Publications by authors named "Kristen Cagino"

11 Publications

  • Page 1 of 1

Laparoscopic management of a primary posterior cul-de-sac abdominal ectopic pregnancy.

Fertil Steril 2021 Apr 20. Epub 2021 Apr 20.

Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York. Electronic address:

Objective: To report a case of laparoscopic management of a primary posterior cul-de-sac abdominal ectopic pregnancy (AEP).

Design: Video article.

Setting: Academic medical center.

Patient(s): A 40-year-old G5P3013 woman at approximately 7 weeks of pregnancy was referred to our emergency department because of abnormally rising β-human chorionic gonadotropin levels. Transvaginal ultrasonography revealed a cystic structure measuring 2.8 × 1.6 ×1.9 cm in the posterior cul-de-sac distinct from the cervix. The mass was noted to have peripheral hypervascularity and a thickened wall. A moderate amount of complex free fluid was noted adjacent to the mass. The patient's baseline β-human chorionic gonadotropin level and hematocrit were 6,810.7 mIU/mL and 42.4%, respectively.

Intervention(s): Laparoscopy for suspected AEP.

Main Outcome Measure(s): Laparoscopic excision of a primary AEP.

Result(s): Diagnostic laparoscopy revealed a normal uterus, normal right ovary, normal left ovary with a corpus luteal cyst, and normal bilateral fallopian tubes without dilatation or hemorrhage. The AEP was noted in the right posterior cul-de-sac and was excised from the underlying peritoneum. The left lateral aspect of the AEP extended into the posterior vaginal wall. The patient was admitted for overnight observation, and her postoperative hematocrit was 35.1%.

Conclusion(s): AEPs are extremely rare and account for 1% of all ectopic pregnancies. Approximately 90% of AEPs require surgical management. Historically, AEPs were treated with laparotomy because of the high risk of hemorrhage and hemodynamic instability. However, as exemplified by the current case, laparoscopy is a safe and feasible option for surgical management of AEPs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fertnstert.2021.03.042DOI Listing
April 2021

Surgical Management of Adnexal Masses in Pregnancy: A Systematic Review and Meta-analysis.

J Minim Invasive Gynecol 2021 Jan 28. Epub 2021 Jan 28.

Department of Obstetrics and Gynecology (Drs. Cagino, Li, and Acholonu, Jr).

Objective: The incidence of adnexal masses in pregnancy is 1% to 6%. Although surgery is often indicated, there are no definitive management guidelines. We aimed to investigate the optimal approach to surgical management of adnexal masses in pregnancy on the basis of a meta-analysis of previous studies.

Data Sources: We performed a systematic review using MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov from inception to July 17, 2020.

Methods Of Study Selection: There were no restrictions on study type, language, or publication date. Comparative and noncomparative retrospective studies that reviewed operative techniques used in surgery of adnexal masses in pregnancy were included. Meta-analyses were performed to assess outcomes. This study was registered in the International Prospective Register of Systematic Reviews (CRD42019129709).

Tabulation, Integration, And Results: Comparative studies were identified for laparoscopy vs laparotomy and elective vs emergent surgery (11 and 4, respectively). Elective surgery is defined as a scheduled antepartum procedure. For laparoscopy vs laparotomy, the mean maternal ages and gestational ages at time of surgery were similar (27.8 years vs 27.7 years, p = .85; 16.2 weeks in laparoscopy vs 15.4 weeks in laparotomy, p = .59). Mass size was larger in those undergoing laparotomy (mean 8.8 cm vs 7.8 cm, p = .03). The most common pathologic condition was dermoid cyst (36%), and the risk of discovering a malignant tumor was 1%. Laparoscopy was not associated with a statistically increased risk of spontaneous abortion (SAB) or preterm delivery (PTD) (odds ratio [OR] 1.53; 95% confidence interval [CI], 0.67-3.52; p = .31 and OR 0.95; 95% CI, 0.47-1.89; p = .88, respectively). The mean length of hospital stay was 2.5 days after laparoscopy vs 5.3 days after laparotomy (p <.001). The decrease in estimated blood loss in laparoscopy was not statistically significant (94.0 mL in laparotomy vs 54.0 mL in laparoscopy, p = .06). Operative times were similar in laparoscopy and laparotomy (80.0 minutes vs 72.5 minutes, p = .09). Elective surgery was associated with a decreased risk of PTD (OR 0.13; 95% CI, 0.04-0.48; p = .05). Noncomparative studies were identified for laparoscopy and laparotomy. Laparotomy had more SABs and PTDs than laparoscopy (pooled proportion = 0.02 vs 0.07 and pooled proportion = 0.02 vs 0.14, respectively).

