2002
Kopans, D. B.; Halpern, Elkan F.
Re: All-cause mortality in randomized trials of cancer screening Journal Article
In: J Natl Cancer Inst, vol. 94, no. 11, pp. 863; author reply 86, 2002, ISSN: 0027-8874 (Print) 0027-8874 (Lin, ().
@article{Kopans2002,
title = {Re: All-cause mortality in randomized trials of cancer screening},
author = {D. B. Kopans and Elkan F. Halpern},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12048280},
issn = {0027-8874 (Print) 0027-8874 (Lin},
year = {2002},
date = {2002-06-01},
journal = {J Natl Cancer Inst},
volume = {94},
number = {11},
pages = {863; author reply 86},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Lamont, Elizabeth; Christakis, N. A.
Physician factors in the timing of cancer patient referral to hospice palliative care Journal Article
In: Cancer, vol. 94, no. 10, pp. 2733-7, 2002, ISSN: 0008-543X (Print) 0008-543X (Lin, ().
@article{Lamont2002a,
title = {Physician factors in the timing of cancer patient referral to hospice
palliative care},
author = {Elizabeth Lamont and N. A. Christakis},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12173344},
issn = {0008-543X (Print) 0008-543X (Lin},
year = {2002},
date = {2002-05-01},
journal = {Cancer},
volume = {94},
number = {10},
pages = {2733-7},
abstract = {BACKGROUND: Although physicians state that patients ideally should
receive hospice care for 3 months before death, the majority of patients
survive \< 1 month in hospice care. In the current study, the authors
attempted to determine whether the attributes of referring physicians
were associated with the survival of terminally ill cancer patients
in hospice. METHODS: Using a prospective cohort study design, the
authors observed the survival of 326 terminally ill cancer patients
who were referred by 258 different physicians to 5 outpatient hospice
programs in Chicago. The authors evaluated associations between patient,
physician, and patient-physician relationship factors and patient
survival. RESULTS: Of the 326 participating patients, 313 (96%) had
known dates of death. For these patients, the median survival was
26 days. Controlling for patient demographic and disease factors,
there were several physician factors found to be associated with
the length of patient survival after hospice referral. For example, when a physician had referred \> or = 2 patients to hospice care in
the previous 3 months, the patient survived 17 days longer in hospice
compared with those patients whose physician referred fewer patients
to hospice. When a physician estimated patient survival accurately
(estimate obtained at the time of referral), the patient lived 20
days longer in hospice compared with those patients whose physicians
made inaccurate survival estimates. The practice specialty of the
physician also was found to be associated with patient survival after
hospice referral, with patients referred by general internists and
geriatricians living 18 days longer in hospice compared with those
patients who were referred by oncologists. CONCLUSIONS: In the current
study, referring physician factors were found to be associated with
the survival of terminally ill cancer patients after referral to
hospice.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Although physicians state that patients ideally should
receive hospice care for 3 months before death, the majority of patients
survive < 1 month in hospice care. In the current study, the authors
attempted to determine whether the attributes of referring physicians
were associated with the survival of terminally ill cancer patients
in hospice. METHODS: Using a prospective cohort study design, the
authors observed the survival of 326 terminally ill cancer patients
who were referred by 258 different physicians to 5 outpatient hospice
programs in Chicago. The authors evaluated associations between patient,
physician, and patient-physician relationship factors and patient
survival. RESULTS: Of the 326 participating patients, 313 (96%) had
known dates of death. For these patients, the median survival was
26 days. Controlling for patient demographic and disease factors,
there were several physician factors found to be associated with
the length of patient survival after hospice referral. For example, when a physician had referred > or = 2 patients to hospice care in
the previous 3 months, the patient survived 17 days longer in hospice
compared with those patients whose physician referred fewer patients
to hospice. When a physician estimated patient survival accurately
(estimate obtained at the time of referral), the patient lived 20
days longer in hospice compared with those patients whose physicians
made inaccurate survival estimates. The practice specialty of the
physician also was found to be associated with patient survival after
hospice referral, with patients referred by general internists and
geriatricians living 18 days longer in hospice compared with those
patients who were referred by oncologists. CONCLUSIONS: In the current
study, referring physician factors were found to be associated with
the survival of terminally ill cancer patients after referral to
hospice.
receive hospice care for 3 months before death, the majority of patients
survive < 1 month in hospice care. In the current study, the authors
attempted to determine whether the attributes of referring physicians
were associated with the survival of terminally ill cancer patients
in hospice. METHODS: Using a prospective cohort study design, the
authors observed the survival of 326 terminally ill cancer patients
who were referred by 258 different physicians to 5 outpatient hospice
programs in Chicago. The authors evaluated associations between patient,
physician, and patient-physician relationship factors and patient
survival. RESULTS: Of the 326 participating patients, 313 (96%) had
known dates of death. For these patients, the median survival was
26 days. Controlling for patient demographic and disease factors,
there were several physician factors found to be associated with
the length of patient survival after hospice referral. For example, when a physician had referred > or = 2 patients to hospice care in
the previous 3 months, the patient survived 17 days longer in hospice
compared with those patients whose physician referred fewer patients
to hospice. When a physician estimated patient survival accurately
(estimate obtained at the time of referral), the patient lived 20
days longer in hospice compared with those patients whose physicians
made inaccurate survival estimates. The practice specialty of the
physician also was found to be associated with patient survival after
hospice referral, with patients referred by general internists and
geriatricians living 18 days longer in hospice compared with those
patients who were referred by oncologists. CONCLUSIONS: In the current
study, referring physician factors were found to be associated with
the survival of terminally ill cancer patients after referral to
hospice.
Walensky, R. P.; Losina, E.; Steger-Craven, K. A.; Freedberg, K. A.
Identifying undiagnosed human immunodeficiency virus: the yield of routine, voluntary inpatient testing Journal Article
In: Arch Intern Med, vol. 162, no. 8, pp. 887-92, 2002, ISSN: 0003-9926 (Print) 0003-9926 (Lin, ().
@article{Walensky2002a,
title = {Identifying undiagnosed human immunodeficiency virus: the yield of routine, voluntary inpatient testing},
author = {R. P. Walensky and E. Losina and K. A. Steger-Craven and K. A. Freedberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11966339},
issn = {0003-9926 (Print) 0003-9926 (Lin},
year = {2002},
date = {2002-04-01},
urldate = {2002-04-01},
journal = {Arch Intern Med},
volume = {162},
number = {8},
pages = {887-92},
abstract = {BACKGROUND: Despite current recommendations for human immunodeficiency
virus (HIV) counseling and testing among patients admitted to hospitals
with at least a 1% prevalence of HIV infection, an estimated 300
000 people in the United States remain unaware of their HIV infection.
METHODS: We implemented the Think HIV program, which offered voluntary
HIV counseling and testing to patients admitted to the medical service
of a Boston, Mass, teaching hospital. We compared the results of
this effort with testing results from a 15-month historical control
period. RESULTS: Patients admitted during the program period were
3.4 times more likely to undergo testing for HIV than those admitted
during the control period (95% confidence interval [CI], 2.8-4.1).
The testing program detected approximately 2 new diagnoses of HIV
infection per month, compared with 1 per month during the control
period. Patients who underwent testing during the program, and who
likely would not have done so without this initiative, had an estimated
prevalence of HIV infection of 3.8% (95% CI, 1.8%-5.8%). CONCLUSIONS:
Testing efforts for HIV targeted to only symptomatic patients are
inadequate to identify the one third of HIV-seropositive people in
the United States who are unaware of their infection. We have shown
that in a single urban hospital, offering voluntary, routine inpatient
HIV counseling and testing can be successful as a screening program
by identifying a substantial number of patients with undiagnosed
HIV. These patients then can be informed, counseled, and linked to
care and treatment. Seventy-two hospitals nationwide have demographics
similar to those of the study hospital, suggesting that these results
are generalizable to many urban hospitals.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Despite current recommendations for human immunodeficiency
virus (HIV) counseling and testing among patients admitted to hospitals
with at least a 1% prevalence of HIV infection, an estimated 300
000 people in the United States remain unaware of their HIV infection.
METHODS: We implemented the Think HIV program, which offered voluntary
HIV counseling and testing to patients admitted to the medical service
of a Boston, Mass, teaching hospital. We compared the results of
this effort with testing results from a 15-month historical control
period. RESULTS: Patients admitted during the program period were
3.4 times more likely to undergo testing for HIV than those admitted
during the control period (95% confidence interval [CI], 2.8-4.1).
The testing program detected approximately 2 new diagnoses of HIV
infection per month, compared with 1 per month during the control
period. Patients who underwent testing during the program, and who
likely would not have done so without this initiative, had an estimated
prevalence of HIV infection of 3.8% (95% CI, 1.8%-5.8%). CONCLUSIONS:
Testing efforts for HIV targeted to only symptomatic patients are
inadequate to identify the one third of HIV-seropositive people in
the United States who are unaware of their infection. We have shown
that in a single urban hospital, offering voluntary, routine inpatient
HIV counseling and testing can be successful as a screening program
by identifying a substantial number of patients with undiagnosed
HIV. These patients then can be informed, counseled, and linked to
care and treatment. Seventy-two hospitals nationwide have demographics
similar to those of the study hospital, suggesting that these results
are generalizable to many urban hospitals.
virus (HIV) counseling and testing among patients admitted to hospitals
with at least a 1% prevalence of HIV infection, an estimated 300
000 people in the United States remain unaware of their HIV infection.
METHODS: We implemented the Think HIV program, which offered voluntary
HIV counseling and testing to patients admitted to the medical service
of a Boston, Mass, teaching hospital. We compared the results of
this effort with testing results from a 15-month historical control
period. RESULTS: Patients admitted during the program period were
3.4 times more likely to undergo testing for HIV than those admitted
during the control period (95% confidence interval [CI], 2.8-4.1).
The testing program detected approximately 2 new diagnoses of HIV
infection per month, compared with 1 per month during the control
period. Patients who underwent testing during the program, and who
likely would not have done so without this initiative, had an estimated
prevalence of HIV infection of 3.8% (95% CI, 1.8%-5.8%). CONCLUSIONS:
Testing efforts for HIV targeted to only symptomatic patients are
inadequate to identify the one third of HIV-seropositive people in
the United States who are unaware of their infection. We have shown
that in a single urban hospital, offering voluntary, routine inpatient
HIV counseling and testing can be successful as a screening program
by identifying a substantial number of patients with undiagnosed
HIV. These patients then can be informed, counseled, and linked to
care and treatment. Seventy-two hospitals nationwide have demographics
similar to those of the study hospital, suggesting that these results
are generalizable to many urban hospitals.
Lamont, Elizabeth; Lauderdale, D. S.; Schilsky, R. L.; Christakis, N. A.
Construct validity of medicare chemotherapy claims: the case of 5FU Journal Article
In: Med Care, vol. 40, no. 3, pp. 201-11, 2002, ISSN: 0025-7079 (Print) 0025-7079 (Lin, ().
@article{Lamont2002,
title = {Construct validity of medicare chemotherapy claims: the case of 5FU},
author = {Elizabeth Lamont and D. S. Lauderdale and R. L. Schilsky and N. A. Christakis},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11880793},
issn = {0025-7079 (Print) 0025-7079 (Lin},
year = {2002},
date = {2002-03-01},
journal = {Med Care},
volume = {40},
number = {3},
pages = {201-11},
abstract = {BACKGROUND: The elderly are under represented in clinical trials of
cancer therapy and the elderly who are enrolled may be unrepresentative.
OBJECTIVE: To assess whether Medicare claims data might be used to
understand the benefits and tolerance of chemotherapy in the general
elderly population, the construct validity of Medicare 5FU claims
for elderly colon cancer patients within the SEER-Medicare data set
was determined. METHODS: In this validation study of Medicare chemotherapy
claims from the linked the SEER-Medicare data set, the patterns of
5FU chemotherapy claims were evaluated for an incident cohort of elderly colon cancer patients (n = 15,039) during the 13 months following
their diagnosis. Patterns of Medicare National Claims History (NCH)
5FU claims were evaluated with respect to prespecified patient-level
disease and demographic factors from the data set. RESULTS: Twenty-two
percent of patients had at least one detectable 5FU claim during
the observation period. Among those patients, the median dose of
5FU was 1000 mg, the median interval between 5FU claims was 7 days,
and the median number of claims during this period was 24. Multivariate
regression revealed expected associations between demographic and
disease factors and the likelihood of having a Medicare NCH 5FU claim.
With increasing cancer stage, patients' likelihood of having a 5FU
claim increased. Younger patients, married patients, white patients,
patients with low comorbidity, and patients living in urban and less
impoverished regions were each more likely to have 5FU claims. CONCLUSION:
Because their pattern is consistent with the standard of medical
care and with previously described associations with disease and
demographic factors, it was concluded that Medicare NCH claims for
5FU administration in the SEER-Medicare data set exhibit construct
validity. Criterion validation studies with an external gold standard
should be pursued to determine the sensitivity and specificity of
chemotherapy codes in the Medicare NCH files.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The elderly are under represented in clinical trials of
cancer therapy and the elderly who are enrolled may be unrepresentative.
OBJECTIVE: To assess whether Medicare claims data might be used to
understand the benefits and tolerance of chemotherapy in the general
elderly population, the construct validity of Medicare 5FU claims
for elderly colon cancer patients within the SEER-Medicare data set
was determined. METHODS: In this validation study of Medicare chemotherapy
claims from the linked the SEER-Medicare data set, the patterns of
5FU chemotherapy claims were evaluated for an incident cohort of elderly colon cancer patients (n = 15,039) during the 13 months following
their diagnosis. Patterns of Medicare National Claims History (NCH)
5FU claims were evaluated with respect to prespecified patient-level
disease and demographic factors from the data set. RESULTS: Twenty-two
percent of patients had at least one detectable 5FU claim during
the observation period. Among those patients, the median dose of
5FU was 1000 mg, the median interval between 5FU claims was 7 days,
and the median number of claims during this period was 24. Multivariate
regression revealed expected associations between demographic and
disease factors and the likelihood of having a Medicare NCH 5FU claim.
With increasing cancer stage, patients' likelihood of having a 5FU
claim increased. Younger patients, married patients, white patients,
patients with low comorbidity, and patients living in urban and less
impoverished regions were each more likely to have 5FU claims. CONCLUSION:
Because their pattern is consistent with the standard of medical
care and with previously described associations with disease and
demographic factors, it was concluded that Medicare NCH claims for
5FU administration in the SEER-Medicare data set exhibit construct
validity. Criterion validation studies with an external gold standard
should be pursued to determine the sensitivity and specificity of
chemotherapy codes in the Medicare NCH files.
cancer therapy and the elderly who are enrolled may be unrepresentative.
OBJECTIVE: To assess whether Medicare claims data might be used to
understand the benefits and tolerance of chemotherapy in the general
elderly population, the construct validity of Medicare 5FU claims
for elderly colon cancer patients within the SEER-Medicare data set
was determined. METHODS: In this validation study of Medicare chemotherapy
claims from the linked the SEER-Medicare data set, the patterns of
5FU chemotherapy claims were evaluated for an incident cohort of elderly colon cancer patients (n = 15,039) during the 13 months following
their diagnosis. Patterns of Medicare National Claims History (NCH)
5FU claims were evaluated with respect to prespecified patient-level
disease and demographic factors from the data set. RESULTS: Twenty-two
percent of patients had at least one detectable 5FU claim during
the observation period. Among those patients, the median dose of
5FU was 1000 mg, the median interval between 5FU claims was 7 days,
and the median number of claims during this period was 24. Multivariate
regression revealed expected associations between demographic and
disease factors and the likelihood of having a Medicare NCH 5FU claim.
With increasing cancer stage, patients' likelihood of having a 5FU
claim increased. Younger patients, married patients, white patients,
patients with low comorbidity, and patients living in urban and less
impoverished regions were each more likely to have 5FU claims. CONCLUSION:
Because their pattern is consistent with the standard of medical
care and with previously described associations with disease and
demographic factors, it was concluded that Medicare NCH claims for
5FU administration in the SEER-Medicare data set exhibit construct
validity. Criterion validation studies with an external gold standard
should be pursued to determine the sensitivity and specificity of
chemotherapy codes in the Medicare NCH files.
Goldberg, S. N.; Girnan, G. D.; Lukyanov, A. N.; Ahmed, M.; Monsky, W. L.; Gazelle, G. Scott; Huertas, J. C.; Stuart, K. E.; Jacobs, T.; Torchillin, V. P.; Halpern, Elkan F.; Kruskal, J. B.
In: Radiology, vol. 222, no. 3, pp. 797-804, 2002, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Goldberg2002,
title = {Percutaneous tumor ablation: increased necrosis with combined radio-frequency
ablation and intravenous liposomal doxorubicin in a rat breast tumor
model},
author = {S. N. Goldberg and G. D. Girnan and A. N. Lukyanov and M. Ahmed and W. L. Monsky and G. Scott Gazelle and J. C. Huertas and K. E. Stuart and T. Jacobs and V. P. Torchillin and Elkan F. Halpern and J. B. Kruskal},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11867804},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2002},
date = {2002-03-01},
journal = {Radiology},
volume = {222},
number = {3},
pages = {797-804},
abstract = {PURPOSE: To determine whether a combination of intravenous liposomal
doxorubicin and radio-frequency (RF) ablation increases tumor destruction
compared with RF alone in an animal tumor model. MATERIALS AND METHODS:
R3230 mammary adenocarcinoma 1.4-1.8-cm- diameter nodules were implanted
subcutaneously in 132 female Fischer rats. Initially, tumors were
treated with (a) conventional, monopolar RF (mean, 250 mA +/- 25
[SD] at 70 degrees C +/- 1 for 5 minutes) ablation alone, (b) RF
ablation followed by intravenous administration of 1 mg of liposomal
doxorubicin, (c) RF ablation followed by intravenous administration
of 1 mg of empty liposomes, (d) RF ablation and direct intratumoral
administration of liposomal doxorubicin, or (e) no treatment. Subsequently,
the dose (0.06-2.00 mg) of liposomal doxorubicin, the timing of administration
(3 days before to 3 days after RF ablation), and the time of pathologic
examination (0-72 hours after treatment) were varied. RESULTS: Mean
coagulation diameter for treated tumors follows: 6.7 mm +/- 0.6,
RF ablation alone; 11.1 mm +/- 1.5, RF ablation and intravenous administration
of empty liposomes (P \<.05, compared with RF ablation alone); and
8.4 mm +/- 1.1, RF ablation with intratumoral administration of liposomal
doxorubicin (P \<.05, compared with RF ablation alone). Maximal increased
mean coagulation diameter (13.1 mm +/- 1.5) was observed with a combination
of liposomal doxorubicin and RF ablation (P \<.001, for all comparisons).
