2001
Lester, J. S.; Bosch, Johanna; Kaufman, J. A.; Halpern, Elkan F.; Gazelle, G. Scott
Inpatient costs of routine endovascular repair of abdominal aortic aneurysm Journal Article
In: Acad Radiol, vol. 8, no. 7, pp. 639-46, 2001, ISSN: 1076-6332 (Print) 1076-6332 (Lin, ().
@article{Lester2001,
title = {Inpatient costs of routine endovascular repair of abdominal aortic aneurysm},
author = {J. S. Lester and Johanna Bosch and J. A. Kaufman and Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11450965},
issn = {1076-6332 (Print) 1076-6332 (Lin},
year = {2001},
date = {2001-07-01},
urldate = {2001-07-01},
journal = {Acad Radiol},
volume = {8},
number = {7},
pages = {639-46},
abstract = {RATIONALE AND OBJECTIVES: The purpose of this study was to determine
the inpatient cost of routine (ie, without emergent conversion to
open repair during the hospital stay) endovascular stent-graft placement
in a consecutive series of patients undergoing elective endovascular
repair of abdominal aortic aneurysm (AAA) at a single institution.
MATERIALS AND METHODS: Inpatient hospital costs of 91 patients who
underwent initial elective endovascular repair of AAA were analyzed
retrospectively. All patients had participated in clinical trials
at the authors' institution during the previous 6 years. Financial
data were derived from the hospital's cost-accounting system; additional
procedural data were collected from a departmental database and with
chart review. Stent-graft and professional costs were excluded. RESULTS:
The mean total cost for endovascular repair was $11,842 (standard
deviation [SD], $5,127), mean procedure time was 149 minutes (SD,
79 minutes), and mean length of stay was 3.5 days (SD, 2.3 days).
Total cost depended on stent-graft type (means, $12,428 [bifurcated] vs $9,622 [tube]; P = .0002) and strongly correlated with procedure time and length of hospital stay (r = 0.78 and 0.66, respectively;
P \< .0001). Ninety-six percent of total costs for all patients were
attributable to the following departments: operating theater (31%),
radiology (31%), nursing (22%), and anesthesia (12%). CONCLUSION:
Overall costs are greater with bifurcated than with tube stent-grafts.
Total procedure-related costs are divided relatively equally between
the operating theater, the radiology department, and the combination
of the nursing and anesthesia departments.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
RATIONALE AND OBJECTIVES: The purpose of this study was to determine
the inpatient cost of routine (ie, without emergent conversion to
open repair during the hospital stay) endovascular stent-graft placement
in a consecutive series of patients undergoing elective endovascular
repair of abdominal aortic aneurysm (AAA) at a single institution.
MATERIALS AND METHODS: Inpatient hospital costs of 91 patients who
underwent initial elective endovascular repair of AAA were analyzed
retrospectively. All patients had participated in clinical trials
at the authors' institution during the previous 6 years. Financial
data were derived from the hospital's cost-accounting system; additional
procedural data were collected from a departmental database and with
chart review. Stent-graft and professional costs were excluded. RESULTS:
The mean total cost for endovascular repair was $11,842 (standard
deviation [SD], $5,127), mean procedure time was 149 minutes (SD,
79 minutes), and mean length of stay was 3.5 days (SD, 2.3 days).
Total cost depended on stent-graft type (means, $12,428 [bifurcated] vs $9,622 [tube]; P = .0002) and strongly correlated with procedure time and length of hospital stay (r = 0.78 and 0.66, respectively;
P < .0001). Ninety-six percent of total costs for all patients were
attributable to the following departments: operating theater (31%),
radiology (31%), nursing (22%), and anesthesia (12%). CONCLUSION:
Overall costs are greater with bifurcated than with tube stent-grafts.
Total procedure-related costs are divided relatively equally between
the operating theater, the radiology department, and the combination
of the nursing and anesthesia departments.
the inpatient cost of routine (ie, without emergent conversion to
open repair during the hospital stay) endovascular stent-graft placement
in a consecutive series of patients undergoing elective endovascular
repair of abdominal aortic aneurysm (AAA) at a single institution.
MATERIALS AND METHODS: Inpatient hospital costs of 91 patients who
underwent initial elective endovascular repair of AAA were analyzed
retrospectively. All patients had participated in clinical trials
at the authors' institution during the previous 6 years. Financial
data were derived from the hospital's cost-accounting system; additional
procedural data were collected from a departmental database and with
chart review. Stent-graft and professional costs were excluded. RESULTS:
The mean total cost for endovascular repair was $11,842 (standard
deviation [SD], $5,127), mean procedure time was 149 minutes (SD,
79 minutes), and mean length of stay was 3.5 days (SD, 2.3 days).
Total cost depended on stent-graft type (means, $12,428 [bifurcated] vs $9,622 [tube]; P = .0002) and strongly correlated with procedure time and length of hospital stay (r = 0.78 and 0.66, respectively;
P < .0001). Ninety-six percent of total costs for all patients were
attributable to the following departments: operating theater (31%),
radiology (31%), nursing (22%), and anesthesia (12%). CONCLUSION:
Overall costs are greater with bifurcated than with tube stent-grafts.
Total procedure-related costs are divided relatively equally between
the operating theater, the radiology department, and the combination
of the nursing and anesthesia departments.
Livraghi, T.; Goldberg, S. N.; Solbiati, L.; Meloni, F.; Ierace, T.; Gazelle, G. Scott
Percutaneous radio-frequency ablation of liver metastases from breast cancer: initial experience in 24 patients Journal Article
In: Radiology, vol. 220, no. 1, pp. 145-9, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Livraghi2001,
title = {Percutaneous radio-frequency ablation of liver metastases from breast
cancer: initial experience in 24 patients},
author = {T. Livraghi and S. N. Goldberg and L. Solbiati and F. Meloni and T. Ierace and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11425987},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-07-01},
journal = {Radiology},
volume = {220},
number = {1},
pages = {145-9},
abstract = {PURPOSE: To evaluate the authors' initial experience in a consecutive
series of 24 patients with breast cancer liver metastases treated
with radio-frequency (RF) ablation. MATERIALS AND METHODS: Twenty-four
consecutive patients with 64 metastases measuring 1.0--6.6 cm in
diameter (mean, 1.9 cm) underwent ultrasonography-guided percutaneous
RF ablation with 18-gauge, internally cooled electrodes. Treatment
was performed with the patient under conscious sedation and analgesia
or general anesthesia. A single lesion was treated in 16 patients,
and multiple lesions were treated in eight patients. Follow-up with
serial computed tomography ranged from 4 to 44 months (mean, 10 months;
median, 19 months). RESULTS: Complete necrosis was achieved in 59
(92%) of 64 lesions. Among the 59 lesions, complete necrosis required
a single treatment session in 58 lesions (92%) and two treatment
sessions in one lesion (2%). In 14 (58%) of 24 patients, new metastases
developed during follow-up. Ten (71%) of these 14 patients developed
new liver metastases. Currently, 10 (63%) of 16 patients whose lesions
were initially confined to the liver are free of disease. One patient
died of progressive brain metastases. No major complications occurred.
Two minor complications were observed. CONCLUSION: On the basis of
preliminary study results, percutaneous RF ablation appears to be
a simple, safe, and effective treatment for focal liver metastases
in selected patients with breast cancer.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To evaluate the authors' initial experience in a consecutive
series of 24 patients with breast cancer liver metastases treated
with radio-frequency (RF) ablation. MATERIALS AND METHODS: Twenty-four
consecutive patients with 64 metastases measuring 1.0--6.6 cm in
diameter (mean, 1.9 cm) underwent ultrasonography-guided percutaneous
RF ablation with 18-gauge, internally cooled electrodes. Treatment
was performed with the patient under conscious sedation and analgesia
or general anesthesia. A single lesion was treated in 16 patients,
and multiple lesions were treated in eight patients. Follow-up with
serial computed tomography ranged from 4 to 44 months (mean, 10 months;
median, 19 months). RESULTS: Complete necrosis was achieved in 59
(92%) of 64 lesions. Among the 59 lesions, complete necrosis required
a single treatment session in 58 lesions (92%) and two treatment
sessions in one lesion (2%). In 14 (58%) of 24 patients, new metastases
developed during follow-up. Ten (71%) of these 14 patients developed
new liver metastases. Currently, 10 (63%) of 16 patients whose lesions
were initially confined to the liver are free of disease. One patient
died of progressive brain metastases. No major complications occurred.
Two minor complications were observed. CONCLUSION: On the basis of
preliminary study results, percutaneous RF ablation appears to be
a simple, safe, and effective treatment for focal liver metastases
in selected patients with breast cancer.
series of 24 patients with breast cancer liver metastases treated
with radio-frequency (RF) ablation. MATERIALS AND METHODS: Twenty-four
consecutive patients with 64 metastases measuring 1.0--6.6 cm in
diameter (mean, 1.9 cm) underwent ultrasonography-guided percutaneous
RF ablation with 18-gauge, internally cooled electrodes. Treatment
was performed with the patient under conscious sedation and analgesia
or general anesthesia. A single lesion was treated in 16 patients,
and multiple lesions were treated in eight patients. Follow-up with
serial computed tomography ranged from 4 to 44 months (mean, 10 months;
median, 19 months). RESULTS: Complete necrosis was achieved in 59
(92%) of 64 lesions. Among the 59 lesions, complete necrosis required
a single treatment session in 58 lesions (92%) and two treatment
sessions in one lesion (2%). In 14 (58%) of 24 patients, new metastases
developed during follow-up. Ten (71%) of these 14 patients developed
new liver metastases. Currently, 10 (63%) of 16 patients whose lesions
were initially confined to the liver are free of disease. One patient
died of progressive brain metastases. No major complications occurred.
Two minor complications were observed. CONCLUSION: On the basis of
preliminary study results, percutaneous RF ablation appears to be
a simple, safe, and effective treatment for focal liver metastases
in selected patients with breast cancer.
Lamont, Elizabeth; Christakis, N. A.
