2003
Swan, J. Shannon; Sainfort, F.; Lawrence, W. F.; Kuruchittham, V.; Kongnakorn, T.; Heisey, D. M.
Process utility for imaging in cerebrovascular disease Journal Article
In: vol. 10, pp. 266–74, 2003, ().
@article{Swan2003,
title = {Process utility for imaging in cerebrovascular disease},
author = {J. Shannon Swan and F. Sainfort and W. F. Lawrence and V. Kuruchittham and T. Kongnakorn and D. M. Heisey},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12643553},
year = {2003},
date = {2003-01-01},
volume = {10},
pages = {266--74},
abstract = {RATIONALE AND OBJECTIVES: The morbidity associated with a diagnostic
test can influence its cost-effectiveness, but the quantification
of that morbidity is controversial. Accounting for pain and invasiveness
requires the measurement of "process utility" in addition to the
expected value of testing. An original time trade-off variant was
applied to the imaging evaluation of cerebrovascular disease, for
which differences in morbidity are important to patients. MATERIALS
AND METHODS: A "waiting trade-off" (WTO) was used to evaluate the
preferences of 89 patients for magnetic resonance (MR) angiography
and conventional x-ray angiography. Patients were experienced with
both tests. A weighted difference was calculated between the period
a patient was willing to wait for a test result and treatment after
a hypothetical "ideal" test and the choice to undergo conventional
angiography or MR angiography with immediate treatment. A rating
scale was used to check the convergent validity of the WTO. RESULTS: Paired data showed a highly significant difference (P = .0001) between
the mean preference for conventional and MR angiography, favoring
the latter and translating into a difference of 5 quality-adjusted
life days. The more negatively patients judged their conventional
angiographic experience, the longer they were willing to wait for
the ideal test result. CONCLUSION: The WTO provides a reasonable
estimate of the relative morbidity of more invasive conventional
angiographic procedures and provides a quality-adjustment term for
economic analysis. Such an approach may enable more complete evaluation
of the effects of other processes on medical care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
RATIONALE AND OBJECTIVES: The morbidity associated with a diagnostic
test can influence its cost-effectiveness, but the quantification
of that morbidity is controversial. Accounting for pain and invasiveness
requires the measurement of "process utility" in addition to the
expected value of testing. An original time trade-off variant was
applied to the imaging evaluation of cerebrovascular disease, for
which differences in morbidity are important to patients. MATERIALS
AND METHODS: A "waiting trade-off" (WTO) was used to evaluate the
preferences of 89 patients for magnetic resonance (MR) angiography
and conventional x-ray angiography. Patients were experienced with
both tests. A weighted difference was calculated between the period
a patient was willing to wait for a test result and treatment after
a hypothetical "ideal" test and the choice to undergo conventional
angiography or MR angiography with immediate treatment. A rating
scale was used to check the convergent validity of the WTO. RESULTS: Paired data showed a highly significant difference (P = .0001) between
the mean preference for conventional and MR angiography, favoring
the latter and translating into a difference of 5 quality-adjusted
life days. The more negatively patients judged their conventional
angiographic experience, the longer they were willing to wait for
the ideal test result. CONCLUSION: The WTO provides a reasonable
estimate of the relative morbidity of more invasive conventional
angiographic procedures and provides a quality-adjustment term for
economic analysis. Such an approach may enable more complete evaluation
of the effects of other processes on medical care.
test can influence its cost-effectiveness, but the quantification
of that morbidity is controversial. Accounting for pain and invasiveness
requires the measurement of "process utility" in addition to the
expected value of testing. An original time trade-off variant was
applied to the imaging evaluation of cerebrovascular disease, for
which differences in morbidity are important to patients. MATERIALS
AND METHODS: A "waiting trade-off" (WTO) was used to evaluate the
preferences of 89 patients for magnetic resonance (MR) angiography
and conventional x-ray angiography. Patients were experienced with
both tests. A weighted difference was calculated between the period
a patient was willing to wait for a test result and treatment after
a hypothetical "ideal" test and the choice to undergo conventional
angiography or MR angiography with immediate treatment. A rating
scale was used to check the convergent validity of the WTO. RESULTS: Paired data showed a highly significant difference (P = .0001) between
the mean preference for conventional and MR angiography, favoring
the latter and translating into a difference of 5 quality-adjusted
life days. The more negatively patients judged their conventional
angiographic experience, the longer they were willing to wait for
the ideal test result. CONCLUSION: The WTO provides a reasonable
estimate of the relative morbidity of more invasive conventional
angiographic procedures and provides a quality-adjustment term for
economic analysis. Such an approach may enable more complete evaluation
of the effects of other processes on medical care.
Tearney, G. J.; Yabushita, H.; Houser, S. L.; Aretz, H. T.; Jang, I. K.; Schlendorf, K. H.; Kauffman, C. R.; Shishkov, M.; Halpern, Elkan F.; Bouma, B. E.
Quantification of macrophage content in atherosclerotic plaques by optical coherence tomography Journal Article
In: Circulation, vol. 107, no. 1, pp. 113-9, 2003, ISSN: 1524-4539 (Electronic) 0009-7322, ().
@article{Tearney2003,
title = {Quantification of macrophage content in atherosclerotic plaques by
optical coherence tomography},
author = {G. J. Tearney and H. Yabushita and S. L. Houser and H. T. Aretz and I. K. Jang and K. H. Schlendorf and C. R. Kauffman and M. Shishkov and Elkan F. Halpern and B. E. Bouma},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12515752},
issn = {1524-4539 (Electronic) 0009-7322},
year = {2003},
date = {2003-01-01},
journal = {Circulation},
volume = {107},
number = {1},
pages = {113-9},
abstract = {BACKGROUND: Macrophage degradation of fibrous cap matrix is an important
contributor to atherosclerotic plaque instability. An imaging technology
capable of identifying macrophages in patients could provide valuable
information for assessing plaque vulnerability. Optical coherence
tomography (OCT) is a new intravascular imaging modality that allows
cross-sectional imaging of tissue with a resolution of approximately
10 micro m. The aim of this study was to investigate the use of OCT
for identifying macrophages in fibrous caps. METHODS AND RESULTS:
OCT images of 26 lipid-rich atherosclerotic arterial segments obtained
at autopsy were correlated with histology. Cap macrophage density
was quantified morphometrically by immunoperoxidase staining with
CD68 and smooth muscle actin and compared with the standard deviation
of the OCT signal intensity at corresponding locations. There was
a high degree of positive correlation between OCT and histological measurements of fibrous cap macrophage density (r=0.84, P\<0.0001)
and a negative correlation between OCT and histological measurements of smooth muscle actin density (r=-0.56, P\<0.005). A range of OCT
signal standard deviation thresholds (6.15% to 6.35%) yielded 100%
sensitivity and specificity for identifying caps containing \>10%
CD68 staining. CONCLUSIONS: The high contrast and resolution of OCT
enables the quantification of macrophages within fibrous caps. The
unique capabilities of OCT for fibrous cap characterization suggest
that this technology may be well suited for identifying vulnerable
plaques in patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Macrophage degradation of fibrous cap matrix is an important
contributor to atherosclerotic plaque instability. An imaging technology
capable of identifying macrophages in patients could provide valuable
information for assessing plaque vulnerability. Optical coherence
tomography (OCT) is a new intravascular imaging modality that allows
cross-sectional imaging of tissue with a resolution of approximately
10 micro m. The aim of this study was to investigate the use of OCT
for identifying macrophages in fibrous caps. METHODS AND RESULTS:
OCT images of 26 lipid-rich atherosclerotic arterial segments obtained
at autopsy were correlated with histology. Cap macrophage density
was quantified morphometrically by immunoperoxidase staining with
CD68 and smooth muscle actin and compared with the standard deviation
of the OCT signal intensity at corresponding locations. There was
a high degree of positive correlation between OCT and histological measurements of fibrous cap macrophage density (r=0.84, P<0.0001)
and a negative correlation between OCT and histological measurements of smooth muscle actin density (r=-0.56, P<0.005). A range of OCT
signal standard deviation thresholds (6.15% to 6.35%) yielded 100%
sensitivity and specificity for identifying caps containing >10%
CD68 staining. CONCLUSIONS: The high contrast and resolution of OCT
enables the quantification of macrophages within fibrous caps. The
unique capabilities of OCT for fibrous cap characterization suggest
that this technology may be well suited for identifying vulnerable
plaques in patients.
contributor to atherosclerotic plaque instability. An imaging technology
capable of identifying macrophages in patients could provide valuable
information for assessing plaque vulnerability. Optical coherence
tomography (OCT) is a new intravascular imaging modality that allows
cross-sectional imaging of tissue with a resolution of approximately
10 micro m. The aim of this study was to investigate the use of OCT
for identifying macrophages in fibrous caps. METHODS AND RESULTS:
OCT images of 26 lipid-rich atherosclerotic arterial segments obtained
at autopsy were correlated with histology. Cap macrophage density
was quantified morphometrically by immunoperoxidase staining with
CD68 and smooth muscle actin and compared with the standard deviation
of the OCT signal intensity at corresponding locations. There was
a high degree of positive correlation between OCT and histological measurements of fibrous cap macrophage density (r=0.84, P<0.0001)
and a negative correlation between OCT and histological measurements of smooth muscle actin density (r=-0.56, P<0.005). A range of OCT
signal standard deviation thresholds (6.15% to 6.35%) yielded 100%
sensitivity and specificity for identifying caps containing >10%
CD68 staining. CONCLUSIONS: The high contrast and resolution of OCT
enables the quantification of macrophages within fibrous caps. The
unique capabilities of OCT for fibrous cap characterization suggest
that this technology may be well suited for identifying vulnerable
plaques in patients.
Tseng, W. Y.; Wedeen, V. J.; Reese, T. G.; Smith, R. N.; Halpern, Elkan F.
Diffusion tensor MRI of myocardial fibers and sheets: correspondence with visible cut-face texture Journal Article
In: J Magn Reson Imaging, vol. 17, no. 1, pp. 31-42, 2003, ISSN: 1053-1807 (Print) 1053-1807 (Lin, ().
@article{Tseng2003,
title = {Diffusion tensor MRI of myocardial fibers and sheets: correspondence with visible cut-face texture},
author = {W. Y. Tseng and V. J. Wedeen and T. G. Reese and R. N. Smith and Elkan F. Halpern},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12500272},
issn = {1053-1807 (Print) 1053-1807 (Lin},
year = {2003},
date = {2003-01-01},
urldate = {2003-01-01},
journal = {J Magn Reson Imaging},
volume = {17},
number = {1},
pages = {31-42},
abstract = {PURPOSE: To test the hypothesis that the primary, secondary, and tertiary
eigenvectors of the diffusion tensor (DT) measured with DT-MRI correspond
to the fiber, sheet, and sheet normal directions, respectively, we
compared DT-MRI data with the texture visible in the cut face of
fresh bovine myocardium. MATERIALS AND METHODS: DT-MRI and optical
images obtained under identical conditions were compared objectively.
Ink prints were made of the cut tissue, and the local orientations
within these images were defined by analysis of local autocorrelations
for regions matching DT-MRI pixels. Deviation angles between the
cleavage orientations and the diffusion eigenvectors were analyzed
in eight specimens sliced in three orthogonal planes. RESULTS: Root-mean-square
(RMS) angular disparity was 11 degrees between the first eigenvectors
of the DT and the fiber direction, 14 degrees between the second
eigenvector and the sheet direction, 14 degrees between the third
eigenvector and the sheet normal direction, and 15 degrees between
the tensor orientation in the imaging plane and the cleavage orientation
of the cut face. CONCLUSION: The results support a parallel relationship
between the eigenvectors of the DT and symmetry axes of the myocardial
architecture. Specifically, the first, second and third eigenvectors
correspond to the fiber, sheet, and sheet normal directions, respectively.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To test the hypothesis that the primary, secondary, and tertiary
eigenvectors of the diffusion tensor (DT) measured with DT-MRI correspond
to the fiber, sheet, and sheet normal directions, respectively, we
compared DT-MRI data with the texture visible in the cut face of
fresh bovine myocardium. MATERIALS AND METHODS: DT-MRI and optical
images obtained under identical conditions were compared objectively.
Ink prints were made of the cut tissue, and the local orientations
within these images were defined by analysis of local autocorrelations
for regions matching DT-MRI pixels. Deviation angles between the
cleavage orientations and the diffusion eigenvectors were analyzed
in eight specimens sliced in three orthogonal planes. RESULTS: Root-mean-square
(RMS) angular disparity was 11 degrees between the first eigenvectors
of the DT and the fiber direction, 14 degrees between the second
eigenvector and the sheet direction, 14 degrees between the third
eigenvector and the sheet normal direction, and 15 degrees between
the tensor orientation in the imaging plane and the cleavage orientation
of the cut face. CONCLUSION: The results support a parallel relationship
between the eigenvectors of the DT and symmetry axes of the myocardial
architecture. Specifically, the first, second and third eigenvectors
correspond to the fiber, sheet, and sheet normal directions, respectively.
eigenvectors of the diffusion tensor (DT) measured with DT-MRI correspond
to the fiber, sheet, and sheet normal directions, respectively, we
compared DT-MRI data with the texture visible in the cut face of
fresh bovine myocardium. MATERIALS AND METHODS: DT-MRI and optical
images obtained under identical conditions were compared objectively.
Ink prints were made of the cut tissue, and the local orientations
within these images were defined by analysis of local autocorrelations
for regions matching DT-MRI pixels. Deviation angles between the
cleavage orientations and the diffusion eigenvectors were analyzed
in eight specimens sliced in three orthogonal planes. RESULTS: Root-mean-square
(RMS) angular disparity was 11 degrees between the first eigenvectors
of the DT and the fiber direction, 14 degrees between the second
eigenvector and the sheet direction, 14 degrees between the third
eigenvector and the sheet normal direction, and 15 degrees between
the tensor orientation in the imaging plane and the cleavage orientation
of the cut face. CONCLUSION: The results support a parallel relationship
between the eigenvectors of the DT and symmetry axes of the myocardial
architecture. Specifically, the first, second and third eigenvectors
correspond to the fiber, sheet, and sheet normal directions, respectively.
Visser, K.; Kuntz, K. M.; Donaldson, M. C.; Gazelle, G. Scott; Hunink, M. G.
Pretreatment imaging workup for patients with intermittent claudication: a cost-effectiveness analysis Journal Article
In: J Vasc Interv Radiol, vol. 14, no. 1, pp. 53-62, 2003, ISSN: 1051-0443 (Print) 1051-0443 (Lin, ().
@article{Visser2003,
title = {Pretreatment imaging workup for patients with intermittent claudication:
a cost-effectiveness analysis},
author = {K. Visser and K. M. Kuntz and M. C. Donaldson and G. Scott Gazelle and M. G. Hunink},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12525586},
issn = {1051-0443 (Print) 1051-0443 (Lin},
year = {2003},
date = {2003-01-01},
journal = {J Vasc Interv Radiol},
volume = {14},
number = {1},
pages = {53-62},
abstract = {PURPOSE: To determine the optimal imaging strategy in pretreatment
workup of patients with intermittent claudication with use of noninvasive
imaging modalities and intraarterial digital subtraction angiography
(DSA). MATERIALS AND METHODS: A decision-analytic model that considered
test characteristics such as sensitivity, complications induced by
the test, implications of missing lesions, and the consequences of
overtreating patients, was developed to evaluate the societal cost-effectiveness
(CE) of magnetic resonance (MR) angiography, duplex ultrasonography
(US), and DSA. Our main outcome measures were quality-adjusted life
years (QALYs), lifetime costs (in dollars), and incremental CE ratios.
The base-case analysis considered a cohort of 60-year old male patients
without a history of coronary artery disease who presented with severe
claudication to undergo pretreatment imaging workup. RESULTS: The
range in effectiveness and lifetime costs among different diagnostic
workup strategies was small (largest difference in effectiveness:
0.025 QALYs; largest difference in lifetime costs: $1,800). If treatment
was limited to angioplasty in patients with suitable lesions, MR
angiography had an incremental CE ratio of $35,000 per QALY compared
with no diagnostic workup, and DSA had an incremental CE ratio of
$471,000 per QALY compared with MR angiography. If treatment options
included both angioplasty and bypass surgery, DSA had an incremental
CE ratio of $179,000 per QALY compared with no diagnostic workup,
and MR angiography and duplex US were less effective and more costly.
CONCLUSIONS: The differences in costs and effectiveness among diagnostic
imaging strategies for patients with intermittent claudication are
slight and MR angiography or duplex US can replace DSA without substantial
loss in effectiveness and with a slight cost reduction.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine the optimal imaging strategy in pretreatment
workup of patients with intermittent claudication with use of noninvasive
imaging modalities and intraarterial digital subtraction angiography
(DSA). MATERIALS AND METHODS: A decision-analytic model that considered
test characteristics such as sensitivity, complications induced by
the test, implications of missing lesions, and the consequences of
overtreating patients, was developed to evaluate the societal cost-effectiveness
(CE) of magnetic resonance (MR) angiography, duplex ultrasonography
(US), and DSA. Our main outcome measures were quality-adjusted life
years (QALYs), lifetime costs (in dollars), and incremental CE ratios.
The base-case analysis considered a cohort of 60-year old male patients
without a history of coronary artery disease who presented with severe
claudication to undergo pretreatment imaging workup. RESULTS: The
range in effectiveness and lifetime costs among different diagnostic
workup strategies was small (largest difference in effectiveness:
0.025 QALYs; largest difference in lifetime costs: $1,800). If treatment
was limited to angioplasty in patients with suitable lesions, MR
angiography had an incremental CE ratio of $35,000 per QALY compared
with no diagnostic workup, and DSA had an incremental CE ratio of
$471,000 per QALY compared with MR angiography. If treatment options
included both angioplasty and bypass surgery, DSA had an incremental
CE ratio of $179,000 per QALY compared with no diagnostic workup,
and MR angiography and duplex US were less effective and more costly.
CONCLUSIONS: The differences in costs and effectiveness among diagnostic
imaging strategies for patients with intermittent claudication are
slight and MR angiography or duplex US can replace DSA without substantial
loss in effectiveness and with a slight cost reduction.
workup of patients with intermittent claudication with use of noninvasive
imaging modalities and intraarterial digital subtraction angiography
(DSA). MATERIALS AND METHODS: A decision-analytic model that considered
test characteristics such as sensitivity, complications induced by
the test, implications of missing lesions, and the consequences of
overtreating patients, was developed to evaluate the societal cost-effectiveness
(CE) of magnetic resonance (MR) angiography, duplex ultrasonography
(US), and DSA. Our main outcome measures were quality-adjusted life
years (QALYs), lifetime costs (in dollars), and incremental CE ratios.
The base-case analysis considered a cohort of 60-year old male patients
without a history of coronary artery disease who presented with severe
claudication to undergo pretreatment imaging workup. RESULTS: The
range in effectiveness and lifetime costs among different diagnostic
workup strategies was small (largest difference in effectiveness:
0.025 QALYs; largest difference in lifetime costs: $1,800). If treatment
was limited to angioplasty in patients with suitable lesions, MR
angiography had an incremental CE ratio of $35,000 per QALY compared
with no diagnostic workup, and DSA had an incremental CE ratio of
$471,000 per QALY compared with MR angiography. If treatment options
included both angioplasty and bypass surgery, DSA had an incremental
CE ratio of $179,000 per QALY compared with no diagnostic workup,
and MR angiography and duplex US were less effective and more costly.
CONCLUSIONS: The differences in costs and effectiveness among diagnostic
imaging strategies for patients with intermittent claudication are
slight and MR angiography or duplex US can replace DSA without substantial
loss in effectiveness and with a slight cost reduction.
Wildner, M.; Peters, A.; Raghuvanshi, V. S.; Hohnloser, J.; Siebert, Uwe
Superiority of age and weight as variables in predicting osteoporosis in postmenopausal white women Journal Article
In: Osteoporos Int, vol. 14, pp. 950-6, 2003, ().
@article{Wildner2003,
title = {Superiority of age and weight as variables in predicting osteoporosis
in postmenopausal white women},
author = {M. Wildner and A. Peters and V. S. Raghuvanshi and J. Hohnloser and Uwe Siebert},
url = {http://www.ncbi.nlm.nih.gov/pubmed/13680102},
year = {2003},
date = {2003-01-01},
journal = {Osteoporos Int},
volume = {14},
pages = {950-6},
abstract = {Identification of women at risk for osteoporosis is of great importance
for the prevention of osteoporotic fractures. Routine BMD measurement
of all women is not feasible for most populations, hence identification
of a high-risk subset of women is an important element of effective
preventive strategies. METHODS: We identified 959 postmenopausal
non-Hispanic women aged 51 years and above from the NHANES III study
to assess the relative contribution of risk predictors for low BMD
at the whole proximal femur and the femoral neck regions. Based on
recognized risk factors for osteoporosis identified by a systematic
literature search, we ran several multiple linear regression models
based on the results of preceding bivariate analyses. We show several
models based on their explanatory ability assessed by adjusted r(2),
ROC, and C-value analyses rather than on the coefficients and P values.
We furthermore examined the sensitivity, specificity, and predictive
values of our preferred models for various cutoff T-scores-the choice
of which will vary depending on different study goals and population
characteristics. RESULTS: Age and weight were by far the most informative
predictors for low bone mineral density out of a list of 20 candidate
risk predictors. Our preferred prediction models for the two regions
hence contained only two variables: i.e., age and measured weight.
The resulting parsimonious model to predict BMD at whole proximal
femur had an adjusted r(2) of 0.43, an area under the ROC curve of
0.85, and a C-value of 0.70. Similarly, prediction for BMD at the
femoral neck had adjusted r(2), area under the curve, and C-value
of 0.39, 0.83, and 0.66, respectively. CONCLUSIONS: The model equations, predicted T-score = -1.332-0.0404 x (age) + 0.0386 x (measured weight) and predicted T-score = -1.318-0.0360 x (age) + 0.0314 x (measured
weight) for whole proximal femur and femoral neck, respectively,
can be used in field conditions for screening purposes. More complex
prediction equations add little explanatory power. Based on the study
goals and the population characteristics, specific cutoff T-scores
have to be decided before using these equations.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Identification of women at risk for osteoporosis is of great importance
for the prevention of osteoporotic fractures. Routine BMD measurement
of all women is not feasible for most populations, hence identification
of a high-risk subset of women is an important element of effective
preventive strategies. METHODS: We identified 959 postmenopausal
non-Hispanic women aged 51 years and above from the NHANES III study
to assess the relative contribution of risk predictors for low BMD
at the whole proximal femur and the femoral neck regions. Based on
recognized risk factors for osteoporosis identified by a systematic
literature search, we ran several multiple linear regression models
based on the results of preceding bivariate analyses. We show several
models based on their explanatory ability assessed by adjusted r(2),
ROC, and C-value analyses rather than on the coefficients and P values.