The increased coagulation for combination therapy developed over
48 hours after therapy. Coagulation diameter did not vary with the
doxorubicin concentration range and was not dependent on the timing
of administration of liposomal doxorubicin from 3 days before to
24 hours after RF ablation. CONCLUSION: Intravenous administration
of liposomal doxorubicin can improve RF ablation, since it increases
coagulation diameter in solid tumors compared with RF ablation alone
or a combination of RF ablation with administration of empty liposomes.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine whether a combination of intravenous liposomal
doxorubicin and radio-frequency (RF) ablation increases tumor destruction
compared with RF alone in an animal tumor model. MATERIALS AND METHODS:
R3230 mammary adenocarcinoma 1.4-1.8-cm- diameter nodules were implanted
subcutaneously in 132 female Fischer rats. Initially, tumors were
treated with (a) conventional, monopolar RF (mean, 250 mA +/- 25
[SD] at 70 degrees C +/- 1 for 5 minutes) ablation alone, (b) RF
ablation followed by intravenous administration of 1 mg of liposomal
doxorubicin, (c) RF ablation followed by intravenous administration
of 1 mg of empty liposomes, (d) RF ablation and direct intratumoral
administration of liposomal doxorubicin, or (e) no treatment. Subsequently,
the dose (0.06-2.00 mg) of liposomal doxorubicin, the timing of administration
(3 days before to 3 days after RF ablation), and the time of pathologic
examination (0-72 hours after treatment) were varied. RESULTS: Mean
coagulation diameter for treated tumors follows: 6.7 mm +/- 0.6,
RF ablation alone; 11.1 mm +/- 1.5, RF ablation and intravenous administration
of empty liposomes (P <.05, compared with RF ablation alone); and
8.4 mm +/- 1.1, RF ablation with intratumoral administration of liposomal
doxorubicin (P <.05, compared with RF ablation alone). Maximal increased
mean coagulation diameter (13.1 mm +/- 1.5) was observed with a combination
of liposomal doxorubicin and RF ablation (P <.001, for all comparisons).
The increased coagulation for combination therapy developed over
48 hours after therapy. Coagulation diameter did not vary with the
doxorubicin concentration range and was not dependent on the timing
of administration of liposomal doxorubicin from 3 days before to
24 hours after RF ablation. CONCLUSION: Intravenous administration
of liposomal doxorubicin can improve RF ablation, since it increases
coagulation diameter in solid tumors compared with RF ablation alone
or a combination of RF ablation with administration of empty liposomes.
doxorubicin and radio-frequency (RF) ablation increases tumor destruction
compared with RF alone in an animal tumor model. MATERIALS AND METHODS:
R3230 mammary adenocarcinoma 1.4-1.8-cm- diameter nodules were implanted
subcutaneously in 132 female Fischer rats. Initially, tumors were
treated with (a) conventional, monopolar RF (mean, 250 mA +/- 25
[SD] at 70 degrees C +/- 1 for 5 minutes) ablation alone, (b) RF
ablation followed by intravenous administration of 1 mg of liposomal
doxorubicin, (c) RF ablation followed by intravenous administration
of 1 mg of empty liposomes, (d) RF ablation and direct intratumoral
administration of liposomal doxorubicin, or (e) no treatment. Subsequently,
the dose (0.06-2.00 mg) of liposomal doxorubicin, the timing of administration
(3 days before to 3 days after RF ablation), and the time of pathologic
examination (0-72 hours after treatment) were varied. RESULTS: Mean
coagulation diameter for treated tumors follows: 6.7 mm +/- 0.6,
RF ablation alone; 11.1 mm +/- 1.5, RF ablation and intravenous administration
of empty liposomes (P <.05, compared with RF ablation alone); and
8.4 mm +/- 1.1, RF ablation with intratumoral administration of liposomal
doxorubicin (P <.05, compared with RF ablation alone). Maximal increased
mean coagulation diameter (13.1 mm +/- 1.5) was observed with a combination
of liposomal doxorubicin and RF ablation (P <.001, for all comparisons).
The increased coagulation for combination therapy developed over
48 hours after therapy. Coagulation diameter did not vary with the
doxorubicin concentration range and was not dependent on the timing
of administration of liposomal doxorubicin from 3 days before to
24 hours after RF ablation. CONCLUSION: Intravenous administration
of liposomal doxorubicin can improve RF ablation, since it increases
coagulation diameter in solid tumors compared with RF ablation alone
or a combination of RF ablation with administration of empty liposomes.
Stempfle, H. U.; Werner, C.; Siebert, Uwe; Assum, T.; Wehr, U.; Rambeck, W. A.; Meiser, B.; Theisen, K.; Gartner, R.
In: Transplantation, vol. 73, no. 4, pp. 547-52, 2002, ISSN: 0041-1337 (Print) 0041-1337 (Lin, ().
@article{Stempfle2002,
title = {The role of tacrolimus (FK506)-based immunosuppression on bone mineral density and bone turnover after cardiac transplantation: a prospective, longitudinal, randomized, double-blind trial with calcitriol},
author = {H. U. Stempfle and C. Werner and Uwe Siebert and T. Assum and U. Wehr and W. A. Rambeck and B. Meiser and K. Theisen and R. Gartner},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11889427},
issn = {0041-1337 (Print) 0041-1337 (Lin},
year = {2002},
date = {2002-02-01},
urldate = {2002-02-01},
journal = {Transplantation},
volume = {73},
number = {4},
pages = {547-52},
abstract = {BACKGROUND: Tacrolimus (FK506) is a new immunosuppressive drug in
organ transplantation that has demonstrated experimentally to be
more deleterious on bone mineral metabolism than cyclosporine. The
purpose of this clinical study was to evaluate the effects of a tacrolimus-based
immunosuppression on the skeleton and to investigate in a prospective,
longitudinal, randomized, double-blind, study the effect of 0.25
microg calcitriol (1,25-dihydroxyvitamin D3) versus placebo in the
prevention of bone loss and fracture rate after heart transplantion
(HTx). METHODS: A total of 53 patients (5 female, 48 male, mean age:
53+/-11 years) were randomized to the study medication. Basic therapy
included calcium and sex hormone replacement in hypogonadism. Bone
mineral density of the lumbar spine (LS) and femoral neck (FN) were
performed at baseline, after 12 and 24 months. Biochemical indexes
of mineral metabolism were measured every 3 months. RESULTS: Overall
bone mineral density (BMD) was significantly decreased after HTx
(T-score-LS: 89+/-13%; FN: 88+/-14%). LS-BMD (% change in g/cm2)
increased significantly within the study period in the calcitriol
group (12 months: 7.1+/-8.1%, P\<0.01; 24 months: 14.0+/-10.1%, P\<0.01)
and showed a positive trend in the placebo group (12 months: 4.5+/-9.3%,
NS; 24 months: 6.2+/-8.0%, NS). FN-BMD in the calcitriol group was
stable (12 months: -2.1+/-4.2%; NS; 24 months: -0.9+/-3.2%, NS).
FN-BMD in the placebo group decreased significantly within the first
12 month follow-up period (-7.3+/-5.4; P\<0.05) and stabilized within
2 years (-8.0+/-4.1%; P \< 0.05). Fracture incidence was low during
the study interval (first year: 5.0%, second year: 0%). Bone resorption
markers decreased significantly during calcitriol therapy. CONCLUSIONS:
High dose tacrolimus-based immunosuppressive regimen is associated
with a rapid bone loss early after cardiac transplantation. Beyond
the first 6 months after HTx, calcium, vitamin D, and hormone supplementation
in hypogonadism lead sufficiently to bone mineral recovery. Besides
immunosuppression, both concomitant hypogonadism and secondary hyperparathyroidism
play a major role for the bone loss and should be therefore monitored
and treated adequately. Low dose calcitriol should be substituted
for at least 2 years as additional antiresorptive therapy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Tacrolimus (FK506) is a new immunosuppressive drug in
organ transplantation that has demonstrated experimentally to be
more deleterious on bone mineral metabolism than cyclosporine. The
purpose of this clinical study was to evaluate the effects of a tacrolimus-based
immunosuppression on the skeleton and to investigate in a prospective,
longitudinal, randomized, double-blind, study the effect of 0.25
microg calcitriol (1,25-dihydroxyvitamin D3) versus placebo in the
prevention of bone loss and fracture rate after heart transplantion
(HTx). METHODS: A total of 53 patients (5 female, 48 male, mean age:
53+/-11 years) were randomized to the study medication. Basic therapy
included calcium and sex hormone replacement in hypogonadism. Bone
mineral density of the lumbar spine (LS) and femoral neck (FN) were
performed at baseline, after 12 and 24 months. Biochemical indexes
of mineral metabolism were measured every 3 months. RESULTS: Overall
bone mineral density (BMD) was significantly decreased after HTx
(T-score-LS: 89+/-13%; FN: 88+/-14%). LS-BMD (% change in g/cm2)
increased significantly within the study period in the calcitriol
group (12 months: 7.1+/-8.1%, P<0.01; 24 months: 14.0+/-10.1%, P<0.01)
and showed a positive trend in the placebo group (12 months: 4.5+/-9.3%,
NS; 24 months: 6.2+/-8.0%, NS). FN-BMD in the calcitriol group was
stable (12 months: -2.1+/-4.2%; NS; 24 months: -0.9+/-3.2%, NS).
FN-BMD in the placebo group decreased significantly within the first
12 month follow-up period (-7.3+/-5.4; P<0.05) and stabilized within
2 years (-8.0+/-4.1%; P < 0.05). Fracture incidence was low during
the study interval (first year: 5.0%, second year: 0%). Bone resorption
markers decreased significantly during calcitriol therapy. CONCLUSIONS:
High dose tacrolimus-based immunosuppressive regimen is associated
with a rapid bone loss early after cardiac transplantation. Beyond
the first 6 months after HTx, calcium, vitamin D, and hormone supplementation
in hypogonadism lead sufficiently to bone mineral recovery. Besides
immunosuppression, both concomitant hypogonadism and secondary hyperparathyroidism
play a major role for the bone loss and should be therefore monitored
and treated adequately. Low dose calcitriol should be substituted
for at least 2 years as additional antiresorptive therapy.
organ transplantation that has demonstrated experimentally to be
more deleterious on bone mineral metabolism than cyclosporine. The
purpose of this clinical study was to evaluate the effects of a tacrolimus-based
immunosuppression on the skeleton and to investigate in a prospective,
longitudinal, randomized, double-blind, study the effect of 0.25
microg calcitriol (1,25-dihydroxyvitamin D3) versus placebo in the
prevention of bone loss and fracture rate after heart transplantion
(HTx). METHODS: A total of 53 patients (5 female, 48 male, mean age:
53+/-11 years) were randomized to the study medication. Basic therapy
included calcium and sex hormone replacement in hypogonadism. Bone
mineral density of the lumbar spine (LS) and femoral neck (FN) were
performed at baseline, after 12 and 24 months. Biochemical indexes
of mineral metabolism were measured every 3 months. RESULTS: Overall
bone mineral density (BMD) was significantly decreased after HTx
(T-score-LS: 89+/-13%; FN: 88+/-14%). LS-BMD (% change in g/cm2)
increased significantly within the study period in the calcitriol
group (12 months: 7.1+/-8.1%, P<0.01; 24 months: 14.0+/-10.1%, P<0.01)
and showed a positive trend in the placebo group (12 months: 4.5+/-9.3%,
NS; 24 months: 6.2+/-8.0%, NS). FN-BMD in the calcitriol group was
stable (12 months: -2.1+/-4.2%; NS; 24 months: -0.9+/-3.2%, NS).
FN-BMD in the placebo group decreased significantly within the first
12 month follow-up period (-7.3+/-5.4; P<0.05) and stabilized within
2 years (-8.0+/-4.1%; P < 0.05). Fracture incidence was low during
the study interval (first year: 5.0%, second year: 0%). Bone resorption
markers decreased significantly during calcitriol therapy. CONCLUSIONS:
High dose tacrolimus-based immunosuppressive regimen is associated
with a rapid bone loss early after cardiac transplantation. Beyond
the first 6 months after HTx, calcium, vitamin D, and hormone supplementation
in hypogonadism lead sufficiently to bone mineral recovery. Besides
immunosuppression, both concomitant hypogonadism and secondary hyperparathyroidism
play a major role for the bone loss and should be therefore monitored
and treated adequately. Low dose calcitriol should be substituted
for at least 2 years as additional antiresorptive therapy.
Gazelle, G. Scott; Dunnick, N. R.
Subsidizing radiology research Journal Article
In: Acad Radiol, vol. 9, no. 2, pp. 195-7, 2002, ISSN: 1076-6332 (Print) 1076-6332 (Lin, ().
@article{Gazelle2002,
title = {Subsidizing radiology research},
author = {G. Scott Gazelle and N. R. Dunnick},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11918372},
issn = {1076-6332 (Print) 1076-6332 (Lin},
year = {2002},
date = {2002-02-01},
journal = {Acad Radiol},
volume = {9},
number = {2},
pages = {195-7},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Swan, J. Shannon; Carroll, T. J.; Kennell, T. W.; Heisey, D. M.; Korosec, F. R.; Frayne, R.; Mistretta, C. A.; Grist, T. M.
Time-resolved three-dimensional contrast-enhanced MR angiography of the peripheral vessels Journal Article
In: Radiology, vol. 225, no. 1, pp. 43-52, 2002, ISSN: 0033-8419 (Print) 0033-8419 (Li, ().
@article{Swan2002,
title = {Time-resolved three-dimensional contrast-enhanced MR angiography of the peripheral vessels},
author = {J. Shannon Swan and T. J. Carroll and T. W. Kennell and D. M. Heisey and F. R. Korosec and R. Frayne and C. A. Mistretta and T. M. Grist},
url = {https://www.ncbi.nlm.nih.gov/pubmed/12354982},
doi = {10.1148/radiol.2251011292},
issn = {0033-8419 (Print) 0033-8419 (Li},
year = {2002},
date = {2002-01-01},
urldate = {2002-01-01},
journal = {Radiology},
volume = {225},
number = {1},
pages = {43-52},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Wieben, O.; Carroll, T. J.; Swan, J. Shannon; Frayn, R.
Rapid generation of preview images for real-time 3Đ MR angiography Journal Article
In: Phys Med Biol, vol. 47, no. 1, pp. N17-24, 2002, ISSN: 0031-9155 (Print) 0031-9155 (Li, ().
@article{Wieben2002,
title = {Rapid generation of preview images for real-time 3{D} MR angiography},
author = {O. Wieben and T. J. Carroll and J. Shannon Swan and R. Frayn},
url = {https://www.ncbi.nlm.nih.gov/pubmed/11814233},
doi = {10.1088/0031-9155/47/1/403},
issn = {0031-9155 (Print)
0031-9155 (Li},
year = {2002},
date = {2002-01-01},
journal = {Phys Med Biol},
volume = {47},
number = {1},
pages = {N17-24},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Shaffer, D. W.; Kigin, C. M.; Kaput, J. J.; Gazelle, G. Scott
What is digital medicine? Journal Article
In: Stud Health Technol Inform, vol. 80, pp. 195-204, 2002, ().
@article{Shaffer2002,
title = {What is digital medicine?},
author = {D. W. Shaffer and C. M. Kigin and J. J. Kaput and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12026129},
year = {2002},
date = {2002-01-01},
journal = {Stud Health Technol Inform},
volume = {80},
pages = {195-204},
abstract = {Changes in health care are a fundamental part of social and intellectual
evolution. The modern practice of scientific medicine depends on
the existence of the written and printed word to store medical information.
Because computers can transform information as well as store it,
new digital tools cannot only record clinical data, they can also
generate medical knowledge. In doing so, they make it possible to
develop "digital medicine" that is potentially more precise, more
effective, more experimental, more widely distributed, and more egalitarian
than current medical practice. Critical steps in the creation of
digital medicine are careful analysis of the impact of new technologies
and coordinated efforts to direct technological development towards
creating a new paradigm of medical care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Changes in health care are a fundamental part of social and intellectual
evolution. The modern practice of scientific medicine depends on
the existence of the written and printed word to store medical information.
Because computers can transform information as well as store it,
new digital tools cannot only record clinical data, they can also
generate medical knowledge. In doing so, they make it possible to
develop "digital medicine" that is potentially more precise, more
effective, more experimental, more widely distributed, and more egalitarian
than current medical practice. Critical steps in the creation of
digital medicine are careful analysis of the impact of new technologies
and coordinated efforts to direct technological development towards
creating a new paradigm of medical care.
evolution. The modern practice of scientific medicine depends on
the existence of the written and printed word to store medical information.
Because computers can transform information as well as store it,
new digital tools cannot only record clinical data, they can also
generate medical knowledge. In doing so, they make it possible to
develop "digital medicine" that is potentially more precise, more
effective, more experimental, more widely distributed, and more egalitarian
than current medical practice. Critical steps in the creation of
digital medicine are careful analysis of the impact of new technologies
and coordinated efforts to direct technological development towards
creating a new paradigm of medical care.
Siebert, Uwe
The role of decision-analytic models in the prevention, diagnosis and treatment of coronary heart disease Journal Article
In: Z Kardiol, vol. 91 Suppl 3, pp. 144-51, 2002, ISSN: 0300-5860 (Print) 0300-5860 (Lin, ().
@article{Siebert2002a,
title = {The role of decision-analytic models in the prevention, diagnosis and treatment of coronary heart disease},
author = {Uwe Siebert},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12641030},
issn = {0300-5860 (Print) 0300-5860 (Lin},
year = {2002},
date = {2002-01-01},
urldate = {2002-01-01},
journal = {Z Kardiol},
volume = {91 Suppl 3},
pages = {144-51},
abstract = {BACKGROUND: The rapidly expanding number and scope of health technologies
used in the prevention, diagnosis, and treatment of coronary heart
disease present physicians and policy makers with complex decisions
that must be made even under uncertainty about the risks and benefits
of these procedures. A physician must determine which procedures
offer the best trade-off between potential harm and benefit, and
yield the maximum expected health benefit for the patient. In addition,
the cost-effectiveness of alternative choices must be considered
to optimize resource allocations from a societal perspective, further
complicating the decision making process. METHODS: Decision analysis
is the application of explicit and quantitative methods to analyze
decisions under conditions of uncertainty. Briefly, the basic concepts
of decision analysis and cost-effectiveness analysis are described.
Three examples of decision-analytic models for the prevention, diagnosis,
and treatment of coronary heart disease are discussed to demonstrate
situations in which decision analysis may be helpful, and to introduce
different methodological approaches. CONCLUSION: Decision analysis
may aid clinical decisions affecting individual patients as well
as inform clinical policy decisions and decisions regarding national
health policy. However, this method is not a complete procedure for
determining resource allocation decisions in health care, because
it cannot incorporate all the values relevant to such decisions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The rapidly expanding number and scope of health technologies
used in the prevention, diagnosis, and treatment of coronary heart
disease present physicians and policy makers with complex decisions
that must be made even under uncertainty about the risks and benefits
of these procedures. A physician must determine which procedures
offer the best trade-off between potential harm and benefit, and
yield the maximum expected health benefit for the patient. In addition,
the cost-effectiveness of alternative choices must be considered
to optimize resource allocations from a societal perspective, further
complicating the decision making process. METHODS: Decision analysis
is the application of explicit and quantitative methods to analyze
decisions under conditions of uncertainty. Briefly, the basic concepts
of decision analysis and cost-effectiveness analysis are described.
Three examples of decision-analytic models for the prevention, diagnosis,
and treatment of coronary heart disease are discussed to demonstrate
situations in which decision analysis may be helpful, and to introduce
different methodological approaches. CONCLUSION: Decision analysis
may aid clinical decisions affecting individual patients as well
as inform clinical policy decisions and decisions regarding national
health policy. However, this method is not a complete procedure for
determining resource allocation decisions in health care, because
it cannot incorporate all the values relevant to such decisions.
used in the prevention, diagnosis, and treatment of coronary heart
disease present physicians and policy makers with complex decisions
that must be made even under uncertainty about the risks and benefits
of these procedures. A physician must determine which procedures
offer the best trade-off between potential harm and benefit, and
yield the maximum expected health benefit for the patient. In addition,
the cost-effectiveness of alternative choices must be considered
to optimize resource allocations from a societal perspective, further
complicating the decision making process. METHODS: Decision analysis
is the application of explicit and quantitative methods to analyze
decisions under conditions of uncertainty. Briefly, the basic concepts
of decision analysis and cost-effectiveness analysis are described.