Prognostic disclosure to patients with cancer near the end of life Journal Article
In: Ann Intern Med, vol. 134, no. 12, pp. 1096-105, 2001, ISSN: 0003-4819 (Print) 0003-4819 (Lin, ().
@article{Lamont2001a,
title = {Prognostic disclosure to patients with cancer near the end of life},
author = {Elizabeth Lamont and N. A. Christakis},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11412049},
issn = {0003-4819 (Print) 0003-4819 (Lin},
year = {2001},
date = {2001-06-01},
journal = {Ann Intern Med},
volume = {134},
number = {12},
pages = {1096-105},
abstract = {BACKGROUND: Patients' understanding of their prognosis informs numerous
medical and nonmedical decisions, but patients with cancer and their
physicians often have disparate prognostic expectations. OBJECTIVE:
To determine whether physician behavior might contribute to the disparity
between patients' and physicians' prognostic expectations. DESIGN:
Prospective cohort study. SETTING: Five hospices in Chicago, Illinois.
PATIENTS: 326 patients with cancer. INTERVENTION: Physicians formulated
survival estimates and also indicated the survival estimates that
they would communicate to their patients if the patients insisted.
MEASUREMENTS: Comparison of the formulated and communicated prognoses.
RESULTS: For 300 of 311 evaluable patients (96.5%), physicians were
able to formulate prognoses. Physicians reported that they would
not communicate any survival estimate 22.7% (95% CI, 17.9% to 27.4%)
of the time, would communicate the same survival estimate they formulated
37% (CI, 31.5% to 42.5%) of the time, and would communicate a survival
estimate different from the one they formulated 40.3% (CI, 34.8%
to 45.9%) of the time. Of the discrepant survival estimates, most
(70.2%) were optimistically discrepant. Multivariate analysis revealed
that older patients were more likely to receive frank survival estimates,
that the most experienced physicians and the physicians who were
least confident about their prognoses were more likely to favor no
disclosure over frank disclosure, and that female physicians were
less likely to favor frank disclosure over pessimistically discrepant
disclosure. CONCLUSIONS: Physicians reported that even if patients
with cancer requested survival estimates, they would provide a frank
estimate only 37% of the time and would provide no estimate, a conscious
overestimate, or a conscious underestimate most of the time (63%).
This pattern may contribute to the observed disparities between physicians'
and patients' estimates of survival.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Patients' understanding of their prognosis informs numerous
medical and nonmedical decisions, but patients with cancer and their
physicians often have disparate prognostic expectations. OBJECTIVE:
To determine whether physician behavior might contribute to the disparity
between patients' and physicians' prognostic expectations. DESIGN:
Prospective cohort study. SETTING: Five hospices in Chicago, Illinois.
PATIENTS: 326 patients with cancer. INTERVENTION: Physicians formulated
survival estimates and also indicated the survival estimates that
they would communicate to their patients if the patients insisted.
MEASUREMENTS: Comparison of the formulated and communicated prognoses.
RESULTS: For 300 of 311 evaluable patients (96.5%), physicians were
able to formulate prognoses. Physicians reported that they would
not communicate any survival estimate 22.7% (95% CI, 17.9% to 27.4%)
of the time, would communicate the same survival estimate they formulated
37% (CI, 31.5% to 42.5%) of the time, and would communicate a survival
estimate different from the one they formulated 40.3% (CI, 34.8%
to 45.9%) of the time. Of the discrepant survival estimates, most
(70.2%) were optimistically discrepant. Multivariate analysis revealed
that older patients were more likely to receive frank survival estimates,
that the most experienced physicians and the physicians who were
least confident about their prognoses were more likely to favor no
disclosure over frank disclosure, and that female physicians were
less likely to favor frank disclosure over pessimistically discrepant
disclosure. CONCLUSIONS: Physicians reported that even if patients
with cancer requested survival estimates, they would provide a frank
estimate only 37% of the time and would provide no estimate, a conscious
overestimate, or a conscious underestimate most of the time (63%).
This pattern may contribute to the observed disparities between physicians'
and patients' estimates of survival.
medical and nonmedical decisions, but patients with cancer and their
physicians often have disparate prognostic expectations. OBJECTIVE:
To determine whether physician behavior might contribute to the disparity
between patients' and physicians' prognostic expectations. DESIGN:
Prospective cohort study. SETTING: Five hospices in Chicago, Illinois.
PATIENTS: 326 patients with cancer. INTERVENTION: Physicians formulated
survival estimates and also indicated the survival estimates that
they would communicate to their patients if the patients insisted.
MEASUREMENTS: Comparison of the formulated and communicated prognoses.
RESULTS: For 300 of 311 evaluable patients (96.5%), physicians were
able to formulate prognoses. Physicians reported that they would
not communicate any survival estimate 22.7% (95% CI, 17.9% to 27.4%)
of the time, would communicate the same survival estimate they formulated
37% (CI, 31.5% to 42.5%) of the time, and would communicate a survival
estimate different from the one they formulated 40.3% (CI, 34.8%
to 45.9%) of the time. Of the discrepant survival estimates, most
(70.2%) were optimistically discrepant. Multivariate analysis revealed
that older patients were more likely to receive frank survival estimates,
that the most experienced physicians and the physicians who were
least confident about their prognoses were more likely to favor no
disclosure over frank disclosure, and that female physicians were
less likely to favor frank disclosure over pessimistically discrepant
disclosure. CONCLUSIONS: Physicians reported that even if patients
with cancer requested survival estimates, they would provide a frank
estimate only 37% of the time and would provide no estimate, a conscious
overestimate, or a conscious underestimate most of the time (63%).
This pattern may contribute to the observed disparities between physicians'
and patients' estimates of survival.
Manoach, D. S.; Halpern, Elkan F.; Kramer, T. S.; Chang, Y.; Goff, D. C.; Rauch, S. L.; Kennedy, D. N.; Gollub, R. L.
Test-retest reliability of a functional MRI working memory paradigm in normal and schizophrenic subjects Journal Article
In: Am J Psychiatry, vol. 158, no. 6, pp. 955-8, 2001, ISSN: 0002-953X (Print) 0002-953X (Lin, ().
@article{Manoach2001,
title = {Test-retest reliability of a functional MRI working memory paradigm in normal and schizophrenic subjects},
author = {D. S. Manoach and Elkan F. Halpern and T. S. Kramer and Y. Chang and D. C. Goff and S. L. Rauch and D. N. Kennedy and R. L. Gollub},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11384907},
issn = {0002-953X (Print) 0002-953X (Lin},
year = {2001},
date = {2001-06-01},
urldate = {2001-06-01},
journal = {Am J Psychiatry},
volume = {158},
number = {6},
pages = {955-8},
abstract = {OBJECTIVE: Repeated functional magnetic resonance imaging (fMRI) studies
of schizophrenic subjects may identify brain activity changes in
response to interventions. To interpret the findings, however, it
is crucial to know the test-retest reliability of the measures used.
METHOD: The authors scanned seven normal subjects and seven schizophrenic
subjects on two occasions during performance of a working memory
task. They quantified the reliability of task performance and brain
activation. RESULTS: In both groups, task performance was reliable,
and all a priori regions were activated in group-averaged test and
retest data. In individual schizophrenic subjects, however, indices
of cognitive activation were not reliable across sessions. Normal
subjects showed reasonable reliability of activation. CONCLUSIONS:
Even given reliable task performance, stable clinical status, and
a stable pattern of group-averaged activation, individual subjects
showed unreliable brain activation. This suggests that repeated fMRI
studies of schizophrenia should control for sources of variation,
both artifactual and intrinsic.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: Repeated functional magnetic resonance imaging (fMRI) studies
of schizophrenic subjects may identify brain activity changes in
response to interventions. To interpret the findings, however, it
is crucial to know the test-retest reliability of the measures used.
METHOD: The authors scanned seven normal subjects and seven schizophrenic
subjects on two occasions during performance of a working memory
task. They quantified the reliability of task performance and brain
activation. RESULTS: In both groups, task performance was reliable,
and all a priori regions were activated in group-averaged test and
retest data. In individual schizophrenic subjects, however, indices
of cognitive activation were not reliable across sessions. Normal
subjects showed reasonable reliability of activation. CONCLUSIONS:
Even given reliable task performance, stable clinical status, and
a stable pattern of group-averaged activation, individual subjects
showed unreliable brain activation. This suggests that repeated fMRI
studies of schizophrenia should control for sources of variation,
both artifactual and intrinsic.
of schizophrenic subjects may identify brain activity changes in
response to interventions. To interpret the findings, however, it
is crucial to know the test-retest reliability of the measures used.
METHOD: The authors scanned seven normal subjects and seven schizophrenic
subjects on two occasions during performance of a working memory
task. They quantified the reliability of task performance and brain
activation. RESULTS: In both groups, task performance was reliable,
and all a priori regions were activated in group-averaged test and
retest data. In individual schizophrenic subjects, however, indices
of cognitive activation were not reliable across sessions. Normal
subjects showed reasonable reliability of activation. CONCLUSIONS:
Even given reliable task performance, stable clinical status, and
a stable pattern of group-averaged activation, individual subjects
showed unreliable brain activation. This suggests that repeated fMRI
studies of schizophrenia should control for sources of variation,
both artifactual and intrinsic.
Kubaska, S.; Sahani, D. V.; Saini, S.; Hahn, P. F.; Halpern, Elkan F.
In: Clin Radiol, vol. 56, no. 5, pp. 410-5, 2001, ISSN: 0009-9260 (Print) 0009-9260 (Lin, ().
@article{Kubaska2001,
title = {Dual contrast enhanced magnetic resonance imaging of the liver with superparamagnetic iron oxide followed by gadolinium for lesion detection and characterization},
author = {S. Kubaska and D. V. Sahani and S. Saini and P. F. Hahn and Elkan F. Halpern},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11384141},
issn = {0009-9260 (Print) 0009-9260 (Lin},
year = {2001},
date = {2001-05-01},
urldate = {2001-05-01},
journal = {Clin Radiol},
volume = {56},
number = {5},
pages = {410-5},
abstract = {AIM: Iron oxide contrast agents are useful for lesion detection, and
extracellular gadolinium chelates are advocated for lesion characterization.