We furthermore examined the sensitivity, specificity, and predictive
values of our preferred models for various cutoff T-scores-the choice
of which will vary depending on different study goals and population
characteristics. RESULTS: Age and weight were by far the most informative
predictors for low bone mineral density out of a list of 20 candidate
risk predictors. Our preferred prediction models for the two regions
hence contained only two variables: i.e., age and measured weight.
The resulting parsimonious model to predict BMD at whole proximal
femur had an adjusted r(2) of 0.43, an area under the ROC curve of
0.85, and a C-value of 0.70. Similarly, prediction for BMD at the
femoral neck had adjusted r(2), area under the curve, and C-value
of 0.39, 0.83, and 0.66, respectively. CONCLUSIONS: The model equations, predicted T-score = -1.332-0.0404 x (age) + 0.0386 x (measured weight) and predicted T-score = -1.318-0.0360 x (age) + 0.0314 x (measured
weight) for whole proximal femur and femoral neck, respectively,
can be used in field conditions for screening purposes. More complex
prediction equations add little explanatory power. Based on the study
goals and the population characteristics, specific cutoff T-scores
have to be decided before using these equations.
for the prevention of osteoporotic fractures. Routine BMD measurement
of all women is not feasible for most populations, hence identification
of a high-risk subset of women is an important element of effective
preventive strategies. METHODS: We identified 959 postmenopausal
non-Hispanic women aged 51 years and above from the NHANES III study
to assess the relative contribution of risk predictors for low BMD
at the whole proximal femur and the femoral neck regions. Based on
recognized risk factors for osteoporosis identified by a systematic
literature search, we ran several multiple linear regression models
based on the results of preceding bivariate analyses. We show several
models based on their explanatory ability assessed by adjusted r(2),
ROC, and C-value analyses rather than on the coefficients and P values.
We furthermore examined the sensitivity, specificity, and predictive
values of our preferred models for various cutoff T-scores-the choice
of which will vary depending on different study goals and population
characteristics. RESULTS: Age and weight were by far the most informative
predictors for low bone mineral density out of a list of 20 candidate
risk predictors. Our preferred prediction models for the two regions
hence contained only two variables: i.e., age and measured weight.
The resulting parsimonious model to predict BMD at whole proximal
femur had an adjusted r(2) of 0.43, an area under the ROC curve of
0.85, and a C-value of 0.70. Similarly, prediction for BMD at the
femoral neck had adjusted r(2), area under the curve, and C-value
of 0.39, 0.83, and 0.66, respectively. CONCLUSIONS: The model equations, predicted T-score = -1.332-0.0404 x (age) + 0.0386 x (measured weight) and predicted T-score = -1.318-0.0360 x (age) + 0.0314 x (measured
weight) for whole proximal femur and femoral neck, respectively,
can be used in field conditions for screening purposes. More complex
prediction equations add little explanatory power. Based on the study
goals and the population characteristics, specific cutoff T-scores
have to be decided before using these equations.
Wittenberg, Eve; Goldie, S. J.; Fischhoff, B.; Graham, J. D.
Rationing decisions and individual responsibility for illness: are all lives equal? Journal Article
In: Med Decis Making, vol. 23, pp. 194-211, 2003, ().
@article{Wittenberg2003,
title = {Rationing decisions and individual responsibility for illness: are
all lives equal?},
author = {Eve Wittenberg and S. J. Goldie and B. Fischhoff and J. D. Graham},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12809318},
year = {2003},
date = {2003-01-01},
journal = {Med Decis Making},
volume = {23},
pages = {194-211},
abstract = {OBJECTIVES: This survey measured individuals' rationing allocation
choices for situations in which patients are deemed to hold personal
responsibility for their diseases and the influence of different
arguments on such choices. METHODS: The association between allocation
decisions for liver disease and asthma and the belief that a patient
was responsible for his or her illness was modeled using multivariable
regression analysis, controlling for the effect of arguments on choices.
RESULTS: In data from 310 returned surveys (43% response rate), respondents
were 10 to 17 times more likely to allocate liver transplants or
asthma treatment to patients they deemed not responsible for their
illnesses than to patients they deemed responsible for their conditions (liver transplants: odds ratio [OR] = 10.3, 95% confidence interval ([CI] = 2.5-42.1; asthma: OR = 16.8, 95% CI = 2.1-136.6). CONCLUSIONS:
Personal responsibility for illness was an important consideration
in respondents' rationing allocation decisions. These choices appeared
to be stable although possibly influenced by respondents' interpretations
of the survey scenarios and decision tasks.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: This survey measured individuals' rationing allocation
choices for situations in which patients are deemed to hold personal
responsibility for their diseases and the influence of different
arguments on such choices. METHODS: The association between allocation
decisions for liver disease and asthma and the belief that a patient
was responsible for his or her illness was modeled using multivariable
regression analysis, controlling for the effect of arguments on choices.
RESULTS: In data from 310 returned surveys (43% response rate), respondents
were 10 to 17 times more likely to allocate liver transplants or
asthma treatment to patients they deemed not responsible for their
illnesses than to patients they deemed responsible for their conditions (liver transplants: odds ratio [OR] = 10.3, 95% confidence interval ([CI] = 2.5-42.1; asthma: OR = 16.8, 95% CI = 2.1-136.6). CONCLUSIONS:
Personal responsibility for illness was an important consideration
in respondents' rationing allocation decisions. These choices appeared
to be stable although possibly influenced by respondents' interpretations
of the survey scenarios and decision tasks.
choices for situations in which patients are deemed to hold personal
responsibility for their diseases and the influence of different
arguments on such choices. METHODS: The association between allocation
decisions for liver disease and asthma and the belief that a patient
was responsible for his or her illness was modeled using multivariable
regression analysis, controlling for the effect of arguments on choices.
RESULTS: In data from 310 returned surveys (43% response rate), respondents
were 10 to 17 times more likely to allocate liver transplants or
asthma treatment to patients they deemed not responsible for their
illnesses than to patients they deemed responsible for their conditions (liver transplants: odds ratio [OR] = 10.3, 95% confidence interval ([CI] = 2.5-42.1; asthma: OR = 16.8, 95% CI = 2.1-136.6). CONCLUSIONS:
Personal responsibility for illness was an important consideration
in respondents' rationing allocation decisions. These choices appeared
to be stable although possibly influenced by respondents' interpretations
of the survey scenarios and decision tasks.
O'Hair, D.; Villagran, M. M.; Wittenberg, Eve; Brown, K.; Ferguson, M.; Hall, H. T.; Doty, T.
Cancer survivorship and agency model: implications for patient choice, decision making, and influence Journal Article
In: Health Commun, vol. 15, no. 2, pp. 193-202, 2003, ISSN: 1041-0236 (Print) 1041-0236 (Lin, ().
@article{O'Hair2003,
title = {Cancer survivorship and agency model: implications for patient choice,
decision making, and influence},
author = {D. O'Hair and M. M. Villagran and Eve Wittenberg and K. Brown and M. Ferguson and H. T. Hall and T. Doty},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12742770},
issn = {1041-0236 (Print) 1041-0236 (Lin},
year = {2003},
date = {2003-01-01},
journal = {Health Commun},
volume = {15},
number = {2},
pages = {193-202},
abstract = {Relative to other types of health communication research (acute care
physician patient communication, communication campaigns, compliance
episodes, etc.), investigations of patient communication following
the diagnosis of cancer are infrequent. Theoretically driven, empirical
research is desperately needed in such postdiagnostic communication
processes as survivorship, quality of life, palliative and hospice
care, and loss, bereavement, and grief for those millions of people
who have been diagnosed with the second leading cause of death in
our nation. An organizational model of patient communication is needed
that identifies and describes salient issues and processes involved
when cancer patients attempt to negotiate the difficult courses of
action following the diagnosis of cancer. The cancer survivorship
and agency model (CSAM) proposes both general and specific strategies
that serve as options for patients seeking to take greater control
of the decision-making process related to their treatment and care
of cancer. Although seemingly practical in its offering, CSAM is
intended to serve as a heuristic springboard for theoretically based,
applied communication research focusing exclusively on post diagnostic
cancer processes.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Relative to other types of health communication research (acute care
physician patient communication, communication campaigns, compliance
episodes, etc.), investigations of patient communication following
the diagnosis of cancer are infrequent. Theoretically driven, empirical
research is desperately needed in such postdiagnostic communication
processes as survivorship, quality of life, palliative and hospice
care, and loss, bereavement, and grief for those millions of people
who have been diagnosed with the second leading cause of death in
our nation. An organizational model of patient communication is needed
that identifies and describes salient issues and processes involved
when cancer patients attempt to negotiate the difficult courses of
action following the diagnosis of cancer. The cancer survivorship
and agency model (CSAM) proposes both general and specific strategies
that serve as options for patients seeking to take greater control
of the decision-making process related to their treatment and care
of cancer. Although seemingly practical in its offering, CSAM is
intended to serve as a heuristic springboard for theoretically based,
applied communication research focusing exclusively on post diagnostic
cancer processes.
physician patient communication, communication campaigns, compliance
episodes, etc.), investigations of patient communication following
the diagnosis of cancer are infrequent. Theoretically driven, empirical
research is desperately needed in such postdiagnostic communication
processes as survivorship, quality of life, palliative and hospice
care, and loss, bereavement, and grief for those millions of people
who have been diagnosed with the second leading cause of death in
our nation. An organizational model of patient communication is needed
that identifies and describes salient issues and processes involved
when cancer patients attempt to negotiate the difficult courses of
action following the diagnosis of cancer. The cancer survivorship
and agency model (CSAM) proposes both general and specific strategies
that serve as options for patients seeking to take greater control
of the decision-making process related to their treatment and care
of cancer. Although seemingly practical in its offering, CSAM is
intended to serve as a heuristic springboard for theoretically based,
applied communication research focusing exclusively on post diagnostic
cancer processes.
Roberts, T. G.; Lynch, T. J.; Chabner, B. A.
The phase III trial in the era of targeted therapy: unraveling the "go or no go" decision Journal Article
In: J Clin Oncol, vol. 21, pp. 3683-95, 2003, ().
@article{Roberts2003,
title = {The phase III trial in the era of targeted therapy: unraveling the "go or no go" decision},
author = {T. G. Roberts and T. J. Lynch and B. A. Chabner},
url = {http://www.ncbi.nlm.nih.gov/pubmed/14512401},
year = {2003},
date = {2003-01-01},
urldate = {2003-01-01},
journal = {J Clin Oncol},
volume = {21},
pages = {3683-95},
abstract = {PURPOSE: To review characteristics of contemporary phase III oncology
trials and create an explicit framework to help clinical researchers
prioritize novel therapies for phase III testing. METHODS: We searched
the MEDLINE and EMBASE databases for all reviews of phase III trials;
cataloged all phase III trials in two national clinical trial databases;
and reviewed approval criteria of recently approved oncology drugs
from public data provided by the US Food and Drug Administration.
Industry data not available elsewhere in the medical literature were
obtained from a sourcebook published by a large contract research
organization. RESULTS: Phase III oncology trials are the most expensive
and time-consuming aspect of the drug development process. The results
of these trials continue to exert the greatest influence on the treatment
decision of oncologists and remain pivotal to the granting of drug
approval. Making optimal decisions about which agents to advance
to phase III testing may decrease the overall cost of cancer drug
development and limit the number of patients exposed to ineffective
drugs. A conceptual decision model for prioritizing novel therapies
for phase III testing is presented. CONCLUSION: Cancer drug development
has become more complex and expensive, whereas overall clinical progress
remains slow. The transition from phase II to phase III requires
a strategic decision that is based on new considerations. A greater
investment in phase I and II drug trials may be required to provide
the information necessary for phase III planning.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To review characteristics of contemporary phase III oncology
trials and create an explicit framework to help clinical researchers
prioritize novel therapies for phase III testing. METHODS: We searched
the MEDLINE and EMBASE databases for all reviews of phase III trials;
cataloged all phase III trials in two national clinical trial databases;
and reviewed approval criteria of recently approved oncology drugs
from public data provided by the US Food and Drug Administration.
Industry data not available elsewhere in the medical literature were
obtained from a sourcebook published by a large contract research
organization. RESULTS: Phase III oncology trials are the most expensive
and time-consuming aspect of the drug development process. The results
of these trials continue to exert the greatest influence on the treatment
decision of oncologists and remain pivotal to the granting of drug
approval. Making optimal decisions about which agents to advance
to phase III testing may decrease the overall cost of cancer drug
development and limit the number of patients exposed to ineffective
drugs. A conceptual decision model for prioritizing novel therapies
for phase III testing is presented. CONCLUSION: Cancer drug development
has become more complex and expensive, whereas overall clinical progress
remains slow. The transition from phase II to phase III requires
a strategic decision that is based on new considerations. A greater
investment in phase I and II drug trials may be required to provide
the information necessary for phase III planning.
trials and create an explicit framework to help clinical researchers
prioritize novel therapies for phase III testing. METHODS: We searched
the MEDLINE and EMBASE databases for all reviews of phase III trials;
cataloged all phase III trials in two national clinical trial databases;
and reviewed approval criteria of recently approved oncology drugs
from public data provided by the US Food and Drug Administration.
Industry data not available elsewhere in the medical literature were
obtained from a sourcebook published by a large contract research
organization. RESULTS: Phase III oncology trials are the most expensive
and time-consuming aspect of the drug development process. The results
of these trials continue to exert the greatest influence on the treatment
decision of oncologists and remain pivotal to the granting of drug
approval. Making optimal decisions about which agents to advance
to phase III testing may decrease the overall cost of cancer drug
development and limit the number of patients exposed to ineffective
drugs. A conceptual decision model for prioritizing novel therapies
for phase III testing is presented. CONCLUSION: Cancer drug development
has become more complex and expensive, whereas overall clinical progress
remains slow. The transition from phase II to phase III requires
a strategic decision that is based on new considerations. A greater
investment in phase I and II drug trials may be required to provide
the information necessary for phase III planning.
Sahani, D.; Saini, S.; D'Souza, R. V.; O'Neill, M. J.; Prasad, S. R.; Kalra, M. K.; Halpern, Elkan F.; Mueller, P.
Comparison between low (3:1) and high (6:1) pitch for routine abdominal/pelvic imaging with multislice computed tomography Journal Article
In: J Comput Assist Tomogr, vol. 27, pp. 105-9, 2003, ().
@article{Sahani2003a,
title = {Comparison between low (3:1) and high (6:1) pitch for routine abdominal/pelvic
imaging with multislice computed tomography},
author = {D. Sahani and S. Saini and R. V. D'Souza and M. J. O'Neill and S. R. Prasad and M. K. Kalra and Elkan F. Halpern and P. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12702997},
year = {2003},
date = {2003-01-01},
journal = {J Comput Assist Tomogr},
volume = {27},
pages = {105-9},
abstract = {PURPOSE: The purpose of this study was to compare the performance
of low helical pitch acquisition (3:1) and high helical pitch acquisition
(6:1) for routine abdominal/pelvic imaging with multislice computed
tomography (CT). METHOD: Three hundred eighty-four patients referred
for abdominal/pelvic CT were examined in a breath-hold on a multislice
CT scanner (LightSpeed QX/I; General Electric Medical Systems, Milwaukee,
WI). Patients were randomized and scanned with pitch of 3:1 or 6:1
using a constant 140 peak kV and 280-300 mA. Images were reconstructed
at a 3.75-mm slice thickness. Direct comparison between the two pitches
was possible in a subset of 40 patients who had a follow-up scan
performed with the second pitch used in each patient. A comparison
was also performed between standard dose CT using a pitch of 6:1
and 20% reduced radiation dose CT using a pitch of 3:1. Two readers
performed a blind evaluation using a three-point scale for image
quality, anatomic details, and motion artifacts. Statistical analysis
was performed using a rank sum test and the Wilcoxon signed rank
test. RESULTS: Overall image quality mean scores were 2.5 and 2.3 for a pitch of 3:1 and a pitch of 6:1, respectively (P = 0.134).
Likewise, mean anatomic detail and motion artifact scores were 2.5
and 2.6 for a 3:1 pitch and 2.3 and 2.5 for a 6:1 pitch, respectively
(P textgreater 0.05). In patients with a direct comparison of the
two pitches (with the standard radiation dose as well as with a 20%
reduction in milliamperes), no statistically significant difference
in the performance of the two pitches was observed (P textgreater
0.05). CONCLUSION: Image quality with a high pitch (6:1) is acceptable
for routine abdominal/pelvic CT.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: The purpose of this study was to compare the performance
of low helical pitch acquisition (3:1) and high helical pitch acquisition
(6:1) for routine abdominal/pelvic imaging with multislice computed
tomography (CT). METHOD: Three hundred eighty-four patients referred
for abdominal/pelvic CT were examined in a breath-hold on a multislice
CT scanner (LightSpeed QX/I; General Electric Medical Systems, Milwaukee,
WI). Patients were randomized and scanned with pitch of 3:1 or 6:1
using a constant 140 peak kV and 280-300 mA. Images were reconstructed
at a 3.75-mm slice thickness. Direct comparison between the two pitches
was possible in a subset of 40 patients who had a follow-up scan
performed with the second pitch used in each patient. A comparison
was also performed between standard dose CT using a pitch of 6:1
and 20% reduced radiation dose CT using a pitch of 3:1. Two readers
performed a blind evaluation using a three-point scale for image
quality, anatomic details, and motion artifacts. Statistical analysis
was performed using a rank sum test and the Wilcoxon signed rank
test. RESULTS: Overall image quality mean scores were 2.5 and 2.3 for a pitch of 3:1 and a pitch of 6:1, respectively (P = 0.134).
Likewise, mean anatomic detail and motion artifact scores were 2.5
and 2.6 for a 3:1 pitch and 2.3 and 2.5 for a 6:1 pitch, respectively
(P textgreater 0.05). In patients with a direct comparison of the
two pitches (with the standard radiation dose as well as with a 20%
reduction in milliamperes), no statistically significant difference
in the performance of the two pitches was observed (P textgreater
0.05). CONCLUSION: Image quality with a high pitch (6:1) is acceptable
for routine abdominal/pelvic CT.
of low helical pitch acquisition (3:1) and high helical pitch acquisition
(6:1) for routine abdominal/pelvic imaging with multislice computed
tomography (CT). METHOD: Three hundred eighty-four patients referred
for abdominal/pelvic CT were examined in a breath-hold on a multislice
CT scanner (LightSpeed QX/I; General Electric Medical Systems, Milwaukee,
WI). Patients were randomized and scanned with pitch of 3:1 or 6:1
using a constant 140 peak kV and 280-300 mA. Images were reconstructed
at a 3.75-mm slice thickness. Direct comparison between the two pitches
was possible in a subset of 40 patients who had a follow-up scan
performed with the second pitch used in each patient. A comparison
was also performed between standard dose CT using a pitch of 6:1
and 20% reduced radiation dose CT using a pitch of 3:1. Two readers
performed a blind evaluation using a three-point scale for image
quality, anatomic details, and motion artifacts. Statistical analysis
was performed using a rank sum test and the Wilcoxon signed rank
test. RESULTS: Overall image quality mean scores were 2.5 and 2.3 for a pitch of 3:1 and a pitch of 6:1, respectively (P = 0.134).
Likewise, mean anatomic detail and motion artifact scores were 2.5
and 2.6 for a 3:1 pitch and 2.3 and 2.5 for a 6:1 pitch, respectively
(P textgreater 0.05). In patients with a direct comparison of the
two pitches (with the standard radiation dose as well as with a 20%
reduction in milliamperes), no statistically significant difference
in the performance of the two pitches was observed (P textgreater
0.05). CONCLUSION: Image quality with a high pitch (6:1) is acceptable
for routine abdominal/pelvic CT.
Sahani, D. V.; Jhaveri, K. S.; R, V. D'Souza; Varghese, J. C.; Halpern, Elkan F.; Harisinghani, M. G.; Hahn, P. F.; Saini, S.
Evaluation of simethicone-coated cellulose as a negative oral contrast agent for abdominal CT Journal Article
In: Acad Radiol, vol. 10, pp. 491-6, 2003, ().