Three examples of decision-analytic models for the prevention, diagnosis,
and treatment of coronary heart disease are discussed to demonstrate
situations in which decision analysis may be helpful, and to introduce
different methodological approaches. CONCLUSION: Decision analysis
may aid clinical decisions affecting individual patients as well
as inform clinical policy decisions and decisions regarding national
health policy. However, this method is not a complete procedure for
determining resource allocation decisions in health care, because
it cannot incorporate all the values relevant to such decisions.
Mullins, M. E.; Schaefer, P. W.; Sorensen, A. G.; Halpern, Elkan F.; Ay, H.; He, J.; Koroshetz, W. J.; Gonzalez, R. G.
CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department Journal Article
In: Radiology, vol. 224, pp. 353-60, 2002, ().
@article{Mullins2002,
title = {CT and conventional and diffusion-weighted MR imaging in acute stroke:
study in 691 patients at presentation to the emergency department},
author = {M. E. Mullins and P. W. Schaefer and A. G. Sorensen and Elkan F. Halpern and H. Ay and J. He and W. J. Koroshetz and R. G. Gonzalez},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12147827},
year = {2002},
date = {2002-01-01},
journal = {Radiology},
volume = {224},
pages = {353-60},
abstract = {PURPOSE: To compare the diagnostic accuracy of computed tomography
(CT) and magnetic resonance (MR) imaging in a consecutive series
of patients at presentation to the emergency department with symptoms
of acute stroke. MATERIALS AND METHODS: Clinical data and images
obtained in 691 consecutive patients with suspected acute stroke
were examined. Results of first and second head CT and brain diffusion-weighted
(DW) and conventional MR imaging were compared with each other and
with the final neurologic discharge diagnosis. RESULTS: Five hundred
seventy-three patients underwent CT at presentation, with 42% sensitivity
(95% CI: 37 46 and 91% specificity (95% CI: 82 96. A total of 173
patients underwent a second CT examination, with 77% sensitivity
(95% CI: 70 84 and 79% specificity (95% CI: 49 95. Of 498 MR images,
411 were DW, with 94% sensitivity (95% CI: 1 96 and 97% specificity
(95% CI: 88 100, and 87 were conventional, with 70% sensitivity (95%
CI: 58 81 and 94% specificity (95% CI: 70 100. By using DW MR imaging
in the early period (textless6 hours after presentation to emergency
department), a 97% sensitivity (95% CI: 92 100 and a 100% specificity
(95% CI: 69 100 were achieved, compared with 58% (2984 and 100% (16100,
respectively, with conventional MR imaging, and 40% (3545 and 92%
(8497, respectively, with CT. Negative predictive value was higher
with DW MR imaging (73 than with conventional (42 MR imaging or CT
(24. In studies conducted within 12 hours, DW MR imaging achieved
substantially superior accuracy than did CT. After 12 hours, accuracy
was equivalent. CONCLUSION: In the diagnosis of stroke in the early
period (textless12 hours after presentation), DW MR imaging is superior
to conventional MR imaging and CT.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To compare the diagnostic accuracy of computed tomography
(CT) and magnetic resonance (MR) imaging in a consecutive series
of patients at presentation to the emergency department with symptoms
of acute stroke. MATERIALS AND METHODS: Clinical data and images
obtained in 691 consecutive patients with suspected acute stroke
were examined. Results of first and second head CT and brain diffusion-weighted
(DW) and conventional MR imaging were compared with each other and
with the final neurologic discharge diagnosis. RESULTS: Five hundred
seventy-three patients underwent CT at presentation, with 42% sensitivity
(95% CI: 37 46 and 91% specificity (95% CI: 82 96. A total of 173
patients underwent a second CT examination, with 77% sensitivity
(95% CI: 70 84 and 79% specificity (95% CI: 49 95. Of 498 MR images,
411 were DW, with 94% sensitivity (95% CI: 1 96 and 97% specificity
(95% CI: 88 100, and 87 were conventional, with 70% sensitivity (95%
CI: 58 81 and 94% specificity (95% CI: 70 100. By using DW MR imaging
in the early period (textless6 hours after presentation to emergency
department), a 97% sensitivity (95% CI: 92 100 and a 100% specificity
(95% CI: 69 100 were achieved, compared with 58% (2984 and 100% (16100,
respectively, with conventional MR imaging, and 40% (3545 and 92%
(8497, respectively, with CT. Negative predictive value was higher
with DW MR imaging (73 than with conventional (42 MR imaging or CT
(24. In studies conducted within 12 hours, DW MR imaging achieved
substantially superior accuracy than did CT. After 12 hours, accuracy
was equivalent. CONCLUSION: In the diagnosis of stroke in the early
period (textless12 hours after presentation), DW MR imaging is superior
to conventional MR imaging and CT.
(CT) and magnetic resonance (MR) imaging in a consecutive series
of patients at presentation to the emergency department with symptoms
of acute stroke. MATERIALS AND METHODS: Clinical data and images
obtained in 691 consecutive patients with suspected acute stroke
were examined. Results of first and second head CT and brain diffusion-weighted
(DW) and conventional MR imaging were compared with each other and
with the final neurologic discharge diagnosis. RESULTS: Five hundred
seventy-three patients underwent CT at presentation, with 42% sensitivity
(95% CI: 37 46 and 91% specificity (95% CI: 82 96. A total of 173
patients underwent a second CT examination, with 77% sensitivity
(95% CI: 70 84 and 79% specificity (95% CI: 49 95. Of 498 MR images,
411 were DW, with 94% sensitivity (95% CI: 1 96 and 97% specificity
(95% CI: 88 100, and 87 were conventional, with 70% sensitivity (95%
CI: 58 81 and 94% specificity (95% CI: 70 100. By using DW MR imaging
in the early period (textless6 hours after presentation to emergency
department), a 97% sensitivity (95% CI: 92 100 and a 100% specificity
(95% CI: 69 100 were achieved, compared with 58% (2984 and 100% (16100,
respectively, with conventional MR imaging, and 40% (3545 and 92%
(8497, respectively, with CT. Negative predictive value was higher
with DW MR imaging (73 than with conventional (42 MR imaging or CT
(24. In studies conducted within 12 hours, DW MR imaging achieved
substantially superior accuracy than did CT. After 12 hours, accuracy
was equivalent. CONCLUSION: In the diagnosis of stroke in the early
period (textless12 hours after presentation), DW MR imaging is superior
to conventional MR imaging and CT.
Pijls, N. H.; Klauss, V.; Siebert, Uwe; Powers, E.; Takazawa, K.; Fearon, W. F.; Escaned, J.; Tsurumi, Y.; Akasaka, T.; Samady, H.; Bruyne, B. De; Registry, Investigators Fractional Flow Reserve Post-Stent
Coronary pressure measurement after stenting predicts adverse events at follow-up: a multicenter registry Journal Article
In: Circulation, vol. 105, pp. 2950-4, 2002, ().
@article{Pijls2002,
title = {Coronary pressure measurement after stenting predicts adverse events
at follow-up: a multicenter registry},
author = {N. H. Pijls and V. Klauss and Uwe Siebert and E. Powers and K. Takazawa and W. F. Fearon and J. Escaned and Y. Tsurumi and T. Akasaka and H. Samady and B. De Bruyne and Investigators Fractional Flow Reserve Post-Stent Registry},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12081986},
year = {2002},
date = {2002-01-01},
journal = {Circulation},
volume = {105},
pages = {2950-4},
abstract = {BACKGROUND: Coronary stenting is associated with a restenosis rate
of 15% to 20% at 6-month follow-up, despite optimum angiographic
stent implantation. In this multicenter registry, we investigated
the relation between optimum physiological stent implantation as
assessed by poststent fractional flow reserve (FFR) and outcome at
6 months. METHODS AND RESULTS: In 750 patients, coronary pressure
measurement at maximum hyperemia was performed after angiographically
apparently satisfactory stent implantation. Poststenting FFR was
calculated and related to major adverse events (including need for
repeat target vessel revascularization) at 6 months. In 76 patients
(10.2, at least 1 adverse event occurred. Five patients died, 19
experienced myocardial infarction, and 52 underwent at least 1 repeat
target vessel revascularization. By multivariate analysis, FFR immediately
after stenting was the most significant independent variable related
to all types of events. In 36% of the patients, FFR normalized (textgreater0.95),
and event rate was 4.9% in that group. In 32% of the patients, poststent
FFR was between 0.90 and 0.95, and event rate was 6.2 In 32% of patients,
poststent FFR was textless0.90, and event rate was 20.3 In 6% of
the patients, FFR was textless0.80, and event rate was 29.5% (Ptextless0.001).
CONCLUSIONS: FFR after stenting is a strong independent predictor
of outcome at 6 months.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Coronary stenting is associated with a restenosis rate
of 15% to 20% at 6-month follow-up, despite optimum angiographic
stent implantation. In this multicenter registry, we investigated
the relation between optimum physiological stent implantation as
assessed by poststent fractional flow reserve (FFR) and outcome at
6 months. METHODS AND RESULTS: In 750 patients, coronary pressure
measurement at maximum hyperemia was performed after angiographically
apparently satisfactory stent implantation. Poststenting FFR was
calculated and related to major adverse events (including need for
repeat target vessel revascularization) at 6 months. In 76 patients
(10.2, at least 1 adverse event occurred. Five patients died, 19
experienced myocardial infarction, and 52 underwent at least 1 repeat
target vessel revascularization. By multivariate analysis, FFR immediately
after stenting was the most significant independent variable related
to all types of events. In 36% of the patients, FFR normalized (textgreater0.95),
and event rate was 4.9% in that group. In 32% of the patients, poststent
FFR was between 0.90 and 0.95, and event rate was 6.2 In 32% of patients,
poststent FFR was textless0.90, and event rate was 20.3 In 6% of
the patients, FFR was textless0.80, and event rate was 29.5% (Ptextless0.001).
CONCLUSIONS: FFR after stenting is a strong independent predictor
of outcome at 6 months.
of 15% to 20% at 6-month follow-up, despite optimum angiographic
stent implantation. In this multicenter registry, we investigated
the relation between optimum physiological stent implantation as
assessed by poststent fractional flow reserve (FFR) and outcome at
6 months. METHODS AND RESULTS: In 750 patients, coronary pressure
measurement at maximum hyperemia was performed after angiographically
apparently satisfactory stent implantation. Poststenting FFR was
calculated and related to major adverse events (including need for
repeat target vessel revascularization) at 6 months. In 76 patients
(10.2, at least 1 adverse event occurred. Five patients died, 19
experienced myocardial infarction, and 52 underwent at least 1 repeat
target vessel revascularization. By multivariate analysis, FFR immediately
after stenting was the most significant independent variable related
to all types of events. In 36% of the patients, FFR normalized (textgreater0.95),
and event rate was 4.9% in that group. In 32% of the patients, poststent
FFR was between 0.90 and 0.95, and event rate was 6.2 In 32% of patients,
poststent FFR was textless0.90, and event rate was 20.3 In 6% of
the patients, FFR was textless0.80, and event rate was 29.5% (Ptextless0.001).
CONCLUSIONS: FFR after stenting is a strong independent predictor
of outcome at 6 months.
Rieber, J.; Jung, P.; Schiele, T. M.; Koenig, A.; Erhard, I.; Segmiller, T.; Ebel, S.; Theisen, K.; Siebert, Uwe; Klauss, V.
Safety of FFR-based treatment strategies: the Munich experience Journal Article
In: Z Kardiol, vol. 91 Suppl 3, pp. 115-9, 2002, ISSN: 0300-5860 (Print) 0300-5860 (Lin, ().
@article{Rieber2002b,
title = {Safety of FFR-based treatment strategies: the Munich experience},
author = {J. Rieber and P. Jung and T. M. Schiele and A. Koenig and I. Erhard and T. Segmiller and S. Ebel and K. Theisen and Uwe Siebert and V. Klauss},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12641025},
issn = {0300-5860 (Print) 0300-5860 (Lin},
year = {2002},
date = {2002-01-01},
journal = {Z Kardiol},
volume = {91 Suppl 3},
pages = {115-9},
abstract = {Fractional flow reserve (FFR) as a new technique for physiological
assessment of coronary stenoses could identify patients with CAD
in whom the deferral of an intended PCI was more beneficial than
performing the planned procedure. It is up to now unknown whether
a FFR-based therapy stratification is also safe in patients with
multivessel disease and complex coronary lesions. This study demonstrates
in 71 symptomatic patients with predominantly multivessel disease
and angiographically intermediate coronary lesions that patients
do not benefit from PCI procedures in terms of overall survival,
target vessel patency or clinical symptoms during 12 month follow-up
if FFR is above 0.75.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Fractional flow reserve (FFR) as a new technique for physiological
assessment of coronary stenoses could identify patients with CAD
in whom the deferral of an intended PCI was more beneficial than
performing the planned procedure. It is up to now unknown whether
a FFR-based therapy stratification is also safe in patients with
multivessel disease and complex coronary lesions. This study demonstrates
in 71 symptomatic patients with predominantly multivessel disease
and angiographically intermediate coronary lesions that patients
do not benefit from PCI procedures in terms of overall survival,
target vessel patency or clinical symptoms during 12 month follow-up
if FFR is above 0.75.
assessment of coronary stenoses could identify patients with CAD
in whom the deferral of an intended PCI was more beneficial than
performing the planned procedure. It is up to now unknown whether
a FFR-based therapy stratification is also safe in patients with
multivessel disease and complex coronary lesions. This study demonstrates
in 71 symptomatic patients with predominantly multivessel disease
and angiographically intermediate coronary lesions that patients
do not benefit from PCI procedures in terms of overall survival,
target vessel patency or clinical symptoms during 12 month follow-up
if FFR is above 0.75.
Rieber, J.; Schiele, T. M.; Erdin, P.; Stempfle, H. U.; Konig, A.; Erhard, I.; Segmiller, T.; Baylacher, M.; Theisen, K.; Haufe, M. C.; Siebert, Uwe; Klauss, V.
Fractional flow reserve predicts major adverse cardiac events after coronary stent implantation Journal Article
In: Z Kardiol, vol. 91 Suppl 3, pp. 132-6, 2002, ISSN: 0300-5860 (Print) 0300-5860 (Lin, ().
@article{Rieber2002a,
title = {Fractional flow reserve predicts major adverse cardiac events after
coronary stent implantation},
author = {J. Rieber and T. M. Schiele and P. Erdin and H. U. Stempfle and A. Konig and I. Erhard and T. Segmiller and M. Baylacher and K. Theisen and M. C. Haufe and Uwe Siebert and V. Klauss},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12641028},
issn = {0300-5860 (Print) 0300-5860 (Lin},
year = {2002},
date = {2002-01-01},
journal = {Z Kardiol},
volume = {91 Suppl 3},
pages = {132-6},
abstract = {OBJECTIVES: Determination of fractional flow reserve (FFR) allows
the functional assessment of coronary stenoses before and after an intervention. Preliminary data suggest that a FFR \> or = 0.94 is
associated with an excellent clinical outcome after stent implantation.
However, these results were limited both by the number of patients
included and the use of non-contemporary stent designs. We sought
to determine the prognostic value of FFR measurements in a large
patient cohort undergoing coronary stent implantation. METHODS: Eighty-nine
consecutive patients were enrolled in whom a stent implantation was
performed and a pressure wire was used as a guide wire. Patients
were followed for at least 6 months. Death, myocardial infarction
(MI) and target vessel revascularization (TVR) were considered cardiac events. A FFR \> or = 0.94 was regarded as an optimal functional result.
RESULTS: A complete follow-up was available in all patents. Pre-interventional
FFR increased from 0.66 +/- 0.16 to 0.95 +/- 0.05 (p \< 0.0001) after
stent implantation. Sixteen (18%) events occurred during follow-up
including 10 (11.2%) TVR. Final FFR was significantly higher in patients
without compared to patients with an event (0.92 +/- 0.06 vs. 0.96
+/- 0.05, p \< 0.003). By univariate analysis, the presence of diabetes
mellitus, left ventricular function, residual diameter stenosis and
final FFR were associated with a worse clinical outcome. In the multivariate
analysis, only the final FFR and left ventricular function remained
as significant predictors for cardiac events (relative risk, 3.50; 95% CI: 1.29-9.52, P \< 0.014, and 0.97; 95% CI: 0.93-1.0},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: Determination of fractional flow reserve (FFR) allows
the functional assessment of coronary stenoses before and after an intervention. Preliminary data suggest that a FFR > or = 0.94 is
associated with an excellent clinical outcome after stent implantation.
However, these results were limited both by the number of patients
included and the use of non-contemporary stent designs. We sought
to determine the prognostic value of FFR measurements in a large
patient cohort undergoing coronary stent implantation. METHODS: Eighty-nine
consecutive patients were enrolled in whom a stent implantation was
performed and a pressure wire was used as a guide wire. Patients
were followed for at least 6 months. Death, myocardial infarction
(MI) and target vessel revascularization (TVR) were considered cardiac events. A FFR > or = 0.94 was regarded as an optimal functional result.
RESULTS: A complete follow-up was available in all patents. Pre-interventional
FFR increased from 0.66 +/- 0.16 to 0.95 +/- 0.05 (p < 0.0001) after
stent implantation. Sixteen (18%) events occurred during follow-up
including 10 (11.2%) TVR. Final FFR was significantly higher in patients
without compared to patients with an event (0.92 +/- 0.06 vs. 0.96
+/- 0.05, p < 0.003). By univariate analysis, the presence of diabetes
mellitus, left ventricular function, residual diameter stenosis and
final FFR were associated with a worse clinical outcome. In the multivariate
analysis, only the final FFR and left ventricular function remained
as significant predictors for cardiac events (relative risk, 3.50; 95% CI: 1.29-9.52, P < 0.014, and 0.97; 95% CI: 0.93-1.0
the functional assessment of coronary stenoses before and after an intervention. Preliminary data suggest that a FFR > or = 0.94 is
associated with an excellent clinical outcome after stent implantation.
However, these results were limited both by the number of patients
included and the use of non-contemporary stent designs. We sought
to determine the prognostic value of FFR measurements in a large
patient cohort undergoing coronary stent implantation. METHODS: Eighty-nine
consecutive patients were enrolled in whom a stent implantation was
performed and a pressure wire was used as a guide wire. Patients
were followed for at least 6 months. Death, myocardial infarction
(MI) and target vessel revascularization (TVR) were considered cardiac events. A FFR > or = 0.94 was regarded as an optimal functional result.
RESULTS: A complete follow-up was available in all patents. Pre-interventional
FFR increased from 0.66 +/- 0.16 to 0.95 +/- 0.05 (p < 0.0001) after
stent implantation. Sixteen (18%) events occurred during follow-up
including 10 (11.2%) TVR. Final FFR was significantly higher in patients
without compared to patients with an event (0.92 +/- 0.06 vs. 0.96
+/- 0.05, p < 0.003). By univariate analysis, the presence of diabetes
mellitus, left ventricular function, residual diameter stenosis and
final FFR were associated with a worse clinical outcome. In the multivariate
analysis, only the final FFR and left ventricular function remained
as significant predictors for cardiac events (relative risk, 3.50; 95% CI: 1.29-9.52, P < 0.014, and 0.97; 95% CI: 0.93-1.0
Roberts, T. G.; Lynch, T. J.; Chabner, B. A.
