly associated with all-cause mortality in patients with cancer with normal ejection fractions receiving chemotherapy. Adding GLS to significant clinical variables provided incremental prognostic information.Item Neoplasia at 10-year follow-up screening colonoscopy in a private U.S. practice: comparison of yield to first-time examinations(Elsevier, 2017) Rex, Douglas K.; Ponugoti, Prasanna; Johnson, Cynthia S.; Kittner, Lisa; Yanda, Randy; Department of Medicine, IU School of MedicineBackground and Aims Prior studies assessing the yield of a second screening colonoscopy performed 10 years after an initial negative screening colonoscopy did not include a control group of persons undergoing their first screening colonoscopy during the same time interval. Our aim was to describe the incidence of neoplasia at a second screening colonoscopy (performed at least 8 years after the first colonoscopy) in average risk individuals and compare it with the yield of first screening examinations performed during the same time interval. Methods Review of a database of outpatient screening colonoscopies performed between January 2010 and December 2015 in an Atlanta private practice. Results A total of 2105 average risk individuals underwent screening colonoscopy, including 470 individuals (53.6% female; mean age 64.0 ± 3.9 years) who underwent a second screening examination. In those undergoing second screening, the mean interval between examinations was 10.4 years (±1.1; range 8-15 years). At second screening, the polyp detection rate (PDR), adenoma detection rate (ADR) and advanced neoplasm rate (ANR) were 44.7%, 26.6%, and 7.4%, respectively. Of 40 advanced neoplasms in 35 individuals, 33 (82.5%) were proximal to the sigmoid colon, and there were no cancers. During the same interval, 1635 individuals (49.4% female; mean age 52.6 ± 3.4 years) underwent their first screening colonoscopy. The PDR, ADR and ANR were 53.5%, 32.2%, and 11.7%, respectively. Of 243 advanced neoplasms in 192 individuals, 152 (62.6%) were proximal to the sigmoid colon, and there were no cancers. After adjustment for age, gender, body mass index, and endoscopist, PDR, ADR, and ANR were all lower at the second screening colonoscopies than at first-time colonoscopies (all p<0.001). Conclusions Despite being 10 years older, persons with a negative screening colonoscopy 10 years earlier had numerically lower rates of adenomas and advanced neoplasms at their second screening examination compared with patients in the same practice undergoing their first screening colonoscopy, and they had no cancers. The fraction of advanced neoplasms that were proximal to the sigmoid was high in both first and second screenings. These results support the safety of the recommended 10-year interval between colonoscopies in average risk persons with an initial negative examination.Item Regional center for complex colonoscopy: yield of neoplasia in patients with prior incomplete colonoscopy(Elsevier, 2016-06) Bick, Benjamin L.; Vemulapalli, Krishna C.; Rex, Douglas K.; Department of Medicine, School of MedicineBackground and Aims Incomplete colonoscopy increases the risk of incident proximal colon cancer postcolonoscopy. Incomplete colonoscopy is often followed by barium enema or CT colonography. We sought to describe the yield of completion colonoscopy in a regional center for complex colonoscopy. Methods This is a retrospective cohort study of 520 consecutive patients referred to a single colonoscopist over a 14-year period for completion colonoscopy after a previous incomplete examination. Results Colonoscopy was completed to the cecum in 506 of 520 patients (97.3%). A total of 913 conventional adenomas was removed in 277 patients (adenoma detection rate 53.3%). There were 184 adenomas ≥ 1 cm in size or with advanced pathology. There were 525 serrated-class lesions removed in 175 patients, including 54 sessile serrated polyps in 26 patients and 41 hyperplastic polyps greater than 1 cm in 26 patients. Nine colorectal cancers were found. We estimated that approximately 57% of the conventional adenomas, 58% of the sessile serrated polyps, 27% of the hyperplastic polyps, and all 9 cancers detected by the completion colonoscopy were beyond the extent of the previous examination. Conclusions The yield of completion colonoscopy in a cohort of patients with previous failed cecal intubation was substantial. Regional centers for complex colonoscopy can provide high rates of cecal intubation in cases of incomplete colonoscopy and high yields of lesions in these cases. The regional center for complex colonoscopy is an important medical service.