Surgeons
26 years of experience
Video profile
Accepting new patients
IHA Assoc in General & Vascular Surg
5325 Elliott Dr
Ste 104
Ypsilanti, MI 48197
734-712-8150
Locations and availability (12)

Education ?

Medical School Score
Wayne State University (1984)
  • Currently 1 of 4 apples

Awards & Distinctions ?

Associations
American Board of Colon and Rectal Surgery
American Board of Surgery

Affiliations ?

Dr. Cleary is affiliated with 7 hospitals.

Hospital Affilations

Score

Rankings

  • St. Joseph Mercy Oakland
    44405 Woodward Ave, Pontiac, MI 48341
    • Currently 4 of 4 crosses
    Top 25%
  • St. Mary Mercy Hospital
    36475 5 Mile Rd, Livonia, MI 48154
    • Currently 4 of 4 crosses
    Top 25%
  • Saint Joseph Mercy Saline Hospital
    400 W Russell St, Saline, MI 48176
    • Currently 4 of 4 crosses
    Top 25%
  • Saint Joseph Mercy Hospital
    505 E Huron St, Ann Arbor, MI 48104
    • Currently 3 of 4 crosses
    Top 50%
  • Chelsea Community Hospital
    775 S Main St, Chelsea, MI 48118
    • Currently 2 of 4 crosses
  • St. Joseph Mercy Livingston
  • St. Joseph Mercy Ann Arbor
  • Publications & Research

    Dr. Cleary has contributed to 8 publications.
    Title Isolated Growth Hormone Deficiency Type Ii Caused by a Point Mutation That Alters Both Splice Site Strength and Splicing Enhancer Function.
    Date February 2009
    Journal Clinical Genetics
    Excerpt

    A heterozygous single base mutation in the human growth hormone (GH) gene (GH-1) was identified in a family presenting with isolated GH deficiency type II (IGHD II). Affected individuals have a guanine to adenine transition at the first nucleotide of exon 3 (E3+1 G-->A) that results in exon skipping and production of a dominant-negative 17.5-kDa isoform. We show that the mechanistic basis for exon skipping is due to the unique position of this mutation because it weakens the 3' splice site and simultaneously disrupts a splicing enhancer located within the first seven bases of exon 3. A G-->T mutation at this same position not only affects splicing but also results in a premature stop codon for those transcripts that include exon 3. Thus, mutations that alter the first nucleotide of exon 3 illustrate the various mechanisms by which changes in sequence can cause disease: splice site selection, splicing enhancer function, messenger RNA decay, missense mutations, and nonsense mutations. For IGHD II, only exon skipping leads to production of the dominant-negative isoform, with increasing skipping correlating with increasing disease severity.

    Title Colon and Rectal Injuries.
    Date September 2006
    Journal Diseases of the Colon and Rectum
    Excerpt

    PURPOSE: This study was designed to develop treatment algorithms for colon, rectal, and anal injuries based on the review of relevant literature. METHODS: Information was obtained through a MEDLINE ( www.nobi.nih.gov/entrez/query.fcgi ) search, and additional references were obtained through cross-referencing key articles cited in these papers. RESULTS: A total of 203 articles were considered relevant. CONCLUSIONS: The management of penetrating and blunt colon, rectal, and anal injuries has evolved during the past 150 years. Since the World War II mandate to divert penetrating colon injuries, primary repair or resection and anastomosis have found an increasing role in patients with nondestructive injuries. A critical review of recent literature better defines the role of primary repair and fecal diversion for these injuries and allows for better algorithms for the management of these injuries.

    Title Treatment Options for Perianal Bowen's Disease: Survery of American Society of Colon and Rectal Surgeons Members.
    Date August 2000
    Journal The American Surgeon
    Excerpt

    The aim of this study was to determine current management practices of physicians caring for patients with perianal Bowen's disease. A questionnaire was sent to 1,499 members listed in the 1997 American Society of Colon and Rectal Surgeons Directory asking them how many patients they have treated and which operative or nonoperative treatment option they choose for small (< or =3 cm), large (> 3 cm), and microscopic lesions. Of 1,499, 663 (44.2%) surgeons responded. Not all respondents answered each item. Seventy-five per cent of surgeons surveyed (n = 653) devote greater than 75 per cent of their practice to colon and rectal surgery. Of 642 respondents, 552 (86%) managed a total of <10 patients, and 90/642 (14%), > or =10 patients. Ninety-six per cent of respondents use wide local excision for patients with small lesions. Eighty-seven per cent of respondents use wide local excision for patients with large lesions. Seventy-four per cent treat patients with microscopic disease conservatively and without wide excision. The majority of surgeons caring for patients with perianal Bowen's disease are performing wide local excision for both small and large lesions. Microscopic disease was usually treated conservatively with observation alone.