We undertook a study to determine if dual contrast enhanced liver
imaging with sequential use of ferumoxides particles and gadolinium
(Gd)-DTPA can be performed in the same imaging protocol. MATERIALS
AND METHODS: Sixteen patients underwent dual contrast magnetic resonance
imaging (MRI) of the liver for evaluation of known/suspected focal lesions which included, metastases (n = 5), hepatocellular carcinoma (HCC;n = 3), cholangiocharcinoma(n = 1) and focal nodular hyperplasia (FNH;n = 3). Pre- and post-iron oxide T1-weighted gradient recalled
echo (GRE) and T2-weighted fast spin echo (FSE) sequences were obtained,
followed by post-Gd-DTPA (0.1 mmol/kg) multi-phase dynamic T1-weighted
out-of-phase GRE imaging. Images were analysed in a blinded fashion
by three experts using a three-point scoring system for lesion conspicuity
on pre- and post-iron oxide T1 images as well as for reader's confidence
in characterizing liver lesions on post Gd-DTPA T1 images. RESULTS:
No statistically significant difference in lesion conspicuity was
observed on pre- and post-iron oxide T1-GRE images in this small
study cohort. The presence of iron oxide did not appreciably diminish
image quality of post-gadolinium sequences and did not prevent characterization
of liver lesions. CONCLUSION: Our results suggest that characterization
of focal liver lesion with Gd-enhanced liver MRI is still possible
following iron oxide enhanced imaging.Kubaska, S.et al. (2001). Clinical
Radiology, 56, 410-415},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AIM: Iron oxide contrast agents are useful for lesion detection, and
extracellular gadolinium chelates are advocated for lesion characterization.
We undertook a study to determine if dual contrast enhanced liver
imaging with sequential use of ferumoxides particles and gadolinium
(Gd)-DTPA can be performed in the same imaging protocol. MATERIALS
AND METHODS: Sixteen patients underwent dual contrast magnetic resonance
imaging (MRI) of the liver for evaluation of known/suspected focal lesions which included, metastases (n = 5), hepatocellular carcinoma (HCC;n = 3), cholangiocharcinoma(n = 1) and focal nodular hyperplasia (FNH;n = 3). Pre- and post-iron oxide T1-weighted gradient recalled
echo (GRE) and T2-weighted fast spin echo (FSE) sequences were obtained,
followed by post-Gd-DTPA (0.1 mmol/kg) multi-phase dynamic T1-weighted
out-of-phase GRE imaging. Images were analysed in a blinded fashion
by three experts using a three-point scoring system for lesion conspicuity
on pre- and post-iron oxide T1 images as well as for reader's confidence
in characterizing liver lesions on post Gd-DTPA T1 images. RESULTS:
No statistically significant difference in lesion conspicuity was
observed on pre- and post-iron oxide T1-GRE images in this small
study cohort. The presence of iron oxide did not appreciably diminish
image quality of post-gadolinium sequences and did not prevent characterization
of liver lesions. CONCLUSION: Our results suggest that characterization
of focal liver lesion with Gd-enhanced liver MRI is still possible
following iron oxide enhanced imaging.Kubaska, S.et al. (2001). Clinical
Radiology, 56, 410-415
extracellular gadolinium chelates are advocated for lesion characterization.
We undertook a study to determine if dual contrast enhanced liver
imaging with sequential use of ferumoxides particles and gadolinium
(Gd)-DTPA can be performed in the same imaging protocol. MATERIALS
AND METHODS: Sixteen patients underwent dual contrast magnetic resonance
imaging (MRI) of the liver for evaluation of known/suspected focal lesions which included, metastases (n = 5), hepatocellular carcinoma (HCC;n = 3), cholangiocharcinoma(n = 1) and focal nodular hyperplasia (FNH;n = 3). Pre- and post-iron oxide T1-weighted gradient recalled
echo (GRE) and T2-weighted fast spin echo (FSE) sequences were obtained,
followed by post-Gd-DTPA (0.1 mmol/kg) multi-phase dynamic T1-weighted
out-of-phase GRE imaging. Images were analysed in a blinded fashion
by three experts using a three-point scoring system for lesion conspicuity
on pre- and post-iron oxide T1 images as well as for reader's confidence
in characterizing liver lesions on post Gd-DTPA T1 images. RESULTS:
No statistically significant difference in lesion conspicuity was
observed on pre- and post-iron oxide T1-GRE images in this small
study cohort. The presence of iron oxide did not appreciably diminish
image quality of post-gadolinium sequences and did not prevent characterization
of liver lesions. CONCLUSION: Our results suggest that characterization
of focal liver lesion with Gd-enhanced liver MRI is still possible
following iron oxide enhanced imaging.Kubaska, S.et al. (2001). Clinical
Radiology, 56, 410-415
Lamont, Elizabeth; Vokes, E. E.
Chemotherapy in the management of squamous-cell carcinoma of the head and neck Journal Article
In: Lancet Oncol, vol. 2, no. 5, pp. 261-9, 2001, ISSN: 1470-2045 (Print) 1470-2045 (Lin, ().
@article{Lamont2001,
title = {Chemotherapy in the management of squamous-cell carcinoma of the
head and neck},
author = {Elizabeth Lamont and E. E. Vokes},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11905780},
issn = {1470-2045 (Print) 1470-2045 (Lin},
year = {2001},
date = {2001-05-01},
journal = {Lancet Oncol},
volume = {2},
number = {5},
pages = {261-9},
abstract = {Previously reserved for palliation, chemotherapy is now also a central
component of several curative approaches to the management of patients
with advanced-stage head and neck cancer. Here we review the results
of both induction chemotherapy and chemoradiotherapy trials in patients
with curable disease, and chemotherapy trials in patients with recurrent
and metastatic disease, and we highlight current areas of investigation.
Compared with traditional treatment modalities, chemotherapy given
on induction schedules to patients with advanced laryngeal cancer
allows greater organ preservation without compromise to survival;
when given concomitantly with radiotherapy to patients with resectable
or unresectable advanced disease, chemotherapy again improves survival.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Previously reserved for palliation, chemotherapy is now also a central
component of several curative approaches to the management of patients
with advanced-stage head and neck cancer. Here we review the results
of both induction chemotherapy and chemoradiotherapy trials in patients
with curable disease, and chemotherapy trials in patients with recurrent
and metastatic disease, and we highlight current areas of investigation.
Compared with traditional treatment modalities, chemotherapy given
on induction schedules to patients with advanced laryngeal cancer
allows greater organ preservation without compromise to survival;
when given concomitantly with radiotherapy to patients with resectable
or unresectable advanced disease, chemotherapy again improves survival.
component of several curative approaches to the management of patients
with advanced-stage head and neck cancer. Here we review the results
of both induction chemotherapy and chemoradiotherapy trials in patients
with curable disease, and chemotherapy trials in patients with recurrent
and metastatic disease, and we highlight current areas of investigation.
Compared with traditional treatment modalities, chemotherapy given
on induction schedules to patients with advanced laryngeal cancer
allows greater organ preservation without compromise to survival;
when given concomitantly with radiotherapy to patients with resectable
or unresectable advanced disease, chemotherapy again improves survival.
Schiele, T. M.; Siebert, Uwe; Cohen, D.; Klauss, V.
[Clinical and economic aspects of chronic coronary restenosis: potential advantage of intracoronary brachytherapy] Journal Article
In: Dtsch Med Wochenschr, vol. 126, no. 15, pp. 440-4, 2001, ISSN: 0012-0472 (Print) 0012-0472 (Lin, ().
@article{Schiele2001,
title = {[Clinical and economic aspects of chronic coronary restenosis: potential
advantage of intracoronary brachytherapy]},
author = {T. M. Schiele and Uwe Siebert and D. Cohen and V. Klauss},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11347008},
issn = {0012-0472 (Print) 0012-0472 (Lin},
year = {2001},
date = {2001-04-01},
journal = {Dtsch Med Wochenschr},
volume = {126},
number = {15},
pages = {440-4},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
McMahon, Pamela M.; Bosch, Johanna; Gleason, S.; Halpern, Elkan F.; Lester, J. S.; Gazelle, G. Scott
Cost-effectiveness of colorectal cancer screening Journal Article
In: Radiology, vol. 219, no. 1, pp. 44-50, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{McMahon2001a,
title = {Cost-effectiveness of colorectal cancer screening},
author = {Pamela M. McMahon and Johanna Bosch and S. Gleason and Elkan F. Halpern and J. S. Lester and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11274533},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-04-01},
journal = {Radiology},
volume = {219},
number = {1},
pages = {44-50},
abstract = {PURPOSE: To determine the most cost-effective colorectal cancer screening
strategy costing less than $100,000 per life-year saved and to determine
how available strategies compare with each other. MATERIALS AND METHODS:
Standardized methods were used to calculate incremental cost-effectiveness
ratios (ICERs) from published estimates of cost and effectiveness
of colorectal cancer screening strategies, and the direction and
magnitude of any effect on the ratio from parameter estimate adjustments
based on literature values were estimated. RESULTS: Strategies in
which double-contrast barium enema examination was performed emerged
as optimal from all studies included. In average-risk individuals,
screening with double-contrast barium enema examination every 3 years,
or every 5 years with annual fecal occult blood testing, had an ICER
of less than $55,600 per life-year saved. However, double-contrast
barium enema examination screening every 3 years plus annual fecal
occult blood testing had an ICER of more than $100,000 per life-year
saved. Colonoscopic screening had an ICER of more than $100,000 per
life-year saved, was dominated by other screening strategies, and
offered less benefit than did double-contrast barium enema examination
screening. CONCLUSION: Double-contrast barium enema examination can
be a cost-effective component of colorectal cancer screening, but
further modeling efforts are necessary.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine the most cost-effective colorectal cancer screening
strategy costing less than $100,000 per life-year saved and to determine
how available strategies compare with each other. MATERIALS AND METHODS:
Standardized methods were used to calculate incremental cost-effectiveness
ratios (ICERs) from published estimates of cost and effectiveness
of colorectal cancer screening strategies, and the direction and
magnitude of any effect on the ratio from parameter estimate adjustments
based on literature values were estimated. RESULTS: Strategies in
which double-contrast barium enema examination was performed emerged
as optimal from all studies included. In average-risk individuals,
screening with double-contrast barium enema examination every 3 years,
or every 5 years with annual fecal occult blood testing, had an ICER
of less than $55,600 per life-year saved. However, double-contrast
barium enema examination screening every 3 years plus annual fecal
occult blood testing had an ICER of more than $100,000 per life-year
saved. Colonoscopic screening had an ICER of more than $100,000 per
life-year saved, was dominated by other screening strategies, and
offered less benefit than did double-contrast barium enema examination
screening. CONCLUSION: Double-contrast barium enema examination can
be a cost-effective component of colorectal cancer screening, but
further modeling efforts are necessary.