@article{Sahani2003,
title = {Evaluation of simethicone-coated cellulose as a negative oral contrast agent for abdominal CT},
author = {D. V. Sahani and K. S. Jhaveri and V. D'Souza R and J. C. Varghese and Elkan F. Halpern and M. G. Harisinghani and P. F. Hahn and S. Saini},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12755536},
year = {2003},
date = {2003-01-01},
journal = {Acad Radiol},
volume = {10},
pages = {491-6},
abstract = {RATIONALE AND OBJECTIVES: Because of the increased clinical use of
computed tomography (CT) for imaging the abdominal vasculature and
urinary tract, there is a need for negative contrast agents. The
authors undertook this study to assess the suitability of simethicone-coated
cellulose (SCC), which is approved for use as an oral contrast agent
in sonography, for use as a negative oral contrast agent in abdominal
CT. MATERIALS AND METHODS: This prospective study involved 40 adult
patients scheduled to undergo abdominal CT for the evaluation of
hematuria. Prior to scanning, 20 subjects received 800 mL of SCC
and 20 received 800 mL of water as an oral contrast agent. Imaging
was performed with a multi-detector row helical scanner in two phases,
according to the abdominal CT protocol used for hematuria evaluation
at the authors' institution. The first, early phase began an average
of 15 minutes after the ingestion of contrast material; the second,
late phase began an average of 45 minutes after the ingestion of
contrast material. Blinded analysis was performed by three abdominal radiologists separately, using a three-point scale (0 = poor},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
RATIONALE AND OBJECTIVES: Because of the increased clinical use of
computed tomography (CT) for imaging the abdominal vasculature and
urinary tract, there is a need for negative contrast agents. The
authors undertook this study to assess the suitability of simethicone-coated
cellulose (SCC), which is approved for use as an oral contrast agent
in sonography, for use as a negative oral contrast agent in abdominal
CT. MATERIALS AND METHODS: This prospective study involved 40 adult
patients scheduled to undergo abdominal CT for the evaluation of
hematuria. Prior to scanning, 20 subjects received 800 mL of SCC
and 20 received 800 mL of water as an oral contrast agent. Imaging
was performed with a multi-detector row helical scanner in two phases,
according to the abdominal CT protocol used for hematuria evaluation
at the authors' institution. The first, early phase began an average
of 15 minutes after the ingestion of contrast material; the second,
late phase began an average of 45 minutes after the ingestion of
contrast material. Blinded analysis was performed by three abdominal radiologists separately, using a three-point scale (0 = poor
computed tomography (CT) for imaging the abdominal vasculature and
urinary tract, there is a need for negative contrast agents. The
authors undertook this study to assess the suitability of simethicone-coated
cellulose (SCC), which is approved for use as an oral contrast agent
in sonography, for use as a negative oral contrast agent in abdominal
CT. MATERIALS AND METHODS: This prospective study involved 40 adult
patients scheduled to undergo abdominal CT for the evaluation of
hematuria. Prior to scanning, 20 subjects received 800 mL of SCC
and 20 received 800 mL of water as an oral contrast agent. Imaging
was performed with a multi-detector row helical scanner in two phases,
according to the abdominal CT protocol used for hematuria evaluation
at the authors' institution. The first, early phase began an average
of 15 minutes after the ingestion of contrast material; the second,
late phase began an average of 45 minutes after the ingestion of
contrast material. Blinded analysis was performed by three abdominal radiologists separately, using a three-point scale (0 = poor
Kopans, D. B.; Rafferty, E.; Georgian-Smith, D.; Yeh, E.; D'Alessandro, H.; Moore, R.; Hughes, K.; Halpern, Elkan F.
A simple model of breast carcinoma growth may provide explanations for observations of apparently complex phenomena Journal Article
In: Cancer, vol. 97, pp. 2951-9, 2003, ().
@article{Kopans2003,
title = {A simple model of breast carcinoma growth may provide explanations for observations of apparently complex phenomena},
author = {D. B. Kopans and E. Rafferty and D. Georgian-Smith and E. Yeh and H. D'Alessandro and R. Moore and K. Hughes and Elkan F. Halpern},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12784329},
year = {2003},
date = {2003-01-01},
urldate = {2003-01-01},
journal = {Cancer},
volume = {97},
pages = {2951-9},
abstract = {BACKGROUND: There has been great debate regarding the importance of
ductal carcinoma in situ (DCIS) in the breast. Autopsy results that
demonstrate a much greater number of these lesions compared with
the number of invasive carcinomas, and the numbers of deaths from
breast carcinoma each year have been cited as evidence that DCIS
rarely leads to invasion and death. These analyses have overlooked
the fact that, to sustain a rate of detection each year, there would
have to be a reservoir of undetected breast carcinomas growing in
the population. The authors developed a simple model that makes this
clear. In addition, complex phenomena have been suggested to explain
why invasive breast disease may grow more rapidly among very young
women and more slowly among the very old. A simple model provides
some insight that may simplify the explanation of these observations.
METHODS: The simple model of breast carcinoma growth assumes that
there are three types of breast carcinoma that begin each year in
a cohort of women. It assumes that all breast carcinomas begin as
DCIS and take 9 years to go from a single cell to an invasive lesion
for the slowest growing lesions, 6 years for intermediate growing
DCIS lesions, and 3 years for fast-growing DCIS lesions. Furthermore,
once an invasive clone forms, the model assumes that it will double
in 60 days for fast-growing lesions, 120 days for intermediate growing
lesions, and 180 days for slow-growing lesions. Three new tumors
begin to grow in each successive year (one of each type). The model
uses simple vectors that are defined by the size of the tumors and
the time since tumor initiation, and it assumes that all tumors are
detected when they reach 2 cm in greatest dimension. The model can
be used to show graphically how many undetected tumors (DCIS as well
as invasive carcinomas) there may be in the population to sustain
the detection of three invasive tumors each year. RESULTS: Using
the assumptions described above, the model showed that, by the time
the first slow-growing breast carcinoma reaches 2 cm in greatest
dimension, there will be 29 other slow-growing tumors that have not
reached that size (9 DCIS and 20 smaller invasive carcinomas), 19
moderately growing tumors (6 DCIS and 13 smaller invasive carcinomas),
and 9 fast-growing tumors (3 DCIS and 6 smaller invasive carcinomas).
This means that, for every three breast tumors that reach 2 cm, the
model predicted that there would be another 57 tumors (39 smaller
invasive carcinomas and 18 DCIS) that would be undetected "below
the surface". The model showed clearly that faster growing tumors
would be expected to predominate among the youngest women, because
they are the first to "reach the surface"; and, if the number of
newly initiated tumors decreases with age, then there will be more
of the slowest growing tumors that are left to reach the surface
among the oldest women in the population. CONCLUSIONS: Even if the
authors' assumptions are incorrect, their model made it clear that,
to diagnose several breast carcinomas per 1000 women each year means
that there have to be many more undetected carcinomas in the population
to sustain the rate of detection. Although the model did not prove
that DCIS may become potentially invasive and lethal, it did demonstrate
that, even if all of these in situ lesions become invasive and lethal,
many more DCIS lesions would have to be expected in the population
than the number of invasive carcinomas detected each year and the
number of deaths from breast carcinoma each year. Furthermore, the
model provided a simple, purely mechanical illustration that may
explain the preponderance of faster growing breast carcinomas among
very young women and the preponderance of slower growing tumors among
elderly women.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: There has been great debate regarding the importance of
ductal carcinoma in situ (DCIS) in the breast. Autopsy results that
demonstrate a much greater number of these lesions compared with
the number of invasive carcinomas, and the numbers of deaths from
breast carcinoma each year have been cited as evidence that DCIS
rarely leads to invasion and death. These analyses have overlooked
the fact that, to sustain a rate of detection each year, there would
have to be a reservoir of undetected breast carcinomas growing in
the population. The authors developed a simple model that makes this
clear. In addition, complex phenomena have been suggested to explain
why invasive breast disease may grow more rapidly among very young
women and more slowly among the very old. A simple model provides
some insight that may simplify the explanation of these observations.
METHODS: The simple model of breast carcinoma growth assumes that
there are three types of breast carcinoma that begin each year in
a cohort of women. It assumes that all breast carcinomas begin as
DCIS and take 9 years to go from a single cell to an invasive lesion
for the slowest growing lesions, 6 years for intermediate growing
DCIS lesions, and 3 years for fast-growing DCIS lesions. Furthermore,
once an invasive clone forms, the model assumes that it will double
in 60 days for fast-growing lesions, 120 days for intermediate growing
lesions, and 180 days for slow-growing lesions. Three new tumors
begin to grow in each successive year (one of each type). The model
uses simple vectors that are defined by the size of the tumors and
the time since tumor initiation, and it assumes that all tumors are
detected when they reach 2 cm in greatest dimension. The model can
be used to show graphically how many undetected tumors (DCIS as well
as invasive carcinomas) there may be in the population to sustain
the detection of three invasive tumors each year. RESULTS: Using
the assumptions described above, the model showed that, by the time
the first slow-growing breast carcinoma reaches 2 cm in greatest
dimension, there will be 29 other slow-growing tumors that have not
reached that size (9 DCIS and 20 smaller invasive carcinomas), 19
moderately growing tumors (6 DCIS and 13 smaller invasive carcinomas),
and 9 fast-growing tumors (3 DCIS and 6 smaller invasive carcinomas).
This means that, for every three breast tumors that reach 2 cm, the
model predicted that there would be another 57 tumors (39 smaller
invasive carcinomas and 18 DCIS) that would be undetected "below
the surface". The model showed clearly that faster growing tumors
would be expected to predominate among the youngest women, because
they are the first to "reach the surface"; and, if the number of
newly initiated tumors decreases with age, then there will be more
of the slowest growing tumors that are left to reach the surface
among the oldest women in the population. CONCLUSIONS: Even if the
authors' assumptions are incorrect, their model made it clear that,
to diagnose several breast carcinomas per 1000 women each year means
that there have to be many more undetected carcinomas in the population
to sustain the rate of detection. Although the model did not prove
that DCIS may become potentially invasive and lethal, it did demonstrate
that, even if all of these in situ lesions become invasive and lethal,
many more DCIS lesions would have to be expected in the population
than the number of invasive carcinomas detected each year and the
number of deaths from breast carcinoma each year. Furthermore, the
model provided a simple, purely mechanical illustration that may
explain the preponderance of faster growing breast carcinomas among
very young women and the preponderance of slower growing tumors among
elderly women.
ductal carcinoma in situ (DCIS) in the breast. Autopsy results that
demonstrate a much greater number of these lesions compared with
the number of invasive carcinomas, and the numbers of deaths from
breast carcinoma each year have been cited as evidence that DCIS
rarely leads to invasion and death. These analyses have overlooked
the fact that, to sustain a rate of detection each year, there would
have to be a reservoir of undetected breast carcinomas growing in
the population. The authors developed a simple model that makes this
clear. In addition, complex phenomena have been suggested to explain
why invasive breast disease may grow more rapidly among very young
women and more slowly among the very old. A simple model provides
some insight that may simplify the explanation of these observations.
METHODS: The simple model of breast carcinoma growth assumes that
there are three types of breast carcinoma that begin each year in
a cohort of women. It assumes that all breast carcinomas begin as
DCIS and take 9 years to go from a single cell to an invasive lesion
for the slowest growing lesions, 6 years for intermediate growing
DCIS lesions, and 3 years for fast-growing DCIS lesions. Furthermore,
once an invasive clone forms, the model assumes that it will double
in 60 days for fast-growing lesions, 120 days for intermediate growing
lesions, and 180 days for slow-growing lesions. Three new tumors
begin to grow in each successive year (one of each type). The model
uses simple vectors that are defined by the size of the tumors and
the time since tumor initiation, and it assumes that all tumors are
detected when they reach 2 cm in greatest dimension. The model can
be used to show graphically how many undetected tumors (DCIS as well
as invasive carcinomas) there may be in the population to sustain
the detection of three invasive tumors each year. RESULTS: Using
the assumptions described above, the model showed that, by the time
the first slow-growing breast carcinoma reaches 2 cm in greatest
dimension, there will be 29 other slow-growing tumors that have not
reached that size (9 DCIS and 20 smaller invasive carcinomas), 19
moderately growing tumors (6 DCIS and 13 smaller invasive carcinomas),
and 9 fast-growing tumors (3 DCIS and 6 smaller invasive carcinomas).
This means that, for every three breast tumors that reach 2 cm, the
model predicted that there would be another 57 tumors (39 smaller
invasive carcinomas and 18 DCIS) that would be undetected "below
the surface". The model showed clearly that faster growing tumors
would be expected to predominate among the youngest women, because
they are the first to "reach the surface"; and, if the number of
newly initiated tumors decreases with age, then there will be more
of the slowest growing tumors that are left to reach the surface
among the oldest women in the population. CONCLUSIONS: Even if the
authors' assumptions are incorrect, their model made it clear that,
to diagnose several breast carcinomas per 1000 women each year means
that there have to be many more undetected carcinomas in the population
to sustain the rate of detection. Although the model did not prove
that DCIS may become potentially invasive and lethal, it did demonstrate
that, even if all of these in situ lesions become invasive and lethal,
many more DCIS lesions would have to be expected in the population
than the number of invasive carcinomas detected each year and the
number of deaths from breast carcinoma each year. Furthermore, the
model provided a simple, purely mechanical illustration that may
explain the preponderance of faster growing breast carcinomas among
very young women and the preponderance of slower growing tumors among
elderly women.
Lamont, Elizabeth; Christakis, N. A.
Complexities in prognostication in advanced cancer: "to help them live their lives the way they want to" Journal Article
In: JAMA, vol. 290, pp. 98-104, 2003, ().
@article{Lamont2003c,
title = {Complexities in prognostication in advanced cancer: "to help them
live their lives the way they want to"},
author = {Elizabeth Lamont and N. A. Christakis},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12837717},
year = {2003},
date = {2003-01-01},
journal = {JAMA},
volume = {290},
pages = {98-104},
abstract = {Predicting survival and disclosing the prediction to patients with
advanced disease, particularly cancer, is among the most difficult
tasks that physicians face. With the de-emphasis of prognosis in
favor of diagnosis and therapeutics in the medical literature, physicians
may have difficulty finding the survival information they need to
make appropriate estimates of survival for patients who develop cancer.
Quite separate from the challenge of estimating survival accurately,
physicians may also find the process of disclosing the prognosis
to their patients difficult. Using the vignette of a real patient
with advanced cancer who far outlived her physician's prognostic
estimate, we discuss clinical issues related to the science of prognosis
in advanced cancer and the art of its disclosure.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Predicting survival and disclosing the prediction to patients with
advanced disease, particularly cancer, is among the most difficult
tasks that physicians face. With the de-emphasis of prognosis in
favor of diagnosis and therapeutics in the medical literature, physicians
may have difficulty finding the survival information they need to
make appropriate estimates of survival for patients who develop cancer.
Quite separate from the challenge of estimating survival accurately,
physicians may also find the process of disclosing the prognosis
to their patients difficult. Using the vignette of a real patient
with advanced cancer who far outlived her physician's prognostic
estimate, we discuss clinical issues related to the science of prognosis
in advanced cancer and the art of its disclosure.
advanced disease, particularly cancer, is among the most difficult
tasks that physicians face. With the de-emphasis of prognosis in
favor of diagnosis and therapeutics in the medical literature, physicians
may have difficulty finding the survival information they need to
make appropriate estimates of survival for patients who develop cancer.
Quite separate from the challenge of estimating survival accurately,
physicians may also find the process of disclosing the prognosis
to their patients difficult. Using the vignette of a real patient
with advanced cancer who far outlived her physician's prognostic
estimate, we discuss clinical issues related to the science of prognosis
in advanced cancer and the art of its disclosure.
Lamont, Elizabeth; Christakis, N. A.; Lauderdale, D. S.
Favorable cardiac risk among elderly breast carcinoma survivors Journal Article
In: Cancer, vol. 98, pp. 2-10, 2003, ().
@article{Lamont2003b,
title = {Favorable cardiac risk among elderly breast carcinoma survivors},
author = {Elizabeth Lamont and N. A. Christakis and D. S. Lauderdale},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12833448},
year = {2003},
date = {2003-01-01},
journal = {Cancer},
volume = {98},
pages = {2-10},
abstract = {BACKGROUND: There are two reasons why women who survive breast carcinoma
may be at a lower risk of developing coronary heart disease (CHD)
compared with women without a history of breast carcinoma. First,
estrogens may be etiologic in the development of breast carcinoma
and protective of CHD. Second, a common therapy for breast carcinoma
(tamoxifen) may be associated with cardiac protection. METHODS: In
this population-level cohort study, the authors analyzed data from
the National Cancer Institute's Surveillance, Epidemiology, and End
Results (SEER)-Medicare program to study the cardiac risk of elderly
female Medicare beneficiaries with and without a history of breast
carcinoma. Using the SEER file, the authors identified elderly women survivors of Stage 0, I, or II breast carcinoma (n = 5980) diagnosed
between the ages of 55 and 64. Using the Medicare 5% noncancer file,
the authors also identified elderly women without a history of cancer (n = 23,165). They followed women from age 67 for up to 5 years for
hospitalization for acute myocardial infarction (AMI) through a review
of Medicare claims. The authors controlled the analyses for race,
socioeconomic status, geographic location, cohort entry year, and
medical comorbidity. RESULTS: The hazard of hospitalization for AMI
for breast carcinoma survivors relative to comparison patients was
0.66 (95% confidence interval, 0.49-0.88). This apparent cardioprotective
effect of breast carcinoma survivorship was stronger in breast carcinoma
survivors with documented cardiac risk factors. CONCLUSIONS: Survivors
of early-stage postmenopausal breast carcinoma are at a significantly
lower risk of hospitalization for AMI than women who do not have
a history of breast carcinoma. That survivors' risk varies with previous
cardiac risk factors may be consistent with effects of selective
estrogen receptor modulators. This phenomenon should be evaluated
further with individual-level data containing information on patient
cardiac risk factors and tamoxifen use to help clarify the mechanism
behind the risk reduction.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: There are two reasons why women who survive breast carcinoma
may be at a lower risk of developing coronary heart disease (CHD)
compared with women without a history of breast carcinoma. First,
estrogens may be etiologic in the development of breast carcinoma
and protective of CHD. Second, a common therapy for breast carcinoma
(tamoxifen) may be associated with cardiac protection. METHODS: In
this population-level cohort study, the authors analyzed data from
the National Cancer Institute's Surveillance, Epidemiology, and End
Results (SEER)-Medicare program to study the cardiac risk of elderly
female Medicare beneficiaries with and without a history of breast
carcinoma. Using the SEER file, the authors identified elderly women survivors of Stage 0, I, or II breast carcinoma (n = 5980) diagnosed
between the ages of 55 and 64. Using the Medicare 5% noncancer file,
the authors also identified elderly women without a history of cancer (n = 23,165). They followed women from age 67 for up to 5 years for
hospitalization for acute myocardial infarction (AMI) through a review
of Medicare claims. The authors controlled the analyses for race,
socioeconomic status, geographic location, cohort entry year, and
medical comorbidity. RESULTS: The hazard of hospitalization for AMI
for breast carcinoma survivors relative to comparison patients was
0.66 (95% confidence interval, 0.49-0.88). This apparent cardioprotective
effect of breast carcinoma survivorship was stronger in breast carcinoma
survivors with documented cardiac risk factors. CONCLUSIONS: Survivors
of early-stage postmenopausal breast carcinoma are at a significantly
lower risk of hospitalization for AMI than women who do not have
a history of breast carcinoma. That survivors' risk varies with previous
cardiac risk factors may be consistent with effects of selective
estrogen receptor modulators. This phenomenon should be evaluated
further with individual-level data containing information on patient
cardiac risk factors and tamoxifen use to help clarify the mechanism
behind the risk reduction.
may be at a lower risk of developing coronary heart disease (CHD)
compared with women without a history of breast carcinoma. First,
estrogens may be etiologic in the development of breast carcinoma
and protective of CHD. Second, a common therapy for breast carcinoma
(tamoxifen) may be associated with cardiac protection. METHODS: In
this population-level cohort study, the authors analyzed data from
the National Cancer Institute's Surveillance, Epidemiology, and End
Results (SEER)-Medicare program to study the cardiac risk of elderly
female Medicare beneficiaries with and without a history of breast
carcinoma. Using the SEER file, the authors identified elderly women survivors of Stage 0, I, or II breast carcinoma (n = 5980) diagnosed
between the ages of 55 and 64. Using the Medicare 5% noncancer file,
the authors also identified elderly women without a history of cancer (n = 23,165). They followed women from age 67 for up to 5 years for
hospitalization for acute myocardial infarction (AMI) through a review
of Medicare claims. The authors controlled the analyses for race,
socioeconomic status, geographic location, cohort entry year, and
medical comorbidity. RESULTS: The hazard of hospitalization for AMI
for breast carcinoma survivors relative to comparison patients was
0.66 (95% confidence interval, 0.49-0.88). This apparent cardioprotective
effect of breast carcinoma survivorship was stronger in breast carcinoma
survivors with documented cardiac risk factors. CONCLUSIONS: Survivors
of early-stage postmenopausal breast carcinoma are at a significantly
lower risk of hospitalization for AMI than women who do not have
a history of breast carcinoma. That survivors' risk varies with previous
cardiac risk factors may be consistent with effects of selective
estrogen receptor modulators. This phenomenon should be evaluated
further with individual-level data containing information on patient
cardiac risk factors and tamoxifen use to help clarify the mechanism
behind the risk reduction.
Lamont, Elizabeth; Lauderdale, D. S.
Low risk of hip fracture among elderly breast cancer survivors Journal Article
In: Ann Epidemiol, vol. 13, pp. 698-703, 2003, ().
@article{Lamont2003,
title = {Low risk of hip fracture among elderly breast cancer survivors},
author = {Elizabeth Lamont and D. S. Lauderdale},
url = {http://www.ncbi.nlm.nih.gov/pubmed/14599734},
year = {2003},
date = {2003-01-01},
journal = {Ann Epidemiol},
volume = {13},
pages = {698-703},
abstract = {PURPOSE: Prior research has shown that women with either osteoporotic
fracture or low bone density are at a decreased risk of breast cancer.
Little prior work has evaluated whether women with breast cancer
are at a decreased risk of osteoporotic fracture. METHODS: We used
data from the National Cancer Institute's Surveillance Epidemiology
and End Results (SEER)-Medicare program to study the risk of hip
fracture among elderly female Medicare beneficiaries with and without
histories of breast cancer. Using the SEER file, we identified elderly women survivors of stage 0, I, or II breast cancer (N=5980) diagnosed
between the ages of 55 and 64 years; using the Medicare 5% file, we identified elderly women without histories of cancer (N=23,165)
from SEER regions. Using Medicare claims from 1993 through 1998,
we followed women for hospitalization for hip fracture or death until
December 31, 1998. RESULTS: We found the rate ratio of hospitalization
for hip fracture for breast cancer survivors relative to comparison
patients was 0.63 (95% CI: 0.43-0.94) after adjusting for age, race,
socioeconomic status, geographic location, cohort entry year, and
medical comorbidity. CONCLUSIONS: We conclude that survivors of early
stage post-menopausal breast cancer are at significantly lower risk
of hip fracture than women who do not have histories of breast cancer.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: Prior research has shown that women with either osteoporotic
fracture or low bone density are at a decreased risk of breast cancer.