Choosing chemotherapy for lung cancer based on cost: not yet Journal Article
In: Oncologist, vol. 7, pp. 177-8, 2002, ().
@article{Roberts2002,
title = {Choosing chemotherapy for lung cancer based on cost: not yet},
author = {T. G. Roberts and T. J. Lynch and B. A. Chabner},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12065787},
year = {2002},
date = {2002-01-01},
journal = {Oncologist},
volume = {7},
pages = {177-8},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Sahani, D.; Saini, S.; Pena, C.; Nichols, S.; Prasad, S. R.; Hahn, P. F.; Halpern, Elkan F.; Tanabe, K. K.; Mueller, P. R.
Using multidetector CT for preoperative vascular evaluation of liver neoplasms: technique and results Journal Article
In: AJR Am J Roentgenol, vol. 179, pp. 53-9, 2002, ().
@article{Sahani2002,
title = {Using multidetector CT for preoperative vascular evaluation of liver neoplasms: technique and results},
author = {D. Sahani and S. Saini and C. Pena and S. Nichols and S. R. Prasad and P. F. Hahn and Elkan F. Halpern and K. K. Tanabe and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12076905},
year = {2002},
date = {2002-01-01},
urldate = {2002-01-01},
journal = {AJR Am J Roentgenol},
volume = {179},
pages = {53-9},
abstract = {OBJECTIVE: The purpose of our study was to evaluate the performance
of CT angiography using multidetector CT (MDCT) for preoperative
vascular evaluation in candidates who were scheduled for liver neoplasm
resection. SUBJECTS AND METHODS: Forty-two consecutive subjects with
malignant liver tumors scheduled for resection were studied with
multiphase MDCT. The first 22 subjects underwent both multiphase
MDCT angiography and catheter angiography before surgery. The subsequent
20 subjects underwent only preoperative CT angiography. Postprocessing
was performed, and the images were analyzed for the depiction of
arterial, portal vein, and hepatic vein anatomy and for the identification
of important vascular variants. The postprocessing findings were
compared and correlated with the findings from catheter angiography
(22/42) or intraoperative sonography (42/42) and surgery (42/42).
RESULTS: Arterial anomalies were detected on the images of 17 of
42 patients, including a replaced right hepatic artery in five, replaced
left hepatic artery in six, accessory right and left hepatic arteries
in two, common trunk for the celiac and superior mesenteric arteries
in one, and early bifurcation of the celiac artery in one. In 22
patients in whom catheter angiography confirmation was available,
the number of arteries and almost all the significant anomalies were
correctly identified on CT angiography (accuracy, 97 sensitivity,
94 specificity, 100. In the subset of 20 patients who underwent MDCT
angiography without catheter angiography confirmation, all clinically
relevant information was provided by CT angiography. The portal and
hepatic vein anatomy and the relationships of the liver tumors to
the neighboring venous structures were shown on CT. CONCLUSION: Multidetector
CT provides valuable preoperative information about hepatic vascular
architecture and can be used as a noninvasive alternative to catheter
angiography before oncologic liver surgery.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: The purpose of our study was to evaluate the performance
of CT angiography using multidetector CT (MDCT) for preoperative
vascular evaluation in candidates who were scheduled for liver neoplasm
resection. SUBJECTS AND METHODS: Forty-two consecutive subjects with
malignant liver tumors scheduled for resection were studied with
multiphase MDCT. The first 22 subjects underwent both multiphase
MDCT angiography and catheter angiography before surgery. The subsequent
20 subjects underwent only preoperative CT angiography. Postprocessing
was performed, and the images were analyzed for the depiction of
arterial, portal vein, and hepatic vein anatomy and for the identification
of important vascular variants. The postprocessing findings were
compared and correlated with the findings from catheter angiography
(22/42) or intraoperative sonography (42/42) and surgery (42/42).
RESULTS: Arterial anomalies were detected on the images of 17 of
42 patients, including a replaced right hepatic artery in five, replaced
left hepatic artery in six, accessory right and left hepatic arteries
in two, common trunk for the celiac and superior mesenteric arteries
in one, and early bifurcation of the celiac artery in one. In 22
patients in whom catheter angiography confirmation was available,
the number of arteries and almost all the significant anomalies were
correctly identified on CT angiography (accuracy, 97 sensitivity,
94 specificity, 100. In the subset of 20 patients who underwent MDCT
angiography without catheter angiography confirmation, all clinically
relevant information was provided by CT angiography. The portal and
hepatic vein anatomy and the relationships of the liver tumors to
the neighboring venous structures were shown on CT. CONCLUSION: Multidetector
CT provides valuable preoperative information about hepatic vascular
architecture and can be used as a noninvasive alternative to catheter
angiography before oncologic liver surgery.
of CT angiography using multidetector CT (MDCT) for preoperative
vascular evaluation in candidates who were scheduled for liver neoplasm
resection. SUBJECTS AND METHODS: Forty-two consecutive subjects with
malignant liver tumors scheduled for resection were studied with
multiphase MDCT. The first 22 subjects underwent both multiphase
MDCT angiography and catheter angiography before surgery. The subsequent
20 subjects underwent only preoperative CT angiography. Postprocessing
was performed, and the images were analyzed for the depiction of
arterial, portal vein, and hepatic vein anatomy and for the identification
of important vascular variants. The postprocessing findings were
compared and correlated with the findings from catheter angiography
(22/42) or intraoperative sonography (42/42) and surgery (42/42).
RESULTS: Arterial anomalies were detected on the images of 17 of
42 patients, including a replaced right hepatic artery in five, replaced
left hepatic artery in six, accessory right and left hepatic arteries
in two, common trunk for the celiac and superior mesenteric arteries
in one, and early bifurcation of the celiac artery in one. In 22
patients in whom catheter angiography confirmation was available,
the number of arteries and almost all the significant anomalies were
correctly identified on CT angiography (accuracy, 97 sensitivity,
94 specificity, 100. In the subset of 20 patients who underwent MDCT
angiography without catheter angiography confirmation, all clinically
relevant information was provided by CT angiography. The portal and
hepatic vein anatomy and the relationships of the liver tumors to
the neighboring venous structures were shown on CT. CONCLUSION: Multidetector
CT provides valuable preoperative information about hepatic vascular
architecture and can be used as a noninvasive alternative to catheter
angiography before oncologic liver surgery.
Schiele, T. M.; Konig, A.; Zimmermann, A.; Krotz, F.; Sohn, H. Y.; Rieber, J.; Kantlehner, R.; Pollinger, B.; Duhmke, E.; Theisen, K.; Siebert, Uwe; Klauss, V.
Safety and mechanisms of intracoronary manual stepping brachytherapy as gained from serial angiographic and intravascular ultrasound studies Journal Article
In: Am J Cardiol, vol. 90, pp. 1385-8, 2002, ().
@article{Schiele2002,
title = {Safety and mechanisms of intracoronary manual stepping brachytherapy
as gained from serial angiographic and intravascular ultrasound studies},
author = {T. M. Schiele and A. Konig and A. Zimmermann and F. Krotz and H. Y. Sohn and J. Rieber and R. Kantlehner and B. Pollinger and E. Duhmke and K. Theisen and Uwe Siebert and V. Klauss},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12480051},
year = {2002},
date = {2002-01-01},
journal = {Am J Cardiol},
volume = {90},
pages = {1385-8},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kong, Chung Yin; Muthukumar, M.
Modeling of polynucleotide translocation through protein pores and nanotubes Journal Article
In: Electrophoresis, vol. 23, no. 16, pp. 2697-2703, 2002, ().
@article{Kong2002,
title = {Modeling of polynucleotide translocation through protein pores and nanotubes},
author = {Chung Yin Kong and M. Muthukumar},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12210174},
year = {2002},
date = {2002-01-01},
booktitle = {Electrophoresis},
journal = {Electrophoresis},
volume = {23},
number = {16},
pages = {2697-2703},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Manoach, D. S.; Lindgren, K. A.; Cherkasova, M. V.; Goff, D. C.; Halpern, Elkan F.; Intriligator, J.; Barton, J. J.
Schizophrenic subjects show deficient inhibition but intact task switching on saccadic tasks Journal Article
In: Biol Psychiatry, vol. 51, pp. 816-26, 2002, ().
@article{Manoach2002,
title = {Schizophrenic subjects show deficient inhibition but intact task
switching on saccadic tasks},
author = {D. S. Manoach and K. A. Lindgren and M. V. Cherkasova and D. C. Goff and Elkan F. Halpern and J. Intriligator and J. J. Barton},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12007456},
year = {2002},
date = {2002-01-01},
journal = {Biol Psychiatry},
volume = {51},
pages = {816-26},
abstract = {BACKGROUND: Schizophrenic patients have executive function deficits,
presumably on the basis of prefrontal cortex dysfunction. Although
they consistently show impaired inhibition, the evidence of a task
switching deficit is less consistent and is often based on performance
of neuropsychological tests that require several cognitive processes
(e.g., the Wisconsin Card Sort Test [WCST]). We investigated inhibition
and task switching using saccadic tasks to determine whether schizophrenic
patients have selective impairments of these executive functions.
METHODS: Sixteen normal and 21 schizophrenic subjects performed blocks
of randomly mixed prosaccade and antisaccade trials. This gave rise
to four trial types: prosaccades and antisaccades that were either
repeated or switched. Response accuracy and latency were measured.
Schizophrenic subjects also performed the WCST. RESULTS: Schizophrenic
subjects showed abnormal antisaccade and WCST performance. In contrast,
task switching was normal and unrelated to either antisaccade or
WCST performance. CONCLUSIONS: The finding of intact task switching
performance that is unrelated to other measures of executive function
demonstrates selective rather than general impairments of executive
functions in schizophrenia. The findings also suggest that abnormal
WCST performance is unlikely to be a consequence of deficient task
switching. We hypothesize that inhibition and task switching are
mediated by distinct neural networks, only one of which is dysfunctional
in schizophrenia.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Schizophrenic patients have executive function deficits,
presumably on the basis of prefrontal cortex dysfunction. Although
they consistently show impaired inhibition, the evidence of a task
switching deficit is less consistent and is often based on performance
of neuropsychological tests that require several cognitive processes
(e.g., the Wisconsin Card Sort Test [WCST]). We investigated inhibition
and task switching using saccadic tasks to determine whether schizophrenic
patients have selective impairments of these executive functions.
METHODS: Sixteen normal and 21 schizophrenic subjects performed blocks
of randomly mixed prosaccade and antisaccade trials. This gave rise
to four trial types: prosaccades and antisaccades that were either
repeated or switched. Response accuracy and latency were measured.
Schizophrenic subjects also performed the WCST. RESULTS: Schizophrenic
subjects showed abnormal antisaccade and WCST performance. In contrast,
task switching was normal and unrelated to either antisaccade or
WCST performance. CONCLUSIONS: The finding of intact task switching
performance that is unrelated to other measures of executive function
demonstrates selective rather than general impairments of executive
functions in schizophrenia. The findings also suggest that abnormal
WCST performance is unlikely to be a consequence of deficient task
switching. We hypothesize that inhibition and task switching are
mediated by distinct neural networks, only one of which is dysfunctional
in schizophrenia.
presumably on the basis of prefrontal cortex dysfunction. Although
they consistently show impaired inhibition, the evidence of a task
switching deficit is less consistent and is often based on performance
of neuropsychological tests that require several cognitive processes
(e.g., the Wisconsin Card Sort Test [WCST]). We investigated inhibition
and task switching using saccadic tasks to determine whether schizophrenic
patients have selective impairments of these executive functions.
METHODS: Sixteen normal and 21 schizophrenic subjects performed blocks
of randomly mixed prosaccade and antisaccade trials. This gave rise
to four trial types: prosaccades and antisaccades that were either
repeated or switched. Response accuracy and latency were measured.
Schizophrenic subjects also performed the WCST. RESULTS: Schizophrenic
subjects showed abnormal antisaccade and WCST performance. In contrast,
task switching was normal and unrelated to either antisaccade or
WCST performance. CONCLUSIONS: The finding of intact task switching
performance that is unrelated to other measures of executive function
demonstrates selective rather than general impairments of executive
functions in schizophrenia. The findings also suggest that abnormal
WCST performance is unlikely to be a consequence of deficient task
switching. We hypothesize that inhibition and task switching are
mediated by distinct neural networks, only one of which is dysfunctional
in schizophrenia.
Marckmann, G.; Siebert, Uwe
[Priorities in health care: what can we learn from the Oregon Health Plan Journal Article
In: Dtsch Med Wochenschr, vol. 127, pp. 1601-4, 2002, ().
@article{Marckmann2002,
title = {[Priorities in health care: what can we learn from the Oregon Health Plan},
author = {G. Marckmann and Uwe Siebert},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12143017},
year = {2002},
date = {2002-01-01},
urldate = {2002-01-01},
journal = {Dtsch Med Wochenschr},
volume = {127},
pages = {1601-4},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
McNamara, J.; Kong, Chung Yin; Muthukumar, M.
Monte Carlo Studies of Adsorption of a Sequenced Polyelectrolyte to Patterned Surfaces Journal Article
In: J. Chem Phys, vol. 117, no. 11, pp. 5354-5360, 2002, ().
@article{McNamara2002,
title = {Monte Carlo Studies of Adsorption of a Sequenced Polyelectrolyte to Patterned Surfaces},
author = {J. McNamara and Chung Yin Kong and M. Muthukumar},
url = {http://scitation.aip.org/content/aip/journal/jcp/117/11/10.1063/1.1501125},
year = {2002},
date = {2002-01-01},
booktitle = {J Chem Phys},
journal = {J. Chem Phys},
volume = {117},
number = {11},
pages = {5354-5360},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Michaelson, J.; Satija, S.; Moore, R.; Weber, G.; Halpern, Elkan F.; Garland, A.; Puri, D.; Kopans, D. B.
The pattern of breast cancer screening utilization and its consequences Journal Article
In: Cancer, vol. 94, no. 1, pp. 37-43, 2002, ISSN: 0008-543X (Print) 0008-543X (Lin, ().
@article{Michaelson2002a,
title = {The pattern of breast cancer screening utilization and its consequences},
author = {J. Michaelson and S. Satija and R. Moore and G. Weber and Elkan F. Halpern and A. Garland and D. Puri and D. B. Kopans},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11815958},
issn = {0008-543X (Print) 0008-543X (Lin},
year = {2002},
date = {2002-01-01},
urldate = {2002-01-01},
journal = {Cancer},
volume = {94},
number = {1},
pages = {37-43},
abstract = {BACKGROUND: The objective of this study was to describe the pattern
of screening utilization and its consequences in terms of tumor size
and time of tumor appearance of invasive breast carcinoma among a
population of women who were examined at a large service screening/diagnostic
program over the last decade. METHODS: Utilization of mammography
was assessed from a population of 59,899 women who received 196,891
mammograms at the Massachusetts General Hospital Breast Imaging Division
from January 1, 1990 to March 1, 1999, among which 604 invasive breast
tumors were found. Two hundred six invasive, clinically detected
tumors also were seen during this period among women who had no record
of a previous mammogram. Additional information was available on
screening of women from March 1, 1999 to June 1, 2001. RESULTS: Fifty
percent of the women who used screening did not begin until the age
of 50 years, although 25% of the invasive breast tumors were found
in women age \< 50 years. Relatively few of the women who used screening
returned promptly for their annual examinations; by 1.5 years, only
50% had returned. Approximately 25% of the invasive breast tumors
were found in women for whom there was no record of a previous screening
mammogram, and these tumors were larger (median, 15 mm) than the
screen-detected tumors (median, 10 mm). Approximately 30% of the
604 invasive breast tumors in the screening population were found
on nonmammographic grounds, and they also were larger (median, 15
mm) than the screen-detected tumors (median, 10 mm). However, only
3% of these 604 tumors were found by nonmammographic criteria within
6 months of the previous negative examination, and only 12% were
found within 1 year. By back calculating the likely size of each
of these tumors at the time of the negative mammogram, it could be
seen that most tumors probably emerged as larger, palpable masses
not because they were missed at the previous negative mammogram,
because most were too small then to have been detected, but because
too much time had been allowed to pass. CONCLUSIONS: Far too many
women did not comply with the American Cancer Society recommendation
of prompt annual screening from the age of 40 years. Consequently,
almost 50% of the invasive tumors emerged as larger and, thus, potentially
more lethal, palpable masses.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The objective of this study was to describe the pattern
of screening utilization and its consequences in terms of tumor size
and time of tumor appearance of invasive breast carcinoma among a
population of women who were examined at a large service screening/diagnostic
program over the last decade. METHODS: Utilization of mammography
was assessed from a population of 59,899 women who received 196,891
mammograms at the Massachusetts General Hospital Breast Imaging Division
from January 1, 1990 to March 1, 1999, among which 604 invasive breast
tumors were found. Two hundred six invasive, clinically detected
tumors also were seen during this period among women who had no record
of a previous mammogram. Additional information was available on
screening of women from March 1, 1999 to June 1, 2001. RESULTS: Fifty
percent of the women who used screening did not begin until the age
of 50 years, although 25% of the invasive breast tumors were found
in women age < 50 years. Relatively few of the women who used screening
returned promptly for their annual examinations; by 1.5 years, only
50% had returned. Approximately 25% of the invasive breast tumors
were found in women for whom there was no record of a previous screening
mammogram, and these tumors were larger (median, 15 mm) than the
screen-detected tumors (median, 10 mm). Approximately 30% of the
604 invasive breast tumors in the screening population were found
on nonmammographic grounds, and they also were larger (median, 15
mm) than the screen-detected tumors (median, 10 mm). However, only
3% of these 604 tumors were found by nonmammographic criteria within
6 months of the previous negative examination, and only 12% were
found within 1 year. By back calculating the likely size of each
of these tumors at the time of the negative mammogram, it could be
seen that most tumors probably emerged as larger, palpable masses
not because they were missed at the previous negative mammogram,
because most were too small then to have been detected, but because
too much time had been allowed to pass. CONCLUSIONS: Far too many
women did not comply with the American Cancer Society recommendation
of prompt annual screening from the age of 40 years. Consequently,
almost 50% of the invasive tumors emerged as larger and, thus, potentially
more lethal, palpable masses.
of screening utilization and its consequences in terms of tumor size
and time of tumor appearance of invasive breast carcinoma among a
population of women who were examined at a large service screening/diagnostic
program over the last decade. METHODS: Utilization of mammography
was assessed from a population of 59,899 women who received 196,891
mammograms at the Massachusetts General Hospital Breast Imaging Division
from January 1, 1990 to March 1, 1999, among which 604 invasive breast
tumors were found. Two hundred six invasive, clinically detected
tumors also were seen during this period among women who had no record
of a previous mammogram. Additional information was available on
screening of women from March 1, 1999 to June 1, 2001. RESULTS: Fifty
percent of the women who used screening did not begin until the age
of 50 years, although 25% of the invasive breast tumors were found
in women age < 50 years. Relatively few of the women who used screening
returned promptly for their annual examinations; by 1.5 years, only
50% had returned. Approximately 25% of the invasive breast tumors
were found in women for whom there was no record of a previous screening
mammogram, and these tumors were larger (median, 15 mm) than the
screen-detected tumors (median, 10 mm). Approximately 30% of the
604 invasive breast tumors in the screening population were found
on nonmammographic grounds, and they also were larger (median, 15
mm) than the screen-detected tumors (median, 10 mm). However, only
3% of these 604 tumors were found by nonmammographic criteria within
6 months of the previous negative examination, and only 12% were
found within 1 year. By back calculating the likely size of each
of these tumors at the time of the negative mammogram, it could be
seen that most tumors probably emerged as larger, palpable masses
not because they were missed at the previous negative mammogram,
because most were too small then to have been detected, but because
too much time had been allowed to pass. CONCLUSIONS: Far too many
women did not comply with the American Cancer Society recommendation
of prompt annual screening from the age of 40 years. Consequently,
almost 50% of the invasive tumors emerged as larger and, thus, potentially
more lethal, palpable masses.