strategy costing less than $100,000 per life-year saved and to determine
how available strategies compare with each other. MATERIALS AND METHODS:
Standardized methods were used to calculate incremental cost-effectiveness
ratios (ICERs) from published estimates of cost and effectiveness
of colorectal cancer screening strategies, and the direction and
magnitude of any effect on the ratio from parameter estimate adjustments
based on literature values were estimated. RESULTS: Strategies in
which double-contrast barium enema examination was performed emerged
as optimal from all studies included. In average-risk individuals,
screening with double-contrast barium enema examination every 3 years,
or every 5 years with annual fecal occult blood testing, had an ICER
of less than $55,600 per life-year saved. However, double-contrast
barium enema examination screening every 3 years plus annual fecal
occult blood testing had an ICER of more than $100,000 per life-year
saved. Colonoscopic screening had an ICER of more than $100,000 per
life-year saved, was dominated by other screening strategies, and
offered less benefit than did double-contrast barium enema examination
screening. CONCLUSION: Double-contrast barium enema examination can
be a cost-effective component of colorectal cancer screening, but
further modeling efforts are necessary.
Goldberg, S. N.; Ahmed, M.; Gazelle, G. Scott; Kruskal, J. B.; Huertas, J. C.; Halpern, Elkan F.; Oliver, B. S.; Lenkinski, R. E.
In: Radiology, vol. 219, no. 1, pp. 157-65, 2001, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Goldberg2001a,
title = {Radio-frequency thermal ablation with NaCl solution injection: effect
of electrical conductivity on tissue heating and coagulation-phantom
and porcine liver study},
author = {S. N. Goldberg and M. Ahmed and G. Scott Gazelle and J. B. Kruskal and J. C. Huertas and Elkan F. Halpern and B. S. Oliver and R. E. Lenkinski},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11274551},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2001},
date = {2001-04-01},
journal = {Radiology},
volume = {219},
number = {1},
pages = {157-65},
abstract = {PURPOSE: To characterize the effects of NaCl concentration on tissue
electrical conductivity, radio-frequency (RF) deposition, and heating
in phantoms and optimize adjunctive NaCl solution injection for RF
ablation in an in vivo model. MATERIALS AND METHODS: RF was applied
for 12-15 minutes with internally cooled electrodes. For phantom experiments (n = 51), the NaCl concentration in standardized 5% agar
was varied (0%-25.0%). A nonlinear simplex optimization strategy was then used in normal porcine liver (n = 44) to determine optimal
pre-RF NaCl solution injection parameters (concentration, 0%-38.5%;
volume, 0-25 mL). NaCl concentration and tissue conductivity were
correlated with RF energy deposition, tissue heating, and induced
coagulation. RESULTS: NaCl concentration had significant but nonlinear
effects on electrical conductivity, RF deposition, and heating of
agar phantoms (P\<.01). Progressively greater heating was observed
to 5.0% NaCl, with reduced temperatures at higher concentrations.
For in vivo liver, NaCl solution volume and concentration significantly
influenced both tissue heating and coagulation (P\<.001). Maximum
heating 20 mm from the electrode (102.9 degrees C +/- 4.3 [SD]) and
coagulation (7.1 cm +/- 1.1) occurred with injection of 6 mL of 38.5%
(saturated) NaCl solution. CONCLUSION: Injection of NaCl solution
before RF ablation can increase energy deposition, tissue heating,
and induced coagulation, which will likely benefit clinical RF ablation.
In normal well-perfused liver, maximum coagulation (7.0 cm) occurs
with injection of small volumes of saturated NaCl solution.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To characterize the effects of NaCl concentration on tissue
electrical conductivity, radio-frequency (RF) deposition, and heating
in phantoms and optimize adjunctive NaCl solution injection for RF
ablation in an in vivo model. MATERIALS AND METHODS: RF was applied
for 12-15 minutes with internally cooled electrodes. For phantom experiments (n = 51), the NaCl concentration in standardized 5% agar
was varied (0%-25.0%). A nonlinear simplex optimization strategy was then used in normal porcine liver (n = 44) to determine optimal
pre-RF NaCl solution injection parameters (concentration, 0%-38.5%;
volume, 0-25 mL). NaCl concentration and tissue conductivity were
correlated with RF energy deposition, tissue heating, and induced
coagulation. RESULTS: NaCl concentration had significant but nonlinear
effects on electrical conductivity, RF deposition, and heating of
agar phantoms (P<.01). Progressively greater heating was observed
to 5.0% NaCl, with reduced temperatures at higher concentrations.
For in vivo liver, NaCl solution volume and concentration significantly
influenced both tissue heating and coagulation (P<.001). Maximum
heating 20 mm from the electrode (102.9 degrees C +/- 4.3 [SD]) and
coagulation (7.1 cm +/- 1.1) occurred with injection of 6 mL of 38.5%
(saturated) NaCl solution. CONCLUSION: Injection of NaCl solution
before RF ablation can increase energy deposition, tissue heating,
and induced coagulation, which will likely benefit clinical RF ablation.
In normal well-perfused liver, maximum coagulation (7.0 cm) occurs
with injection of small volumes of saturated NaCl solution.
electrical conductivity, radio-frequency (RF) deposition, and heating
in phantoms and optimize adjunctive NaCl solution injection for RF
ablation in an in vivo model. MATERIALS AND METHODS: RF was applied
for 12-15 minutes with internally cooled electrodes. For phantom experiments (n = 51), the NaCl concentration in standardized 5% agar
was varied (0%-25.0%). A nonlinear simplex optimization strategy was then used in normal porcine liver (n = 44) to determine optimal
pre-RF NaCl solution injection parameters (concentration, 0%-38.5%;
volume, 0-25 mL). NaCl concentration and tissue conductivity were
correlated with RF energy deposition, tissue heating, and induced
coagulation. RESULTS: NaCl concentration had significant but nonlinear
effects on electrical conductivity, RF deposition, and heating of
agar phantoms (P<.01). Progressively greater heating was observed
to 5.0% NaCl, with reduced temperatures at higher concentrations.
For in vivo liver, NaCl solution volume and concentration significantly
influenced both tissue heating and coagulation (P<.001). Maximum
heating 20 mm from the electrode (102.9 degrees C +/- 4.3 [SD]) and
coagulation (7.1 cm +/- 1.1) occurred with injection of 6 mL of 38.5%
(saturated) NaCl solution. CONCLUSION: Injection of NaCl solution
before RF ablation can increase energy deposition, tissue heating,
and induced coagulation, which will likely benefit clinical RF ablation.
In normal well-perfused liver, maximum coagulation (7.0 cm) occurs
with injection of small volumes of saturated NaCl solution.
Segui-Gomez, M.; Wittenberg, Eve; Glass, R.; Levenson, S.; Hingson, R.; Graham, J. D.
Where children sit in cars: the impact of Rhode Island's new legislation Journal Article
In: Am J Public Health, vol. 91, no. 2, pp. 311-3, 2001, ISSN: 0090-0036 (Print) 0090-0036 (Lin, ().
@article{Segui-Gomez2001,
title = {Where children sit in cars: the impact of Rhode Island's new legislation},
author = {M. Segui-Gomez and Eve Wittenberg and R. Glass and S. Levenson and R. Hingson and J. D. Graham},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11211647},
issn = {0090-0036 (Print) 0090-0036 (Lin},
year = {2001},
date = {2001-02-01},
journal = {Am J Public Health},
volume = {91},
number = {2},
pages = {311-3},
abstract = {OBJECTIVES: This study evaluated the impact of Rhode Island's legislation
requiring children younger than 6 years to sit in the rear of motor
vehicles. METHODS: Roadside observations were conducted in Rhode
Island and Massachusetts in 1997 and 1998. Multivariate regression
was used to evaluate the proportion of vehicles carrying a child
in the front seat. RESULTS: Data were collected on 3226 vehicles
carrying at least 1 child. In 1998, Rhode Island vehicles were less
likely to have a child in the front seat than in 1997 (odds ratio = 0.6; 95% confidence interval = 0.5, 0.7), whereas no significant
changes in child passenger seating behavior occurred in Massachusetts
during that period. CONCLUSIONS: Rhode Island's legislation seems
to have promoted safer child passenger seating behavior.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: This study evaluated the impact of Rhode Island's legislation
requiring children younger than 6 years to sit in the rear of motor
vehicles. METHODS: Roadside observations were conducted in Rhode
Island and Massachusetts in 1997 and 1998. Multivariate regression
was used to evaluate the proportion of vehicles carrying a child
in the front seat. RESULTS: Data were collected on 3226 vehicles
carrying at least 1 child. In 1998, Rhode Island vehicles were less
likely to have a child in the front seat than in 1997 (odds ratio = 0.6; 95% confidence interval = 0.5, 0.7), whereas no significant
changes in child passenger seating behavior occurred in Massachusetts
during that period. CONCLUSIONS: Rhode Island's legislation seems
to have promoted safer child passenger seating behavior.
requiring children younger than 6 years to sit in the rear of motor
vehicles. METHODS: Roadside observations were conducted in Rhode
Island and Massachusetts in 1997 and 1998. Multivariate regression
was used to evaluate the proportion of vehicles carrying a child
in the front seat. RESULTS: Data were collected on 3226 vehicles
carrying at least 1 child. In 1998, Rhode Island vehicles were less
likely to have a child in the front seat than in 1997 (odds ratio = 0.6; 95% confidence interval = 0.5, 0.7), whereas no significant
changes in child passenger seating behavior occurred in Massachusetts
during that period. CONCLUSIONS: Rhode Island's legislation seems
to have promoted safer child passenger seating behavior.