Little prior work has evaluated whether women with breast cancer
are at a decreased risk of osteoporotic fracture. METHODS: We used
data from the National Cancer Institute's Surveillance Epidemiology
and End Results (SEER)-Medicare program to study the risk of hip
fracture among elderly female Medicare beneficiaries with and without
histories of breast cancer. Using the SEER file, we identified elderly women survivors of stage 0, I, or II breast cancer (N=5980) diagnosed
between the ages of 55 and 64 years; using the Medicare 5% file, we identified elderly women without histories of cancer (N=23,165)
from SEER regions. Using Medicare claims from 1993 through 1998,
we followed women for hospitalization for hip fracture or death until
December 31, 1998. RESULTS: We found the rate ratio of hospitalization
for hip fracture for breast cancer survivors relative to comparison
patients was 0.63 (95% CI: 0.43-0.94) after adjusting for age, race,
socioeconomic status, geographic location, cohort entry year, and
medical comorbidity. CONCLUSIONS: We conclude that survivors of early
stage post-menopausal breast cancer are at significantly lower risk
of hip fracture than women who do not have histories of breast cancer.
fracture or low bone density are at a decreased risk of breast cancer.
Little prior work has evaluated whether women with breast cancer
are at a decreased risk of osteoporotic fracture. METHODS: We used
data from the National Cancer Institute's Surveillance Epidemiology
and End Results (SEER)-Medicare program to study the risk of hip
fracture among elderly female Medicare beneficiaries with and without
histories of breast cancer. Using the SEER file, we identified elderly women survivors of stage 0, I, or II breast cancer (N=5980) diagnosed
between the ages of 55 and 64 years; using the Medicare 5% file, we identified elderly women without histories of cancer (N=23,165)
from SEER regions. Using Medicare claims from 1993 through 1998,
we followed women for hospitalization for hip fracture or death until
December 31, 1998. RESULTS: We found the rate ratio of hospitalization
for hip fracture for breast cancer survivors relative to comparison
patients was 0.63 (95% CI: 0.43-0.94) after adjusting for age, race,
socioeconomic status, geographic location, cohort entry year, and
medical comorbidity. CONCLUSIONS: We conclude that survivors of early
stage post-menopausal breast cancer are at significantly lower risk
of hip fracture than women who do not have histories of breast cancer.
Livraghi, T.; Solbiati, L.; Meloni, F.; Ierace, T.; Goldberg, S. N.; Gazelle, G. Scott
Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the "test-of-time approach" Journal Article
In: Cancer, vol. 97, pp. 3027-35, 2003, ().
@article{Livraghi2003a,
title = {Percutaneous radiofrequency ablation of liver metastases in potential
candidates for resection: the "test-of-time approach"},
author = {T. Livraghi and L. Solbiati and F. Meloni and T. Ierace and S. N. Goldberg and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12784338},
year = {2003},
date = {2003-01-01},
journal = {Cancer},
volume = {97},
pages = {3027-35},
abstract = {BACKGROUND: Some surgeons have advocated delaying resection of liver
metastases to allow additional metastases which may be present, but
are undetected, to be identified. This "test-of-time" approach can
limit the number of resections performed on patients who ultimately
will develop additional metastases. The current study evaluated the
potential role and possible advantages of performing radiofrequency
(RF) ablation during the interval between diagnosis and hepatic metastasectomy
as part of a test-of-time management approach. METHODS: Eighty-eight
consecutive patients with 134 colorectal carcinoma liver metastases
were potential candidates for hepatic metastasectomy. They were treated
with percutaneous RF ablation using single (101 treatments) or triple-probe
cluster (22 treatments) 18-gauge internally cooled electrodes. Treatment
was performed under conscious sedation (22 of 119 treatments), anesthesia
(14 of 119 treatments), or general anesthesia (83 of 119 treatments).
At the time of the initial RF ablation procedure, 49 of 88 patients
(56 were found to have 1 metastasis, 32 of 88 patients (36 had 2
metastases, and 7 of 88 patients (8 had 3 metastases. Metastases
ranged from 0.6 to 4.0 cm in greatest dimension (mean, 2.1 cm). Follow-up
with serial computed tomography scans scans ranged from 18 to 75
months (median, 33 months) after the initial RF ablation. RESULTS:
A total of 119 RF ablations were performed. Complete necrosis was
obtained in 53 of 88 patients (60 and in 85 of 134 lesions (63. During
follow-up of these 53 patients, 16 (30 remained free of disease and
37 (70 developed new lesions. New lesions were intrahepatic in 26
of 37 patients (70, extrahepatic in 4 patients (11, and both intrahepatic
and extrahepatic in 7 patients (19. Of 26 patients whose new lesions
were intrahepatic only, 15 (58 were retreated with RF and 7 were
free of disease at the time of last follow-up (median follow-up,
28 months). Ten additional patients with only intrahepatic new lesions
were deemed untreatable and 1 patient underwent resection. Overall,
among the 53 patients in whom complete tumor necrosis was achieved
after RF ablation therapy, 52 (98 were spared surgical resection:
23 (44 because they have remained free of disease and 29 (56 because
they developed disease progression. Among all 88 patients, 21 (24
underwent resection after RF ablation (8 were free of disease at
the time of last follow-up), 23 (26 remained free of disease after
successful RF ablation, and 56 (64 developed untreatable disease
progression (44 after RF alone, 12 after RF and surgery). Lesions
in 35 of 88 patients (40 demonstrated local tumor recurrence on follow-up
imaging studies. Twenty of these 35 patients (57 underwent surgical
resection, whereas the remaining 15 patients (43 developed additional,
untreatable metastases. New lesions were intrahepatic in 9 of 15
patients (60, extrahepatic in 1 of 15 patients (7, and both intrahepatic
and extrahepatic in 5 of 15 patients (33. No patient who had been
treated with RF ablation became unresectable due to the growth of
metastases and there was no evidence of needle track seeding in any
patient after RF ablation. Overall, among the 35 patients in whom
complete tumor necrosis was not achieved after RF ablation therapy,
15 (43 were spared surgical resection. CONCLUSIONS: The results of
the current study suggest that current RF ablation techniques, when
used as part of a test-of-time management approach, can decrease
the number of resections performed. The approach results in complete
tumor necrosis in some patients and provide an interval for others
who ultimately will develop new intrahepatic and/or extrahepatic
metastases to do so.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Some surgeons have advocated delaying resection of liver
metastases to allow additional metastases which may be present, but
are undetected, to be identified. This "test-of-time" approach can
limit the number of resections performed on patients who ultimately
will develop additional metastases. The current study evaluated the
potential role and possible advantages of performing radiofrequency
(RF) ablation during the interval between diagnosis and hepatic metastasectomy
as part of a test-of-time management approach. METHODS: Eighty-eight
consecutive patients with 134 colorectal carcinoma liver metastases
were potential candidates for hepatic metastasectomy. They were treated
with percutaneous RF ablation using single (101 treatments) or triple-probe
cluster (22 treatments) 18-gauge internally cooled electrodes. Treatment
was performed under conscious sedation (22 of 119 treatments), anesthesia
(14 of 119 treatments), or general anesthesia (83 of 119 treatments).
At the time of the initial RF ablation procedure, 49 of 88 patients
(56 were found to have 1 metastasis, 32 of 88 patients (36 had 2
metastases, and 7 of 88 patients (8 had 3 metastases. Metastases
ranged from 0.6 to 4.0 cm in greatest dimension (mean, 2.1 cm). Follow-up
with serial computed tomography scans scans ranged from 18 to 75
months (median, 33 months) after the initial RF ablation. RESULTS:
A total of 119 RF ablations were performed. Complete necrosis was
obtained in 53 of 88 patients (60 and in 85 of 134 lesions (63. During
follow-up of these 53 patients, 16 (30 remained free of disease and
37 (70 developed new lesions. New lesions were intrahepatic in 26
of 37 patients (70, extrahepatic in 4 patients (11, and both intrahepatic
and extrahepatic in 7 patients (19. Of 26 patients whose new lesions
were intrahepatic only, 15 (58 were retreated with RF and 7 were
free of disease at the time of last follow-up (median follow-up,
28 months). Ten additional patients with only intrahepatic new lesions
were deemed untreatable and 1 patient underwent resection. Overall,
among the 53 patients in whom complete tumor necrosis was achieved
after RF ablation therapy, 52 (98 were spared surgical resection:
23 (44 because they have remained free of disease and 29 (56 because
they developed disease progression. Among all 88 patients, 21 (24
underwent resection after RF ablation (8 were free of disease at
the time of last follow-up), 23 (26 remained free of disease after
successful RF ablation, and 56 (64 developed untreatable disease
progression (44 after RF alone, 12 after RF and surgery). Lesions
in 35 of 88 patients (40 demonstrated local tumor recurrence on follow-up
imaging studies. Twenty of these 35 patients (57 underwent surgical
resection, whereas the remaining 15 patients (43 developed additional,
untreatable metastases. New lesions were intrahepatic in 9 of 15
patients (60, extrahepatic in 1 of 15 patients (7, and both intrahepatic
and extrahepatic in 5 of 15 patients (33. No patient who had been
treated with RF ablation became unresectable due to the growth of
metastases and there was no evidence of needle track seeding in any
patient after RF ablation. Overall, among the 35 patients in whom
complete tumor necrosis was not achieved after RF ablation therapy,
15 (43 were spared surgical resection. CONCLUSIONS: The results of
the current study suggest that current RF ablation techniques, when
used as part of a test-of-time management approach, can decrease
the number of resections performed. The approach results in complete
tumor necrosis in some patients and provide an interval for others
who ultimately will develop new intrahepatic and/or extrahepatic
metastases to do so.
metastases to allow additional metastases which may be present, but
are undetected, to be identified. This "test-of-time" approach can
limit the number of resections performed on patients who ultimately
will develop additional metastases. The current study evaluated the
potential role and possible advantages of performing radiofrequency
(RF) ablation during the interval between diagnosis and hepatic metastasectomy
as part of a test-of-time management approach. METHODS: Eighty-eight
consecutive patients with 134 colorectal carcinoma liver metastases
were potential candidates for hepatic metastasectomy. They were treated
with percutaneous RF ablation using single (101 treatments) or triple-probe
cluster (22 treatments) 18-gauge internally cooled electrodes. Treatment
was performed under conscious sedation (22 of 119 treatments), anesthesia
(14 of 119 treatments), or general anesthesia (83 of 119 treatments).
At the time of the initial RF ablation procedure, 49 of 88 patients
(56 were found to have 1 metastasis, 32 of 88 patients (36 had 2
metastases, and 7 of 88 patients (8 had 3 metastases. Metastases
ranged from 0.6 to 4.0 cm in greatest dimension (mean, 2.1 cm). Follow-up
with serial computed tomography scans scans ranged from 18 to 75
months (median, 33 months) after the initial RF ablation. RESULTS:
A total of 119 RF ablations were performed. Complete necrosis was
obtained in 53 of 88 patients (60 and in 85 of 134 lesions (63. During
follow-up of these 53 patients, 16 (30 remained free of disease and
37 (70 developed new lesions. New lesions were intrahepatic in 26
of 37 patients (70, extrahepatic in 4 patients (11, and both intrahepatic
and extrahepatic in 7 patients (19. Of 26 patients whose new lesions
were intrahepatic only, 15 (58 were retreated with RF and 7 were
free of disease at the time of last follow-up (median follow-up,
28 months). Ten additional patients with only intrahepatic new lesions
were deemed untreatable and 1 patient underwent resection. Overall,
among the 53 patients in whom complete tumor necrosis was achieved
after RF ablation therapy, 52 (98 were spared surgical resection:
23 (44 because they have remained free of disease and 29 (56 because
they developed disease progression. Among all 88 patients, 21 (24
underwent resection after RF ablation (8 were free of disease at
the time of last follow-up), 23 (26 remained free of disease after
successful RF ablation, and 56 (64 developed untreatable disease
progression (44 after RF alone, 12 after RF and surgery). Lesions
in 35 of 88 patients (40 demonstrated local tumor recurrence on follow-up
imaging studies. Twenty of these 35 patients (57 underwent surgical
resection, whereas the remaining 15 patients (43 developed additional,
untreatable metastases. New lesions were intrahepatic in 9 of 15
patients (60, extrahepatic in 1 of 15 patients (7, and both intrahepatic
and extrahepatic in 5 of 15 patients (33. No patient who had been
treated with RF ablation became unresectable due to the growth of
metastases and there was no evidence of needle track seeding in any
patient after RF ablation. Overall, among the 35 patients in whom
complete tumor necrosis was not achieved after RF ablation therapy,
15 (43 were spared surgical resection. CONCLUSIONS: The results of
the current study suggest that current RF ablation techniques, when
used as part of a test-of-time management approach, can decrease
the number of resections performed. The approach results in complete
tumor necrosis in some patients and provide an interval for others
who ultimately will develop new intrahepatic and/or extrahepatic
metastases to do so.
Halpern, Elkan F.; Gazelle, G. Scott
Probability in radiology Journal Article
In: Radiology, vol. 226, no. 1, pp. 12-5, 2003, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Halpern2003,
title = {Probability in radiology},
author = {Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12511662},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2003},
date = {2003-01-01},
journal = {Radiology},
volume = {226},
number = {1},
pages = {12-5},
abstract = {In this article, a summary of the basic rules of probability using
examples of their application in radiology is presented. Those rules
describe how probabilities may be combined to obtain the chance of
"success" with either of two diagnostic or therapeutic procedures
or with both. They define independence and relate it to the conditional
probability. They describe the relationship (Bayes rule) between
sensitivity, specificity, and prevalence on the one hand and the
positive and negative predictive values on the other. Finally, the
two distributions most commonly encountered in statistical models
of radiologic data are presented: the binomial and normal distributions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In this article, a summary of the basic rules of probability using
examples of their application in radiology is presented. Those rules
describe how probabilities may be combined to obtain the chance of
"success" with either of two diagnostic or therapeutic procedures
or with both. They define independence and relate it to the conditional
probability. They describe the relationship (Bayes rule) between
sensitivity, specificity, and prevalence on the one hand and the
positive and negative predictive values on the other. Finally, the
two distributions most commonly encountered in statistical models
of radiologic data are presented: the binomial and normal distributions.
examples of their application in radiology is presented. Those rules
describe how probabilities may be combined to obtain the chance of
"success" with either of two diagnostic or therapeutic procedures
or with both. They define independence and relate it to the conditional
probability. They describe the relationship (Bayes rule) between
sensitivity, specificity, and prevalence on the one hand and the
positive and negative predictive values on the other. Finally, the
two distributions most commonly encountered in statistical models
of radiologic data are presented: the binomial and normal distributions.
Kalra, M. K.; Maher, M. M.; Prasad, S. R.; Hayat, M. S.; Blake, M. A.; Varghese, J.; Halpern, Elkan F.; Saini, S.
Correlation of patient weight and cross-sectional dimensions with subjective image quality at standard dose abdominal CT Journal Article
In: Korean J Radiol, vol. 4, pp. 234-8, 2003, ().
@article{Kalra2003b,
title = {Correlation of patient weight and cross-sectional dimensions with subjective image quality at standard dose abdominal CT},
author = {M. K. Kalra and M. M. Maher and S. R. Prasad and M. S. Hayat and M. A. Blake and J. Varghese and Elkan F. Halpern and S. Saini},
url = {http://www.ncbi.nlm.nih.gov/pubmed/14726640},
year = {2003},
date = {2003-01-01},
journal = {Korean J Radiol},
volume = {4},
pages = {234-8},
abstract = {OBJECTIVE: We evaluated the association between patients' weight and
abdominal cross-sectional dimensions and CT image quality. MATERIALS
AND METHODS: We prospectively evaluated 39 cancer patients aged more
than 65 years with multislice CT scan of abdomen. All patients underwent
equilibrium phase contrast-enhanced abdominal CT with 4 slices (from
top of the right kidney) obtained at standard tube current (240-280
mA). All other scanning parameters were held constant. Patients'
weight was measured just prior to the study. Cross-sectional abdominal
dimensions such as circumference, area, average anterior abdominal
wall fat thickness and, anteroposterior and transverse diameters
were measured in all patients. Two subspecialty radiologists reviewed
randomized images for overall image quality of abdominal structures
using 5- point scale. Non-parametric correlation analysis was performed
to determine the association of image quality with patients' weight
and cross-sectional abdominal dimensions. RESULTS: A statistically
significant negative linear correlation of 0.46, 0.47, 0.47, 0.58,
0.56, 0.54, and 0.56 between patient weight, anterior abdominal fat
thickness, anteroposterior and transverse diameter, circumference,
cross-sectional area and image quality at standard scanning parameters
was found (ptextless0.01). CONCLUSION: There is a significant association
between image quality, patients' weight and cross-sectional abdominal
dimensions. Maximum transverse diameter of the abdomen has the strongest
association with subjective image quality.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: We evaluated the association between patients' weight and
abdominal cross-sectional dimensions and CT image quality. MATERIALS
AND METHODS: We prospectively evaluated 39 cancer patients aged more
than 65 years with multislice CT scan of abdomen. All patients underwent
equilibrium phase contrast-enhanced abdominal CT with 4 slices (from
top of the right kidney) obtained at standard tube current (240-280
mA). All other scanning parameters were held constant. Patients'
weight was measured just prior to the study. Cross-sectional abdominal
dimensions such as circumference, area, average anterior abdominal
wall fat thickness and, anteroposterior and transverse diameters
were measured in all patients. Two subspecialty radiologists reviewed
randomized images for overall image quality of abdominal structures
using 5- point scale. Non-parametric correlation analysis was performed
to determine the association of image quality with patients' weight
and cross-sectional abdominal dimensions. RESULTS: A statistically
significant negative linear correlation of 0.46, 0.47, 0.47, 0.58,
0.56, 0.54, and 0.56 between patient weight, anterior abdominal fat
thickness, anteroposterior and transverse diameter, circumference,
cross-sectional area and image quality at standard scanning parameters
was found (ptextless0.01). CONCLUSION: There is a significant association
between image quality, patients' weight and cross-sectional abdominal
dimensions. Maximum transverse diameter of the abdomen has the strongest
association with subjective image quality.
abdominal cross-sectional dimensions and CT image quality. MATERIALS
AND METHODS: We prospectively evaluated 39 cancer patients aged more
than 65 years with multislice CT scan of abdomen. All patients underwent
equilibrium phase contrast-enhanced abdominal CT with 4 slices (from
top of the right kidney) obtained at standard tube current (240-280
mA). All other scanning parameters were held constant. Patients'
weight was measured just prior to the study. Cross-sectional abdominal
dimensions such as circumference, area, average anterior abdominal
wall fat thickness and, anteroposterior and transverse diameters
were measured in all patients. Two subspecialty radiologists reviewed
randomized images for overall image quality of abdominal structures
using 5- point scale. Non-parametric correlation analysis was performed
to determine the association of image quality with patients' weight
and cross-sectional abdominal dimensions. RESULTS: A statistically
significant negative linear correlation of 0.46, 0.47, 0.47, 0.58,
0.56, 0.54, and 0.56 between patient weight, anterior abdominal fat
thickness, anteroposterior and transverse diameter, circumference,
cross-sectional area and image quality at standard scanning parameters
was found (ptextless0.01). CONCLUSION: There is a significant association
between image quality, patients' weight and cross-sectional abdominal
dimensions. Maximum transverse diameter of the abdomen has the strongest
association with subjective image quality.
Kalra, M. K.; Maher, M. M.; Sahani, D. V.; Blake, M. A.; Hahn, P. F.; Avinash, G. B.; Toth, T. L.; Halpern, Elkan F.; Saini, S.
Low-dose CT of the abdomen: evaluation of image improvement with use of noise reduction filters pilot study Journal Article
In: Radiology, vol. 228, pp. 251-6, 2003, ().
@article{Kalra2003a,
title = {Low-dose CT of the abdomen: evaluation of image improvement with
use of noise reduction filters pilot study},
author = {M. K. Kalra and M. M. Maher and D. V. Sahani and M. A. Blake and P. F. Hahn and G. B. Avinash and T. L. Toth and Elkan F. Halpern and S. Saini},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12832586},
year = {2003},
date = {2003-01-01},
journal = {Radiology},
volume = {228},
pages = {251-6},
abstract = {A prospective assessment of improvement in image quality at low-radiation-dose
computed tomography (CT) of the abdomen by using noise reduction
filters was performed. CT images acquired at standard and 50% reduced
tube current were processed with six noise reduction filters and
evaluated by three radiologists for image noise, sharpness, contrast,
and overall image quality in terms of abdominal organ depiction.
Quantitative image noise and contrast-to-noise ratio were measured.
Baseline low-dose CT images were significantly worse than standard-dose
CT images (P textless.05). A statistically significant reduction
of noise in low-dose images processed with three filters was noted.
In conclusion, use of noise reduction filters decreased image noise
at low-dose CT.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
A prospective assessment of improvement in image quality at low-radiation-dose
computed tomography (CT) of the abdomen by using noise reduction
filters was performed. CT images acquired at standard and 50% reduced
tube current were processed with six noise reduction filters and
evaluated by three radiologists for image noise, sharpness, contrast,
and overall image quality in terms of abdominal organ depiction.
Quantitative image noise and contrast-to-noise ratio were measured.
Baseline low-dose CT images were significantly worse than standard-dose
CT images (P textless.05). A statistically significant reduction
of noise in low-dose images processed with three filters was noted.
In conclusion, use of noise reduction filters decreased image noise
at low-dose CT.
computed tomography (CT) of the abdomen by using noise reduction
filters was performed. CT images acquired at standard and 50% reduced
tube current were processed with six noise reduction filters and
evaluated by three radiologists for image noise, sharpness, contrast,
and overall image quality in terms of abdominal organ depiction.
Quantitative image noise and contrast-to-noise ratio were measured.
Baseline low-dose CT images were significantly worse than standard-dose
CT images (P textless.05). A statistically significant reduction
of noise in low-dose images processed with three filters was noted.
In conclusion, use of noise reduction filters decreased image noise
at low-dose CT.
Kalra, M. K.; Wittram, C.; Maher, M. M.; Sharma, A.; Avinash, G. B.; Karau, K.; Toth, T. L.; Halpern, Elkan F.; Saini, S.; Shepard, J. A.
Can noise reduction filters improve low-radiation-dose chest CT images? Pilot study Journal Article
In: Radiology, vol. 228, pp. 257-64, 2003, ().
@article{Kalra2003,
title = {Can noise reduction filters improve low-radiation-dose chest CT images?