    Title Perianal Bowen's Disease and Anal Intraepithelial Neoplasia: Review of the Literature.
    Date August 1999
    Journal Diseases of the Colon and Rectum
    Excerpt

    PURPOSE: The aim of this study was to review the literature with regard to perianal Bowen's disease and anal intraepithelial neoplasia. METHODS: A literature review was conducted from 1960 to 1999 using MEDLINE. RESULTS: Perianal Bowen's disease and anal intraepithelial neoplasia are precursors to squamous carcinoma of the anus. They are analogous to and are associated with cervical and vulvar intraepithelial neoplasia, and have human papillomavirus as a common cause. Biopsy and histopathologic examination is required for diagnosis and to distinguish other perianal dermatoses. Treatment options range from aggressive wide local excision of all disease with negative margins to observation alone for microscopic lesions not visible to the naked eye. The disease has a proclivity for recurrence and recalcitrance. CONCLUSIONS: Most surgeons caring for patients with perianal Bowen's disease and high-grade anal epithelial neoplasia use wide local excision, with an effort to obtain disease-free margins. Some authors have reported the advantages of ablative procedures such as laser ablation and cryotherapy. Microscopic disease found serendipitously in hemorrhoidectomy specimens can probably be treated conservatively with serial examinations alone. There is a lack of controlled data supporting an optimal treatment strategy. A multicenter controlled study comparing wide local excision with ablative procedures may be warranted.

    Title Clostridium Difficile-associated Diarrhea and Colitis: Clinical Manifestations, Diagnosis, and Treatment.
    Date December 1998
    Journal Diseases of the Colon and Rectum
    Excerpt

    PURPOSE: This review examines the pathogenesis, clinical manifestations, diagnosis, and current medical and operative strategies in the treatment of Clostridium difficile diarrhea and colitis. Prevention and future avenues of research are also investigated. METHODS: A review of the literature was conducted with the use of MEDLINE. RESULTS: C. difficile is a gram-positive, spore-forming bacterium capable of causing toxigenic colitis in susceptible patients, usually those receiving antibiotics. Overgrowth of toxigenic strains may result in a spectrum of disease, including becoming an asymptomatic carrier, diarrhea, self-limited colitis, fulminant colitis, and toxic megacolon. Diagnosis requires a high index of suspicion and depends on clinical data, laboratory stool studies (enzyme-linked immunoabsorbent assay and cytotoxin test), and endoscopy in selected cases. Protocols for treatment of primary and relapsing infections are provided in algorithm format. Discontinuation of antibiotics may be enough to resolve symptoms. Medical management with oral metronidazole or vancomycin is the first-line therapy for those with symptomatic colitis. Teicoplanin, Saccharomyces spp. and Lactobacillus spp., and intravenous IgG antitoxin are reserved for more recalcitrant cases. Refractory or relapsing infections may require vancomycin given orally or other newer modalities. Fulminant colitis and toxic megacolon warrant subtotal colectomy. Cost, in terms of extended hospital stay, medical and surgical management, and, in some cases, ward closure, is thought to be formidable. Review of perioperative antibiotic policies and analysis of hospital formularies may contribute to prevention and decreased costs. CONCLUSION: C. difficile diarrhea and colitis is a nosocomial infection that may result in significant morbidity, mortality, and medical costs. Standard laboratory studies and endoscopic evaluation assist in the diagnosis of clinically suspicious cases. Appropriate perioperative antibiotic dosing, narrowing the antibiotic spectrum when treating infections, and discontinuing antibiotics at appropriate intervals prevent toxic sequelae.