Conclusion: Laparoscopy for the surgical management of adnexal masses in pregnancy is associated with shorter length of hospital stay and similar risk of SAB or PTD. Elective surgery is associated with a decreased risk of PTD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2021.01.020DOI Listing
January 2021

Severe acute respiratory syndrome coronavirus 2 serology levels in pregnant women and their neonates.

Am J Obstet Gynecol 2021 Jan 23. Epub 2021 Jan 23.

Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; Laboratory of Molecular Neuro-Oncology, The Rockefeller University, New York, NY. Electronic address:

Background: Pregnant women and their neonates represent 2 vulnerable populations with an interdependent immune system that are highly susceptible to viral infections. The immune response of pregnant women to severe acute respiratory syndrome coronavirus 2 and the interplay of how the maternal immune response affects the neonatal passive immunity have not been studied systematically.

Objective: We characterized the serologic response in pregnant women and studied how this serologic response correlates with the maternal clinical presentation and with the rate and level of passive immunity that the neonate received from the mother.

Study Design: Women who gave birth and who tested positive for immunoglobulin M or immunoglobulin G against severe acute respiratory syndrome coronavirus 2 using semiquantitative detection in a New York City hospital between March 22, 2020, and May 31, 2020, were included in this study. A retrospective chart review of the cases that met the inclusion criteria was conducted to determine the presence of coronavirus disease 2019 symptoms and the use of oxygen support. Serology levels were compared between the symptomatic and asymptomatic patients using a Welch 2 sample t test. Further chart review of the same patient cohort was conducted to identify the dates of self-reported onset of coronavirus disease 2019 symptoms and the timing of the peak immunoglobulin M and immunoglobulin G antibody levels after symptom onset was visualized using local polynomial regression smoothing on log-scaled serologic values. To study the neonatal serology response, umbilical cord blood samples of the neonates born to the subset of serology positive pregnant women were tested for serologic antibody responses. The maternal antibody levels of serology positive vs the maternal antibody levels of serology negative neonates were compared using the Welch 2 sample t test. The relationship between the quantitative maternal and quantitative neonatal serologic data was studied using a Pearson correlation and linear regression. A multiple linear regression analysis was conducted using maternal symptoms, maternal serology levels, and maternal use of oxygen support to determine the predictors of neonatal immunoglobulin G levels.

Results: A total of 88 serology positive pregnant women were included in this study. The antibody levels were higher in symptomatic pregnant women than in asymptomatic pregnant women. Serology studies in 34 women with symptom onset data revealed that the maternal immunoglobulin M and immunoglobulin G levels peak around 15 and 30 days after the onset of coronavirus disease 2019 symptoms, respectively. Furthermore, studies of 50 neonates born to this subset of serology positive women showed that passive immunity in the form of immunoglobulin G is conferred in 78% of all neonates. The presence of passive immunity is dependent on the maternal antibody levels, and the levels of neonatal immunoglobulin G correlate with maternal immunoglobulin G levels. The maternal immunoglobulin G levels and maternal use of oxygen support were predictive of the neonatal immunoglobulin G levels.