Pilot study},
author = {M. K. Kalra and C. Wittram and M. M. Maher and A. Sharma and G. B. Avinash and K. Karau and T. L. Toth and Elkan F. Halpern and S. Saini and J. A. Shepard},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12750460},
year = {2003},
date = {2003-01-01},
journal = {Radiology},
volume = {228},
pages = {257-64},
abstract = {Effect of noise reduction filters on chest computed tomographic (CT)
images acquired with 50% radiation dose reduction was evaluated.
Two sets of images were acquired with multi-detector row CT at standard
(220-280 mA) and 50% reduced (110-140 mA) tube current at the level
of the carina. After postprocessing with six noise reduction filters,
images were compared with baseline standard-dose images for noise,
sharpness, and contrast in lungs, mediastinum, and chest wall. Quantitative
image noise was measured in descending thoracic aorta. Modulation
transfer functions were calculated from CT images of 50-microm wire.
Noise reduction filters reduced image noise on low-radiation-dose
chest CT images, with some compromise in image sharpness and contrast
assessed qualitatively, and slightly altered modulation transfer
function at higher spatial frequencies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Effect of noise reduction filters on chest computed tomographic (CT)
images acquired with 50% radiation dose reduction was evaluated.
Two sets of images were acquired with multi-detector row CT at standard
(220-280 mA) and 50% reduced (110-140 mA) tube current at the level
of the carina. After postprocessing with six noise reduction filters,
images were compared with baseline standard-dose images for noise,
sharpness, and contrast in lungs, mediastinum, and chest wall. Quantitative
image noise was measured in descending thoracic aorta. Modulation
transfer functions were calculated from CT images of 50-microm wire.
Noise reduction filters reduced image noise on low-radiation-dose
chest CT images, with some compromise in image sharpness and contrast
assessed qualitatively, and slightly altered modulation transfer
function at higher spatial frequencies.
images acquired with 50% radiation dose reduction was evaluated.
Two sets of images were acquired with multi-detector row CT at standard
(220-280 mA) and 50% reduced (110-140 mA) tube current at the level
of the carina. After postprocessing with six noise reduction filters,
images were compared with baseline standard-dose images for noise,
sharpness, and contrast in lungs, mediastinum, and chest wall. Quantitative
image noise was measured in descending thoracic aorta. Modulation
transfer functions were calculated from CT images of 50-microm wire.
Noise reduction filters reduced image noise on low-radiation-dose
chest CT images, with some compromise in image sharpness and contrast
assessed qualitatively, and slightly altered modulation transfer
function at higher spatial frequencies.
Belton, A. L.; Saini, S.; Liebermann, K.; Boland, G. W.; Halpern, Elkan F.
Tumour size measurement in an oncology clinical trial: comparison between off-site and on-site measurements Journal Article
In: Clin Radiol, vol. 58, pp. 311-4, 2003, ().
@article{Belton2003,
title = {Tumour size measurement in an oncology clinical trial: comparison between off-site and on-site measurements},
author = {A. L. Belton and S. Saini and K. Liebermann and G. W. Boland and Elkan F. Halpern},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12662953},
year = {2003},
date = {2003-01-01},
urldate = {2003-01-01},
journal = {Clin Radiol},
volume = {58},
pages = {311-4},
abstract = {AIM: To evaluate the degree of variability between lesion measurements
obtained by a single observer compared with multiple observers, and
in selected cases evaluate which of the two measurements more accurately
represented the lesion size. MATERIALS AND METHODS: In this study
we compared the performance of a single off-site observer to multiple
on-site observers during measurement of 300 abdominal and thoracic
lesions. Lesion measurements that were larger than 1cm(2), differed
by more than 50 but by less than 100 were compared by a single adjudicator, who was blinded to the measurement source (n=46). RESULTS: Measurements
of the 300 lesions differed by an average of 109% (SD 251. Of 266
lesions larger than 1cm(2), results of the single observer compared
with multiple observers differed by more than 10% for 249 lesions,
more than 30% for 169 lesions, more than 50% for 126 lesions, and
more than 100% for 66 lesions. Forty-six lesions were compared by
the adjudicator. The adjudicator selected the measurement of the
single observer for 37 lesions (80.4, and the measurement determined by one of the multiple observers for nine lesions (19.6 p=0.00002).
CONCLUSION: Measurement of lesion size by a single observer compared
with multiple observers reveals a high degree of variability. An
adjudicator selected the measurement of the single observer more
frequently than that of multiple observers, with statistical significance.
These findings suggest that studies designed to quantify imaging
features should limit the number of observers.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AIM: To evaluate the degree of variability between lesion measurements
obtained by a single observer compared with multiple observers, and
in selected cases evaluate which of the two measurements more accurately
represented the lesion size. MATERIALS AND METHODS: In this study
we compared the performance of a single off-site observer to multiple
on-site observers during measurement of 300 abdominal and thoracic
lesions. Lesion measurements that were larger than 1cm(2), differed
by more than 50 but by less than 100 were compared by a single adjudicator, who was blinded to the measurement source (n=46). RESULTS: Measurements
of the 300 lesions differed by an average of 109% (SD 251. Of 266
lesions larger than 1cm(2), results of the single observer compared
with multiple observers differed by more than 10% for 249 lesions,
more than 30% for 169 lesions, more than 50% for 126 lesions, and
more than 100% for 66 lesions. Forty-six lesions were compared by
the adjudicator. The adjudicator selected the measurement of the
single observer for 37 lesions (80.4, and the measurement determined by one of the multiple observers for nine lesions (19.6 p=0.00002).
CONCLUSION: Measurement of lesion size by a single observer compared
with multiple observers reveals a high degree of variability. An
adjudicator selected the measurement of the single observer more
frequently than that of multiple observers, with statistical significance.
These findings suggest that studies designed to quantify imaging
features should limit the number of observers.
obtained by a single observer compared with multiple observers, and
in selected cases evaluate which of the two measurements more accurately
represented the lesion size. MATERIALS AND METHODS: In this study
we compared the performance of a single off-site observer to multiple
on-site observers during measurement of 300 abdominal and thoracic
lesions. Lesion measurements that were larger than 1cm(2), differed
by more than 50 but by less than 100 were compared by a single adjudicator, who was blinded to the measurement source (n=46). RESULTS: Measurements
of the 300 lesions differed by an average of 109% (SD 251. Of 266
lesions larger than 1cm(2), results of the single observer compared
with multiple observers differed by more than 10% for 249 lesions,
more than 30% for 169 lesions, more than 50% for 126 lesions, and
more than 100% for 66 lesions. Forty-six lesions were compared by
the adjudicator. The adjudicator selected the measurement of the
single observer for 37 lesions (80.4, and the measurement determined by one of the multiple observers for nine lesions (19.6 p=0.00002).
CONCLUSION: Measurement of lesion size by a single observer compared
with multiple observers reveals a high degree of variability. An
adjudicator selected the measurement of the single observer more
frequently than that of multiple observers, with statistical significance.
These findings suggest that studies designed to quantify imaging
features should limit the number of observers.
Boiselle, Phillip M.; Dippolito, Giuseppe; Copeland, John; Kang, Haejin; Ahmed, Muneeb; Weeks, Dawn; Halpern, Elkan F.; Goldberg, S. Nahum
In: Radiology, vol. 228, pp. 107-11, 2003, ().
@article{Boiselle2003,
title = {Multiplanar and 3{D} imaging of the central airways: comparison of
image quality and radiation dose of single-detector row CT and multi-detector
row CT at differing tube currents in dogs},
author = {Phillip M. Boiselle and Giuseppe Dippolito and John Copeland and Haejin Kang and Muneeb Ahmed and Dawn Weeks and Elkan F. Halpern and S. Nahum Goldberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12832576},
year = {2003},
date = {2003-01-01},
journal = {Radiology},
volume = {228},
pages = {107-11},
abstract = {To compare in an animal model the image quality of multiplanar reformation
and three-dimensional (3D) reconstruction images of the central airways
by using single-detector row computed tomography (CT) and multi-detector
row CT at varied tube currents and to compare radiation dose.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To compare in an animal model the image quality of multiplanar reformation
and three-dimensional (3D) reconstruction images of the central airways
by using single-detector row computed tomography (CT) and multi-detector
row CT at varied tube currents and to compare radiation dose.
and three-dimensional (3D) reconstruction images of the central airways
by using single-detector row computed tomography (CT) and multi-detector
row CT at varied tube currents and to compare radiation dose.
Carson, Paul L.; Giger, Maryellen; Welch, Michael J.; Halpern, Howard; Kurdziel, Karen; Vannier, Michael; Evelhoch, Jeffrey L.; Gazelle, G. Scott; Seltzer, Steven E.; Judy, Philip; Hendee, William R.; Bourland, J. Daniel
Biomedical Imaging Research Opportunities Workshop: report and recommendations Journal Article
In: Radiology, vol. 229, pp. 328-39, 2003, ().
@article{Carson2003,
title = {Biomedical Imaging Research Opportunities Workshop: report and recommendations},
author = {Paul L. Carson and Maryellen Giger and Michael J. Welch and Howard Halpern and Karen Kurdziel and Michael Vannier and Jeffrey L. Evelhoch and G. Scott Gazelle and Steven E. Seltzer and Philip Judy and William R. Hendee and J. Daniel Bourland},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12925715},
year = {2003},
date = {2003-01-01},
journal = {Radiology},
volume = {229},
pages = {328-39},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Dijkhuizen, R. M.; Singhal, A. B.; Mandeville, J. B.; Wu, O.; Halpern, Elkan F.; Finklestein, S. P.; Rosen, B. R.; Lo, E. H.
In: J Neurosci, vol. 23, pp. 510-7, 2003, ().
@article{Dijkhuizen2003,
title = {Correlation between brain reorganization, ischemic damage, and neurologic
status after transient focal cerebral ischemia in rats: a functional
magnetic resonance imaging study},
author = {R. M. Dijkhuizen and A. B. Singhal and J. B. Mandeville and O. Wu and Elkan F. Halpern and S. P. Finklestein and B. R. Rosen and E. H. Lo},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12533611},
year = {2003},
date = {2003-01-01},
journal = {J Neurosci},
volume = {23},
pages = {510-7},
abstract = {The pattern and role of brain plasticity in stroke recovery has been
incompletely characterized. Both ipsilesional and contralesional
changes have been described, but it remains unclear how these relate
to functional recovery. Our goal was to correlate brain activation
patterns with tissue damage, hemodynamics, and neurologic status
after temporary stroke, using functional magnetic resonance imaging
(fMRI). Transverse relaxation time (T2)-weighted, diffusion-weighted, and perfusion MRI were performed at days 1 (n = 7), 3 (n = 7), and 14 (n = 7) after 2 hr unilateral middle cerebral artery occlusion
in rats. Functional activation and cerebrovascular reactivity maps
were generated from contrast-enhanced fMRI during forelimb stimulation
and hypercapnia, respectively. Before MRI, rats were examined neurologically.
We detected loss of activation responses in the ipsilesional sensorimotor cortex, which was related to T2 lesion size (r = -0.858 on day},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The pattern and role of brain plasticity in stroke recovery has been
incompletely characterized. Both ipsilesional and contralesional
changes have been described, but it remains unclear how these relate
to functional recovery. Our goal was to correlate brain activation
patterns with tissue damage, hemodynamics, and neurologic status
after temporary stroke, using functional magnetic resonance imaging
(fMRI). Transverse relaxation time (T2)-weighted, diffusion-weighted, and perfusion MRI were performed at days 1 (n = 7), 3 (n = 7), and 14 (n = 7) after 2 hr unilateral middle cerebral artery occlusion
in rats. Functional activation and cerebrovascular reactivity maps
were generated from contrast-enhanced fMRI during forelimb stimulation
and hypercapnia, respectively. Before MRI, rats were examined neurologically.
We detected loss of activation responses in the ipsilesional sensorimotor cortex, which was related to T2 lesion size (r = -0.858 on day
incompletely characterized. Both ipsilesional and contralesional
changes have been described, but it remains unclear how these relate
to functional recovery. Our goal was to correlate brain activation
patterns with tissue damage, hemodynamics, and neurologic status
after temporary stroke, using functional magnetic resonance imaging
(fMRI). Transverse relaxation time (T2)-weighted, diffusion-weighted, and perfusion MRI were performed at days 1 (n = 7), 3 (n = 7), and 14 (n = 7) after 2 hr unilateral middle cerebral artery occlusion
in rats. Functional activation and cerebrovascular reactivity maps
were generated from contrast-enhanced fMRI during forelimb stimulation
and hypercapnia, respectively. Before MRI, rats were examined neurologically.
We detected loss of activation responses in the ipsilesional sensorimotor cortex, which was related to T2 lesion size (r = -0.858 on day
Aquino, S. L.; Asmuth, J. C.; Alpert, N. M.; Halpern, Elkan F.; Fischman, A. J.
In: J Comput Assist Tomogr, vol. 27, no. 4, pp. 479-84, 2003, ISSN: 0363-8715 (Print) 0363-8715 (Lin, ().
@article{Aquino2003,
title = {Improved radiologic staging of lung cancer with 2-[18F]-fluoro-2-deoxy-D-glucose-positron emission tomography and computed tomography registration},
author = {S. L. Aquino and J. C. Asmuth and N. M. Alpert and Elkan F. Halpern and A. J. Fischman},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12886128},
issn = {0363-8715 (Print) 0363-8715 (Lin},
year = {2003},
date = {2003-00-01},
urldate = {2003-00-01},
journal = {J Comput Assist Tomogr},
volume = {27},
number = {4},
pages = {479-84},
abstract = {PURPOSE: To determine if volumetric nonlinear registration or registration
of thoracic computed tomography (CT) and 2-[18F]-fluoro-2-deoxy-D-glucose-positron
emission tomography (FDG-PET) datasets changes the detection of mediastinal
and hilar nodal disease in patients undergoing staging for lung cancer
and if it has any impact on radiologic lung cancer staging. METHOD:
Computer-based image registration was performed on 45 clinical thoracic
helical CT and FDG-PET scans of patients with lung cancer who were
staged by mediastinoscopy and/or thoracotomy. Thoracic CT, FDG-PET,
and registration datasets were each interpreted by 2 readers for
the presence of metastatic nodal disease and were staged independently
of each other. Results were compared with surgical pathologic findings.
RESULTS: One hundred and thirty lymph node stations in the mediastinum
and hila were evaluated each on CT, PET, and registration datasets.
Sensitivity, specificity, positive predictive value, and negative
predictive value, respectively, for detecting metastatic nodal disease
for CT were 74%, 78%, 55%, 88%; for PET with CT side by side, 59%
to 76%, 77% to 89%, 48% to 68%, and 84% to 91%; and for CT-PET registration,
71% to 76%, 89% to 96%, 70% to 86%, and 90% to 91%. Registration
images were significantly more sensitive in detecting nodal disease over PET for 1 reader (P = 0.0156) and were more specific than PET (P = 0.0107 and 0.0017) in identifying the absence of mediastinal
disease for both readers. Registration was significantly more accurate for staging when compared with PET for both readers (P = 0.002 and
0.035). CONCLUSION: Registration of CT and FDG-PET datasets significantly
improved the specificity of detecting metastatic disease. In addition,
registration improved the radiologic staging of lung cancer patients
when compared with CT or FDG-PET alone.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine if volumetric nonlinear registration or registration
of thoracic computed tomography (CT) and 2-[18F]-fluoro-2-deoxy-D-glucose-positron
emission tomography (FDG-PET) datasets changes the detection of mediastinal
and hilar nodal disease in patients undergoing staging for lung cancer
and if it has any impact on radiologic lung cancer staging. METHOD:
Computer-based image registration was performed on 45 clinical thoracic
helical CT and FDG-PET scans of patients with lung cancer who were
staged by mediastinoscopy and/or thoracotomy. Thoracic CT, FDG-PET,
and registration datasets were each interpreted by 2 readers for
the presence of metastatic nodal disease and were staged independently
of each other. Results were compared with surgical pathologic findings.
RESULTS: One hundred and thirty lymph node stations in the mediastinum
and hila were evaluated each on CT, PET, and registration datasets.
Sensitivity, specificity, positive predictive value, and negative
predictive value, respectively, for detecting metastatic nodal disease
for CT were 74%, 78%, 55%, 88%; for PET with CT side by side, 59%
to 76%, 77% to 89%, 48% to 68%, and 84% to 91%; and for CT-PET registration,
71% to 76%, 89% to 96%, 70% to 86%, and 90% to 91%. Registration
images were significantly more sensitive in detecting nodal disease over PET for 1 reader (P = 0.0156) and were more specific than PET (P = 0.0107 and 0.0017) in identifying the absence of mediastinal
disease for both readers. Registration was significantly more accurate for staging when compared with PET for both readers (P = 0.002 and
0.035). CONCLUSION: Registration of CT and FDG-PET datasets significantly
improved the specificity of detecting metastatic disease. In addition,
registration improved the radiologic staging of lung cancer patients
when compared with CT or FDG-PET alone.
of thoracic computed tomography (CT) and 2-[18F]-fluoro-2-deoxy-D-glucose-positron
emission tomography (FDG-PET) datasets changes the detection of mediastinal
and hilar nodal disease in patients undergoing staging for lung cancer
and if it has any impact on radiologic lung cancer staging. METHOD:
Computer-based image registration was performed on 45 clinical thoracic
helical CT and FDG-PET scans of patients with lung cancer who were
staged by mediastinoscopy and/or thoracotomy. Thoracic CT, FDG-PET,
and registration datasets were each interpreted by 2 readers for
the presence of metastatic nodal disease and were staged independently
of each other. Results were compared with surgical pathologic findings.
RESULTS: One hundred and thirty lymph node stations in the mediastinum
and hila were evaluated each on CT, PET, and registration datasets.
Sensitivity, specificity, positive predictive value, and negative
predictive value, respectively, for detecting metastatic nodal disease
for CT were 74%, 78%, 55%, 88%; for PET with CT side by side, 59%
to 76%, 77% to 89%, 48% to 68%, and 84% to 91%; and for CT-PET registration,
71% to 76%, 89% to 96%, 70% to 86%, and 90% to 91%. Registration
images were significantly more sensitive in detecting nodal disease over PET for 1 reader (P = 0.0156) and were more specific than PET (P = 0.0107 and 0.0017) in identifying the absence of mediastinal
disease for both readers. Registration was significantly more accurate for staging when compared with PET for both readers (P = 0.002 and
0.035). CONCLUSION: Registration of CT and FDG-PET datasets significantly
improved the specificity of detecting metastatic disease. In addition,
registration improved the radiologic staging of lung cancer patients
when compared with CT or FDG-PET alone.
2002
Siebert, Uwe; Brach, M.; Sroczynski, G.; Berla, K.
In: Int Angiol, vol. 21, no. 4, pp. 305-15, 2002, ISSN: 0392-9590 (Print) 0392-9590 (Lin, ().
@article{Siebert2002,
title = {Efficacy, routine effectiveness, and safety of horsechestnut seed extract in the treatment of chronic venous insufficiency. A meta-analysis of randomized controlled trials and large observational studies},
author = {Uwe Siebert and M. Brach and G. Sroczynski and K. Berla},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12518108},
issn = {0392-9590 (Print) 0392-9590 (Lin},
year = {2002},
date = {2002-12-01},
urldate = {2002-12-01},
journal = {Int Angiol},
volume = {21},
number = {4},
pages = {305-15},
abstract = {BACKGROUND: Safe and effective oral therapies for chronic venous insufficiency
(CVI) would provide an important alternative to mechanical compression
treatment. Several narrative reviews and one systematic review have
summarized the efficacy of horse chestnut seed extract (HCSE), but
to our knowledge no systematic review has included data from both
randomized controlled trials (RCTs) and large-scale observational
studies regarding outcomes as well as adverse events. METHODS: Using
a systematic literature search, we identified 13 RCTs of CVI (1,051
patients) and 3 observational studies (10,725 patients) that met
our inclusion criteria. Examined outcomes were leg volume, ankle
and calf circumference, edema, pain, sensation of tension, swelling,
leg fatigue/heaviness, calf cramps, and itching. Random and fixed
effect models were used to pool outcomes and adverse events separately
for RCTs and observational studies. RESULTS: Overall, the RCTs indicated
that HCSE improved symptoms in patients with CVI. Compared to placebo,
HCSE reduced leg volume by 46.4 ml (95% CI, 11.3-81.4 ml) and increased
the likelihood of improvement in leg pain 4.1-fold (95% CI, 0.98-16.8).
Similarly, improvement probabilities were increased 1.5-fold (95%
CI, 1.2-1.9) for edema and 1.7-fold (95% CI, 0.01-3.0) for itching.
There was insufficient evidence to demonstrate HCSE's effect on leg
fatigue/heaviness or calf cramps. Observational studies showed significant
effectiveness regarding pain, edema, and leg fatigue/heaviness. No
severe adverse events were reported, and HCSE did not significantly
increase mild adverse events. CONCLUSIONS: Based on meta-analyses
of RCTs and observational studies, HCSE appears to be an effective
and safe treatment for CVI. Further RCTs and carefully conducted
large-scale observational studies are required to evaluate the long-term
effectiveness and safety of HCSE in routine settings.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Safe and effective oral therapies for chronic venous insufficiency
(CVI) would provide an important alternative to mechanical compression
treatment. Several narrative reviews and one systematic review have
summarized the efficacy of horse chestnut seed extract (HCSE), but
to our knowledge no systematic review has included data from both
randomized controlled trials (RCTs) and large-scale observational
studies regarding outcomes as well as adverse events. METHODS: Using
a systematic literature search, we identified 13 RCTs of CVI (1,051
patients) and 3 observational studies (10,725 patients) that met
our inclusion criteria. Examined outcomes were leg volume, ankle
and calf circumference, edema, pain, sensation of tension, swelling,
leg fatigue/heaviness, calf cramps, and itching. Random and fixed
effect models were used to pool outcomes and adverse events separately
for RCTs and observational studies. RESULTS: Overall, the RCTs indicated
that HCSE improved symptoms in patients with CVI. Compared to placebo,
HCSE reduced leg volume by 46.4 ml (95% CI, 11.3-81.4 ml) and increased
the likelihood of improvement in leg pain 4.1-fold (95% CI, 0.98-16.8).
Similarly, improvement probabilities were increased 1.5-fold (95%
CI, 1.2-1.9) for edema and 1.7-fold (95% CI, 0.01-3.0) for itching.