Michaelson, J. S.; Silverstein, Marc; Wyatt, J.; Weber, G.; Moore, R.; Halpern, Elkan F.; Kopans, D. B.; Hughes, K.
Predicting the survival of patients with breast carcinoma using tumor size Journal Article
In: Cancer, vol. 95, pp. 713-23, 2002, ().
@article{Michaelson2002,
title = {Predicting the survival of patients with breast carcinoma using tumor
size},
author = {J. S. Michaelson and Marc Silverstein and J. Wyatt and G. Weber and R. Moore and Elkan F. Halpern and D. B. Kopans and K. Hughes},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12209713},
year = {2002},
date = {2002-01-01},
journal = {Cancer},
volume = {95},
pages = {713-23},
abstract = {BACKGROUND: Tumor size has long been recognized as the strongest predictor
of the outcome of patients with invasive breast carcinoma, although
it has not been settled whether the correlation between tumor size
and the chance of death is independent of the method of detection,
nor is it clear how tumor size at the time of treatment may be translated
into a specific expectation of survival. In this report, the authors
provide such a method. METHODS: A Kaplan-Meier survival analysis
was carried out for a population of 1352 women with invasive breast
carcinoma who were treated at the Van Nuys Breast Center between
1966 and 1990, and the data were analyzed together with survival
data published by others. RESULTS: The authors found that the survival
of patients with invasive breast carcinoma was a direct function
of tumor size, independent of the method of detection. The results
showed that the correlation between tumor size and survival was well
fit by a simple equation, with which survival predictions could be
made from information on tumor size. For example, a comparison of
three large populations studied over the last 5 decades revealed
a marked improvement (approximately 35% absolute) in the survival
of patients with invasive breast carcinoma diagnosed on clinical
grounds that could be ascribed to a reduction in tumor size. However,
the capacity of screening mammography to find smaller tumors remains
the best way reduce breast carcinoma deaths, with the potential for
adding an additional approximately 20% absolute reduction in breast
carcinoma deaths. The mathematic correlation between tumor size and
survival is consistent with a biologic mechanism in which lethal
distant metastasis occurs by discrete events of spread such that,
for every invasive breast carcinoma cell in the primary tumor at
the time of surgery, there is approximately a 1-in-1-billion chance
that a lethal distant metastasis has formed. CONCLUSIONS: The correlation
between tumor size and lethality is well captured by a simple equation
that is consistent with breast carcinoma death as the result of discrete
events of cellular spread occurring with small but definable probabilities.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Tumor size has long been recognized as the strongest predictor
of the outcome of patients with invasive breast carcinoma, although
it has not been settled whether the correlation between tumor size
and the chance of death is independent of the method of detection,
nor is it clear how tumor size at the time of treatment may be translated
into a specific expectation of survival. In this report, the authors
provide such a method. METHODS: A Kaplan-Meier survival analysis
was carried out for a population of 1352 women with invasive breast
carcinoma who were treated at the Van Nuys Breast Center between
1966 and 1990, and the data were analyzed together with survival
data published by others. RESULTS: The authors found that the survival
of patients with invasive breast carcinoma was a direct function
of tumor size, independent of the method of detection. The results
showed that the correlation between tumor size and survival was well
fit by a simple equation, with which survival predictions could be
made from information on tumor size. For example, a comparison of
three large populations studied over the last 5 decades revealed
a marked improvement (approximately 35% absolute) in the survival
of patients with invasive breast carcinoma diagnosed on clinical
grounds that could be ascribed to a reduction in tumor size. However,
the capacity of screening mammography to find smaller tumors remains
the best way reduce breast carcinoma deaths, with the potential for
adding an additional approximately 20% absolute reduction in breast
carcinoma deaths. The mathematic correlation between tumor size and
survival is consistent with a biologic mechanism in which lethal
distant metastasis occurs by discrete events of spread such that,
for every invasive breast carcinoma cell in the primary tumor at
the time of surgery, there is approximately a 1-in-1-billion chance
that a lethal distant metastasis has formed. CONCLUSIONS: The correlation
between tumor size and lethality is well captured by a simple equation
that is consistent with breast carcinoma death as the result of discrete
events of cellular spread occurring with small but definable probabilities.
of the outcome of patients with invasive breast carcinoma, although
it has not been settled whether the correlation between tumor size
and the chance of death is independent of the method of detection,
nor is it clear how tumor size at the time of treatment may be translated
into a specific expectation of survival. In this report, the authors
provide such a method. METHODS: A Kaplan-Meier survival analysis
was carried out for a population of 1352 women with invasive breast
carcinoma who were treated at the Van Nuys Breast Center between
1966 and 1990, and the data were analyzed together with survival
data published by others. RESULTS: The authors found that the survival
of patients with invasive breast carcinoma was a direct function
of tumor size, independent of the method of detection. The results
showed that the correlation between tumor size and survival was well
fit by a simple equation, with which survival predictions could be
made from information on tumor size. For example, a comparison of
three large populations studied over the last 5 decades revealed
a marked improvement (approximately 35% absolute) in the survival
of patients with invasive breast carcinoma diagnosed on clinical
grounds that could be ascribed to a reduction in tumor size. However,
the capacity of screening mammography to find smaller tumors remains
the best way reduce breast carcinoma deaths, with the potential for
adding an additional approximately 20% absolute reduction in breast
carcinoma deaths. The mathematic correlation between tumor size and
survival is consistent with a biologic mechanism in which lethal
distant metastasis occurs by discrete events of spread such that,
for every invasive breast carcinoma cell in the primary tumor at
the time of surgery, there is approximately a 1-in-1-billion chance
that a lethal distant metastasis has formed. CONCLUSIONS: The correlation
between tumor size and lethality is well captured by a simple equation
that is consistent with breast carcinoma death as the result of discrete
events of cellular spread occurring with small but definable probabilities.
Bosch, Johanna; Halpern, Elkan F.; Gazelle, G. Scott
In: Med Decis Making, vol. 22, pp. 403-9, 2002, ().
@article{Bosch2002,
title = {Comparison of preference-based utilities of the Short-Form 36 Health Survey and Health Utilities Index before and after treatment of patients with intermittent claudication},
author = {Johanna Bosch and Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12365482},
year = {2002},
date = {2002-01-01},
urldate = {2002-01-01},
journal = {Med Decis Making},
volume = {22},
pages = {403-9},
abstract = {The authors compared SF-36 utilities with Health Utilities Index (HUI)
utilities (HUI2 and HUI3) assessed in patients with intermittent
claudication. A total of 87 patients with intermittent claudication
completed the SF-36 and HUI before and 1, 3, and 12 months after
revascularization. Utilities were estimated using SF-36 and HUI published
algorithms (i.e., both algorithms were based on standard-gamble utilities
assessed in random samples of the general population). The utilities
were compared using repeated-measures multivariate analysis of variance,
paired t tests, and univariate linear regression analyses. Before
treatment, the mean SF-36 and HUI3 utilities were the same (0.66 vs. 0.6},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The authors compared SF-36 utilities with Health Utilities Index (HUI)
utilities (HUI2 and HUI3) assessed in patients with intermittent
claudication. A total of 87 patients with intermittent claudication
completed the SF-36 and HUI before and 1, 3, and 12 months after
revascularization. Utilities were estimated using SF-36 and HUI published
algorithms (i.e., both algorithms were based on standard-gamble utilities
assessed in random samples of the general population). The utilities
were compared using repeated-measures multivariate analysis of variance,
paired t tests, and univariate linear regression analyses. Before
treatment, the mean SF-36 and HUI3 utilities were the same (0.66 vs. 0.6
utilities (HUI2 and HUI3) assessed in patients with intermittent
claudication. A total of 87 patients with intermittent claudication
completed the SF-36 and HUI before and 1, 3, and 12 months after
revascularization. Utilities were estimated using SF-36 and HUI published
algorithms (i.e., both algorithms were based on standard-gamble utilities
assessed in random samples of the general population). The utilities
were compared using repeated-measures multivariate analysis of variance,
paired t tests, and univariate linear regression analyses. Before
treatment, the mean SF-36 and HUI3 utilities were the same (0.66 vs. 0.6
Abdulla, C.; Kalra, M. K.; Saini, S.; Maher, M. M.; Ahmad, A.; Halpern, Elkan F.; Silverman, S. G.
Pseudoenhancement of simulated renal cysts in a phantom using different multidetector CT scanners Journal Article
In: AJR Am J Roentgenol, vol. 179, pp. 1473-6, 2002, ().
@article{Abdulla2002,
title = {Pseudoenhancement of simulated renal cysts in a phantom using different
multidetector CT scanners},
author = {C. Abdulla and M. K. Kalra and S. Saini and M. M. Maher and A. Ahmad and Elkan F. Halpern and S. G. Silverman},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12438037},
year = {2002},
date = {2002-01-01},
journal = {AJR Am J Roentgenol},
volume = {179},
pages = {1473-6},
abstract = {OBJECTIVE: We undertook this study to determine whether pseudoenhancement
of renal cysts occurs on scans obtained with multidetector CT (MDCT)
scanners and whether the effect is influenced by scanning parameters.
MATERIALS AND METHODS: A kidney phantom with varying attenuation
was created to simulate different levels of renal parenchymal enhancement
(150 and 250 H). Two water-filled cylinders simulating renal cysts-one
with a 5-mm diameter and one with a 15-mm diameter-were suspended
in the "kidney." After validating the pseudoenhancement effect produced
in our phantom model with a single-detector helical CT scanner, we
investigated the effect with matrix array and adaptive array MDCT
scanners using detector configurations of 1.25 and 2.5 mm and beam
pitches of 0.75:1.0 and 1.5:1.0 at an effective reconstructed slice
thickness of approximately 3 mm. Three sets of experiments were performed
at each setting, and mean cyst density was measured. Data were statistically
analyzed using the Student's t test and multiple logistic regression
analysis when appropriate. RESULTS: Although pseudoenhancement was
observed with MDCT scanners, the effect was statistically significant
only for scans depicting the smaller cyst at a background renal density
of 250 H on the matrix array MDCT. Modulation of scanning parameters
did not alter these findings. Pseudoenhancement was significantly
higher with the matrix array MDCT scanner than with the adaptive
array MDCT scanner (p textless 0.05). CONCLUSION: In our phantom
model, high levels of renal enhancement produced pseudoenhancement
in small renal cysts with different models of MDCT scanners, irrespective
of pitch or detector configuration.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: We undertook this study to determine whether pseudoenhancement
of renal cysts occurs on scans obtained with multidetector CT (MDCT)
scanners and whether the effect is influenced by scanning parameters.
MATERIALS AND METHODS: A kidney phantom with varying attenuation
was created to simulate different levels of renal parenchymal enhancement
(150 and 250 H). Two water-filled cylinders simulating renal cysts-one
with a 5-mm diameter and one with a 15-mm diameter-were suspended
in the "kidney." After validating the pseudoenhancement effect produced
in our phantom model with a single-detector helical CT scanner, we
investigated the effect with matrix array and adaptive array MDCT
scanners using detector configurations of 1.25 and 2.5 mm and beam
pitches of 0.75:1.0 and 1.5:1.0 at an effective reconstructed slice
thickness of approximately 3 mm. Three sets of experiments were performed
at each setting, and mean cyst density was measured. Data were statistically
analyzed using the Student's t test and multiple logistic regression
analysis when appropriate. RESULTS: Although pseudoenhancement was
observed with MDCT scanners, the effect was statistically significant
only for scans depicting the smaller cyst at a background renal density
of 250 H on the matrix array MDCT. Modulation of scanning parameters
did not alter these findings. Pseudoenhancement was significantly
higher with the matrix array MDCT scanner than with the adaptive
array MDCT scanner (p textless 0.05). CONCLUSION: In our phantom
model, high levels of renal enhancement produced pseudoenhancement
in small renal cysts with different models of MDCT scanners, irrespective
of pitch or detector configuration.
of renal cysts occurs on scans obtained with multidetector CT (MDCT)
scanners and whether the effect is influenced by scanning parameters.
MATERIALS AND METHODS: A kidney phantom with varying attenuation
was created to simulate different levels of renal parenchymal enhancement
(150 and 250 H). Two water-filled cylinders simulating renal cysts-one
with a 5-mm diameter and one with a 15-mm diameter-were suspended
in the "kidney." After validating the pseudoenhancement effect produced
in our phantom model with a single-detector helical CT scanner, we
investigated the effect with matrix array and adaptive array MDCT
scanners using detector configurations of 1.25 and 2.5 mm and beam
pitches of 0.75:1.0 and 1.5:1.0 at an effective reconstructed slice
thickness of approximately 3 mm. Three sets of experiments were performed
at each setting, and mean cyst density was measured. Data were statistically
analyzed using the Student's t test and multiple logistic regression
analysis when appropriate. RESULTS: Although pseudoenhancement was
observed with MDCT scanners, the effect was statistically significant
only for scans depicting the smaller cyst at a background renal density
of 250 H on the matrix array MDCT. Modulation of scanning parameters
did not alter these findings. Pseudoenhancement was significantly
higher with the matrix array MDCT scanner than with the adaptive
array MDCT scanner (p textless 0.05). CONCLUSION: In our phantom
model, high levels of renal enhancement produced pseudoenhancement
in small renal cysts with different models of MDCT scanners, irrespective
of pitch or detector configuration.
Prasad, S. R.; Saini, S.; Stewart, S.; Hahn, P. F.; Halpern, Elkan F.
CT characterization of "indeterminate" renal masses: targeted or comprehensive scanning? Journal Article
In: J Comput Assist Tomogr, vol. 26, no. 5, pp. 725-7, 2002, ISSN: 0363-8715 (Print) 0363-8715 (Lin, ().
@article{Prasad2002,
title = {CT characterization of "indeterminate" renal masses: targeted or
comprehensive scanning?},
author = {S. R. Prasad and S. Saini and S. Stewart and P. F. Hahn and Elkan F. Halpern},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12439305},
issn = {0363-8715 (Print) 0363-8715 (Lin},
year = {2002},
date = {2002-00-01},
journal = {J Comput Assist Tomogr},
volume = {26},
number = {5},
pages = {725-7},
abstract = {PURPOSE: A comprehensive renal mass evaluation CT protocol is usually
performed for simultaneous characterization and staging of incidentally
discovered renal masses considered indeterminate on ultrasound (US).
The purpose of the study was to determine if a comprehensive examination
is appropriate in these patients. MATERIALS AND METHODS: The authors
performed a retrospective review of 100 patients (mean age, 61 years)
with 102 sonographically indeterminate renal masses and who were
referred to undergo CT for lesion characterization. Lesions were
classified according to surgical histology or imaging follow-up evaluation.
Statistical analysis was performed. RESULTS: Thirteen lesions (12.7%)
in 11 (11%) patients (mean age, 59 years) were malignant. Eighty-seven
lesions (85.3%) in 87 patients (87%; mean age, 62 years) were benign.
Two lesions (1.96%) in two patients (2%) remained indeterminate.
CONCLUSION: Although comprehensive renal mass evaluation protocol
provides a more thorough patient evaluation, only a small fraction
of indeterminate renal masses seen on US are malignant. The authors'
results suggest a targeted renal CT imaging protocol for evaluation
of indeterminate renal masses incidentally discovered on US.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: A comprehensive renal mass evaluation CT protocol is usually
performed for simultaneous characterization and staging of incidentally
discovered renal masses considered indeterminate on ultrasound (US).
The purpose of the study was to determine if a comprehensive examination
is appropriate in these patients. MATERIALS AND METHODS: The authors
performed a retrospective review of 100 patients (mean age, 61 years)
with 102 sonographically indeterminate renal masses and who were
referred to undergo CT for lesion characterization. Lesions were
classified according to surgical histology or imaging follow-up evaluation.
Statistical analysis was performed. RESULTS: Thirteen lesions (12.7%)
in 11 (11%) patients (mean age, 59 years) were malignant. Eighty-seven
lesions (85.3%) in 87 patients (87%; mean age, 62 years) were benign.
Two lesions (1.96%) in two patients (2%) remained indeterminate.
CONCLUSION: Although comprehensive renal mass evaluation protocol
provides a more thorough patient evaluation, only a small fraction
of indeterminate renal masses seen on US are malignant. The authors'
results suggest a targeted renal CT imaging protocol for evaluation
of indeterminate renal masses incidentally discovered on US.
performed for simultaneous characterization and staging of incidentally
discovered renal masses considered indeterminate on ultrasound (US).
The purpose of the study was to determine if a comprehensive examination
is appropriate in these patients. MATERIALS AND METHODS: The authors
performed a retrospective review of 100 patients (mean age, 61 years)
with 102 sonographically indeterminate renal masses and who were
referred to undergo CT for lesion characterization. Lesions were
classified according to surgical histology or imaging follow-up evaluation.
Statistical analysis was performed. RESULTS: Thirteen lesions (12.7%)
in 11 (11%) patients (mean age, 59 years) were malignant. Eighty-seven
lesions (85.3%) in 87 patients (87%; mean age, 62 years) were benign.
Two lesions (1.96%) in two patients (2%) remained indeterminate.
CONCLUSION: Although comprehensive renal mass evaluation protocol
provides a more thorough patient evaluation, only a small fraction
of indeterminate renal masses seen on US are malignant. The authors'
results suggest a targeted renal CT imaging protocol for evaluation
of indeterminate renal masses incidentally discovered on US.
McMahon, Pamela M.; Gazelle, G. Scott
Colorectal cancer screening issues: a role for CT colonography? Journal Article
In: Abdom Imaging, vol. 27, no. 3, pp. 235-43, 2002, ISSN: 0942-8925 (Print) 0942-8925 (Lin, ().
@article{McMahon2002,
title = {Colorectal cancer screening issues: a role for CT colonography?},
author = {Pamela M. McMahon and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12173353},
issn = {0942-8925 (Print) 0942-8925 (Lin},
year = {2002},
date = {2002-00-01},
journal = {Abdom Imaging},
volume = {27},
number = {3},
pages = {235-43},
abstract = {Colorectal cancer is the third most common cancer in the United States
and will cause 56,700 deaths in 2001, despite the availability of
screening tests capable of detecting the disease at earlier stages
and reducing mortality. This article reviews the natural history
of colorectal cancer, common risk factors and prevention strategies,
and the strengths, limitations, and cost effectiveness of available
screening tests. Although reminders to undergo colorectal cancer
screening have become commonplace in the popular media, compliance
with screening guidelines remains poor. Although still an unproven
technology for widespread screening, computed tomographic (CT) colonography
has several attractive characteristics for a screening test. For
example, CT scanners are widely available, in contrast to limited
numbers of gastroenterologists and radiologists' declining skill
and interest in barium enema examinations. Also, patients may be
less reluctant to undergo CT colonography than screening colonoscopy.