Carroll, T. J.; Korosec, F. R.; Swan, J. Shannon; Hany, T. F.; Grist, T. M.; Mistretta, C. A.
The effect of injection rate on time-resolved contrast-enhanced peripheral MRA Journal Article
In: J Magn Reson Imaging, vol. 14, no. 4, pp. 401-10, 2001, ISSN: 1053-1807 (Print) 1053-1807 (Li, ().
@article{Carroll2001,
title = {The effect of injection rate on time-resolved contrast-enhanced peripheral MRA},
author = {T. J. Carroll and F. R. Korosec and J. Shannon Swan and T. F. Hany and T. M. Grist and C. A. Mistretta},
url = {https://www.ncbi.nlm.nih.gov/pubmed/11599064},
doi = {10.1002/jmri.1200},
issn = {1053-1807 (Print) 1053-1807 (Li},
year = {2001},
date = {2001-01-01},
urldate = {2001-01-01},
journal = {J Magn Reson Imaging},
volume = {14},
number = {4},
pages = {401-10},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Slanetz, P. J.; Giardino, A. A.; Oyama, T.; Koerner, F. C.; Halpern, Elkan F.; Moore, R. H.; Kopans, D. B.
Mammographic appearance of ductal carcinoma in situ does not reliably predict histologic subtype Journal Article
In: Breast J, vol. 7, pp. 417-21, 2001, ().
@article{Slanetz2001,
title = {Mammographic appearance of ductal carcinoma in situ does not reliably
predict histologic subtype},
author = {P. J. Slanetz and A. A. Giardino and T. Oyama and F. C. Koerner and Elkan F. Halpern and R. H. Moore and D. B. Kopans},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11843854},
year = {2001},
date = {2001-01-01},
journal = {Breast J},
volume = {7},
pages = {417-21},
abstract = {Histologic subtypes of ductal carcinoma in situ (DCIS) have been correlated
with disease prognosis. There are conflicting reports on whether
the grade of DCIS can be predicted by the morphology of calcifications
seen on mammography. We undertook this study to determine whether
the grade of DCIS can be reliably and accurately determined by mammography
prior to excisional biopsy. Ninety consecutive cases of DCIS from
1993 to 1996 were identified, of which 75 cases had mammograms available
for review. Any lesion with invasion was excluded. The mammogram
showed only a mass in 10 of 75 cases, a mass and calcifications in
3 of 75 cases, and calcifications alone in 62 of 75 cases. Three
board-certified radiologists with special expertise in mammography
reviewed and categorized the mammographic findings as well, intermediate
or poorly differentiated DCIS without knowledge of the histologic
diagnosis. Histologic grading was performed without knowledge of
the mammographic finding. Receiver operating curves (ROCs) were computed
for each of the radiologists. For microcalcifications, the ROC comparisons
of the radiologists' opinions of tumor grade and random chance were
not significantly different. In those cases with available magnification
views, the grade assessment did not change significantly. If only
a mass was present on mammography, well-differentiated DCIS was the
predominant histologic subtype. A histologic grade of DCIS cannot
accurately be determined prospectively based on the mammographic
appearance of microcalcifications. However, if only a mass is present,
this is more likely to represent well-differentiated DCIS.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Histologic subtypes of ductal carcinoma in situ (DCIS) have been correlated
with disease prognosis. There are conflicting reports on whether
the grade of DCIS can be predicted by the morphology of calcifications
seen on mammography. We undertook this study to determine whether
the grade of DCIS can be reliably and accurately determined by mammography
prior to excisional biopsy. Ninety consecutive cases of DCIS from
1993 to 1996 were identified, of which 75 cases had mammograms available
for review. Any lesion with invasion was excluded. The mammogram
showed only a mass in 10 of 75 cases, a mass and calcifications in
3 of 75 cases, and calcifications alone in 62 of 75 cases. Three
board-certified radiologists with special expertise in mammography
reviewed and categorized the mammographic findings as well, intermediate
or poorly differentiated DCIS without knowledge of the histologic
diagnosis. Histologic grading was performed without knowledge of
the mammographic finding. Receiver operating curves (ROCs) were computed
for each of the radiologists. For microcalcifications, the ROC comparisons
of the radiologists' opinions of tumor grade and random chance were
not significantly different. In those cases with available magnification
views, the grade assessment did not change significantly. If only
a mass was present on mammography, well-differentiated DCIS was the
predominant histologic subtype. A histologic grade of DCIS cannot
accurately be determined prospectively based on the mammographic
appearance of microcalcifications. However, if only a mass is present,
this is more likely to represent well-differentiated DCIS.
with disease prognosis. There are conflicting reports on whether
the grade of DCIS can be predicted by the morphology of calcifications
seen on mammography. We undertook this study to determine whether
the grade of DCIS can be reliably and accurately determined by mammography
prior to excisional biopsy. Ninety consecutive cases of DCIS from
1993 to 1996 were identified, of which 75 cases had mammograms available
for review. Any lesion with invasion was excluded. The mammogram
showed only a mass in 10 of 75 cases, a mass and calcifications in
3 of 75 cases, and calcifications alone in 62 of 75 cases. Three
board-certified radiologists with special expertise in mammography
reviewed and categorized the mammographic findings as well, intermediate
or poorly differentiated DCIS without knowledge of the histologic
diagnosis. Histologic grading was performed without knowledge of
the mammographic finding. Receiver operating curves (ROCs) were computed
for each of the radiologists. For microcalcifications, the ROC comparisons
of the radiologists' opinions of tumor grade and random chance were
not significantly different. In those cases with available magnification
views, the grade assessment did not change significantly. If only
a mass was present on mammography, well-differentiated DCIS was the
predominant histologic subtype. A histologic grade of DCIS cannot
accurately be determined prospectively based on the mammographic
appearance of microcalcifications. However, if only a mass is present,
this is more likely to represent well-differentiated DCIS.
Zalis, M. E.; Hahn, P. F.; Arellano, R. S.; Gazelle, G. Scott; Mueller, P. R.
CT colonography with teleradiology: effect of lossy wavelet compression on polyp detection--initial observations Journal Article
In: Radiology, vol. 220, pp. 387-92, 2001, ().
@article{Zalis2001,
title = {CT colonography with teleradiology: effect of lossy wavelet compression
on polyp detection--initial observations},
author = {M. E. Zalis and P. F. Hahn and R. S. Arellano and G. Scott Gazelle and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11477241},
year = {2001},
date = {2001-01-01},
journal = {Radiology},
volume = {220},
pages = {387-92},
abstract = {PURPOSE: To assess the consequences of lossy compression on the diagnostic
accuracy of CT colonography for detecting colonic polyps. MATERIALS
AND METHODS: Helical CT images of cleansed colonic segments were
evaluated. Source images were compressed to 1:1, 10:1, and 20:1 ratios
with lossy wavelet compression. Two independent readers blinded to
corresponding colonoscopic results analyzed 144 randomly ordered
colonic segments in multiplanar and volume-rendered endoscopic views.
Sensitivity, specificity, and receiver operating characteristic curves
were generated for each compression ratio on the basis of expressed
confidence in lesion presence. Similar analyses were performed to
assess distention and bowel preparation adequacy and evaluation time
required. RESULTS: Results based on video colonoscopy-confirmed lesions
revealed 100% (four of four) sensitivity for lesions larger than
10 mm for compression ratios 1:1, 10:1, and 20:1 for both readers;
sensitivities for all lesions smaller than 10 mm were 5078 3867 and
3867% for respective ratios for both readers. Differences in diagnostic
performance for each reader across ratios were not significant (P =.30-.99, McNemar test). The time required to evaluate and assess
bowel preparation and distention adequacy did not change significantly
across ratios. CONCLUSION: On the basis of the patient sample, lossy
compression of transverse source images to at least a 20:1 ratio
did not adversely affect diagnostic performance or evaluation time
for CT colonography.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To assess the consequences of lossy compression on the diagnostic
accuracy of CT colonography for detecting colonic polyps. MATERIALS
AND METHODS: Helical CT images of cleansed colonic segments were
evaluated. Source images were compressed to 1:1, 10:1, and 20:1 ratios
with lossy wavelet compression. Two independent readers blinded to
corresponding colonoscopic results analyzed 144 randomly ordered
colonic segments in multiplanar and volume-rendered endoscopic views.
Sensitivity, specificity, and receiver operating characteristic curves
were generated for each compression ratio on the basis of expressed
confidence in lesion presence. Similar analyses were performed to
assess distention and bowel preparation adequacy and evaluation time
required. RESULTS: Results based on video colonoscopy-confirmed lesions
revealed 100% (four of four) sensitivity for lesions larger than
10 mm for compression ratios 1:1, 10:1, and 20:1 for both readers;
sensitivities for all lesions smaller than 10 mm were 5078 3867 and
3867% for respective ratios for both readers. Differences in diagnostic
performance for each reader across ratios were not significant (P =.30-.99, McNemar test). The time required to evaluate and assess
bowel preparation and distention adequacy did not change significantly
across ratios. CONCLUSION: On the basis of the patient sample, lossy
compression of transverse source images to at least a 20:1 ratio
did not adversely affect diagnostic performance or evaluation time
for CT colonography.
accuracy of CT colonography for detecting colonic polyps. MATERIALS
AND METHODS: Helical CT images of cleansed colonic segments were
evaluated. Source images were compressed to 1:1, 10:1, and 20:1 ratios
with lossy wavelet compression. Two independent readers blinded to
corresponding colonoscopic results analyzed 144 randomly ordered
colonic segments in multiplanar and volume-rendered endoscopic views.