There was insufficient evidence to demonstrate HCSE's effect on leg
fatigue/heaviness or calf cramps. Observational studies showed significant
effectiveness regarding pain, edema, and leg fatigue/heaviness. No
severe adverse events were reported, and HCSE did not significantly
increase mild adverse events. CONCLUSIONS: Based on meta-analyses
of RCTs and observational studies, HCSE appears to be an effective
and safe treatment for CVI. Further RCTs and carefully conducted
large-scale observational studies are required to evaluate the long-term
effectiveness and safety of HCSE in routine settings.
(CVI) would provide an important alternative to mechanical compression
treatment. Several narrative reviews and one systematic review have
summarized the efficacy of horse chestnut seed extract (HCSE), but
to our knowledge no systematic review has included data from both
randomized controlled trials (RCTs) and large-scale observational
studies regarding outcomes as well as adverse events. METHODS: Using
a systematic literature search, we identified 13 RCTs of CVI (1,051
patients) and 3 observational studies (10,725 patients) that met
our inclusion criteria. Examined outcomes were leg volume, ankle
and calf circumference, edema, pain, sensation of tension, swelling,
leg fatigue/heaviness, calf cramps, and itching. Random and fixed
effect models were used to pool outcomes and adverse events separately
for RCTs and observational studies. RESULTS: Overall, the RCTs indicated
that HCSE improved symptoms in patients with CVI. Compared to placebo,
HCSE reduced leg volume by 46.4 ml (95% CI, 11.3-81.4 ml) and increased
the likelihood of improvement in leg pain 4.1-fold (95% CI, 0.98-16.8).
Similarly, improvement probabilities were increased 1.5-fold (95%
CI, 1.2-1.9) for edema and 1.7-fold (95% CI, 0.01-3.0) for itching.
There was insufficient evidence to demonstrate HCSE's effect on leg
fatigue/heaviness or calf cramps. Observational studies showed significant
effectiveness regarding pain, edema, and leg fatigue/heaviness. No
severe adverse events were reported, and HCSE did not significantly
increase mild adverse events. CONCLUSIONS: Based on meta-analyses
of RCTs and observational studies, HCSE appears to be an effective
and safe treatment for CVI. Further RCTs and carefully conducted
large-scale observational studies are required to evaluate the long-term
effectiveness and safety of HCSE in routine settings.
Pandharipande, Pari; Lee, V. S.; Reuss, P. M.; Charles, H. W.; Rosen, R. J.; Krinsky, G. A.; Weinreb, J. C.; Rofsky, N. M.
Two-station bolus-chase MR angiography with a stationary table: a simple alternative to automated-table techniques Journal Article
In: AJR Am J Roentgenol, vol. 179, no. 6, pp. 1583-9, 2002, ISSN: 0361-803X (Print) 0361-803X (Lin, ().
@article{Pandharipande2002,
title = {Two-station bolus-chase MR angiography with a stationary table: a simple alternative to automated-table techniques},
author = {Pari Pandharipande and V. S. Lee and P. M. Reuss and H. W. Charles and R. J. Rosen and G. A. Krinsky and J. C. Weinreb and N. M. Rofsky},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12438059},
issn = {0361-803X (Print) 0361-803X (Lin},
year = {2002},
date = {2002-12-01},
urldate = {2002-12-01},
journal = {AJR Am J Roentgenol},
volume = {179},
number = {6},
pages = {1583-9},
abstract = {OBJECTIVE: Our purpose was to evaluate a simple, two-station, bolus-chase,
peripheral MR angiography technique that relies on manual patient
translation using a plastic patient-transfer board. SUBJECTS AND
METHODS: Twenty patients successfully completed both lower extremity
MR angiography and digital subtraction angiography within a 3-month
period. For MR angiography, patients were placed on the scanner table
on a standard plastic patient-transfer board. We performed unenhanced
and contrast-enhanced imaging at the level of the pelvis using a
three-dimensional gradient-echo sequence (TR range/TE range, 3.8-4.6/1.3-1.8;
flip angle range, 25-40 degrees ). Then patients were quickly pulled
350-400 mm using the transfer-board handles, and two subsequent acquisitions
were obtained at the level of the thighs. For each modality, two
radiologists who were unaware of correlative imaging results retrospectively
scored all vessel segments as either greater than or equal to 50%
stenosis or less than 50% stenosis, and interobserver agreement was
determined. Using digital subtraction angiography as the standard
of reference, we used consensus data to compute MR angiography sensitivity
and specificity. RESULTS: In the 261 vessel segments considered,
MR angiography had a sensitivity of 75% (12/16) and a specificity
of 98% (94/96) for the detection of stenosis greater than or equal
to 50% from the aorta through the common femoral arteries. For the
superficial and profunda femoral arteries through the popliteal arteries,
these values were 97% (31/32) and 94% (34/36), respectively. MR angiography
interobserver agreement for detection of stenosis was good (kappa = 0.68) for the aorta through the common femoral arteries and excellent (kappa = 0.88) for the superficial and profunda femoral arteries
through the popliteal arteries. These values were comparable to those found for digital subtraction angiography (kappa = 0.67 and kappa = 0.88, respectively). CONCLUSION: Stationary-table MR angiography
is a useful, simple strategy for lower extremity angiography in centers
without a moving table.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: Our purpose was to evaluate a simple, two-station, bolus-chase,
peripheral MR angiography technique that relies on manual patient
translation using a plastic patient-transfer board. SUBJECTS AND
METHODS: Twenty patients successfully completed both lower extremity
MR angiography and digital subtraction angiography within a 3-month
period. For MR angiography, patients were placed on the scanner table
on a standard plastic patient-transfer board. We performed unenhanced
and contrast-enhanced imaging at the level of the pelvis using a
three-dimensional gradient-echo sequence (TR range/TE range, 3.8-4.6/1.3-1.8;
flip angle range, 25-40 degrees ). Then patients were quickly pulled
350-400 mm using the transfer-board handles, and two subsequent acquisitions
were obtained at the level of the thighs. For each modality, two
radiologists who were unaware of correlative imaging results retrospectively
scored all vessel segments as either greater than or equal to 50%
stenosis or less than 50% stenosis, and interobserver agreement was
determined. Using digital subtraction angiography as the standard
of reference, we used consensus data to compute MR angiography sensitivity
and specificity. RESULTS: In the 261 vessel segments considered,
MR angiography had a sensitivity of 75% (12/16) and a specificity
of 98% (94/96) for the detection of stenosis greater than or equal
to 50% from the aorta through the common femoral arteries. For the
superficial and profunda femoral arteries through the popliteal arteries,
these values were 97% (31/32) and 94% (34/36), respectively. MR angiography
interobserver agreement for detection of stenosis was good (kappa = 0.68) for the aorta through the common femoral arteries and excellent (kappa = 0.88) for the superficial and profunda femoral arteries
through the popliteal arteries. These values were comparable to those found for digital subtraction angiography (kappa = 0.67 and kappa = 0.88, respectively). CONCLUSION: Stationary-table MR angiography
is a useful, simple strategy for lower extremity angiography in centers
without a moving table.
peripheral MR angiography technique that relies on manual patient
translation using a plastic patient-transfer board. SUBJECTS AND
METHODS: Twenty patients successfully completed both lower extremity
MR angiography and digital subtraction angiography within a 3-month
period. For MR angiography, patients were placed on the scanner table
on a standard plastic patient-transfer board. We performed unenhanced
and contrast-enhanced imaging at the level of the pelvis using a
three-dimensional gradient-echo sequence (TR range/TE range, 3.8-4.6/1.3-1.8;
flip angle range, 25-40 degrees ). Then patients were quickly pulled
350-400 mm using the transfer-board handles, and two subsequent acquisitions
were obtained at the level of the thighs. For each modality, two
radiologists who were unaware of correlative imaging results retrospectively
scored all vessel segments as either greater than or equal to 50%
stenosis or less than 50% stenosis, and interobserver agreement was
determined. Using digital subtraction angiography as the standard
of reference, we used consensus data to compute MR angiography sensitivity
and specificity. RESULTS: In the 261 vessel segments considered,
MR angiography had a sensitivity of 75% (12/16) and a specificity
of 98% (94/96) for the detection of stenosis greater than or equal
to 50% from the aorta through the common femoral arteries. For the
superficial and profunda femoral arteries through the popliteal arteries,
these values were 97% (31/32) and 94% (34/36), respectively. MR angiography
interobserver agreement for detection of stenosis was good (kappa = 0.68) for the aorta through the common femoral arteries and excellent (kappa = 0.88) for the superficial and profunda femoral arteries
through the popliteal arteries. These values were comparable to those found for digital subtraction angiography (kappa = 0.67 and kappa = 0.88, respectively). CONCLUSION: Stationary-table MR angiography
is a useful, simple strategy for lower extremity angiography in centers
without a moving table.
Prasad, S. R.; Jhaveri, K. S.; Saini, S.; Hahn, P. F.; Halpern, Elkan F.; Sumner, J. E.
In: Radiology, vol. 225, no. 2, pp. 416-9, 2002, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Prasad2002a,
title = {CT tumor measurement for therapeutic response assessment: comparison
of unidimensional, bidimensional, and volumetric techniques initial
observations},
author = {S. R. Prasad and K. S. Jhaveri and S. Saini and P. F. Hahn and Elkan F. Halpern and J. E. Sumner},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12409574},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2002},
date = {2002-11-01},
journal = {Radiology},
volume = {225},
number = {2},
pages = {416-9},
abstract = {PURPOSE: To compare unidimensional, bidimensional, and volumetric
techniques for evaluation of treatment response in patients with
liver metastases from breast cancer in a phase III clinical trial.
MATERIALS AND METHODS: Helical computed tomographic (CT) studies
in 38 patients with liver metastases from breast cancer who were
enrolled in a phase III clinical trial were evaluated before treatment
and at 6 months after treatment. Two subspecialty radiologists measured
all lesions on transverse CT scans with use of electronic calipers
according to both unidimensional and bidimensional criteria. Volumetric
measurements were made by tracing individual lesions. Measurements
of individual lesions were summed to obtain patient response, which
was categorized as complete response, disappearance of lesions; partial
response, greater than 30% decrease in tumor diameter (unidimensional),
greater than 50% reduction in tumor area (bidimensional), or greater
than 65% reduction in tumor volume (volumetric); disease progression,
greater than 20% increase in tumor diameter, greater than 25% increase
in tumor area, or greater than 73% increase in tumor volume: or stable
disease (size response other than that of complete response, partial
response, or disease progression). RESULTS: In 37 patients, there
was concordant treatment response with use of unidimensional and
bidimensional techniques. Volumetric measurement produced results
different from those of the unidimensional and bidimensional techniques
in 12 and 13 patients, respectively. In six patients with partial
response per unidimensional and bidimensional criteria, the response
based on the volumetric technique was stable disease. In two patients
with stable disease per bidimensional and unidimensional criteria,
the response was partial response by volumetric measurement. In four
patients with disease progression per bidimensional and unidimensional
criteria, the response was stable disease per volumetric criteria.
CONCLUSION: Volumetric measurement of tumor burden gives different
results for treatment response compared with that of the unidimensional
or bidimensional technique in a considerable proportion of patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To compare unidimensional, bidimensional, and volumetric
techniques for evaluation of treatment response in patients with
liver metastases from breast cancer in a phase III clinical trial.
MATERIALS AND METHODS: Helical computed tomographic (CT) studies
in 38 patients with liver metastases from breast cancer who were
enrolled in a phase III clinical trial were evaluated before treatment
and at 6 months after treatment. Two subspecialty radiologists measured
all lesions on transverse CT scans with use of electronic calipers
according to both unidimensional and bidimensional criteria. Volumetric
measurements were made by tracing individual lesions. Measurements
of individual lesions were summed to obtain patient response, which
was categorized as complete response, disappearance of lesions; partial
response, greater than 30% decrease in tumor diameter (unidimensional),
greater than 50% reduction in tumor area (bidimensional), or greater
than 65% reduction in tumor volume (volumetric); disease progression,
greater than 20% increase in tumor diameter, greater than 25% increase
in tumor area, or greater than 73% increase in tumor volume: or stable
disease (size response other than that of complete response, partial
response, or disease progression). RESULTS: In 37 patients, there
was concordant treatment response with use of unidimensional and
bidimensional techniques. Volumetric measurement produced results
different from those of the unidimensional and bidimensional techniques
in 12 and 13 patients, respectively. In six patients with partial
response per unidimensional and bidimensional criteria, the response
based on the volumetric technique was stable disease. In two patients
with stable disease per bidimensional and unidimensional criteria,
the response was partial response by volumetric measurement. In four
patients with disease progression per bidimensional and unidimensional
criteria, the response was stable disease per volumetric criteria.
CONCLUSION: Volumetric measurement of tumor burden gives different
results for treatment response compared with that of the unidimensional
or bidimensional technique in a considerable proportion of patients.
techniques for evaluation of treatment response in patients with
liver metastases from breast cancer in a phase III clinical trial.
MATERIALS AND METHODS: Helical computed tomographic (CT) studies
in 38 patients with liver metastases from breast cancer who were
enrolled in a phase III clinical trial were evaluated before treatment
and at 6 months after treatment. Two subspecialty radiologists measured
all lesions on transverse CT scans with use of electronic calipers
according to both unidimensional and bidimensional criteria. Volumetric
measurements were made by tracing individual lesions. Measurements
of individual lesions were summed to obtain patient response, which
was categorized as complete response, disappearance of lesions; partial
response, greater than 30% decrease in tumor diameter (unidimensional),
greater than 50% reduction in tumor area (bidimensional), or greater
than 65% reduction in tumor volume (volumetric); disease progression,
greater than 20% increase in tumor diameter, greater than 25% increase
in tumor area, or greater than 73% increase in tumor volume: or stable
disease (size response other than that of complete response, partial
response, or disease progression). RESULTS: In 37 patients, there
was concordant treatment response with use of unidimensional and
bidimensional techniques. Volumetric measurement produced results
different from those of the unidimensional and bidimensional techniques
in 12 and 13 patients, respectively. In six patients with partial
response per unidimensional and bidimensional criteria, the response
based on the volumetric technique was stable disease. In two patients
with stable disease per bidimensional and unidimensional criteria,
the response was partial response by volumetric measurement. In four
patients with disease progression per bidimensional and unidimensional
criteria, the response was stable disease per volumetric criteria.
CONCLUSION: Volumetric measurement of tumor burden gives different
results for treatment response compared with that of the unidimensional
or bidimensional technique in a considerable proportion of patients.
Rieber, J.; Schiele, T. M.; Koenig, A.; Erhard, I.; Segmiller, T.; Stempfle, H. U.; Theisen, K.; Jung, P.; Siebert, Uwe; Klauss, V.
Long-term safety of therapy stratification in patients with intermediate coronary lesions based on intracoronary pressure measurements Journal Article
In: Am J Cardiol, vol. 90, no. 10, pp. 1160-4, 2002, ISSN: 0002-9149 (Print) 0002-9149 (Lin, ().
@article{Rieber2002,
title = {Long-term safety of therapy stratification in patients with intermediate
coronary lesions based on intracoronary pressure measurements},
author = {J. Rieber and T. M. Schiele and A. Koenig and I. Erhard and T. Segmiller and H. U. Stempfle and K. Theisen and P. Jung and Uwe Siebert and V. Klauss},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12423726},
issn = {0002-9149 (Print) 0002-9149 (Lin},
year = {2002},
date = {2002-11-01},
journal = {Am J Cardiol},
volume = {90},
number = {10},
pages = {1160-4},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kalra, M. K.; Prasad, S.; Saini, S.; Blake, M. A.; Varghese, J.; Halpern, Elkan F.; Thrall, J. H.; Rhea, J. T.
Clinical comparison of standard-dose and 50% reduced-dose abdominal CT: effect on image quality Journal Article
In: AJR Am J Roentgenol, vol. 179, no. 5, pp. 1101-6, 2002, ISSN: 0361-803X (Print) 0361-803X (Lin, ().
@article{Kalra2002,
title = {Clinical comparison of standard-dose and 50% reduced-dose abdominal
CT: effect on image quality},
author = {M. K. Kalra and S. Prasad and S. Saini and M. A. Blake and J. Varghese and Elkan F. Halpern and J. H. Thrall and J. T. Rhea},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12388481},
issn = {0361-803X (Print) 0361-803X (Lin},
year = {2002},
date = {2002-11-01},
journal = {AJR Am J Roentgenol},
volume = {179},
number = {5},
pages = {1101-6},
abstract = {OBJECTIVE: We hypothesized that radiation doses for abdominal CT could
be reduced by adjusting the dose for a patient's weight and cross-sectional
abdominal dimensions, with the resultant scans still being of diagnostic
quality. SUBJECTS AND METHODS: Using a multidetector CT scanner,
we prospectively studied 39 patients who were 65 years and older
who had a known history of cancer. After performing a diagnostic
contrast-enhanced CT examination, we obtained four slices each (centered
at the top of the right kidney) at a standard radiation dose (240-300
mA) and at a 50% reduced dose (120-150 mA) at a constant kilovoltage
of 140. Scans were obtained during a single breath-hold, with a 2.5-mm
detector configuration and a slice pitch of 6:1. Reconstructed slice
thickness was 5 mm. In a blinded review, two radiologists rated the
randomized CT scans for overall image quality and anatomic details
of liver, spleen, adrenal glands, kidneys, pancreas, and abdominal wall, using a 5-point scale (1 = unacceptabl},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: We hypothesized that radiation doses for abdominal CT could
be reduced by adjusting the dose for a patient's weight and cross-sectional
abdominal dimensions, with the resultant scans still being of diagnostic
quality. SUBJECTS AND METHODS: Using a multidetector CT scanner,
we prospectively studied 39 patients who were 65 years and older
who had a known history of cancer. After performing a diagnostic
contrast-enhanced CT examination, we obtained four slices each (centered
at the top of the right kidney) at a standard radiation dose (240-300
mA) and at a 50% reduced dose (120-150 mA) at a constant kilovoltage
of 140. Scans were obtained during a single breath-hold, with a 2.5-mm
detector configuration and a slice pitch of 6:1. Reconstructed slice
thickness was 5 mm. In a blinded review, two radiologists rated the
randomized CT scans for overall image quality and anatomic details
of liver, spleen, adrenal glands, kidneys, pancreas, and abdominal wall, using a 5-point scale (1 = unacceptabl
be reduced by adjusting the dose for a patient's weight and cross-sectional
abdominal dimensions, with the resultant scans still being of diagnostic
quality. SUBJECTS AND METHODS: Using a multidetector CT scanner,
we prospectively studied 39 patients who were 65 years and older
who had a known history of cancer. After performing a diagnostic
contrast-enhanced CT examination, we obtained four slices each (centered
at the top of the right kidney) at a standard radiation dose (240-300
mA) and at a 50% reduced dose (120-150 mA) at a constant kilovoltage
of 140. Scans were obtained during a single breath-hold, with a 2.5-mm
detector configuration and a slice pitch of 6:1. Reconstructed slice
thickness was 5 mm. In a blinded review, two radiologists rated the
randomized CT scans for overall image quality and anatomic details
of liver, spleen, adrenal glands, kidneys, pancreas, and abdominal wall, using a 5-point scale (1 = unacceptabl
Beinfeld, M. T.; Bosch, Johanna; Gazelle, G. Scott
Hospital costs of uterine artery embolization and hysterectomy for uterine fibroid tumors Journal Article
In: Acad Radiol, vol. 9, no. 11, pp. 1300-4, 2002, ISSN: 1076-6332 (Print) 1076-6332 (Lin, ().
@article{Beinfeld2002,
title = {Hospital costs of uterine artery embolization and hysterectomy for uterine fibroid tumors},
author = {M. T. Beinfeld and Johanna Bosch and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12449362},
issn = {1076-6332 (Print) 1076-6332 (Lin},
year = {2002},
date = {2002-11-01},
urldate = {2002-11-01},
journal = {Acad Radiol},
volume = {9},
number = {11},
pages = {1300-4},
abstract = {RATIONALE AND OBJECTIVES: The purpose of this study was to compare
the total actual hospital costs of uterine artery embolization (UAE)
and hysterectomy for treatment of uterine fibroid tumors and to evaluate
factors that might influence cost. MATERIALS AND METHODS: Total actual
hospital costs were collected from the institution's cost accounting system on patients who underwent UAE (n = 57) or hysterectomy (n = 300) for uterine fibroids between 1998 and 2001. Electronic medical
records were reviewed to collect clinical information. Standard statistical
techniques were used to determine which factors influenced hospital
costs. RESULTS: The mean total actual hospital costs of UAE were
significantly higher than hysterectomy ($8,223 vs $6,046, P \< .0001),
but the mean length of stay was shorter (0.95 vs 2.6 days, P \< .0001).
In linear regression analyses, complications were predictive of increased
costs of UAE; length of stay, complications, and laparoscopic hysterectomy
were predictive of increased costs of hysterectomy. CONCLUSION: Hospital
costs of UAE were higher than hysterectomy for the treatment of uterine
fibroids, but the hospital stays were shorter.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
RATIONALE AND OBJECTIVES: The purpose of this study was to compare
the total actual hospital costs of uterine artery embolization (UAE)
and hysterectomy for treatment of uterine fibroid tumors and to evaluate
factors that might influence cost. MATERIALS AND METHODS: Total actual
hospital costs were collected from the institution's cost accounting system on patients who underwent UAE (n = 57) or hysterectomy (n = 300) for uterine fibroids between 1998 and 2001. Electronic medical
records were reviewed to collect clinical information. Standard statistical
techniques were used to determine which factors influenced hospital
costs. RESULTS: The mean total actual hospital costs of UAE were
significantly higher than hysterectomy ($8,223 vs $6,046, P < .0001),
but the mean length of stay was shorter (0.95 vs 2.6 days, P < .0001).