Conclusion: We demonstrated that maternal serologies correlate with symptomatic maternal infection, and higher levels of maternal antibodies are associated with passive neonatal immunity. The maternal immunoglobulin G levels and maternal use of oxygen support, a marker of disease severity, predicted the neonatal immunoglobulin G levels. These data will further guide the screening for this uniquely linked population of mothers and their neonates and can aid in developing maternal vaccination strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajog.2021.01.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825873PMC
January 2021

Treatment patterns and outcomes among women with brain metastases from gynecologic malignancies.

Gynecol Oncol Rep 2020 Nov 31;34:100664. Epub 2020 Oct 31.

Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA.

Background: Brain metastasis secondary to gynecologic malignancy is rare and has no definitive management guidelines. In this descriptive study, we aimed to identify prognostic factors and treatments that may be associated with longer overall survival.

Methods: Patients with brain metastases from gynecologic malignancies were identified between 2004 and 2019 at two institutions. Descriptive statistics were performed using N (%) and median (interquartile range). Univariate cox proportional hazards regression was performed to evaluate the effect of different factors on overall survival.

Results: 32 patients presented with brain metastasis from gynecologic primaries (ovarian/fallopian tube/primary peritoneal n = 14, uterine n = 11, cervical n = 7). Median age of initial cancer diagnosis was 61 (34-79). At initial cancer diagnosis 83% of patients were Stage III/IV and underwent surgery (66%), chemotherapy (100%), and/or pelvic radiation (33%). Median time from initial cancer diagnosis to brain metastasis was 18 months. Treatment of brain metastasis with surgery and radiation compared to stereotactic radiosurgery or whole brain radiation therapy alone revealed a trend toward longer overall survival (p = 0.07). Time from initial cancer diagnosis to brain metastasis was associated with longer overall survival with each one-month increase from initial cancer diagnosis associated with a 7% reduction in risk of death (HR 0.93, 95% CI = 0.89-0.97, p = 0.01). Initial cancer treatment, stage, histology, and number of brain lesions did not affect overall survival.

Conclusions: Patients with brain metastasis secondary to gynecologic malignancies with the longest overall survival had the greatest lag time between initial cancer diagnosis and brain metastasis. Brain metastasis treated with surgery and radiation was associated with longer overall survival.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gore.2020.100664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649617PMC
November 2020

Multiple malignant transformations of an ovarian mature cystic teratoma.

Ecancermedicalscience 2020 4;14:1009. Epub 2020 Feb 4.

Department of Gynecologic Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10021, USA.

Background: Malignant transformation of mature cystic teratomas (MCTs) is a rare phenomenon. The most common histology of a malignant transformation is squamous cell carcinoma, and there are limited reports of multiple malignancies arising in a single MCT. Further data are necessary to guide management of these atypical cases.

Case: We present the case of a 48-year-old with MCT containing a malignant papillary thyroid carcinoma (PTC) arising in the context of struma ovarii and a carcinoid tumour.

Conclusion: Malignant transformations of MCTs are exceedingly rare with no guidelines on management. We use this case to demonstrate an approach for the workup and management of malignantly transformed MCTs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3332/ecancer.2020.1009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105337PMC
February 2020

Inverse relationship between the evans index and cognitive performance in non-disabled, stroke-free, community-dwelling older adults. A population-based study.

Clin Neurol Neurosurg 2018 06 30;169:139-143. Epub 2018 Mar 30.

School of Medicine, Stony Brook University, New York, NY, USA.

Objective: The Evans Index (EI) is used for recognition of individuals with normal pressure hydrocephalus. However, recent studies suggest that the EI is not a reliable marker of this condition. Rather, the EI may be inversely correlated with cognitive performance, but information on this correlation is lacking. We aimed to assess the relationship between the EI and cognitive performance in community-dwelling older adults.

Patients And Methods: The study included 314 non-disabled, stroke-free, individuals aged ≥60 years enrolled in the Atahualpa Project undergoing brain MRI and MoCA testing. Using generalized linear models, adjusted for demographics, cardiovascular risk factors edentulism, depression, global cortical atrophy and white matter hyperintensities of vascular origin, we assessed the relationship between the EI and cognitive performance. Predictive margins of the MoCA score according to percentiles of the EI were also evaluated, after adjusting for variables reaching significance in univariate models.