Sensitivity, specificity, and receiver operating characteristic curves
were generated for each compression ratio on the basis of expressed
confidence in lesion presence. Similar analyses were performed to
assess distention and bowel preparation adequacy and evaluation time
required. RESULTS: Results based on video colonoscopy-confirmed lesions
revealed 100% (four of four) sensitivity for lesions larger than
10 mm for compression ratios 1:1, 10:1, and 20:1 for both readers;
sensitivities for all lesions smaller than 10 mm were 5078 3867 and
3867% for respective ratios for both readers. Differences in diagnostic
performance for each reader across ratios were not significant (P =.30-.99, McNemar test). The time required to evaluate and assess
bowel preparation and distention adequacy did not change significantly
across ratios. CONCLUSION: On the basis of the patient sample, lossy
compression of transverse source images to at least a 20:1 ratio
did not adversely affect diagnostic performance or evaluation time
for CT colonography.
Rubin, J. P.; Cober, S. R.; Butler, P. E.; Randolph, M. A.; Gazelle, G. Scott; Ierino, F. L.; Sachs, D. H.; Lee, W. P.
Injection of allogeneic bone marrow cells into the portal vein of swine in utero Journal Article
In: J Surg Res, vol. 95, pp. 188-94, 2001, ().
@article{Rubin2001,
title = {Injection of allogeneic bone marrow cells into the portal vein of swine in utero},
author = {J. P. Rubin and S. R. Cober and P. E. Butler and M. A. Randolph and G. Scott Gazelle and F. L. Ierino and D. H. Sachs and W. P. Lee},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11162044},
year = {2001},
date = {2001-01-01},
urldate = {2001-01-01},
journal = {J Surg Res},
volume = {95},
pages = {188-94},
abstract = {The ability to safely manipulate the immune system of the developing
fetus carries the hope of effective treatment strategies for certain
congenital disorders that can be diagnosed during gestation. One
possible intervention is the induction of specific transplantation
tolerance to an adult donor who could provide tissue after birth
without the need for immunosuppression. Although the introduction
of allogeneic stem cells to a developing immune system has been shown
to result in hematopoietic chimerism, donor-specific transplantation
tolerance has not been demonstrated in a large animal model. In previous
reports of in utero stem-cell transplantation, the cells were injected
into the fetus by an intraperitoneal route. We sought to improve
upon this technique of cell transplantation by developing a method
for the safe delivery of allogeneic stem cells directly into the
hepatic circulation of fetal swine. In the second phase of our study,
we determined if adult allogeneic bone marrow cells delivered to
the fetus by this intravascular route could result in result in hematopoietic
chimerism and donor-specific transplantation tolerance. A method
of successful intravascular injection was designed in which a laparotomy
was performed on a sow at midgestation (50-55 days) to administer
1 cc of inoculum into the portal vein of each fetus using transuterine
ultrasound guidance and a 25-gauge spinal needle. In one sow, 10
piglets were injected with saline to test safety, and 8 piglets were
born. For transplantation of stem cells to the fetuses, donor bone
marrow was harvested from a genetically defined miniature swine.
In one sow the marrow was injected without T-cell depletion resulting
in abortion. In the third sow, the marrow was depleted of T-cells
to less than 0.01% using magnetic beads conjugated to anti-CD3 monoclonal
antibodies. No chimerism was detected in these offspring. Only in
the fourth sow where the T-cell depletion was reduced to about 1%
of the cells in the inoculum did one animal demonstrate chimerism.
This piglet showed reproducible blood chimerism (0.95% donor cells)
detected by flow cytometry measurement of monoclonal antibodies to
the donor MHC. In addition, this animal demonstrated hyporesponsiveness
to donor lymphocytes in an MLR assay while reacting strongly to third-party
stimulator cells. A split-thickness skin graft from the donor was
accepted, and a third-party graft was rapidly rejected.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The ability to safely manipulate the immune system of the developing
fetus carries the hope of effective treatment strategies for certain
congenital disorders that can be diagnosed during gestation. One
possible intervention is the induction of specific transplantation
tolerance to an adult donor who could provide tissue after birth
without the need for immunosuppression. Although the introduction
of allogeneic stem cells to a developing immune system has been shown
to result in hematopoietic chimerism, donor-specific transplantation
tolerance has not been demonstrated in a large animal model. In previous
reports of in utero stem-cell transplantation, the cells were injected
into the fetus by an intraperitoneal route. We sought to improve
upon this technique of cell transplantation by developing a method
for the safe delivery of allogeneic stem cells directly into the
hepatic circulation of fetal swine. In the second phase of our study,
we determined if adult allogeneic bone marrow cells delivered to
the fetus by this intravascular route could result in result in hematopoietic
chimerism and donor-specific transplantation tolerance. A method
of successful intravascular injection was designed in which a laparotomy
was performed on a sow at midgestation (50-55 days) to administer
1 cc of inoculum into the portal vein of each fetus using transuterine
ultrasound guidance and a 25-gauge spinal needle. In one sow, 10
piglets were injected with saline to test safety, and 8 piglets were
born. For transplantation of stem cells to the fetuses, donor bone
marrow was harvested from a genetically defined miniature swine.
In one sow the marrow was injected without T-cell depletion resulting
in abortion. In the third sow, the marrow was depleted of T-cells
to less than 0.01% using magnetic beads conjugated to anti-CD3 monoclonal
antibodies. No chimerism was detected in these offspring. Only in
the fourth sow where the T-cell depletion was reduced to about 1%
of the cells in the inoculum did one animal demonstrate chimerism.
This piglet showed reproducible blood chimerism (0.95% donor cells)
detected by flow cytometry measurement of monoclonal antibodies to
the donor MHC. In addition, this animal demonstrated hyporesponsiveness
to donor lymphocytes in an MLR assay while reacting strongly to third-party
stimulator cells. A split-thickness skin graft from the donor was
accepted, and a third-party graft was rapidly rejected.
fetus carries the hope of effective treatment strategies for certain
congenital disorders that can be diagnosed during gestation. One
possible intervention is the induction of specific transplantation
tolerance to an adult donor who could provide tissue after birth
without the need for immunosuppression. Although the introduction
of allogeneic stem cells to a developing immune system has been shown
to result in hematopoietic chimerism, donor-specific transplantation
tolerance has not been demonstrated in a large animal model. In previous
reports of in utero stem-cell transplantation, the cells were injected
into the fetus by an intraperitoneal route. We sought to improve
upon this technique of cell transplantation by developing a method
for the safe delivery of allogeneic stem cells directly into the
hepatic circulation of fetal swine. In the second phase of our study,
we determined if adult allogeneic bone marrow cells delivered to
the fetus by this intravascular route could result in result in hematopoietic
chimerism and donor-specific transplantation tolerance. A method
of successful intravascular injection was designed in which a laparotomy
was performed on a sow at midgestation (50-55 days) to administer
1 cc of inoculum into the portal vein of each fetus using transuterine
ultrasound guidance and a 25-gauge spinal needle. In one sow, 10
piglets were injected with saline to test safety, and 8 piglets were
born. For transplantation of stem cells to the fetuses, donor bone
marrow was harvested from a genetically defined miniature swine.
In one sow the marrow was injected without T-cell depletion resulting
in abortion. In the third sow, the marrow was depleted of T-cells
to less than 0.01% using magnetic beads conjugated to anti-CD3 monoclonal
antibodies. No chimerism was detected in these offspring. Only in
the fourth sow where the T-cell depletion was reduced to about 1%
of the cells in the inoculum did one animal demonstrate chimerism.
This piglet showed reproducible blood chimerism (0.95% donor cells)
detected by flow cytometry measurement of monoclonal antibodies to
the donor MHC. In addition, this animal demonstrated hyporesponsiveness
to donor lymphocytes in an MLR assay while reacting strongly to third-party
stimulator cells. A split-thickness skin graft from the donor was
accepted, and a third-party graft was rapidly rejected.
Ko, J. P.; Shepard, J. O.; Drucker, E. A.; Aquino, S. L.; Sharma, A.; Sabloff, B.; Halpern, Elkan F.; McLoud, T. C.
Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors? Journal Article
In: Radiology, vol. 218, pp. 491-6, 2001, ().
@article{Ko2001,
title = {Factors influencing pneumothorax rate at lung biopsy: are dwell time
and angle of pleural puncture contributing factors?},
author = {J. P. Ko and J. O. Shepard and E. A. Drucker and S. L. Aquino and A. Sharma and B. Sabloff and Elkan F. Halpern and T. C. McLoud},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11161167},
year = {2001},
date = {2001-01-01},
journal = {Radiology},
volume = {218},
pages = {491-6},
abstract = {PURPOSE: To study factors that may influence pneumothorax and chest
tube placement rate, especially needle dwell time and pleural puncture
angle. MATERIALS AND METHODS: In 159 patients, 160 coaxial computed
tomography (CT)-guided lung biopsies were performed. Dwell time,
the time between pleural puncture and needle removal, was calculated.
The smallest angle of the needle with the pleura ("needle-pleural
angle") was measured. These and other variables were correlated with
pneumothorax and chest tube rates. RESULTS: One hundred fifty biopsies
were included. There were 58 (39 pneumothoraces (14 noted only at
CT), with eight (5 biopsies resulting in chest tube placement. Longer
dwell times (mean, 29 minutes; range, 12-66 minutes) did not correlate with pneumothoraces (P =.81). Smaller needle-pleural angles (textless
80 degrees) [corrected], decreased forced expiratory volume in 1
second to vital capacity ratio (textless50, lateral pleural puncture,
and lesions along fissures were associated with higher [corrected]
pneumothorax rates (P textless.05). Emphysema along the needle path,
pulmonary function tests showing ventilatory obstruction, and lesions
along fissures predisposed patients to chest tube placement (P textless.05).