In linear regression analyses, complications were predictive of increased
costs of UAE; length of stay, complications, and laparoscopic hysterectomy
were predictive of increased costs of hysterectomy. CONCLUSION: Hospital
costs of UAE were higher than hysterectomy for the treatment of uterine
fibroids, but the hospital stays were shorter.
the total actual hospital costs of uterine artery embolization (UAE)
and hysterectomy for treatment of uterine fibroid tumors and to evaluate
factors that might influence cost. MATERIALS AND METHODS: Total actual
hospital costs were collected from the institution's cost accounting system on patients who underwent UAE (n = 57) or hysterectomy (n = 300) for uterine fibroids between 1998 and 2001. Electronic medical
records were reviewed to collect clinical information. Standard statistical
techniques were used to determine which factors influenced hospital
costs. RESULTS: The mean total actual hospital costs of UAE were
significantly higher than hysterectomy ($8,223 vs $6,046, P < .0001),
but the mean length of stay was shorter (0.95 vs 2.6 days, P < .0001).
In linear regression analyses, complications were predictive of increased
costs of UAE; length of stay, complications, and laparoscopic hysterectomy
were predictive of increased costs of hysterectomy. CONCLUSION: Hospital
costs of UAE were higher than hysterectomy for the treatment of uterine
fibroids, but the hospital stays were shorter.
Moy, L.; Slanetz, P. J.; Moore, R.; Satija, S.; Yeh, E. D.; McCarthy, K. A.; Hall, D.; Staffa, M.; Rafferty, E. A.; Halpern, Elkan F.; Kopans, D. B.
Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review Journal Article
In: Radiology, vol. 225, no. 1, pp. 176-81, 2002, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Moy2002,
title = {Specificity of mammography and US in the evaluation of a palpable
abnormality: retrospective review},
author = {L. Moy and P. J. Slanetz and R. Moore and S. Satija and E. D. Yeh and K. A. McCarthy and D. Hall and M. Staffa and E. A. Rafferty and Elkan F. Halpern and D. B. Kopans},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12355002},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2002},
date = {2002-10-01},
journal = {Radiology},
volume = {225},
number = {1},
pages = {176-81},
abstract = {PURPOSE: To determine the number of patients who received a diagnosis
of breast cancer after having an area of clinical concern at presentation
and combined negative mammographic and ultrasonographic (US) findings.
MATERIALS AND METHODS: During a 4-year period, 829 patients with
a palpable abnormality at presentation and combined negative mammographic
and US findings were identified. The number of women who went on
to receive a diagnosis of breast cancer was determined retrospectively.
The authors searched the breast imaging database and the pathology
database, sent a contact letter to the referring physicians, and
linked their data to the State Cancer Registry. They also analyzed
the breast parenchymal density among all patients who had more than
2 years of follow-up. RESULTS: Of the 829 women, 374 had follow-up
information. Two-hundred thirty-three patients had negative imaging
findings with more than 2 years of follow-up. The other 141 women
were presumed to be cancer free, as they were not identified by the
State Cancer Registry. Six (2.6%) of the 233 women had a diagnosis
of breast cancer in the area of the palpable abnormality. The six
cancers were diagnosed among the 156 women who had radiographically
dense breast tissue (Breast Imaging Reporting and Data System category
3 or 4). Among the 77 women with predominantly fatty tissues, no
cancers were diagnosed. CONCLUSION: A negative mammographic and US
finding of a palpable abnormality does not exclude breast cancer,
but the likelihood of breast cancer is low, approximately 2.6%-2.7%.
It may be higher if the breast tissues are dense and lower if they
are predominantly fatty.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine the number of patients who received a diagnosis
of breast cancer after having an area of clinical concern at presentation
and combined negative mammographic and ultrasonographic (US) findings.
MATERIALS AND METHODS: During a 4-year period, 829 patients with
a palpable abnormality at presentation and combined negative mammographic
and US findings were identified. The number of women who went on
to receive a diagnosis of breast cancer was determined retrospectively.
The authors searched the breast imaging database and the pathology
database, sent a contact letter to the referring physicians, and
linked their data to the State Cancer Registry. They also analyzed
the breast parenchymal density among all patients who had more than
2 years of follow-up. RESULTS: Of the 829 women, 374 had follow-up
information. Two-hundred thirty-three patients had negative imaging
findings with more than 2 years of follow-up. The other 141 women
were presumed to be cancer free, as they were not identified by the
State Cancer Registry. Six (2.6%) of the 233 women had a diagnosis
of breast cancer in the area of the palpable abnormality. The six
cancers were diagnosed among the 156 women who had radiographically
dense breast tissue (Breast Imaging Reporting and Data System category
3 or 4). Among the 77 women with predominantly fatty tissues, no
cancers were diagnosed. CONCLUSION: A negative mammographic and US
finding of a palpable abnormality does not exclude breast cancer,
but the likelihood of breast cancer is low, approximately 2.6%-2.7%.
It may be higher if the breast tissues are dense and lower if they
are predominantly fatty.
of breast cancer after having an area of clinical concern at presentation
and combined negative mammographic and ultrasonographic (US) findings.
MATERIALS AND METHODS: During a 4-year period, 829 patients with
a palpable abnormality at presentation and combined negative mammographic
and US findings were identified. The number of women who went on
to receive a diagnosis of breast cancer was determined retrospectively.
The authors searched the breast imaging database and the pathology
database, sent a contact letter to the referring physicians, and
linked their data to the State Cancer Registry. They also analyzed
the breast parenchymal density among all patients who had more than
2 years of follow-up. RESULTS: Of the 829 women, 374 had follow-up
information. Two-hundred thirty-three patients had negative imaging
findings with more than 2 years of follow-up. The other 141 women
were presumed to be cancer free, as they were not identified by the
State Cancer Registry. Six (2.6%) of the 233 women had a diagnosis
of breast cancer in the area of the palpable abnormality. The six
cancers were diagnosed among the 156 women who had radiographically
dense breast tissue (Breast Imaging Reporting and Data System category
3 or 4). Among the 77 women with predominantly fatty tissues, no
cancers were diagnosed. CONCLUSION: A negative mammographic and US
finding of a palpable abnormality does not exclude breast cancer,
but the likelihood of breast cancer is low, approximately 2.6%-2.7%.
It may be higher if the breast tissues are dense and lower if they
are predominantly fatty.
Iwashyna, T. J.; Lamont, Elizabeth
Effectiveness of adjuvant fluorouracil in clinical practice: a population-based cohort study of elderly patients with stage III colon cancer Journal Article
In: J Clin Oncol, vol. 20, no. 19, pp. 3992-8, 2002, ISSN: 0732-183X (Print) 0732-183X (Lin, ().
@article{Iwashyna2002,
title = {Effectiveness of adjuvant fluorouracil in clinical practice: a population-based cohort study of elderly patients with stage III colon cancer},
author = {T. J. Iwashyna and Elizabeth Lamont},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12351596},
issn = {0732-183X (Print) 0732-183X (Lin},
year = {2002},
date = {2002-10-01},
urldate = {2002-10-01},
journal = {J Clin Oncol},
volume = {20},
number = {19},
pages = {3992-8},
abstract = {PURPOSE: Although randomized controlled trials (RCTs) consistently
show that adjuvant fluorouracil (5-FU) extends the survival of patients
with stage III colon cancer, it is not yet known whether this benefit
exists in populations underrepresented on clinical trials, particularly
the elderly with medical comorbidity treated in the community. In
this study, we ask the following: (1) What is the hazard of death
associated with adjuvant 5-FU in the general population of elderly
stage III colon cancer patients? (2) Does the hazard vary with patient
age? PATIENTS AND METHODS: In this prospective, nonrandomized, population-based
cohort study of 3,357 elderly Medicare beneficiaries who had undergone
resection of stage III colon cancer according to the Surveillance,
Epidemiology, and End-Results registries, we use propensity score
matching to compare the all-cause mortality of patients who received
5-FU to matched untreated patients. RESULTS: 5-FU reduces the hazard
of death by 27% (hazard ratio, 0.73; 95% confidence interval [CI],
0.65 to 0.82) across the 6 years of our data in a Cox model. At 5
years, 52.7% (95% CI, 49.6% to 55.6%) of the treated and 40.7% (95%
CI, 38.1% to 43.4%) of the matched untreated are still alive. We
find that these effects do not diminish with advancing patient age.
CONCLUSION: The survival benefit of adjuvant 5-FU that has been demonstrated
in participants of RCTs is also evident in a population sample of
elderly Medicare beneficiaries with stage III colon cancer treated
in the community. Furthermore, this survival benefit does not appear
to diminish with patient age. These findings support the continued
use of adjuvant 5-FU in the general population of elderly patients
with stage III colon cancer and suggest that oncologists in the community
are practicing at a high level of effectiveness.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: Although randomized controlled trials (RCTs) consistently
show that adjuvant fluorouracil (5-FU) extends the survival of patients
with stage III colon cancer, it is not yet known whether this benefit
exists in populations underrepresented on clinical trials, particularly
the elderly with medical comorbidity treated in the community. In
this study, we ask the following: (1) What is the hazard of death
associated with adjuvant 5-FU in the general population of elderly
stage III colon cancer patients? (2) Does the hazard vary with patient
age? PATIENTS AND METHODS: In this prospective, nonrandomized, population-based
cohort study of 3,357 elderly Medicare beneficiaries who had undergone
resection of stage III colon cancer according to the Surveillance,
Epidemiology, and End-Results registries, we use propensity score
matching to compare the all-cause mortality of patients who received
5-FU to matched untreated patients. RESULTS: 5-FU reduces the hazard
of death by 27% (hazard ratio, 0.73; 95% confidence interval [CI],
0.65 to 0.82) across the 6 years of our data in a Cox model. At 5
years, 52.7% (95% CI, 49.6% to 55.6%) of the treated and 40.7% (95%
CI, 38.1% to 43.4%) of the matched untreated are still alive. We
find that these effects do not diminish with advancing patient age.
CONCLUSION: The survival benefit of adjuvant 5-FU that has been demonstrated
in participants of RCTs is also evident in a population sample of
elderly Medicare beneficiaries with stage III colon cancer treated
in the community. Furthermore, this survival benefit does not appear
to diminish with patient age. These findings support the continued
use of adjuvant 5-FU in the general population of elderly patients
with stage III colon cancer and suggest that oncologists in the community
are practicing at a high level of effectiveness.
show that adjuvant fluorouracil (5-FU) extends the survival of patients
with stage III colon cancer, it is not yet known whether this benefit
exists in populations underrepresented on clinical trials, particularly
the elderly with medical comorbidity treated in the community. In
this study, we ask the following: (1) What is the hazard of death
associated with adjuvant 5-FU in the general population of elderly
stage III colon cancer patients? (2) Does the hazard vary with patient
age? PATIENTS AND METHODS: In this prospective, nonrandomized, population-based
cohort study of 3,357 elderly Medicare beneficiaries who had undergone
resection of stage III colon cancer according to the Surveillance,
Epidemiology, and End-Results registries, we use propensity score
matching to compare the all-cause mortality of patients who received
5-FU to matched untreated patients. RESULTS: 5-FU reduces the hazard
of death by 27% (hazard ratio, 0.73; 95% confidence interval [CI],
0.65 to 0.82) across the 6 years of our data in a Cox model. At 5
years, 52.7% (95% CI, 49.6% to 55.6%) of the treated and 40.7% (95%
CI, 38.1% to 43.4%) of the matched untreated are still alive. We
find that these effects do not diminish with advancing patient age.
CONCLUSION: The survival benefit of adjuvant 5-FU that has been demonstrated
in participants of RCTs is also evident in a population sample of
elderly Medicare beneficiaries with stage III colon cancer treated
in the community. Furthermore, this survival benefit does not appear
to diminish with patient age. These findings support the continued
use of adjuvant 5-FU in the general population of elderly patients
with stage III colon cancer and suggest that oncologists in the community
are practicing at a high level of effectiveness.
Stylopoulos, Nicholas; Gazelle, G. Scott; Rattner, David W.
Paraesophageal hernias: operation or observation? Journal Article
In: Annals of surgery, vol. 236, pp. 492–500; discussion 500-1, 2002, ISSN: 0003-4932, ().
@article{Stylopoulos2002,
title = {Paraesophageal hernias: operation or observation?},
author = {Nicholas Stylopoulos and G. Scott Gazelle and David W. Rattner},
url = {https://pubmed.ncbi.nlm.nih.gov/12368678/},
doi = {10.1097/00000658-200210000-00012},
issn = {0003-4932},
year = {2002},
date = {2002-10-01},
journal = {Annals of surgery},
volume = {236},
pages = {492--500; discussion 500-1},
abstract = {To examine the hypothesis that elective laparoscopic repair should be routinely performed on patients with asymptomatic or minimally symptomatic paraesophageal hernias. The management of asymptomatic paraesophageal hernias is a controversial issue. Most surgeons believe that all paraesophageal hernias should be corrected electively on diagnosis, irrespective of symptoms, to prevent the development of complications and avoid the risk of emergency surgery. A Markov Monte Carlo decision analytic model was developed to track a hypothetical cohort of patients with asymptomatic or minimally symptomatic paraesophageal hernia and reflect the possible clinical outcomes associated with two treatment strategies: elective laparoscopic paraesophageal hernia repair (ELHR) or watchful waiting (WW). The input variables for ELHR were estimated from a pooled analysis of 20 published studies, while those for WW and emergency surgery were derived from the 1997 HCUP-NIS database and surgical literature published from 1964 to 2000. Outcomes for the two strategies were expressed in quality-adjusted life-years (QALYs). Analysis of the HCUP-NIS database showed that published studies overestimate the mortality of emergency surgery (17% vs. 5.4%). The mortality rate of ELHR was 1.4%. The annual probability of developing acute symptoms requiring emergency surgery with the WW strategy was 1.1%. For patients 65 years of age, ELHR resulted in reduction of 0.13 QALYs (10.78 vs. 10.65) compared with WW. The model predicted that WW was the optimal treatment strategy in 83% of patients and ELHR in the remaining 17%. The model was sensitive only to alterations of the mortality rates of ELHR and emergency surgery. If ELHR is routinely recommended, it would be more beneficial than WW in fewer than one of five patients. WW is a reasonable alternative for the initial management of patients with asymptomatic or minimally symptomatic paraesophageal hernias, and even if an emergency operation is required, the burden of the procedure is not as severe as was thought in the past.},
keywords = {},
pubstate = {ppublish},
tppubtype = {article}
}
To examine the hypothesis that elective laparoscopic repair should be routinely performed on patients with asymptomatic or minimally symptomatic paraesophageal hernias. The management of asymptomatic paraesophageal hernias is a controversial issue. Most surgeons believe that all paraesophageal hernias should be corrected electively on diagnosis, irrespective of symptoms, to prevent the development of complications and avoid the risk of emergency surgery. A Markov Monte Carlo decision analytic model was developed to track a hypothetical cohort of patients with asymptomatic or minimally symptomatic paraesophageal hernia and reflect the possible clinical outcomes associated with two treatment strategies: elective laparoscopic paraesophageal hernia repair (ELHR) or watchful waiting (WW). The input variables for ELHR were estimated from a pooled analysis of 20 published studies, while those for WW and emergency surgery were derived from the 1997 HCUP-NIS database and surgical literature published from 1964 to 2000. Outcomes for the two strategies were expressed in quality-adjusted life-years (QALYs). Analysis of the HCUP-NIS database showed that published studies overestimate the mortality of emergency surgery (17% vs. 5.4%). The mortality rate of ELHR was 1.4%. The annual probability of developing acute symptoms requiring emergency surgery with the WW strategy was 1.1%. For patients 65 years of age, ELHR resulted in reduction of 0.13 QALYs (10.78 vs. 10.65) compared with WW. The model predicted that WW was the optimal treatment strategy in 83% of patients and ELHR in the remaining 17%. The model was sensitive only to alterations of the mortality rates of ELHR and emergency surgery. If ELHR is routinely recommended, it would be more beneficial than WW in fewer than one of five patients. WW is a reasonable alternative for the initial management of patients with asymptomatic or minimally symptomatic paraesophageal hernias, and even if an emergency operation is required, the burden of the procedure is not as severe as was thought in the past.
Walensky, R. P.; Goldie, S. J.; Sax, P. E.; Weinstein, M. C.; Paltiel, A. D.; Kimmel, A. D.; Seage, G. R.; Losina, E.; Zhang, H.; Islam, R.; Freedberg, K. A.
Treatment for primary HIV infection: projecting outcomes of immediate, interrupted, or delayed therapy Journal Article
In: J Acquir Immune Defic Syndr, vol. 31, no. 1, pp. 27-37, 2002, ISSN: 1525-4135 (Print) 1525-4135 (Lin, ().
@article{Walensky2002b,
title = {Treatment for primary HIV infection: projecting outcomes of immediate, interrupted, or delayed therapy},
author = {R. P. Walensky and S. J. Goldie and P. E. Sax and M. C. Weinstein and A. D. Paltiel and A. D. Kimmel and G. R. Seage and E. Losina and H. Zhang and R. Islam and K. A. Freedberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12352147},
issn = {1525-4135 (Print) 1525-4135 (Lin},
year = {2002},
date = {2002-09-01},
urldate = {2002-09-01},
journal = {J Acquir Immune Defic Syndr},
volume = {31},
number = {1},
pages = {27-37},
abstract = {With limited data available on the optimal treatment of primary HIV
infection, disease modeling can be used to project clinical outcomes
and inform decision makers. The authors developed a simulation model
to evaluate the clinical outcomes and life expectancy projections
for three primary HIV infection treatment strategies: 1) continuous
antiretroviral therapy (ART) initiated at CD4 count \<350 cells/mm(3);
2) continuous ART initiated immediately on diagnosis of primary HIV
infection; and 3) ART initiated on diagnosis followed by structured
treatment interruption. Projected life expectancies for the three
strategies were 23.92, 24.46, and 26.07 years, respectively. The
impact of key variables was assessed in sensitivity analysis, with
the structured treatment interruption strategy remaining the most
effective over a broad range of inputs. The immunologic benefit associated
with immediate therapy and the potential for antiretroviral resistance
due to structured treatment interruption have the most important
impact on the optimal strategy. Based on current data, immediate
treatment on diagnosis of primary HIV infection followed by structured
treatment interruption will likely yield the best outcome. These
results can assist decision makers and those planning clinical trials
in defining evidence-based performance measures for primary HIV infection
treatment and future trials.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
With limited data available on the optimal treatment of primary HIV
infection, disease modeling can be used to project clinical outcomes
and inform decision makers. The authors developed a simulation model
to evaluate the clinical outcomes and life expectancy projections
for three primary HIV infection treatment strategies: 1) continuous
antiretroviral therapy (ART) initiated at CD4 count <350 cells/mm(3);
2) continuous ART initiated immediately on diagnosis of primary HIV
infection; and 3) ART initiated on diagnosis followed by structured
treatment interruption. Projected life expectancies for the three
strategies were 23.92, 24.46, and 26.07 years, respectively. The
impact of key variables was assessed in sensitivity analysis, with
the structured treatment interruption strategy remaining the most
effective over a broad range of inputs. The immunologic benefit associated
with immediate therapy and the potential for antiretroviral resistance
due to structured treatment interruption have the most important
impact on the optimal strategy. Based on current data, immediate
treatment on diagnosis of primary HIV infection followed by structured
treatment interruption will likely yield the best outcome. These
results can assist decision makers and those planning clinical trials
in defining evidence-based performance measures for primary HIV infection
treatment and future trials.
infection, disease modeling can be used to project clinical outcomes
and inform decision makers. The authors developed a simulation model
to evaluate the clinical outcomes and life expectancy projections
for three primary HIV infection treatment strategies: 1) continuous
antiretroviral therapy (ART) initiated at CD4 count <350 cells/mm(3);
2) continuous ART initiated immediately on diagnosis of primary HIV
infection; and 3) ART initiated on diagnosis followed by structured
treatment interruption. Projected life expectancies for the three
strategies were 23.92, 24.46, and 26.07 years, respectively. The
impact of key variables was assessed in sensitivity analysis, with
the structured treatment interruption strategy remaining the most
effective over a broad range of inputs. The immunologic benefit associated
with immediate therapy and the potential for antiretroviral resistance
due to structured treatment interruption have the most important
impact on the optimal strategy. Based on current data, immediate
treatment on diagnosis of primary HIV infection followed by structured
treatment interruption will likely yield the best outcome. These
results can assist decision makers and those planning clinical trials
in defining evidence-based performance measures for primary HIV infection
treatment and future trials.
Walensky, R. P.; Paltiel, A. D.; Freedberg, K. A.
AIDS Drug Assistance Programs: highlighting inequities in human immunodeficiency virus-infection health care in the United States Journal Article
In: Clin Infect Dis, vol. 35, no. 5, pp. 606-10, 2002, ISSN: 1537-6591 (Electronic) 1058-4838, ().
@article{Walensky2002,
title = {AIDS Drug Assistance Programs: highlighting inequities in human immunodeficiency virus-infection health care in the United States},
author = {R. P. Walensky and A. D. Paltiel and K. A. Freedberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12173137},
issn = {1537-6591 (Electronic) 1058-4838},
year = {2002},
date = {2002-09-01},
urldate = {2002-09-01},
journal = {Clin Infect Dis},
volume = {35},
number = {5},
pages = {606-10},
abstract = {The AIDS Drug Assistance Programs (ADAPs) were founded in 1987 to
pay for human immunodeficiency virus (HIV)-related medications in
the United States and to help provide prescriptions for HIV-infected
patients ineligible for Medicaid who have no private health insurance.
As HIV care has shifted from the inpatient to the outpatient arena
and as patients live longer because of more-effective antiretroviral
therapy, medication costs have increased, and ADAPs have increasingly
been operating under emergency measures, with coverage limitations
and eligibility restrictions. Because these programs operate at the
state level, inequalities in resource distribution to those in need
are manifest and appear to contribute to differences in disease outcomes
that are based solely on patients' place of residence. Cost-effectiveness
analysis would offer a more informed basis for distribution of ADAP
resources in an efficient and equitable manner, leading to a standardized
national structure.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The AIDS Drug Assistance Programs (ADAPs) were founded in 1987 to
pay for human immunodeficiency virus (HIV)-related medications in
the United States and to help provide prescriptions for HIV-infected
patients ineligible for Medicaid who have no private health insurance.