Development of virtual bowel cleansing could further increase compliance
and thereby reduce mortality from colorectal cancer. Other articles
in this Feature Section discuss technical details of CT colonography
and its methodologic challenges.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Colorectal cancer is the third most common cancer in the United States
and will cause 56,700 deaths in 2001, despite the availability of
screening tests capable of detecting the disease at earlier stages
and reducing mortality. This article reviews the natural history
of colorectal cancer, common risk factors and prevention strategies,
and the strengths, limitations, and cost effectiveness of available
screening tests. Although reminders to undergo colorectal cancer
screening have become commonplace in the popular media, compliance
with screening guidelines remains poor. Although still an unproven
technology for widespread screening, computed tomographic (CT) colonography
has several attractive characteristics for a screening test. For
example, CT scanners are widely available, in contrast to limited
numbers of gastroenterologists and radiologists' declining skill
and interest in barium enema examinations. Also, patients may be
less reluctant to undergo CT colonography than screening colonoscopy.
Development of virtual bowel cleansing could further increase compliance
and thereby reduce mortality from colorectal cancer. Other articles
in this Feature Section discuss technical details of CT colonography
and its methodologic challenges.
and will cause 56,700 deaths in 2001, despite the availability of
screening tests capable of detecting the disease at earlier stages
and reducing mortality. This article reviews the natural history
of colorectal cancer, common risk factors and prevention strategies,
and the strengths, limitations, and cost effectiveness of available
screening tests. Although reminders to undergo colorectal cancer
screening have become commonplace in the popular media, compliance
with screening guidelines remains poor. Although still an unproven
technology for widespread screening, computed tomographic (CT) colonography
has several attractive characteristics for a screening test. For
example, CT scanners are widely available, in contrast to limited
numbers of gastroenterologists and radiologists' declining skill
and interest in barium enema examinations. Also, patients may be
less reluctant to undergo CT colonography than screening colonoscopy.
Development of virtual bowel cleansing could further increase compliance
and thereby reduce mortality from colorectal cancer. Other articles
in this Feature Section discuss technical details of CT colonography
and its methodologic challenges.
2001
Siebert, Uwe; Rothenbacher, D.; Daniel, U.; Brenner, H.
Demonstration of the healthy worker survivor effect in a cohort of workers in the construction industry Journal Article
In: Occup Environ Med, vol. 58, no. 12, pp. 774-9, 2001, ISSN: 1351-0711 (Print) 1351-0711 (Lin, ().
@article{Siebert2001,
title = {Demonstration of the healthy worker survivor effect in a cohort of workers in the construction industry},
author = {Uwe Siebert and D. Rothenbacher and U. Daniel and H. Brenner},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11706143},
issn = {1351-0711 (Print) 1351-0711 (Lin},
year = {2001},
date = {2001-12-01},
urldate = {2001-12-01},
journal = {Occup Environ Med},
volume = {58},
number = {12},
pages = {774-9},
abstract = {OBJECTIVES: To assess the potential of a healthy worker survivor effect
due to differential occupational mobility in a cohort of construction
workers. METHODS: A cohort of 10 809 male employees in the German
construction industry aged 15-64 years was followed up for occupational
mobility, early retirement due to permanent disability, and total
mortality from 1986 to 1994. Using the Cox's proportional hazards
model of relative rates (RRs) with 95% confidence intervals (95%
CIs) of occupational mobility, early retirement and total mortality
were estimated according to medical diagnoses at baseline after adjustment
for various covariates. RESULTS: During follow up, 2472 subjects
changed employment, 359 employees were granted a disability pension
for health reasons and 188 subjects died. A wide range of chronic
diseases was associated with increased rates of early retirement
and total mortality but not occupational mobility. However, a healthy
worker survivor effect was identified related to disorders of the
back and spine (ninth revision of the international classification
of diseases, ICD-9, code 720-4), a common predictor of both occupational
mobility (RR 1.17, 95% CI 1.04 to 1.32) and early retirement (RR
1.50, 95% CI 1.20 to 1.88). In total, there were about as many events of occupational changes (n = 41) as events of early retirement due to permanent disability (n = 39) significantly attributable to disorders
of the back and spine. Differential occupational mobility preceded
differential early retirement due to permanent disability by more
than one decade. CONCLUSIONS: These findings show the need to consider
a healthy worker survivor effect due to occupational mobility in
occupational epidemiological research. Furthermore these results
underline the necessity of further health promotion targeting work
related conditions in the construction industry.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: To assess the potential of a healthy worker survivor effect
due to differential occupational mobility in a cohort of construction
workers. METHODS: A cohort of 10 809 male employees in the German
construction industry aged 15-64 years was followed up for occupational
mobility, early retirement due to permanent disability, and total
mortality from 1986 to 1994. Using the Cox's proportional hazards
model of relative rates (RRs) with 95% confidence intervals (95%
CIs) of occupational mobility, early retirement and total mortality
were estimated according to medical diagnoses at baseline after adjustment
for various covariates. RESULTS: During follow up, 2472 subjects
changed employment, 359 employees were granted a disability pension
for health reasons and 188 subjects died. A wide range of chronic
diseases was associated with increased rates of early retirement
and total mortality but not occupational mobility. However, a healthy
worker survivor effect was identified related to disorders of the
back and spine (ninth revision of the international classification
of diseases, ICD-9, code 720-4), a common predictor of both occupational
mobility (RR 1.17, 95% CI 1.04 to 1.32) and early retirement (RR
1.50, 95% CI 1.20 to 1.88). In total, there were about as many events of occupational changes (n = 41) as events of early retirement due to permanent disability (n = 39) significantly attributable to disorders
of the back and spine. Differential occupational mobility preceded
differential early retirement due to permanent disability by more
than one decade. CONCLUSIONS: These findings show the need to consider
a healthy worker survivor effect due to occupational mobility in
occupational epidemiological research. Furthermore these results
underline the necessity of further health promotion targeting work
related conditions in the construction industry.
due to differential occupational mobility in a cohort of construction
workers. METHODS: A cohort of 10 809 male employees in the German
construction industry aged 15-64 years was followed up for occupational
mobility, early retirement due to permanent disability, and total
mortality from 1986 to 1994. Using the Cox's proportional hazards
model of relative rates (RRs) with 95% confidence intervals (95%
CIs) of occupational mobility, early retirement and total mortality
were estimated according to medical diagnoses at baseline after adjustment
for various covariates. RESULTS: During follow up, 2472 subjects
changed employment, 359 employees were granted a disability pension
for health reasons and 188 subjects died. A wide range of chronic
diseases was associated with increased rates of early retirement
and total mortality but not occupational mobility. However, a healthy
worker survivor effect was identified related to disorders of the
back and spine (ninth revision of the international classification
of diseases, ICD-9, code 720-4), a common predictor of both occupational
mobility (RR 1.17, 95% CI 1.04 to 1.32) and early retirement (RR
1.50, 95% CI 1.20 to 1.88). In total, there were about as many events of occupational changes (n = 41) as events of early retirement due to permanent disability (n = 39) significantly attributable to disorders
of the back and spine. Differential occupational mobility preceded
differential early retirement due to permanent disability by more
than one decade. CONCLUSIONS: These findings show the need to consider
a healthy worker survivor effect due to occupational mobility in
occupational epidemiological research. Furthermore these results
underline the necessity of further health promotion targeting work
related conditions in the construction industry.
Solbiati, L.; Livraghi, T.; Goldberg, S. N.; Ierace, T.; Meloni, F.; Dellanoce, M.; Cova, L.; Halpern, Elkan F.; Gazelle, G. Scott
Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients Journal Article
In: Radiology, vol. 221, no. 1, pp. 159-66, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Solbiati2001,
title = {Percutaneous radio-frequency ablation of hepatic metastases from
colorectal cancer: long-term results in 117 patients},
author = {L. Solbiati and T. Livraghi and S. N. Goldberg and T. Ierace and F. Meloni and M. Dellanoce and L. Cova and Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11568334},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-10-01},
journal = {Radiology},
volume = {221},
number = {1},
pages = {159-66},
abstract = {PURPOSE: To describe the results of an ongoing radio-frequency (RF)
ablation study in patients with hepatic metastases from colorectal
carcinoma. MATERIALS AND METHODS: In 117 patients, 179 metachronous
colorectal carcinoma hepatic metastases (0.9-9.6 cm in diameter)
were treated with RF ablation by using 17-gauge internally cooled
electrodes. Computed tomographic follow-up was performed every 4-6
months. Recurrent tumors were retreated when feasible. Time to new
metastases and death for each patient and time to local recurrence
for individual lesions were modeled with Kaplan-Meier analysis. Modeling
determined the effect of number of metastases on the time to new
metastases and death and effect of tumor size on local recurrence.
RESULTS: Estimated median survival was 36 months (95% CI; 28, 52
months). Estimated 1, 2, and 3-year survival rates were 93%, 69%,
and 46%, respectively. Survival was not significantly related to
number of metastases treated. In 77 (66%) of 117 patients, new metastases
were observed at follow-up. Estimated median time until new metastases
was 12 months (95% CI; 10, 18 months). Percentages of patients with
no new metastases after initial treatment at 1 and 2 years were 49%
and 35%, respectively. Time to new metastases was not significantly
related to number of metastases. Seventy (39%) of 179 lesions developed
local recurrence after treatment. Of these, 54 were observed by 6
months and 67 by 1 year. No local recurrence was observed after 18
months. Frequency and time to local recurrence were related to lesion size (P \< or =.001). CONCLUSION: RF ablation is an effective method
to treat hepatic metastases from colorectal carcinoma.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To describe the results of an ongoing radio-frequency (RF)
ablation study in patients with hepatic metastases from colorectal
carcinoma. MATERIALS AND METHODS: In 117 patients, 179 metachronous
colorectal carcinoma hepatic metastases (0.9-9.6 cm in diameter)
were treated with RF ablation by using 17-gauge internally cooled
electrodes. Computed tomographic follow-up was performed every 4-6
months. Recurrent tumors were retreated when feasible. Time to new
metastases and death for each patient and time to local recurrence
for individual lesions were modeled with Kaplan-Meier analysis. Modeling
determined the effect of number of metastases on the time to new
metastases and death and effect of tumor size on local recurrence.
RESULTS: Estimated median survival was 36 months (95% CI; 28, 52
months). Estimated 1, 2, and 3-year survival rates were 93%, 69%,
and 46%, respectively. Survival was not significantly related to
number of metastases treated. In 77 (66%) of 117 patients, new metastases
were observed at follow-up. Estimated median time until new metastases
was 12 months (95% CI; 10, 18 months). Percentages of patients with
no new metastases after initial treatment at 1 and 2 years were 49%
and 35%, respectively. Time to new metastases was not significantly
related to number of metastases. Seventy (39%) of 179 lesions developed
local recurrence after treatment. Of these, 54 were observed by 6
months and 67 by 1 year. No local recurrence was observed after 18
months. Frequency and time to local recurrence were related to lesion size (P < or =.001). CONCLUSION: RF ablation is an effective method
to treat hepatic metastases from colorectal carcinoma.
ablation study in patients with hepatic metastases from colorectal
carcinoma. MATERIALS AND METHODS: In 117 patients, 179 metachronous
colorectal carcinoma hepatic metastases (0.9-9.6 cm in diameter)
were treated with RF ablation by using 17-gauge internally cooled
electrodes. Computed tomographic follow-up was performed every 4-6
months. Recurrent tumors were retreated when feasible. Time to new
metastases and death for each patient and time to local recurrence
for individual lesions were modeled with Kaplan-Meier analysis. Modeling
determined the effect of number of metastases on the time to new
metastases and death and effect of tumor size on local recurrence.
RESULTS: Estimated median survival was 36 months (95% CI; 28, 52
months). Estimated 1, 2, and 3-year survival rates were 93%, 69%,
and 46%, respectively. Survival was not significantly related to
number of metastases treated. In 77 (66%) of 117 patients, new metastases
were observed at follow-up. Estimated median time until new metastases
was 12 months (95% CI; 10, 18 months). Percentages of patients with
no new metastases after initial treatment at 1 and 2 years were 49%
and 35%, respectively. Time to new metastases was not significantly
related to number of metastases. Seventy (39%) of 179 lesions developed
local recurrence after treatment. Of these, 54 were observed by 6
months and 67 by 1 year. No local recurrence was observed after 18
months. Frequency and time to local recurrence were related to lesion size (P < or =.001). CONCLUSION: RF ablation is an effective method
to treat hepatic metastases from colorectal carcinoma.
McMahon, Pamela M.; Halpern, Elkan F.; Castillo, C. Fernandez-del; Clark, J. W.; Gazelle, G. Scott
Pancreatic cancer: cost-effectiveness of imaging technologies for assessing resectability Journal Article
In: Radiology, vol. 221, no. 1, pp. 93-106, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{McMahon2001,
title = {Pancreatic cancer: cost-effectiveness of imaging technologies for
assessing resectability},
author = {Pamela M. McMahon and Elkan F. Halpern and C. Fernandez-del Castillo and J. W. Clark and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11568326},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-10-01},
journal = {Radiology},
volume = {221},
number = {1},
pages = {93-106},
abstract = {PURPOSE: To evaluate the cost-effectiveness of imaging strategies
for the assessment of resectability in patients with pancreatic cancer.
MATERIALS AND METHODS: A decision model was developed to calculate
costs and benefits (survival) accruing to hypothetical cohorts of
patients with known or suspected pancreatic cancer. Results are presented
as cost per life-year gained under various scenarios and assumptions
of diagnostic test characteristics, surgical mortality, disease characteristics,
and costs. RESULTS: With best estimates for all data inputs, the
strategy of computed tomography (CT) followed by laparoscopy and
laparoscopic ultrasonography (US) had an incremental cost-effectiveness
ratio of $87,502 per life-year gained, compared with best supportive
care. This strategy was significantly more cost-effective than CT
followed by magnetic resonance (MR) imaging and was significantly
less expensive than other imaging strategies while providing a statistically
and clinically insignificant difference in life-year gains. A strategy
involving no imaging (immediate surgery) was more expensive but less
effective than all imaging strategies. A hypothetical perfect test
with cost equal to that of CT followed by MR had an incremental cost-effectiveness
ratio of $64,401 per life-year gained, compared to best supportive
care. CONCLUSION: Most available imaging tests for assessing resectability
of pancreatic cancer do not differ in effectiveness, but a strategy
of CT, laparoscopy, and laparoscopic US would consistently result
in significantly lower costs than other imaging tests under a wide
range of scenarios.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To evaluate the cost-effectiveness of imaging strategies
for the assessment of resectability in patients with pancreatic cancer.
MATERIALS AND METHODS: A decision model was developed to calculate
costs and benefits (survival) accruing to hypothetical cohorts of
patients with known or suspected pancreatic cancer. Results are presented
as cost per life-year gained under various scenarios and assumptions
of diagnostic test characteristics, surgical mortality, disease characteristics,
and costs. RESULTS: With best estimates for all data inputs, the
strategy of computed tomography (CT) followed by laparoscopy and
laparoscopic ultrasonography (US) had an incremental cost-effectiveness
ratio of $87,502 per life-year gained, compared with best supportive
care. This strategy was significantly more cost-effective than CT
followed by magnetic resonance (MR) imaging and was significantly
less expensive than other imaging strategies while providing a statistically
and clinically insignificant difference in life-year gains. A strategy
involving no imaging (immediate surgery) was more expensive but less
effective than all imaging strategies. A hypothetical perfect test
with cost equal to that of CT followed by MR had an incremental cost-effectiveness
ratio of $64,401 per life-year gained, compared to best supportive
care. CONCLUSION: Most available imaging tests for assessing resectability
of pancreatic cancer do not differ in effectiveness, but a strategy
of CT, laparoscopy, and laparoscopic US would consistently result
in significantly lower costs than other imaging tests under a wide
range of scenarios.
for the assessment of resectability in patients with pancreatic cancer.
MATERIALS AND METHODS: A decision model was developed to calculate
costs and benefits (survival) accruing to hypothetical cohorts of
patients with known or suspected pancreatic cancer. Results are presented
as cost per life-year gained under various scenarios and assumptions
of diagnostic test characteristics, surgical mortality, disease characteristics,
and costs. RESULTS: With best estimates for all data inputs, the
strategy of computed tomography (CT) followed by laparoscopy and
laparoscopic ultrasonography (US) had an incremental cost-effectiveness
ratio of $87,502 per life-year gained, compared with best supportive
care. This strategy was significantly more cost-effective than CT
followed by magnetic resonance (MR) imaging and was significantly
less expensive than other imaging strategies while providing a statistically
and clinically insignificant difference in life-year gains. A strategy
involving no imaging (immediate surgery) was more expensive but less
effective than all imaging strategies. A hypothetical perfect test
with cost equal to that of CT followed by MR had an incremental cost-effectiveness
ratio of $64,401 per life-year gained, compared to best supportive
care. CONCLUSION: Most available imaging tests for assessing resectability
of pancreatic cancer do not differ in effectiveness, but a strategy
of CT, laparoscopy, and laparoscopic US would consistently result
in significantly lower costs than other imaging tests under a wide
range of scenarios.
Gleason, S.; Furie, K. L.; Lev, M. H.; O'Donnell, J.; McMahon, Pamela M.; Beinfeld, M. T.; Halpern, Elkan F.; Mullins, M.; Harris, G.; Koroshetz, W. J.; Gazelle, G. Scott
Potential influence of acute CT on inpatient costs in patients with ischemic stroke Journal Article
In: Acad Radiol, vol. 8, no. 10, pp. 955-64, 2001, ISSN: 1076-6332 (Print) 1076-6332 (Lin, ().
@article{Gleason2001,
title = {Potential influence of acute CT on inpatient costs in patients with
ischemic stroke},
author = {S. Gleason and K. L. Furie and M. H. Lev and J. O'Donnell and Pamela M. McMahon and M. T. Beinfeld and Elkan F. Halpern and M. Mullins and G. Harris and W. J. Koroshetz and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11699848},
issn = {1076-6332 (Print) 1076-6332 (Lin},
year = {2001},
date = {2001-10-01},
journal = {Acad Radiol},
volume = {8},
number = {10},
pages = {955-64},
abstract = {RATIONALE AND OBJECTIVES: Patients presenting with ischemic brain
symptoms have widely variable outcomes dependent to some degree on
the pathologic basis of their stroke syndrome. The purpose of this
study was to determine the cost implications of the emergency use
of a computed tomographic (CT) protocol comprising unenhanced CT,
head and neck CT angiography, and whole-brain CT perfusion. MATERIALS
AND METHODS: By using a retrospective patient database from a tertiary
care facility and publicly available cost data, the authors derived
the potential savings from the use of CT angiography. CT perfusion,
or both at hospital arrival by means of a cost model. The cost of
the CT angiography-CT perfusion protocol was determined from Medicare
reimbursement rates and compared with that of traditional imaging
protocols. Cost savings were estimated as a decrease in the length
of stay for most stroke patients, whereas the most benign (lacunar)
strokes were assumed to be managed in a non-acute setting. Misdiagnosis
cost (erroneously not admitting a patient with nonlacunar stroke)
was calculated as the cost of a severe complication. Sensitivity
testing included varying the percentage of misdiagnosed patients
and admitting patients with lacunar stroke. RESULTS: The nationwide
net savings that would result from the adoption of the CT angiography-CT
perfusion protocol are in the $1.2 billion range (-$154 million to
$2.1 billion) when patients with lacunar strokes are treated nonacutely
and $1.8 billion when those patients are admitted for acute care.