Pleural thickening and prior surgery were associated with lower pneumothorax
rates (P textless.05). CONCLUSION: Longer dwell times do not correlate
with pneumothorax and should not influence the decision to obtain
more biopsy samples. A shallow pleural puncture angle may increase
the pneumothorax rate.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To study factors that may influence pneumothorax and chest
tube placement rate, especially needle dwell time and pleural puncture
angle. MATERIALS AND METHODS: In 159 patients, 160 coaxial computed
tomography (CT)-guided lung biopsies were performed. Dwell time,
the time between pleural puncture and needle removal, was calculated.
The smallest angle of the needle with the pleura ("needle-pleural
angle") was measured. These and other variables were correlated with
pneumothorax and chest tube rates. RESULTS: One hundred fifty biopsies
were included. There were 58 (39 pneumothoraces (14 noted only at
CT), with eight (5 biopsies resulting in chest tube placement. Longer
dwell times (mean, 29 minutes; range, 12-66 minutes) did not correlate with pneumothoraces (P =.81). Smaller needle-pleural angles (textless
80 degrees) [corrected], decreased forced expiratory volume in 1
second to vital capacity ratio (textless50, lateral pleural puncture,
and lesions along fissures were associated with higher [corrected]
pneumothorax rates (P textless.05). Emphysema along the needle path,
pulmonary function tests showing ventilatory obstruction, and lesions
along fissures predisposed patients to chest tube placement (P textless.05).
Pleural thickening and prior surgery were associated with lower pneumothorax
rates (P textless.05). CONCLUSION: Longer dwell times do not correlate
with pneumothorax and should not influence the decision to obtain
more biopsy samples. A shallow pleural puncture angle may increase
the pneumothorax rate.
tube placement rate, especially needle dwell time and pleural puncture
angle. MATERIALS AND METHODS: In 159 patients, 160 coaxial computed
tomography (CT)-guided lung biopsies were performed. Dwell time,
the time between pleural puncture and needle removal, was calculated.
The smallest angle of the needle with the pleura ("needle-pleural
angle") was measured. These and other variables were correlated with
pneumothorax and chest tube rates. RESULTS: One hundred fifty biopsies
were included. There were 58 (39 pneumothoraces (14 noted only at
CT), with eight (5 biopsies resulting in chest tube placement. Longer
dwell times (mean, 29 minutes; range, 12-66 minutes) did not correlate with pneumothoraces (P =.81). Smaller needle-pleural angles (textless
80 degrees) [corrected], decreased forced expiratory volume in 1
second to vital capacity ratio (textless50, lateral pleural puncture,
and lesions along fissures were associated with higher [corrected]
pneumothorax rates (P textless.05). Emphysema along the needle path,
pulmonary function tests showing ventilatory obstruction, and lesions
along fissures predisposed patients to chest tube placement (P textless.05).
Pleural thickening and prior surgery were associated with lower pneumothorax
rates (P textless.05). CONCLUSION: Longer dwell times do not correlate
with pneumothorax and should not influence the decision to obtain
more biopsy samples. A shallow pleural puncture angle may increase
the pneumothorax rate.
Mathes, D. W.; Yamada, K.; Randolph, M. A.; Utsugi, R.; Solari, M. G.; Gazelle, G. Scott; Wu, A.; Sachs, D. H.; Lee, W. P.
In utero induction of transplantation tolerance Journal Article
In: Transplant Proc, vol. 33, no. 1-2, pp. 98-100, 2001, ISSN: 0041-1345 (Print) 0041-1345 (Lin, ().
@article{Mathes2001,
title = {In utero induction of transplantation tolerance},
author = {D. W. Mathes and K. Yamada and M. A. Randolph and R. Utsugi and M. G. Solari and G. Scott Gazelle and A. Wu and D. H. Sachs and W. P. Lee},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11266726},
issn = {0041-1345 (Print) 0041-1345 (Lin},
year = {2001},
date = {2001-00-01},
urldate = {2001-00-01},
journal = {Transplant Proc},
volume = {33},
number = {1-2},
pages = {98-100},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Goldberg, S. N.; Gazelle, G. Scott
Radiofrequency tissue ablation: physical principles and techniques for increasing coagulation necrosis Journal Article
In: Hepatogastroenterology, vol. 48, no. 38, pp. 359-67, 2001, ISSN: 0172-6390 (Print) 0172-6390 (Lin, ().
@article{Goldberg2001,
title = {Radiofrequency tissue ablation: physical principles and techniques
for increasing coagulation necrosis},
author = {S. N. Goldberg and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11379309},
issn = {0172-6390 (Print) 0172-6390 (Lin},
year = {2001},
date = {2001-00-01},
journal = {Hepatogastroenterology},
volume = {48},
number = {38},
pages = {359-67},
abstract = {Radiofrequency tumor ablation has been demonstrated as a reliable
method for creating thermally-induced coagulation necrosis using
either a percutaneous approach with image-guidance or direct surgical
placement of thin electrodes into tissues to be treated. Early clinical
trials with this technology have studied the treatment of hepatic,
cerebral, and bony malignancies. The extent of coagulation necrosis
induced with conventional monopolar radiofrequency electrodes is
dependent on overall energy deposition, the duration of radiofrequency
application, and radiofrequency electrode tip length and gauge. This
article will discuss these technical considerations with the goal
of defining optimal parameters for radiofrequency ablation. Strategies
to further increase induced coagulation necrosis including: multiprobe
and bipolar arrays, and internally-cooled radiofrequency electrodes,
with or without pulsed-radiofrequency or cluster technique will be
presented. The development and laboratory results for many of these
radiofrequency techniques and potential biophysical limitations to
radiofrequency induced coagulation, such as perfusion mediated tissue
cooling (vascular flow) will likewise be discussed.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Radiofrequency tumor ablation has been demonstrated as a reliable
method for creating thermally-induced coagulation necrosis using
either a percutaneous approach with image-guidance or direct surgical
placement of thin electrodes into tissues to be treated. Early clinical
trials with this technology have studied the treatment of hepatic,
cerebral, and bony malignancies. The extent of coagulation necrosis
induced with conventional monopolar radiofrequency electrodes is
dependent on overall energy deposition, the duration of radiofrequency
application, and radiofrequency electrode tip length and gauge. This
article will discuss these technical considerations with the goal
of defining optimal parameters for radiofrequency ablation. Strategies
to further increase induced coagulation necrosis including: multiprobe
and bipolar arrays, and internally-cooled radiofrequency electrodes,
with or without pulsed-radiofrequency or cluster technique will be
presented. The development and laboratory results for many of these
radiofrequency techniques and potential biophysical limitations to
radiofrequency induced coagulation, such as perfusion mediated tissue
cooling (vascular flow) will likewise be discussed.
method for creating thermally-induced coagulation necrosis using
either a percutaneous approach with image-guidance or direct surgical
placement of thin electrodes into tissues to be treated. Early clinical
trials with this technology have studied the treatment of hepatic,
cerebral, and bony malignancies. The extent of coagulation necrosis
induced with conventional monopolar radiofrequency electrodes is
dependent on overall energy deposition, the duration of radiofrequency
application, and radiofrequency electrode tip length and gauge. This
article will discuss these technical considerations with the goal
of defining optimal parameters for radiofrequency ablation. Strategies
to further increase induced coagulation necrosis including: multiprobe
and bipolar arrays, and internally-cooled radiofrequency electrodes,
with or without pulsed-radiofrequency or cluster technique will be
presented. The development and laboratory results for many of these
radiofrequency techniques and potential biophysical limitations to
radiofrequency induced coagulation, such as perfusion mediated tissue
cooling (vascular flow) will likewise be discussed.
Aquino, S. L.; Shepard, J. A.; Ginns, L. C.; Moore, R. H.; Halpern, Elkan F.; Grillo, H. C.; McLoud, T. C.
Acquired tracheomalacia: detection by expiratory CT scan Journal Article
In: J Comput Assist Tomogr, vol. 25, no. 3, pp. 394-9, 2001, ISSN: 0363-8715 (Print) 0363-8715 (Lin, ().
@article{Aquino2001,
title = {Acquired tracheomalacia: detection by expiratory CT scan},
author = {S. L. Aquino and J. A. Shepard and L. C. Ginns and R. H. Moore and Elkan F. Halpern and H. C. Grillo and T. C. McLoud},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11351189},
issn = {0363-8715 (Print) 0363-8715 (Lin},
year = {2001},
date = {2001-00-01},
urldate = {2001-00-01},
journal = {J Comput Assist Tomogr},
volume = {25},
number = {3},
pages = {394-9},
abstract = {PURPOSE: The purpose of this work was to determine whether cross-sectional
area and coronal and sagittal diameter measurements of the trachea
between inspiration and end-expiration on CT are significantly different
between patients with acquired tracheomalacia and those without this
condition. METHOD: Inspiratory and end-expiratory CT scans of the
trachea of 23 normal patients and 10 patients with acquired tracheomalacia
were analyzed. Percent changes in cross-sectional area, coronal,
and sagittal diameters were calculated. RESULTS: For patients with
tracheomalacia, mean percent changes in the upper and middle trachea
between inspiration and expiration were 49 and 44%; mean changes
in the coronal and sagittal diameters in the upper and middle tracheal
were 4 and 10% and 39 and 54%, respectively. Control group mean percent
changes in the upper and middle tracheal area were 12 and 14%, respectively,
and mean changes in the coronal and sagittal diameters in the upper
and middle trachea were 4 and 4% and 11 and 13%, respectively. Significant
differences were calculated for changes in cross-sectional area and
sagittal diameter between groups (p \< 10-5). Based on receiver operator
curve analysis, a \> 18% change in the upper trachea and 28% change
in the midtrachea between inspiration and expiration were observed;
the probability of tracheomalacia was 89-100%. The probability of
tracheomalacia was \> 89%, especially if the change in sagittal diameter
was \> 28%. CONCLUSION: By measuring changes in tracheal cross-sectional
area and sagittal diameters between inspiratory and end-expiratory
CT, a significant difference can be identified between normal patients
and those with acquired tracheomalacia.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: The purpose of this work was to determine whether cross-sectional
area and coronal and sagittal diameter measurements of the trachea
between inspiration and end-expiration on CT are significantly different
between patients with acquired tracheomalacia and those without this
condition. METHOD: Inspiratory and end-expiratory CT scans of the
trachea of 23 normal patients and 10 patients with acquired tracheomalacia
were analyzed. Percent changes in cross-sectional area, coronal,
and sagittal diameters were calculated. RESULTS: For patients with
tracheomalacia, mean percent changes in the upper and middle trachea
between inspiration and expiration were 49 and 44%; mean changes
in the coronal and sagittal diameters in the upper and middle tracheal
were 4 and 10% and 39 and 54%, respectively. Control group mean percent
changes in the upper and middle tracheal area were 12 and 14%, respectively,
and mean changes in the coronal and sagittal diameters in the upper
and middle trachea were 4 and 4% and 11 and 13%, respectively. Significant
differences were calculated for changes in cross-sectional area and
sagittal diameter between groups (p < 10-5). Based on receiver operator
curve analysis, a > 18% change in the upper trachea and 28% change
in the midtrachea between inspiration and expiration were observed;
the probability of tracheomalacia was 89-100%. The probability of
tracheomalacia was > 89%, especially if the change in sagittal diameter
was > 28%. CONCLUSION: By measuring changes in tracheal cross-sectional
area and sagittal diameters between inspiratory and end-expiratory
CT, a significant difference can be identified between normal patients
and those with acquired tracheomalacia.