As HIV care has shifted from the inpatient to the outpatient arena
and as patients live longer because of more-effective antiretroviral
therapy, medication costs have increased, and ADAPs have increasingly
been operating under emergency measures, with coverage limitations
and eligibility restrictions. Because these programs operate at the
state level, inequalities in resource distribution to those in need
are manifest and appear to contribute to differences in disease outcomes
that are based solely on patients' place of residence. Cost-effectiveness
analysis would offer a more informed basis for distribution of ADAP
resources in an efficient and equitable manner, leading to a standardized
national structure.
pay for human immunodeficiency virus (HIV)-related medications in
the United States and to help provide prescriptions for HIV-infected
patients ineligible for Medicaid who have no private health insurance.
As HIV care has shifted from the inpatient to the outpatient arena
and as patients live longer because of more-effective antiretroviral
therapy, medication costs have increased, and ADAPs have increasingly
been operating under emergency measures, with coverage limitations
and eligibility restrictions. Because these programs operate at the
state level, inequalities in resource distribution to those in need
are manifest and appear to contribute to differences in disease outcomes
that are based solely on patients' place of residence. Cost-effectiveness
analysis would offer a more informed basis for distribution of ADAP
resources in an efficient and equitable manner, leading to a standardized
national structure.
Yabushita, H.; Bouma, B. E.; Houser, S. L.; Aretz, H. T.; Jang, I. K.; Schlendorf, K. H.; Kauffman, C. R.; Shishkov, M.; Kang, D. H.; Halpern, Elkan F.; Tearney, G. J.
Characterization of human atherosclerosis by optical coherence tomography Journal Article
In: Circulation, vol. 106, no. 13, pp. 1640-5, 2002, ISSN: 1524-4539 (Electronic) 0009-7322, ().
@article{Yabushita2002,
title = {Characterization of human atherosclerosis by optical coherence tomography},
author = {H. Yabushita and B. E. Bouma and S. L. Houser and H. T. Aretz and I. K. Jang and K. H. Schlendorf and C. R. Kauffman and M. Shishkov and D. H. Kang and Elkan F. Halpern and G. J. Tearney},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12270856},
issn = {1524-4539 (Electronic) 0009-7322},
year = {2002},
date = {2002-09-01},
journal = {Circulation},
volume = {106},
number = {13},
pages = {1640-5},
abstract = {BACKGROUND: High-resolution visualization of atherosclerotic plaque
morphology may be essential for identifying coronary plaques that
cause acute coronary events. Optical coherence tomography (OCT) is
an intravascular imaging modality capable of providing cross-sectional
images of tissue with a resolution of 10 micro m. To date, OCT imaging
has not been investigated in sufficient detail to assess its accuracy
for characterizing atherosclerotic plaques. The aim of this study
was to establish objective OCT image criteria for atherosclerotic
plaque characterization in vitro. METHODS AND RESULTS: OCT images
of 357 (diseased) atherosclerotic arterial segments obtained at autopsy
were correlated with histology. OCT image criteria for 3 types of plaque were formulated by analysis of a subset (n=50) of arterial
segments. OCT images of fibrous plaques were characterized by homogeneous,
signal-rich regions; fibrocalcific plaques by well-delineated, signal-poor
regions with sharp borders; and lipid-rich plaques by signal-poor
regions with diffuse borders. Independent validation of these criteria by 2 OCT readers for the remaining segments (n=307) demonstrated
a sensitivity and specificity ranging from 71% to 79% and 97% to
98% for fibrous plaques, 95% to 96% and 97% for fibrocalcific plaques,
and 90% to 94% and 90% to 92% for lipid-rich plaques, respectively (overall agreemen},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: High-resolution visualization of atherosclerotic plaque
morphology may be essential for identifying coronary plaques that
cause acute coronary events. Optical coherence tomography (OCT) is
an intravascular imaging modality capable of providing cross-sectional
images of tissue with a resolution of 10 micro m. To date, OCT imaging
has not been investigated in sufficient detail to assess its accuracy
for characterizing atherosclerotic plaques. The aim of this study
was to establish objective OCT image criteria for atherosclerotic
plaque characterization in vitro. METHODS AND RESULTS: OCT images
of 357 (diseased) atherosclerotic arterial segments obtained at autopsy
were correlated with histology. OCT image criteria for 3 types of plaque were formulated by analysis of a subset (n=50) of arterial
segments. OCT images of fibrous plaques were characterized by homogeneous,
signal-rich regions; fibrocalcific plaques by well-delineated, signal-poor
regions with sharp borders; and lipid-rich plaques by signal-poor
regions with diffuse borders. Independent validation of these criteria by 2 OCT readers for the remaining segments (n=307) demonstrated
a sensitivity and specificity ranging from 71% to 79% and 97% to
98% for fibrous plaques, 95% to 96% and 97% for fibrocalcific plaques,
and 90% to 94% and 90% to 92% for lipid-rich plaques, respectively (overall agreemen
morphology may be essential for identifying coronary plaques that
cause acute coronary events. Optical coherence tomography (OCT) is
an intravascular imaging modality capable of providing cross-sectional
images of tissue with a resolution of 10 micro m. To date, OCT imaging
has not been investigated in sufficient detail to assess its accuracy
for characterizing atherosclerotic plaques. The aim of this study
was to establish objective OCT image criteria for atherosclerotic
plaque characterization in vitro. METHODS AND RESULTS: OCT images
of 357 (diseased) atherosclerotic arterial segments obtained at autopsy
were correlated with histology. OCT image criteria for 3 types of plaque were formulated by analysis of a subset (n=50) of arterial
segments. OCT images of fibrous plaques were characterized by homogeneous,
signal-rich regions; fibrocalcific plaques by well-delineated, signal-poor
regions with sharp borders; and lipid-rich plaques by signal-poor
regions with diffuse borders. Independent validation of these criteria by 2 OCT readers for the remaining segments (n=307) demonstrated
a sensitivity and specificity ranging from 71% to 79% and 97% to
98% for fibrous plaques, 95% to 96% and 97% for fibrocalcific plaques,
and 90% to 94% and 90% to 92% for lipid-rich plaques, respectively (overall agreemen
Monsky, W. L.; Kruskal, J. B.; Lukyanov, A. N.; Girnun, G. D.; Ahmed, M.; Gazelle, G. Scott; Huertas, J. C.; Stuart, K. E.; Torchilin, V. P.; Goldberg, S. N.
Radio-frequency ablation increases intratumoral liposomal doxorubicin accumulation in a rat breast tumor model Journal Article
In: Radiology, vol. 224, no. 3, pp. 823-9, 2002, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Monsky2002,
title = {Radio-frequency ablation increases intratumoral liposomal doxorubicin
accumulation in a rat breast tumor model},
author = {W. L. Monsky and J. B. Kruskal and A. N. Lukyanov and G. D. Girnun and M. Ahmed and G. Scott Gazelle and J. C. Huertas and K. E. Stuart and V. P. Torchilin and S. N. Goldberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12202721},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2002},
date = {2002-09-01},
journal = {Radiology},
volume = {224},
number = {3},
pages = {823-9},
abstract = {PURPOSE: To determine whether intratumoral accumulation of liposomal
doxorubicin or free unencapsulated doxorubicin is increased when
combined with radio-frequency (RF) ablation. MATERIALS AND METHODS:
Two 1.2-1.5-cm R3230 mammary adenocarcinomas were grown within the
mammary fat pads of 19 female Fischer rats. One tumor of each pair
was treated with RF ablation (tip temperature, 70 degrees C +/- 2
[SD]; 120 mA +/- 75) for 5 minutes, whereas the other tumor was a
control. Intravenous liposomal doxorubicin (1 mg in 500 micro},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine whether intratumoral accumulation of liposomal
doxorubicin or free unencapsulated doxorubicin is increased when
combined with radio-frequency (RF) ablation. MATERIALS AND METHODS:
Two 1.2-1.5-cm R3230 mammary adenocarcinomas were grown within the
mammary fat pads of 19 female Fischer rats. One tumor of each pair
was treated with RF ablation (tip temperature, 70 degrees C +/- 2
[SD]; 120 mA +/- 75) for 5 minutes, whereas the other tumor was a
control. Intravenous liposomal doxorubicin (1 mg in 500 micro
doxorubicin or free unencapsulated doxorubicin is increased when
combined with radio-frequency (RF) ablation. MATERIALS AND METHODS:
Two 1.2-1.5-cm R3230 mammary adenocarcinomas were grown within the
mammary fat pads of 19 female Fischer rats. One tumor of each pair
was treated with RF ablation (tip temperature, 70 degrees C +/- 2
[SD]; 120 mA +/- 75) for 5 minutes, whereas the other tumor was a
control. Intravenous liposomal doxorubicin (1 mg in 500 micro
Schiele, T. M.; Konig, A.; Rieber, J.; Theisen, K.; Siebert, Uwe; Klauss, V.
In: Am J Cardiol, vol. 90, no. 5, pp. 539-42, 2002, ISSN: 0002-9149 (Print) 0002-9149 (Lin, ().
@article{Schiele2002a,
title = {Comparison of volumetric intravascular ultrasound analysis of acute
results and underlying mechanisms from cutting balloon and conventional
balloon angioplasty for the treatment of coronary in-stent restenotic
lesions},
author = {T. M. Schiele and A. Konig and J. Rieber and K. Theisen and Uwe Siebert and V. Klauss},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12208420},
issn = {0002-9149 (Print) 0002-9149 (Lin},
year = {2002},
date = {2002-09-01},
journal = {Am J Cardiol},
volume = {90},
number = {5},
pages = {539-42},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Adriaensen, M. E.; Bosch, Johanna; Halpern, Elkan F.; Hunink, M. G. Myriam; Gazelle, G. Scott
Elective endovascular versus open surgical repair of abdominal aortic aneurysms: systematic review of short-term results Journal Article
In: Radiology, vol. 224, no. 3, pp. 739-47, 2002, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Adriaensen2002,
title = {Elective endovascular versus open surgical repair of abdominal aortic aneurysms: systematic review of short-term results},
author = {M. E. Adriaensen and Johanna Bosch and Elkan F. Halpern and M. G. Myriam Hunink and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12202708},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2002},
date = {2002-09-01},
urldate = {2002-09-01},
journal = {Radiology},
volume = {224},
number = {3},
pages = {739-47},
abstract = {PURPOSE: To summarize and compare published short-term results of
elective endovascular and open surgical repair of abdominal aortic
aneurysms. MATERIALS AND METHODS: A MEDLINE search of the English
literature was performed. Studies with at least 10 patients in each
treatment group were included if they reported patient characteristics,
complications, and mortality. Two reviewers independently extracted
the data. A random-effects model was used to pool the data and calculate
pooled odds ratios (endovascular vs open surgical repair). RESULTS:
Nine studies were included, reporting results of 1,318 procedures
(687 endovascular repair and 631 open surgical repair). Mean blood
loss was 456 mL for endovascular repair and 1,202 mL for open surgical repair (P =.003). On average, patients undergoing endovascular repair
spent 0.5 days in the intensive care unit and 3.9 days in the hospital, and patients undergoing open surgical repair spent 2.2 days (P =.04) in the intensive care unit and 10.3 days (P =.02) in the hospital.
The pooled 30-day-mortality was 0.03 for endovascular repair (95%
CI: 0.02, 0.04) and 0.04 for open surgical repair (95% CI: 0.00, 0.07) (P =.03), and the odds ratio was 0.55 (95% CI: 0.33, 0.92).
The pooled local and/or vascular complication rate was 0.16 for endovascular
repair (95% CI: 0.06, 0.25) and 0.12 for open surgical repair (95% CI: 0.06, 0.18) (P =.46), and the odds ratio was 0.97 (95% CI: 0.62,
1.54). The pooled systemic and/or remote complication rate was 0.17
for endovascular repair (95% CI: 0.09, 0.25) and 0.44 for open surgical
repair (95% CI: 0.21, 0.66) (P \<.001), and the odds ratio was 0.22
(95% CI: 0.11, 0.45). CONCLUSION: On the basis of this systematic
review, endovascular repair results in less blood loss, shorter intensive
care unit and hospital stays, lower 30-day mortality, and lower systemic
and/or remote complication rates than those of open surgical repair.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To summarize and compare published short-term results of
elective endovascular and open surgical repair of abdominal aortic
aneurysms. MATERIALS AND METHODS: A MEDLINE search of the English
literature was performed. Studies with at least 10 patients in each
treatment group were included if they reported patient characteristics,
complications, and mortality. Two reviewers independently extracted
the data. A random-effects model was used to pool the data and calculate
pooled odds ratios (endovascular vs open surgical repair). RESULTS:
Nine studies were included, reporting results of 1,318 procedures
(687 endovascular repair and 631 open surgical repair). Mean blood
loss was 456 mL for endovascular repair and 1,202 mL for open surgical repair (P =.003). On average, patients undergoing endovascular repair
spent 0.5 days in the intensive care unit and 3.9 days in the hospital, and patients undergoing open surgical repair spent 2.2 days (P =.04) in the intensive care unit and 10.3 days (P =.02) in the hospital.
The pooled 30-day-mortality was 0.03 for endovascular repair (95%
CI: 0.02, 0.04) and 0.04 for open surgical repair (95% CI: 0.00, 0.07) (P =.03), and the odds ratio was 0.55 (95% CI: 0.33, 0.92).
The pooled local and/or vascular complication rate was 0.16 for endovascular
repair (95% CI: 0.06, 0.25) and 0.12 for open surgical repair (95% CI: 0.06, 0.18) (P =.46), and the odds ratio was 0.97 (95% CI: 0.62,
1.54). The pooled systemic and/or remote complication rate was 0.17
for endovascular repair (95% CI: 0.09, 0.25) and 0.44 for open surgical
repair (95% CI: 0.21, 0.66) (P <.001), and the odds ratio was 0.22
(95% CI: 0.11, 0.45). CONCLUSION: On the basis of this systematic
review, endovascular repair results in less blood loss, shorter intensive
care unit and hospital stays, lower 30-day mortality, and lower systemic
and/or remote complication rates than those of open surgical repair.
elective endovascular and open surgical repair of abdominal aortic
aneurysms. MATERIALS AND METHODS: A MEDLINE search of the English
literature was performed. Studies with at least 10 patients in each
treatment group were included if they reported patient characteristics,
complications, and mortality. Two reviewers independently extracted
the data. A random-effects model was used to pool the data and calculate
pooled odds ratios (endovascular vs open surgical repair). RESULTS:
Nine studies were included, reporting results of 1,318 procedures
(687 endovascular repair and 631 open surgical repair). Mean blood
loss was 456 mL for endovascular repair and 1,202 mL for open surgical repair (P =.003). On average, patients undergoing endovascular repair
spent 0.5 days in the intensive care unit and 3.9 days in the hospital, and patients undergoing open surgical repair spent 2.2 days (P =.04) in the intensive care unit and 10.3 days (P =.02) in the hospital.
The pooled 30-day-mortality was 0.03 for endovascular repair (95%
CI: 0.02, 0.04) and 0.04 for open surgical repair (95% CI: 0.00, 0.07) (P =.03), and the odds ratio was 0.55 (95% CI: 0.33, 0.92).
The pooled local and/or vascular complication rate was 0.16 for endovascular
repair (95% CI: 0.06, 0.25) and 0.12 for open surgical repair (95% CI: 0.06, 0.18) (P =.46), and the odds ratio was 0.97 (95% CI: 0.62,
1.54). The pooled systemic and/or remote complication rate was 0.17
for endovascular repair (95% CI: 0.09, 0.25) and 0.44 for open surgical
repair (95% CI: 0.21, 0.66) (P <.001), and the odds ratio was 0.22
(95% CI: 0.11, 0.45). CONCLUSION: On the basis of this systematic
review, endovascular repair results in less blood loss, shorter intensive
care unit and hospital stays, lower 30-day mortality, and lower systemic
and/or remote complication rates than those of open surgical repair.
Ahmed, M.; Lobo, S. M.; Weinstein, J.; Kruskal, J. B.; Gazelle, G. Scott; Halpern, Elkan F.; Afzal, S. K.; Lenkinski, R. E.; Goldberg, S. N.
Improved coagulation with saline solution pretreatment during radiofrequency tumor ablation in a canine model Journal Article
In: J Vasc Interv Radiol, vol. 13, no. 7, pp. 717-24, 2002, ISSN: 1051-0443 (Print) 1051-0443 (Lin, ().
@article{Ahmed2002,
title = {Improved coagulation with saline solution pretreatment during radiofrequency tumor ablation in a canine model},
author = {M. Ahmed and S. M. Lobo and J. Weinstein and J. B. Kruskal and G. Scott Gazelle and Elkan F. Halpern and S. K. Afzal and R. E. Lenkinski and S. N. Goldberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12119331},
issn = {1051-0443 (Print) 1051-0443 (Lin},
year = {2002},
date = {2002-07-01},
urldate = {2002-07-01},
journal = {J Vasc Interv Radiol},
volume = {13},
number = {7},
pages = {717-24},
abstract = {PURPOSE: To determine whether pretreatment with local NaCl injection
can increase radiofrequency (RF)-induced coagulation in a large animal
model. MATERIAL AND METHODS: Multiple canine venereal sarcomas (n = 25) were implanted subcutaneously in eight mildly immunosuppressed
dogs (25 mg/kg cyclosporin A twice daily). Tumors were incubated
for 8-12 weeks to a diameter of 4.2-6.3 cm (5.1 cm +/- 0.7). Internally
cooled RF ablation (1-cm tip; 12 min; pulsed technique; 2,000-mA
maximum) was performed. Tumors were pretreated with 6 mL of 18%,
24%, or 36% NaCl injected intratumorally under direct ultrasound
guidance after RF electrode insertion, and this treatment was compared
to RF treatment without NaCl injection and to 36% NaCl injection
without RF ablation. Impedance measurements and remote thermometry
were performed. These measurements and resultant coagulation were
compared. RESULTS: Significantly greater RF heating (73 degrees C
+/- 11 degrees C at 20 mm) was observed when the tumors were treated
with 24% or 36% NaCl pretreatment, compared to the 47 degrees C +/-
5 degrees C observed when 18% or no NaCl was injected (P \<.02). In
the 36% NaCl group, the entire tumor (5.2 cm +/- 0.8 diameter) was
completely ablated in every case, with coagulation extending several
centimeters into the surrounding tissues. By comparison, control
tumors (without NaCl injection) contained coagulation measuring 3.1
cm +/- 0.2, surrounded by viable, well-perfused tumor (P \<.01), and
36% NaCl alone produced 2.7 cm +/- 0.6 of patchy necrosis. CONCLUSIONS:
Pretreatment with intratumoral injection of small volumes of highly
concentrated NaCl markedly increases RF heating and coagulation in
a large animal tumor model. The complete destruction of tumors 5
cm in diameter or larger suggests that this substantial increase
may be achieved for tumor ablation in clinical practice.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine whether pretreatment with local NaCl injection
can increase radiofrequency (RF)-induced coagulation in a large animal
model. MATERIAL AND METHODS: Multiple canine venereal sarcomas (n = 25) were implanted subcutaneously in eight mildly immunosuppressed
dogs (25 mg/kg cyclosporin A twice daily). Tumors were incubated
for 8-12 weeks to a diameter of 4.2-6.3 cm (5.1 cm +/- 0.7). Internally
cooled RF ablation (1-cm tip; 12 min; pulsed technique; 2,000-mA
maximum) was performed. Tumors were pretreated with 6 mL of 18%,
24%, or 36% NaCl injected intratumorally under direct ultrasound
guidance after RF electrode insertion, and this treatment was compared
to RF treatment without NaCl injection and to 36% NaCl injection
without RF ablation. Impedance measurements and remote thermometry
were performed. These measurements and resultant coagulation were
compared. RESULTS: Significantly greater RF heating (73 degrees C
+/- 11 degrees C at 20 mm) was observed when the tumors were treated
with 24% or 36% NaCl pretreatment, compared to the 47 degrees C +/-
5 degrees C observed when 18% or no NaCl was injected (P <.02). In
the 36% NaCl group, the entire tumor (5.2 cm +/- 0.8 diameter) was
completely ablated in every case, with coagulation extending several
centimeters into the surrounding tissues. By comparison, control
tumors (without NaCl injection) contained coagulation measuring 3.1
cm +/- 0.2, surrounded by viable, well-perfused tumor (P <.01), and
36% NaCl alone produced 2.7 cm +/- 0.6 of patchy necrosis. CONCLUSIONS:
Pretreatment with intratumoral injection of small volumes of highly
concentrated NaCl markedly increases RF heating and coagulation in
a large animal tumor model. The complete destruction of tumors 5
cm in diameter or larger suggests that this substantial increase
may be achieved for tumor ablation in clinical practice.
can increase radiofrequency (RF)-induced coagulation in a large animal
model. MATERIAL AND METHODS: Multiple canine venereal sarcomas (n = 25) were implanted subcutaneously in eight mildly immunosuppressed
dogs (25 mg/kg cyclosporin A twice daily). Tumors were incubated
for 8-12 weeks to a diameter of 4.2-6.3 cm (5.1 cm +/- 0.7). Internally
cooled RF ablation (1-cm tip; 12 min; pulsed technique; 2,000-mA
maximum) was performed. Tumors were pretreated with 6 mL of 18%,
24%, or 36% NaCl injected intratumorally under direct ultrasound
guidance after RF electrode insertion, and this treatment was compared
to RF treatment without NaCl injection and to 36% NaCl injection
without RF ablation. Impedance measurements and remote thermometry
were performed. These measurements and resultant coagulation were
compared. RESULTS: Significantly greater RF heating (73 degrees C
+/- 11 degrees C at 20 mm) was observed when the tumors were treated
with 24% or 36% NaCl pretreatment, compared to the 47 degrees C +/-
5 degrees C observed when 18% or no NaCl was injected (P <.02). In
the 36% NaCl group, the entire tumor (5.2 cm +/- 0.8 diameter) was
completely ablated in every case, with coagulation extending several
centimeters into the surrounding tissues. By comparison, control
tumors (without NaCl injection) contained coagulation measuring 3.1
cm +/- 0.2, surrounded by viable, well-perfused tumor (P <.01), and
36% NaCl alone produced 2.7 cm +/- 0.6 of patchy necrosis. CONCLUSIONS:
Pretreatment with intratumoral injection of small volumes of highly
concentrated NaCl markedly increases RF heating and coagulation in
a large animal tumor model. The complete destruction of tumors 5
cm in diameter or larger suggests that this substantial increase
may be achieved for tumor ablation in clinical practice.