CONCLUSION: The results demonstrate the potential effect of implementing
a CT angiography-CT perfusion protocol. In particular, prompt CT
angiography-CT perfusion imaging could have an effect on the cost
of acute care in the treatment of stroke.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
RATIONALE AND OBJECTIVES: Patients presenting with ischemic brain
symptoms have widely variable outcomes dependent to some degree on
the pathologic basis of their stroke syndrome. The purpose of this
study was to determine the cost implications of the emergency use
of a computed tomographic (CT) protocol comprising unenhanced CT,
head and neck CT angiography, and whole-brain CT perfusion. MATERIALS
AND METHODS: By using a retrospective patient database from a tertiary
care facility and publicly available cost data, the authors derived
the potential savings from the use of CT angiography. CT perfusion,
or both at hospital arrival by means of a cost model. The cost of
the CT angiography-CT perfusion protocol was determined from Medicare
reimbursement rates and compared with that of traditional imaging
protocols. Cost savings were estimated as a decrease in the length
of stay for most stroke patients, whereas the most benign (lacunar)
strokes were assumed to be managed in a non-acute setting. Misdiagnosis
cost (erroneously not admitting a patient with nonlacunar stroke)
was calculated as the cost of a severe complication. Sensitivity
testing included varying the percentage of misdiagnosed patients
and admitting patients with lacunar stroke. RESULTS: The nationwide
net savings that would result from the adoption of the CT angiography-CT
perfusion protocol are in the $1.2 billion range (-$154 million to
$2.1 billion) when patients with lacunar strokes are treated nonacutely
and $1.8 billion when those patients are admitted for acute care.
CONCLUSION: The results demonstrate the potential effect of implementing
a CT angiography-CT perfusion protocol. In particular, prompt CT
angiography-CT perfusion imaging could have an effect on the cost
of acute care in the treatment of stroke.
symptoms have widely variable outcomes dependent to some degree on
the pathologic basis of their stroke syndrome. The purpose of this
study was to determine the cost implications of the emergency use
of a computed tomographic (CT) protocol comprising unenhanced CT,
head and neck CT angiography, and whole-brain CT perfusion. MATERIALS
AND METHODS: By using a retrospective patient database from a tertiary
care facility and publicly available cost data, the authors derived
the potential savings from the use of CT angiography. CT perfusion,
or both at hospital arrival by means of a cost model. The cost of
the CT angiography-CT perfusion protocol was determined from Medicare
reimbursement rates and compared with that of traditional imaging
protocols. Cost savings were estimated as a decrease in the length
of stay for most stroke patients, whereas the most benign (lacunar)
strokes were assumed to be managed in a non-acute setting. Misdiagnosis
cost (erroneously not admitting a patient with nonlacunar stroke)
was calculated as the cost of a severe complication. Sensitivity
testing included varying the percentage of misdiagnosed patients
and admitting patients with lacunar stroke. RESULTS: The nationwide
net savings that would result from the adoption of the CT angiography-CT
perfusion protocol are in the $1.2 billion range (-$154 million to
$2.1 billion) when patients with lacunar strokes are treated nonacutely
and $1.8 billion when those patients are admitted for acute care.
CONCLUSION: The results demonstrate the potential effect of implementing
a CT angiography-CT perfusion protocol. In particular, prompt CT
angiography-CT perfusion imaging could have an effect on the cost
of acute care in the treatment of stroke.
Grant, P. E.; He, J.; Halpern, Elkan F.; Wu, O.; Schaefer, P. W.; Schwamm, L. H.; Budzik, R. F.; Sorensen, A. G.; Koroshetz, W. J.; Gonzalez, R. G.
Frequency and clinical context of decreased apparent diffusion coefficient reversal in the human brain Journal Article
In: Radiology, vol. 221, no. 1, pp. 43-50, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Grant2001,
title = {Frequency and clinical context of decreased apparent diffusion coefficient
reversal in the human brain},
author = {P. E. Grant and J. He and Elkan F. Halpern and O. Wu and P. W. Schaefer and L. H. Schwamm and R. F. Budzik and A. G. Sorensen and W. J. Koroshetz and R. G. Gonzalez},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11568319},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-10-01},
journal = {Radiology},
volume = {221},
number = {1},
pages = {43-50},
abstract = {PURPOSE: To determine the probability that regions of decreased apparent
diffusion coefficient (ADC) return to normal without persistent symptoms
or T2 change and the settings in which these ADC reversals occur.
MATERIALS AND METHODS: Three hundred magnetic resonance (MR) imaging
studies were selected at random from a database of 7,147 examinations
to determine the probability of a pathologically decreased ADC. In
cases with decreased ADC, the clinical history was recorded and,
if available, follow-up MR imaging findings were evaluated. Five
cases of ADC reversal became known during the same period and were
evaluated to determine the initial ADC decrease, clinical outcome,
and findings at follow-up imaging. RESULTS: Findings in 116 of 300
MR imaging studies revealed regions of decreased ADC. In 49 of 116
studies, follow-up MR imaging examinations were performed at least
4 weeks after the onset of symptoms; ADC did not reverse. Five cases
of ADC reversal were identified in the same period, giving an estimated
0.2%-0.4% probability of ADC reversal. Clinical settings were venous sinus thrombosis and seizure (n = 3), hemiplegic migraine (n = 1), and hyperacute arterial infarction (n = 1). Both white matter (n = 3) and gray matter (n = 3) regions were involved. CONCLUSION: Reversal
of ADC lesions is rare, occurs in complicated clinical settings,
and can involve white or gray matter.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine the probability that regions of decreased apparent
diffusion coefficient (ADC) return to normal without persistent symptoms
or T2 change and the settings in which these ADC reversals occur.
MATERIALS AND METHODS: Three hundred magnetic resonance (MR) imaging
studies were selected at random from a database of 7,147 examinations
to determine the probability of a pathologically decreased ADC. In
cases with decreased ADC, the clinical history was recorded and,
if available, follow-up MR imaging findings were evaluated. Five
cases of ADC reversal became known during the same period and were
evaluated to determine the initial ADC decrease, clinical outcome,
and findings at follow-up imaging. RESULTS: Findings in 116 of 300
MR imaging studies revealed regions of decreased ADC. In 49 of 116
studies, follow-up MR imaging examinations were performed at least
4 weeks after the onset of symptoms; ADC did not reverse. Five cases
of ADC reversal were identified in the same period, giving an estimated
0.2%-0.4% probability of ADC reversal. Clinical settings were venous sinus thrombosis and seizure (n = 3), hemiplegic migraine (n = 1), and hyperacute arterial infarction (n = 1). Both white matter (n = 3) and gray matter (n = 3) regions were involved. CONCLUSION: Reversal
of ADC lesions is rare, occurs in complicated clinical settings,
and can involve white or gray matter.
diffusion coefficient (ADC) return to normal without persistent symptoms
or T2 change and the settings in which these ADC reversals occur.
MATERIALS AND METHODS: Three hundred magnetic resonance (MR) imaging
studies were selected at random from a database of 7,147 examinations
to determine the probability of a pathologically decreased ADC. In
cases with decreased ADC, the clinical history was recorded and,
if available, follow-up MR imaging findings were evaluated. Five
cases of ADC reversal became known during the same period and were
evaluated to determine the initial ADC decrease, clinical outcome,
and findings at follow-up imaging. RESULTS: Findings in 116 of 300
MR imaging studies revealed regions of decreased ADC. In 49 of 116
studies, follow-up MR imaging examinations were performed at least
4 weeks after the onset of symptoms; ADC did not reverse. Five cases
of ADC reversal were identified in the same period, giving an estimated
0.2%-0.4% probability of ADC reversal. Clinical settings were venous sinus thrombosis and seizure (n = 3), hemiplegic migraine (n = 1), and hyperacute arterial infarction (n = 1). Both white matter (n = 3) and gray matter (n = 3) regions were involved. CONCLUSION: Reversal
of ADC lesions is rare, occurs in complicated clinical settings,
and can involve white or gray matter.
Jhaveri, K. S.; Saini, S.; Levine, L. A.; Piazzo, D. J.; Doncaster, R. J.; Halpern, Elkan F.; Jordan, P. F.; Thrall, J. H.
Effect of multislice CT technology on scanner productivity Journal Article
In: AJR Am J Roentgenol, vol. 177, no. 4, pp. 769-72, 2001, ISSN: 0361-803X (Print) 0361-803X (Lin, ().
@article{Jhaveri2001,
title = {Effect of multislice CT technology on scanner productivity},
author = {K. S. Jhaveri and S. Saini and L. A. Levine and D. J. Piazzo and R. J. Doncaster and Elkan F. Halpern and P. F. Jordan and J. H. Thrall},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11566670},
issn = {0361-803X (Print) 0361-803X (Lin},
year = {2001},
date = {2001-10-01},
urldate = {2001-10-01},
journal = {AJR Am J Roentgenol},
volume = {177},
number = {4},
pages = {769-72},
abstract = {OBJECTIVE: In this study we analyzed the impact of multislice CT technology
on scanner productivity in a tertiary care medical center. MATERIALS
AND METHODS: We compared the productivity of two diagnostic CT scanners
during the periods January 1 to August 31, 1999 (when both scanners
had single-slice CT capability) and January 1 to August 31, 2000
(when one of these scanners was replaced with a multislice CT scanner).
The scanners were used primarily for outpatients during the day shift
and for inpatients during the evening shift; the demand for CT services
was stable. For this analysis, we queried the hospital's radiology
information system and identified the number of CT examinations performed
during the two analysis periods. We also determined the examination
mix, including proportion of enhanced and unenhanced examinations
and the anatomic region examined, to ensure comparable patient populations.
Statistical analysis was performed. RESULTS: The number of CT studies
performed on the two scanners increased by 1772 (13.1%) from 13,548
(before multislice CT) to 15,320 (when multislice CT was available).
The number of examinations enhanced with contrast media increased
from 52% to 65%. Between 9:00 A.M. and 5:00 P.M., the number of CT
examinations was similar on the single-slice scanners in the two
periods (p \> 0.05). However, in the period when multislice CT was
available, the number of studies performed on the multislice scanner
(5919) was 51.9% higher than those performed using the single-slice
scanner (3896) (p \< 0.0006). CONCLUSION: Using a multislice CT scanner
leads to an increase in CT productivity, even though multislice studies
are performed using more complicated protocols than are used on a
single-slice CT scanner.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: In this study we analyzed the impact of multislice CT technology
on scanner productivity in a tertiary care medical center. MATERIALS
AND METHODS: We compared the productivity of two diagnostic CT scanners
during the periods January 1 to August 31, 1999 (when both scanners
had single-slice CT capability) and January 1 to August 31, 2000
(when one of these scanners was replaced with a multislice CT scanner).
The scanners were used primarily for outpatients during the day shift
and for inpatients during the evening shift; the demand for CT services
was stable. For this analysis, we queried the hospital's radiology
information system and identified the number of CT examinations performed
during the two analysis periods. We also determined the examination
mix, including proportion of enhanced and unenhanced examinations
and the anatomic region examined, to ensure comparable patient populations.
Statistical analysis was performed. RESULTS: The number of CT studies
performed on the two scanners increased by 1772 (13.1%) from 13,548
(before multislice CT) to 15,320 (when multislice CT was available).
The number of examinations enhanced with contrast media increased
from 52% to 65%. Between 9:00 A.M. and 5:00 P.M., the number of CT
examinations was similar on the single-slice scanners in the two
periods (p > 0.05). However, in the period when multislice CT was
available, the number of studies performed on the multislice scanner
(5919) was 51.9% higher than those performed using the single-slice
scanner (3896) (p < 0.0006). CONCLUSION: Using a multislice CT scanner
leads to an increase in CT productivity, even though multislice studies
are performed using more complicated protocols than are used on a
single-slice CT scanner.
on scanner productivity in a tertiary care medical center. MATERIALS
AND METHODS: We compared the productivity of two diagnostic CT scanners
during the periods January 1 to August 31, 1999 (when both scanners
had single-slice CT capability) and January 1 to August 31, 2000
(when one of these scanners was replaced with a multislice CT scanner).
The scanners were used primarily for outpatients during the day shift
and for inpatients during the evening shift; the demand for CT services
was stable. For this analysis, we queried the hospital's radiology
information system and identified the number of CT examinations performed
during the two analysis periods. We also determined the examination
mix, including proportion of enhanced and unenhanced examinations
and the anatomic region examined, to ensure comparable patient populations.
Statistical analysis was performed. RESULTS: The number of CT studies
performed on the two scanners increased by 1772 (13.1%) from 13,548
(before multislice CT) to 15,320 (when multislice CT was available).
The number of examinations enhanced with contrast media increased
from 52% to 65%. Between 9:00 A.M. and 5:00 P.M., the number of CT
examinations was similar on the single-slice scanners in the two
periods (p > 0.05). However, in the period when multislice CT was
available, the number of studies performed on the multislice scanner
(5919) was 51.9% higher than those performed using the single-slice
scanner (3896) (p < 0.0006). CONCLUSION: Using a multislice CT scanner
leads to an increase in CT productivity, even though multislice studies
are performed using more complicated protocols than are used on a
single-slice CT scanner.
Bosch, Johanna; Beinfeld, M. T.; Halpern, Elkan F.; Lester, J. S.; Gazelle, G. Scott
Endovascular versus open surgical elective repair of infrarenal abdominal aortic aneurysm: predictors of patient discharge destination Journal Article
In: Radiology, vol. 220, no. 3, pp. 576-80, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Bosch2001,
title = {Endovascular versus open surgical elective repair of infrarenal abdominal aortic aneurysm: predictors of patient discharge destination},
author = {Johanna Bosch and M. T. Beinfeld and Elkan F. Halpern and J. S. Lester and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11526250},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-09-01},
urldate = {2001-09-01},
journal = {Radiology},
volume = {220},
number = {3},
pages = {576-80},
abstract = {PURPOSE: To evaluate patient discharge destination after elective
endovascular or open surgical repair of infrarenal abdominal aortic
aneurysm and to determine predictors for discharge to home or to
a rehabilitation center. MATERIALS AND METHODS: All patients electively
treated for infrarenal abdominal aortic aneurysm with endovascular repair (n = 182) or open surgery (n = 274) between January 1997 and
September 1999 were included. From the hospital database, information
on discharge destination, patient characteristics, complications,
and length of stay was retrieved. Multiple logistic regression analysis
was performed to determine predictors for discharge to home or to
a rehabilitation center. RESULTS: Patient characteristics did not
differ significantly between the treatment groups, with the exception
of age (mean age, 75.1 vs 72.9 years in the endovascular and open surgical group, respectively; P =.005). Patient discharge destinations differed significantly between the treatment groups (P =.001). After
endovascular procedures, 156 (85.7%) of 182 patients went home and
19 (10.4%) of 182 patients went to a rehabilitation center. After
open surgery, 187 (68.2%) of 274 patients went home and 64 (23.4%)
of 274 patients went to a rehabilitation center. The odds ratio of
discharge to a rehabilitation center, instead of home, following
endovascular procedures versus open surgery was 0.23 (95% CI: 0.13,
0.43). CONCLUSION: Following elective repair of infrarenal abdominal
aortic aneurysm, significantly more patients went home after an endovascular
procedure than after open surgery. Procedure type was a significant
predictor of discharge destination.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To evaluate patient discharge destination after elective
endovascular or open surgical repair of infrarenal abdominal aortic
aneurysm and to determine predictors for discharge to home or to
a rehabilitation center. MATERIALS AND METHODS: All patients electively
treated for infrarenal abdominal aortic aneurysm with endovascular repair (n = 182) or open surgery (n = 274) between January 1997 and
September 1999 were included. From the hospital database, information
on discharge destination, patient characteristics, complications,
and length of stay was retrieved. Multiple logistic regression analysis
was performed to determine predictors for discharge to home or to
a rehabilitation center. RESULTS: Patient characteristics did not
differ significantly between the treatment groups, with the exception
of age (mean age, 75.1 vs 72.9 years in the endovascular and open surgical group, respectively; P =.005). Patient discharge destinations differed significantly between the treatment groups (P =.001). After
endovascular procedures, 156 (85.7%) of 182 patients went home and
19 (10.4%) of 182 patients went to a rehabilitation center. After
open surgery, 187 (68.2%) of 274 patients went home and 64 (23.4%)
of 274 patients went to a rehabilitation center. The odds ratio of
discharge to a rehabilitation center, instead of home, following
endovascular procedures versus open surgery was 0.23 (95% CI: 0.13,
0.43). CONCLUSION: Following elective repair of infrarenal abdominal
aortic aneurysm, significantly more patients went home after an endovascular
procedure than after open surgery. Procedure type was a significant
predictor of discharge destination.
endovascular or open surgical repair of infrarenal abdominal aortic
aneurysm and to determine predictors for discharge to home or to
a rehabilitation center. MATERIALS AND METHODS: All patients electively
treated for infrarenal abdominal aortic aneurysm with endovascular repair (n = 182) or open surgery (n = 274) between January 1997 and
September 1999 were included. From the hospital database, information
on discharge destination, patient characteristics, complications,
and length of stay was retrieved. Multiple logistic regression analysis
was performed to determine predictors for discharge to home or to
a rehabilitation center. RESULTS: Patient characteristics did not
differ significantly between the treatment groups, with the exception
of age (mean age, 75.1 vs 72.9 years in the endovascular and open surgical group, respectively; P =.005). Patient discharge destinations differed significantly between the treatment groups (P =.001). After
endovascular procedures, 156 (85.7%) of 182 patients went home and
19 (10.4%) of 182 patients went to a rehabilitation center. After
open surgery, 187 (68.2%) of 274 patients went home and 64 (23.4%)
of 274 patients went to a rehabilitation center. The odds ratio of
discharge to a rehabilitation center, instead of home, following
endovascular procedures versus open surgery was 0.23 (95% CI: 0.13,
0.43). CONCLUSION: Following elective repair of infrarenal abdominal
aortic aneurysm, significantly more patients went home after an endovascular
procedure than after open surgery. Procedure type was a significant
predictor of discharge destination.
Vidrih, J. A.; Walensky, R. P.; Sax, P. E.; Freedberg, K. A.
Positive Epstein-Barr virus heterophile antibody tests in patients with primary human immunodeficiency virus infection Journal Article
In: Am J Med, vol. 111, no. 3, pp. 192-4, 2001, ISSN: 0002-9343 (Print) 0002-9343 (Lin, ().
@article{Vidrih2001,
title = {Positive Epstein-Barr virus heterophile antibody tests in patients
with primary human immunodeficiency virus infection},
author = {J. A. Vidrih and R. P. Walensky and P. E. Sax and K. A. Freedberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11530029},
issn = {0002-9343 (Print) 0002-9343 (Lin},
year = {2001},
date = {2001-08-01},
journal = {Am J Med},
volume = {111},
number = {3},
pages = {192-4},
abstract = {PURPOSE: To describe three cases of primary human immunodeficiency
virus (HIV) infection in patients who had laboratory studies consistent
with infectious mononucleosis. SUBJECTS: We describe 3 patients who
presented with a viral syndrome, had a positive heterophile antibody
test, and were diagnosed with primary HIV infection. RESULTS: The
results of Epstein-Barr virus serology studies in each of these patients
were consistent with chronic, but not acute, Epstein-Barr virus infection.