Results: The mean EI was 0.248 ± 0.022 and the mean MoCA score was 19.7 ± 4.8 points. A fully-adjusted generalized linear model showed a significant inverse relationship between the EI and the MoCA score. Predictive models showed a decrease in the MoCA score according to increased levels of the EI (β: -3.28; 95% C.I.: -6.09 to -0.47; p = 0.022).

Conclusion: The independent effect of the EI on the MoCA score provides evidence of the utility of the EI to evaluate cognitive performance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clineuro.2018.03.021DOI Listing
June 2018

Effect of academic status on outcomes of surgery for rectal cancer.

Surg Endosc 2018 06 7;32(6):2774-2780. Epub 2017 Dec 7.

Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.

Background: The purpose of our study was to investigate surgical outcomes following advanced colorectal procedures at academic versus community institutions.

Methods: The SPARCS database was used to identify patients undergoing Abdominoperineal resection (APR) and Low Anterior Resection between 2009 and 2014. Linear mixed models and generalized linear mixed models were used to compare outcomes. Laparoscopic versus open procedures, surgery type, volume status, and stoma formation between academic and community facilities were compared.

Results: Higher percentages of laparoscopic surgeries (58.68 vs. 41.32%, p value < 0.0001), more APR surgeries (64.60 vs. 35.40%, p value < 0.0001), more high volume hospitals (69.46 vs. 30.54%, p value < 0.0001), and less stoma formation (48.00 vs. 52.00%, p value < 0.0001) were associated with academic centers. After adjusting for confounding factors, academic facilities were more likely to perform APR surgeries (OR 1.35, 95% CI 1.04-1.74, p value = 0.0235). Minorities and Medicaid patients were more likely to receive care at an academic facility. Stoma formation, open surgery, and APR were associated with longer LOS and higher rate of ED visit and 30-day readmission.

Conclusion: Laparoscopy and APR are more commonly performed at academic than community facilities. Age, sex, race, and socioeconomic status affect the facility at which and the type of surgery patients receive, thereby influencing surgical outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-017-5977-zDOI Listing
June 2018

Academic status does not affect outcome following complex hepato-pancreato-biliary procedures.

Surg Endosc 2018 05 3;32(5):2355-2364. Epub 2017 Nov 3.

Division of Bariatric, Department of Surgery, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA.

Introduction: There is a growing debate regarding outcomes following complex hepato-pancreato-biliary (HPB) procedures. The purpose of our study is to examine if facility type has any impact on complications, readmission rates, emergency department (ED) visit rates, and length of stay (LOS) for patients undergoing HPB surgery.

Methods: The SPARCS administrative database was used to identify patients undergoing complex HPB procedures between 2012 and 2014 in New York. Univariate generalized linear mixed models were fit to estimate the marginal association between outcomes such as overall/severe complication rates, 30-day and 1-year readmission rates, 30-day and 1-year ED-visit rates, and potential risk factors. Univariate linear mixed models were used to estimate the marginal association between possible risk factors and LOS. Facility type, as well as any variables found to be significant in our univariate analysis (p = 0.05), was further included in the multivariable regression models.

Results: There were 4122 complex HPB procedures performed. Academic facilities were more likely to have a higher hospital volume (p < 0001). Surgery at academic facilities were less likely to have coexisting comorbidities; however, they were more likely to have metastatic cancer and/or liver disease (p = 0.0114, < 0. 0001, and = 0.0299, respectively). Postoperatively, patients at non-academic facilities experienced higher overall complication rates, and higher severe complication rates, when compared to those at academic facilities (p < 0.0001 and = 0.0018, respectively). Further analysis via adjustment for possible confounding factors, however, revealed no significant difference in the risk of severe complications between the two facility types. Such adjustment also demonstrated higher 30-day readmission risk in patients who underwent their surgery at an academic facility.