    Title Metronidazole May Inhibit Intestinal Colonization with Clostridium Difficile.
    Date April 1998
    Journal Diseases of the Colon and Rectum
    Excerpt

    PURPOSE: Antibiotics suppress normal gut flora, allowing overgrowth of acquired or native Clostridium difficile, with release of toxins that cause mucosal inflammation. Oral metronidazole is used to treat antibiotic-associated colitis (pseudomembranous colitis). This study was designed to determine whether oral metronidazole, as part of preoperative bowel preparation, prevents or decreases incidence of antibiotic-associated colitis after elective colonic and rectal procedures. METHODS: Eighty-two patients (40 men) were prospectively, randomly assigned to receive one of two oral antibiotic regimens before colorectal surgery. All patients underwent mechanical bowel preparation with polyethylene glycol-electrolyte lavage solution before administration of oral antibiotics. Group 1 (n = 42) patients received three doses (1 g/dose) of neomycin and erythromycin. Group 2 (n = 40) patients received three doses (1 g/dose) of neomycin and metronidazole. Both groups received one preoperative and three postoperative doses of intravenous cefotetan (2 g/dose). Both groups had stool samples tested for C. difficile toxin in the preoperative and postoperative periods by enzyme-linked immunoabsorbent assay or by tissue culture cytotoxicity. Patients with preoperative stool studies positive for C. difficile were excluded from the study. RESULTS: Treatment groups were not different for age, gender, or surgical procedure. Mean age +/- 1 standard deviation was 67.6 +/- 13.6 (range, 34-94) years in Group 1 and 62.1 +/- 13.5 (range, 35-84) years in Group 2 (P = 0.069). Mean length of hospital stay +/- 1 standard deviation was 9.76 +/- 4.9 (range, 4-28) days for Group 1 and 8.05 +/- 2.6 (range, 3-14) days for Group 2 (P = 0.053). Five patients in Group 1 (neomycin and erythromycin) and one patient in Group 2 (neomycin and metronidazole) had positive stool studies for C. difficile. Relative risk of colonization with C. difficile in Group 1 was 4.76 times that in Group 2 (95 percent confidence interval, 0.581, 39). This difference was not statistically significant (P = 0.202). There were no significant differences in C. difficile colonization rates with respect to age, length of stay, or gender. CONCLUSIONS: This study suggests that there may be a clinical association between use of metronidazole preoperatively and inhibition of intestinal colonization by C. difficile in this patient population undergoing colonic and rectal surgery.

    Title Salpingocolonic Fistula Secondary to Diverticulitis.
    Date January 1997
    Journal The American Surgeon
    Excerpt

    A rare diverticular fistula is reported in a 37-year-old woman. The case history and literature were reviewed for clinical presentation, radiologic investigations, and treatment options. Internal fistulas may complicate diverticular disease. The least common fistula is between the colon and the fallopian tube. Successful management of this complication is directed at removing the diseased colon. The woman had a salpingocolonic fistula secondary to diverticulitis. To our knowledge, she represents the youngest patient with this complication of diverticular disease in the literature. Diagnosis of a salpingocolonic fistula complicating diverticular disease requires clinical suspicion when genitourinary symptoms complicate the clinical presentation. Hysterosalpingography or contrast injection of percutaneous drainage tubes may contribute to the diagnosis.

    Title Small Bowel Obstruction As the Primary Presentation of Undiagnosed Metastatic Lobular Breast Carcinoma.
    Date
    Journal Breast Disease
    Excerpt

    Breast carcinoma continues to be the most common neoplasm in women, with a lifetime risk affecting approximately 1 in 8. Factors affecting prognosis include the size and grade of the primary lesion, regional axillary lymphadenopathy, the presence of hormonal receptors, and distant metastatic disease. Although metastatic breast disease usually affects the lungs, bones, and brain, abdominal association is not as common. Interestingly, lobular carcinoma, a subtype that only accounts for a minor portion of breast cancers, usually has luminal gastro-intestinal involvement. We describe a 57-year old Caucasian female with recurrent episodes of abdominal pain and concurrent intermittent obstructive symptomatology with overflow diarrhea over a one-year period. Conventional endoscopic and imaging workup was unrevealing. Capsule endoscopy was used, but this caused a complete bowel obstruction necessitating surgery, and subsequent resection of a strictured segment. Pathological examination yielded metastatic adenocarcinoma, consistent with origin in breast, lobular type. Immunohistochemistry confirmed the origin. Luminal gastro-intestinal involvement is a rare, yet recognized, site of breast adenocarcinoma metastasis; it is even more uncommon with an undiagnosed primary. It may mimic other gastro-intestinal disease, and as such, it would be prudent to maintain a modest index of suspicion given the high prevalence of breast neoplasia.


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