HIV antibody tests were negative, and HIV RNA was \>500,000 copies/mL
in each patient. CONCLUSIONS: Clinicians should recognize that a
positive heterophile antibody test in the setting of an acute viral
illness does not exclude the diagnosis of primary HIV infection,
although reactivation of latent Epstein-Barr virus infection cannot
be ruled out. Patients presenting with nonspecific viral syndromes
should be assessed for HIV risk behaviors and tested for primary
HIV infection when appropriate.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To describe three cases of primary human immunodeficiency
virus (HIV) infection in patients who had laboratory studies consistent
with infectious mononucleosis. SUBJECTS: We describe 3 patients who
presented with a viral syndrome, had a positive heterophile antibody
test, and were diagnosed with primary HIV infection. RESULTS: The
results of Epstein-Barr virus serology studies in each of these patients
were consistent with chronic, but not acute, Epstein-Barr virus infection.
HIV antibody tests were negative, and HIV RNA was >500,000 copies/mL
in each patient. CONCLUSIONS: Clinicians should recognize that a
positive heterophile antibody test in the setting of an acute viral
illness does not exclude the diagnosis of primary HIV infection,
although reactivation of latent Epstein-Barr virus infection cannot
be ruled out. Patients presenting with nonspecific viral syndromes
should be assessed for HIV risk behaviors and tested for primary
HIV infection when appropriate.
virus (HIV) infection in patients who had laboratory studies consistent
with infectious mononucleosis. SUBJECTS: We describe 3 patients who
presented with a viral syndrome, had a positive heterophile antibody
test, and were diagnosed with primary HIV infection. RESULTS: The
results of Epstein-Barr virus serology studies in each of these patients
were consistent with chronic, but not acute, Epstein-Barr virus infection.
HIV antibody tests were negative, and HIV RNA was >500,000 copies/mL
in each patient. CONCLUSIONS: Clinicians should recognize that a
positive heterophile antibody test in the setting of an acute viral
illness does not exclude the diagnosis of primary HIV infection,
although reactivation of latent Epstein-Barr virus infection cannot
be ruled out. Patients presenting with nonspecific viral syndromes
should be assessed for HIV risk behaviors and tested for primary
HIV infection when appropriate.
Walensky, R. P.; Rosenberg, E. S.; Ferraro, M. J.; Losina, E.; Walker, B. D.; Freedberg, K. A.
Investigation of primary human immunodeficiency virus infection in patients who test positive for heterophile antibody Journal Article
In: Clin Infect Dis, vol. 33, no. 4, pp. 570-2, 2001, ISSN: 1058-4838 (Print) 1058-4838 (Lin, ().
@article{Walensky2001,
title = {Investigation of primary human immunodeficiency virus infection in patients who test positive for heterophile antibody},
author = {R. P. Walensky and E. S. Rosenberg and M. J. Ferraro and E. Losina and B. D. Walker and K. A. Freedberg},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11462197},
issn = {1058-4838 (Print) 1058-4838 (Lin},
year = {2001},
date = {2001-08-01},
urldate = {2001-08-01},
journal = {Clin Infect Dis},
volume = {33},
number = {4},
pages = {570-2},
abstract = {In light of a recent report of 3 false-positive results of Epstein-Barr
virus heterophile tests caused by HIV infection, we sought to assess
the frequency of this occurrence. One hundred thirty-two positive
heterophile antibody-tested serum samples were obtained from 2 tertiary
care facilities in Boston to assess for HIV, and all tested negative
for HIV plasma RNA. This study shows that false-positive results
of heterophile tests are not frequently associated with primary HIV
infection.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In light of a recent report of 3 false-positive results of Epstein-Barr
virus heterophile tests caused by HIV infection, we sought to assess
the frequency of this occurrence. One hundred thirty-two positive
heterophile antibody-tested serum samples were obtained from 2 tertiary
care facilities in Boston to assess for HIV, and all tested negative
for HIV plasma RNA. This study shows that false-positive results
of heterophile tests are not frequently associated with primary HIV
infection.
virus heterophile tests caused by HIV infection, we sought to assess
the frequency of this occurrence. One hundred thirty-two positive
heterophile antibody-tested serum samples were obtained from 2 tertiary
care facilities in Boston to assess for HIV, and all tested negative
for HIV plasma RNA. This study shows that false-positive results
of heterophile tests are not frequently associated with primary HIV
infection.
Wittenberg, Eve; Goldie, S. J.; Graham, J. D.
Predictors of hazardous child seating behavior in fatal motor vehicle crashes: 1990 to 1998 Journal Article
In: Pediatrics, vol. 108, no. 2, pp. 438-42, 2001, ISSN: 1098-4275 (Electronic) 0031-4005, ().
@article{Wittenberg2001,
title = {Predictors of hazardous child seating behavior in fatal motor vehicle
crashes: 1990 to 1998},
author = {Eve Wittenberg and S. J. Goldie and J. D. Graham},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11483812},
issn = {1098-4275 (Electronic) 0031-4005},
year = {2001},
date = {2001-08-01},
journal = {Pediatrics},
volume = {108},
number = {2},
pages = {438-42},
abstract = {OBJECTIVE: Motor vehicle crashes are the leading cause of death in
children ages 5 to 14. Children seated in the front seats of vehicles
are at increased risk of death and injury in crashes, particularly
in vehicles with passenger-side air bags. This study identifies factors
associated with the seating of children in the front seats of vehicles
involved in fatal crashes between 1990 and 1998. METHODS: Using 1990
to 1998 data from the Fatal Analysis Reporting System, a US census
of motor vehicle crashes involving a fatality, multivariable logistic
regression was used to model the association between child seating
behavior and vehicle, driver, and occupant characteristics. RESULTS:
The proportion of vehicles carrying children in the front declined
from 42% to 31% over the 9-year period. Controlling for driver and
vehicle characteristics, the risk of front-seating declined between
1990 and 1998, and this risk was smaller in vehicles carrying only younger children (\</=6 years) than in those carrying older children.
In the 3 years after the introduction of dual air bags into a significant
proportion of the passenger fleet in late 1995, dual air bags were
associated with fewer children being seated in the front seat. By
the end of 1998, traveling in a vehicle with dual air bags and only
children age 6 or younger was associated with a 95% lower chance of a child being seated in the front (odds ratio = 0.05; 95% confidence
interval: 0.04-0.08). An important factor in safer seating position
was the presence of multiple passengers, especially an older one,
and children were at higher risk of front-seating when they traveled
alone with the driver. CONCLUSIONS: The 1990s saw a decline in front-seating
of children in vehicles involved in fatal crashes among all types
of vehicles and drivers. Although this trend is encouraging, children
ages 6 to 12 and children traveling alone with the driver remain
at higher risk of being seated in the front. These traveling situations
should be targeted for behavioral safety interventions to improve
child motor vehicle safety.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: Motor vehicle crashes are the leading cause of death in
children ages 5 to 14. Children seated in the front seats of vehicles
are at increased risk of death and injury in crashes, particularly
in vehicles with passenger-side air bags. This study identifies factors
associated with the seating of children in the front seats of vehicles
involved in fatal crashes between 1990 and 1998. METHODS: Using 1990
to 1998 data from the Fatal Analysis Reporting System, a US census
of motor vehicle crashes involving a fatality, multivariable logistic
regression was used to model the association between child seating
behavior and vehicle, driver, and occupant characteristics. RESULTS:
The proportion of vehicles carrying children in the front declined
from 42% to 31% over the 9-year period. Controlling for driver and
vehicle characteristics, the risk of front-seating declined between
1990 and 1998, and this risk was smaller in vehicles carrying only younger children (</=6 years) than in those carrying older children.
In the 3 years after the introduction of dual air bags into a significant
proportion of the passenger fleet in late 1995, dual air bags were
associated with fewer children being seated in the front seat. By
the end of 1998, traveling in a vehicle with dual air bags and only
children age 6 or younger was associated with a 95% lower chance of a child being seated in the front (odds ratio = 0.05; 95% confidence
interval: 0.04-0.08). An important factor in safer seating position
was the presence of multiple passengers, especially an older one,
and children were at higher risk of front-seating when they traveled
alone with the driver. CONCLUSIONS: The 1990s saw a decline in front-seating
of children in vehicles involved in fatal crashes among all types
of vehicles and drivers. Although this trend is encouraging, children
ages 6 to 12 and children traveling alone with the driver remain
at higher risk of being seated in the front. These traveling situations
should be targeted for behavioral safety interventions to improve
child motor vehicle safety.
children ages 5 to 14. Children seated in the front seats of vehicles
are at increased risk of death and injury in crashes, particularly
in vehicles with passenger-side air bags. This study identifies factors
associated with the seating of children in the front seats of vehicles
involved in fatal crashes between 1990 and 1998. METHODS: Using 1990
to 1998 data from the Fatal Analysis Reporting System, a US census
of motor vehicle crashes involving a fatality, multivariable logistic
regression was used to model the association between child seating
behavior and vehicle, driver, and occupant characteristics. RESULTS:
The proportion of vehicles carrying children in the front declined
from 42% to 31% over the 9-year period. Controlling for driver and
vehicle characteristics, the risk of front-seating declined between
1990 and 1998, and this risk was smaller in vehicles carrying only younger children (</=6 years) than in those carrying older children.
In the 3 years after the introduction of dual air bags into a significant
proportion of the passenger fleet in late 1995, dual air bags were
associated with fewer children being seated in the front seat. By
the end of 1998, traveling in a vehicle with dual air bags and only
children age 6 or younger was associated with a 95% lower chance of a child being seated in the front (odds ratio = 0.05; 95% confidence
interval: 0.04-0.08). An important factor in safer seating position
was the presence of multiple passengers, especially an older one,
and children were at higher risk of front-seating when they traveled
alone with the driver. CONCLUSIONS: The 1990s saw a decline in front-seating
of children in vehicles involved in fatal crashes among all types
of vehicles and drivers. Although this trend is encouraging, children
ages 6 to 12 and children traveling alone with the driver remain
at higher risk of being seated in the front. These traveling situations
should be targeted for behavioral safety interventions to improve
child motor vehicle safety.
Goldberg, S. N.; Saldinger, P. F.; Gazelle, G. Scott; Huertas, J. C.; Stuart, K. E.; Jacobs, T.; Kruskal, J. B.
In: Radiology, vol. 220, no. 2, pp. 420-7, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Goldberg2001b,
title = {Percutaneous tumor ablation: increased necrosis with combined radio-frequency
ablation and intratumoral doxorubicin injection in a rat breast tumor
model},
author = {S. N. Goldberg and P. F. Saldinger and G. Scott Gazelle and J. C. Huertas and K. E. Stuart and T. Jacobs and J. B. Kruskal},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11477246},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-08-01},
journal = {Radiology},
volume = {220},
number = {2},
pages = {420-7},
abstract = {PURPOSE: To determine whether a combination of intratumoral doxorubicin
injection and radio-frequency (RF) ablation increases tumor destruction
compared with RF ablation alone in an animal tumor model. MATERIALS
AND METHODS: R3230 mammary adenocarcinoma 1.2-1.5-cm- diameter nodules (n = 110) were implanted subcutaneously in 84 female Fischer rats. For initial experiments (n = 46), tumors were treated with (a) conventional,
monopolar RF (250 mA +/- 25 [SD] at 70 degrees C +/- 1 for 5 minutes)
ablation alone; (b) direct intratumoral doxorubicin injection (volume,
250 microL; total dose, 0.5 mg) alone; (c) combined therapy (doxorubicin
injection immediately followed by RF ablation); (d) RF ablation and
injection of 250 microL of distilled water; or (e) no treatment.
In subsequent experiments, amount of doxorubicin (0.02-2.50 mg; n = 40 additional tumors) and timing of doxorubicin administration (2 days before to 2 days after RF ablation; n = 24 more tumors) were
varied. Pathologic examination, including staining for mitochondrial
enzyme activity and perfusion, was performed, and the resultant tumor
destruction from each treatment was evaluated. RESULTS: Coagulation
diameter was 6.7 mm +/- 0.6 for tumors treated with RF ablation alone
and 6.9 mm +/- 0.7 for those treated with RF ablation and water (P =.52), while intratumoral doxorubicin injection alone produced only
2.0-3.0 mm of coagulation (P \<.001). Increased coagulation was observed
only with combined doxorubicin injection and RF therapy (P \<.001).
Coagulation was dependent on concentration and timing of doxorubicin
administration, with greatest coagulation (11.5 mm +/- 1.1) observed
for doxorubicin administered within 30 minutes of RF ablation. CONCLUSION:
Adjuvant intratumoral doxorubicin injection increases coagulation
in solid tumors compared with RF ablation alone. Increased tumor
destruction is also seen when doxorubicin is administered after RF
ablation, which suggests that RF ablation may sensitize tumors to
chemotherapy. Such combination therapies may, therefore, offer improved
methods for ablating solid tumors.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine whether a combination of intratumoral doxorubicin
injection and radio-frequency (RF) ablation increases tumor destruction
compared with RF ablation alone in an animal tumor model. MATERIALS
AND METHODS: R3230 mammary adenocarcinoma 1.2-1.5-cm- diameter nodules (n = 110) were implanted subcutaneously in 84 female Fischer rats. For initial experiments (n = 46), tumors were treated with (a) conventional,
monopolar RF (250 mA +/- 25 [SD] at 70 degrees C +/- 1 for 5 minutes)
ablation alone; (b) direct intratumoral doxorubicin injection (volume,
250 microL; total dose, 0.5 mg) alone; (c) combined therapy (doxorubicin
injection immediately followed by RF ablation); (d) RF ablation and
injection of 250 microL of distilled water; or (e) no treatment.
In subsequent experiments, amount of doxorubicin (0.02-2.50 mg; n = 40 additional tumors) and timing of doxorubicin administration (2 days before to 2 days after RF ablation; n = 24 more tumors) were
varied. Pathologic examination, including staining for mitochondrial
enzyme activity and perfusion, was performed, and the resultant tumor
destruction from each treatment was evaluated. RESULTS: Coagulation
diameter was 6.7 mm +/- 0.6 for tumors treated with RF ablation alone
and 6.9 mm +/- 0.7 for those treated with RF ablation and water (P =.52), while intratumoral doxorubicin injection alone produced only
2.0-3.0 mm of coagulation (P <.001). Increased coagulation was observed
only with combined doxorubicin injection and RF therapy (P <.001).
Coagulation was dependent on concentration and timing of doxorubicin
administration, with greatest coagulation (11.5 mm +/- 1.1) observed
for doxorubicin administered within 30 minutes of RF ablation. CONCLUSION:
Adjuvant intratumoral doxorubicin injection increases coagulation
in solid tumors compared with RF ablation alone. Increased tumor
destruction is also seen when doxorubicin is administered after RF
ablation, which suggests that RF ablation may sensitize tumors to
chemotherapy. Such combination therapies may, therefore, offer improved
methods for ablating solid tumors.
injection and radio-frequency (RF) ablation increases tumor destruction
compared with RF ablation alone in an animal tumor model. MATERIALS
AND METHODS: R3230 mammary adenocarcinoma 1.2-1.5-cm- diameter nodules (n = 110) were implanted subcutaneously in 84 female Fischer rats. For initial experiments (n = 46), tumors were treated with (a) conventional,
monopolar RF (250 mA +/- 25 [SD] at 70 degrees C +/- 1 for 5 minutes)
ablation alone; (b) direct intratumoral doxorubicin injection (volume,
250 microL; total dose, 0.5 mg) alone; (c) combined therapy (doxorubicin
injection immediately followed by RF ablation); (d) RF ablation and
injection of 250 microL of distilled water; or (e) no treatment.
In subsequent experiments, amount of doxorubicin (0.02-2.50 mg; n = 40 additional tumors) and timing of doxorubicin administration (2 days before to 2 days after RF ablation; n = 24 more tumors) were
varied. Pathologic examination, including staining for mitochondrial
enzyme activity and perfusion, was performed, and the resultant tumor
destruction from each treatment was evaluated. RESULTS: Coagulation
diameter was 6.7 mm +/- 0.6 for tumors treated with RF ablation alone
and 6.9 mm +/- 0.7 for those treated with RF ablation and water (P =.52), while intratumoral doxorubicin injection alone produced only
2.0-3.0 mm of coagulation (P <.001). Increased coagulation was observed
only with combined doxorubicin injection and RF therapy (P <.001).
Coagulation was dependent on concentration and timing of doxorubicin
administration, with greatest coagulation (11.5 mm +/- 1.1) observed
for doxorubicin administered within 30 minutes of RF ablation. CONCLUSION:
Adjuvant intratumoral doxorubicin injection increases coagulation
in solid tumors compared with RF ablation alone. Increased tumor
destruction is also seen when doxorubicin is administered after RF
ablation, which suggests that RF ablation may sensitize tumors to
chemotherapy. Such combination therapies may, therefore, offer improved
methods for ablating solid tumors.
Bosch, Johanna; Lester, J. S.; McMahon, Pamela M.; Beinfeld, M. T.; Halpern, Elkan F.; Kaufman, J. A.; Brewster, D. C.; Gazelle, G. Scott
Hospital costs for elective endovascular and surgical repairs of infrarenal abdominal aortic aneurysms Journal Article
In: Radiology, vol. 220, no. 2, pp. 492–497, 2001, ().
@article{Bosch2001a,
title = {Hospital costs for elective endovascular and surgical repairs of infrarenal abdominal aortic aneurysms},
author = {Johanna Bosch and J. S. Lester and Pamela M. McMahon and M. T. Beinfeld and Elkan F. Halpern and J. A. Kaufman and D. C. Brewster and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11477259},
doi = {10.1148/radiology.220.2.r01au29492},
year = {2001},
date = {2001-08-01},
urldate = {2001-08-01},
journal = {Radiology},
volume = {220},
number = {2},
pages = {492--497},
institution = {Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Pl, Suite 2H, Boston, MA 02114, USA. },
abstract = {To determine and compare the average in-hospital costs of elective
open surgical and endovascular repairs of infrarenal abdominal aortic
aneurysms.Total actual cost data for patients undergoing elective endovascular (n = 181) or open surgical (n = 273) repair of abdominal
aortic aneurysms between 1997 and 1999 were retrieved. The mean total
hospital cost (including stent-graft costs and excluding attending
physician fees) and mean postoperative length of stay were calculated
for each treatment group. Costs were expressed in 1999 U.S. dollars.Endovascular
repair yielded a shorter postoperative length of stay than did open
surgery (mean stay, 3.4 vs 8.0 days; P ely $6,400 according to literature data).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To determine and compare the average in-hospital costs of elective
open surgical and endovascular repairs of infrarenal abdominal aortic
aneurysms.Total actual cost data for patients undergoing elective endovascular (n = 181) or open surgical (n = 273) repair of abdominal
aortic aneurysms between 1997 and 1999 were retrieved. The mean total
hospital cost (including stent-graft costs and excluding attending
physician fees) and mean postoperative length of stay were calculated
for each treatment group. Costs were expressed in 1999 U.S. dollars.Endovascular
repair yielded a shorter postoperative length of stay than did open
surgery (mean stay, 3.4 vs 8.0 days; P ely $6,400 according to literature data).
open surgical and endovascular repairs of infrarenal abdominal aortic
aneurysms.Total actual cost data for patients undergoing elective endovascular (n = 181) or open surgical (n = 273) repair of abdominal
aortic aneurysms between 1997 and 1999 were retrieved. The mean total
hospital cost (including stent-graft costs and excluding attending
physician fees) and mean postoperative length of stay were calculated
for each treatment group. Costs were expressed in 1999 U.S. dollars.Endovascular
repair yielded a shorter postoperative length of stay than did open
surgery (mean stay, 3.4 vs 8.0 days; P ely $6,400 according to literature data).