Conclusion: No significant difference was found when comparing the outcomes of academic and non-academic facilities, after adjusting for age, gender, race, region, insurance, and hospital volume. Patients from academic facilities were more likely to be readmitted within the first 30-days after surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-017-5931-0DOI Listing
May 2018

The Effect of Age in the Association between Frailty and Poor Sleep Quality: A Population-Based Study in Community-Dwellers (The Atahualpa Project).

J Am Med Dir Assoc 2016 Mar 28;17(3):269-71. Epub 2016 Jan 28.

Sleep Disorders Center, Mayo Clinic College of Medicine, Jacksonville, FL.

Purpose: To assess the effect of age in the association between poor sleep quality and frailty status.

Design And Setting: Population-based, cross-sectional study conducted in Atahualpa, a rural village located in coastal Ecuador.

Methods: Out of 351 Atahualpa residents aged ≥ 60 years, 311 (89%) were interviewed with the Pittsburgh Sleep Quality Index (PSQI) and the Edmonton Frail Scale (EFS). The independent association between PSQI and EFS scores was evaluated by the use of a generalized linear model adjusted for relevant confounders. A contour plot with Shepard interpolation was constructed to assess the effect of age in this association.

Results: Mean score in the PSQI was 5 ± 2 points, with 34% individuals classified as poor sleepers. Mean score in the EFS was 5 ± 3 points, with 46% individuals classified as robust, 23% as prefrail, and 31% as frail. In the fully adjusted model, higher scores in the PSQI were significantly associated with higher scores in the EFS (β 0.23; 95% CI 0.11-0.35; P < .0001). Several clusters depicted the strong effect of age in the association between PSQI and EFS scores. Older individuals were more likely to have high scores in the EFS and the PSQI, and younger individuals had low EFS scores and were good sleepers. Clusters of younger individuals who were poor sleepers and had high EFS scores accounted for the independent association between PSQI and EFS scores.

Conclusions: This study shows the strong effect of age in the association between poor sleep quality and frailty status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jamda.2015.12.009DOI Listing
March 2016

Neuroimaging signatures of frailty: A population-based study in community-dwelling older adults (the Atahualpa Project).

Geriatr Gerontol Int 2017 Feb 21;17(2):270-276. Epub 2016 Jan 21.

School of Medicine, Stony Brook University, New York, New York, USA.

Aims: Frailty is a geriatric state of physical vulnerability that might be associated with cognitive decline in the absence of a concurrent neurodegenerative disorder. This assumes that neuroimaging studies are normal, but such examinations have rarely been considered for a frailty work-up. The present study identifies neuroimaging signatures in older adults interviewed with the Edmonton Frail Scale (EFS).

Methods: Community-dwellers aged ≥60 years enrolled in the Atahualpa Project were invited to undergo brain magnetic resonance imaging. Using generalized regression models, we evaluated the association between frailty and diffuse cortical and subcortical brain damage, after adjusting for relevant confounders. Multivariate models estimated the interaction of age in the association between frailty and these neuroimaging signatures.

Results: Out of 298 participants (mean age 70 ± 8 years, 57% women), 151 (51%) had moderate-to-severe cortical atrophy and 74 (25%) had moderate-to-severe white matter hyperintensities of presumed vascular origin. Mean EFS scores were 5 ± 3 points, with 140 (47%) individuals classified as robust, 65 (22%) as pre-frail and 93 (31%) as frail. Multivariate models showed a significant association between cortical atrophy with the continuous (P = 0.002) and the categorized (P = 0.008) EFS score. The relationship between white matter hyperintensities and the EFS was marginal. According to interaction models, prefrail or frail individuals aged ≥67 years presented more prominent neuroimaging signatures of diffuse cortical or subcortical damage than their robust counterparts.

Conclusions: Neuroimaging signatures of frailty are mainly related to age. This reinforces the importance of early frailty detection to reduce its catastrophic consequences. Geriatr Gerontol Int 2017; 17: 270-276.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ggi.12708DOI Listing
February 2017