area and coronal and sagittal diameter measurements of the trachea
between inspiration and end-expiration on CT are significantly different
between patients with acquired tracheomalacia and those without this
condition. METHOD: Inspiratory and end-expiratory CT scans of the
trachea of 23 normal patients and 10 patients with acquired tracheomalacia
were analyzed. Percent changes in cross-sectional area, coronal,
and sagittal diameters were calculated. RESULTS: For patients with
tracheomalacia, mean percent changes in the upper and middle trachea
between inspiration and expiration were 49 and 44%; mean changes
in the coronal and sagittal diameters in the upper and middle tracheal
were 4 and 10% and 39 and 54%, respectively. Control group mean percent
changes in the upper and middle tracheal area were 12 and 14%, respectively,
and mean changes in the coronal and sagittal diameters in the upper
and middle trachea were 4 and 4% and 11 and 13%, respectively. Significant
differences were calculated for changes in cross-sectional area and
sagittal diameter between groups (p < 10-5). Based on receiver operator
curve analysis, a > 18% change in the upper trachea and 28% change
in the midtrachea between inspiration and expiration were observed;
the probability of tracheomalacia was 89-100%. The probability of
tracheomalacia was > 89%, especially if the change in sagittal diameter
was > 28%. CONCLUSION: By measuring changes in tracheal cross-sectional
area and sagittal diameters between inspiratory and end-expiratory
CT, a significant difference can be identified between normal patients
and those with acquired tracheomalacia.
2000
Gazelle, G. Scott; Goldberg, S. N.; Solbiati, L.; Livraghi, T.
Tumor ablation with radio-frequency energy Journal Article
In: Radiology, vol. 217, no. 3, pp. 633-46, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Gazelle2000a,
title = {Tumor ablation with radio-frequency energy},
author = {G. Scott Gazelle and S. N. Goldberg and L. Solbiati and T. Livraghi},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11110923},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-12-01},
urldate = {2000-12-01},
journal = {Radiology},
volume = {217},
number = {3},
pages = {633-46},
abstract = {Tumor ablation by using radio-frequency energy has begun to receive
increased attention as an effective minimally invasive approach for
the treatment of patients with a variety of primary and secondary
malignant neoplasms. To date, these techniques have been used to
treat tumors located in the brain, musculoskeletal system, thyroid
and parathyroid glands, pancreas, kidney, lung, and breast; however,
liver tumor ablation has received the greatest attention and has
been the subject of a large number of published reports. In this
article, the authors review the technical developments and early
laboratory results obtained with radio-frequency ablation techniques,
describe some of the early clinical applications of these techniques,
and conclude with a discussion of challenges and opportunities for
the future.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Tumor ablation by using radio-frequency energy has begun to receive
increased attention as an effective minimally invasive approach for
the treatment of patients with a variety of primary and secondary
malignant neoplasms. To date, these techniques have been used to
treat tumors located in the brain, musculoskeletal system, thyroid
and parathyroid glands, pancreas, kidney, lung, and breast; however,
liver tumor ablation has received the greatest attention and has
been the subject of a large number of published reports. In this
article, the authors review the technical developments and early
laboratory results obtained with radio-frequency ablation techniques,
describe some of the early clinical applications of these techniques,
and conclude with a discussion of challenges and opportunities for
the future.
increased attention as an effective minimally invasive approach for
the treatment of patients with a variety of primary and secondary
malignant neoplasms. To date, these techniques have been used to
treat tumors located in the brain, musculoskeletal system, thyroid
and parathyroid glands, pancreas, kidney, lung, and breast; however,
liver tumor ablation has received the greatest attention and has
been the subject of a large number of published reports. In this
article, the authors review the technical developments and early
laboratory results obtained with radio-frequency ablation techniques,
describe some of the early clinical applications of these techniques,
and conclude with a discussion of challenges and opportunities for
the future.
Goldberg, S. N.; Kruskal, J. B.; Oliver, B. S.; Clouse, M. E.; Gazelle, G. Scott
Percutaneous tumor ablation: increased coagulation by combining radio-frequency ablation and ethanol instillation in a rat breast tumor model Journal Article
In: Radiology, vol. 217, no. 3, pp. 827-31, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Goldberg2000b,
title = {Percutaneous tumor ablation: increased coagulation by combining radio-frequency
ablation and ethanol instillation in a rat breast tumor model},
author = {S. N. Goldberg and J. B. Kruskal and B. S. Oliver and M. E. Clouse and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11110950},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-12-01},
journal = {Radiology},
volume = {217},
number = {3},
pages = {827-31},
abstract = {PURPOSE: To determine if percutaneously applied radio frequency (RF)
combined with percutaneous ethanol instillation (PEI) can increase
the extent of ablation in rat breast tumors. MATERIALS AND METHODS:
R3230 mammary adenocarcinoma was implanted bilaterally in the mammary
fat pads of 18 female rats. The tumor nodules measured 1. 2-1.5 cm.
Eight tumors each were treated with (a) conventional, monopolar RF
(96 mA +/- 28; 70 degrees C for 5 minutes); (b) PEI (250 microL of
ethanol infused over 1 minute); (c) combined therapy of PEI immediately
followed by RF ablation; or (d) combined therapy of RF ablation immediately
followed by PEI. Four tumors were not treated and served as controls.
Histopathologic examination included staining for mitochondrial enzyme
activity. Resultant coagulation necrosis was compared between treatment
groups. RESULTS: Coagulation necrosis was observed only within treated
tumors. Tumors treated with RF alone had 6.7 mm +/- 0.6 of coagulation
surrounding the electrode, and those treated with PEI alone had 6.4
mm +/- 0.6 of coagulation around the instillation needle (not significant).
Significantly increased coagulation of 10.1 mm +/- 0.9 (P: \<.001)
was observed with the combined therapy of PEI followed by RF. RF
followed by PEI did not increase coagulation (6.4 mm +/- 0.8 around
the needle; not significant). CONCLUSION: PEI followed by RF ablation
therapy increases the extent of induced coagulation necrosis in rat
breast tumors, as compared with either therapy alone.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine if percutaneously applied radio frequency (RF)
combined with percutaneous ethanol instillation (PEI) can increase
the extent of ablation in rat breast tumors. MATERIALS AND METHODS:
R3230 mammary adenocarcinoma was implanted bilaterally in the mammary
fat pads of 18 female rats. The tumor nodules measured 1. 2-1.5 cm.
Eight tumors each were treated with (a) conventional, monopolar RF
(96 mA +/- 28; 70 degrees C for 5 minutes); (b) PEI (250 microL of
ethanol infused over 1 minute); (c) combined therapy of PEI immediately
followed by RF ablation; or (d) combined therapy of RF ablation immediately
followed by PEI. Four tumors were not treated and served as controls.
Histopathologic examination included staining for mitochondrial enzyme
activity. Resultant coagulation necrosis was compared between treatment
groups. RESULTS: Coagulation necrosis was observed only within treated
tumors. Tumors treated with RF alone had 6.7 mm +/- 0.6 of coagulation
surrounding the electrode, and those treated with PEI alone had 6.4
mm +/- 0.6 of coagulation around the instillation needle (not significant).
Significantly increased coagulation of 10.1 mm +/- 0.9 (P: <.001)
was observed with the combined therapy of PEI followed by RF. RF
followed by PEI did not increase coagulation (6.4 mm +/- 0.8 around
the needle; not significant). CONCLUSION: PEI followed by RF ablation
therapy increases the extent of induced coagulation necrosis in rat
breast tumors, as compared with either therapy alone.
combined with percutaneous ethanol instillation (PEI) can increase
the extent of ablation in rat breast tumors. MATERIALS AND METHODS:
R3230 mammary adenocarcinoma was implanted bilaterally in the mammary
fat pads of 18 female rats. The tumor nodules measured 1. 2-1.5 cm.
Eight tumors each were treated with (a) conventional, monopolar RF
(96 mA +/- 28; 70 degrees C for 5 minutes); (b) PEI (250 microL of
ethanol infused over 1 minute); (c) combined therapy of PEI immediately
followed by RF ablation; or (d) combined therapy of RF ablation immediately
followed by PEI. Four tumors were not treated and served as controls.
Histopathologic examination included staining for mitochondrial enzyme
activity. Resultant coagulation necrosis was compared between treatment
groups. RESULTS: Coagulation necrosis was observed only within treated
tumors. Tumors treated with RF alone had 6.7 mm +/- 0.6 of coagulation
surrounding the electrode, and those treated with PEI alone had 6.4
mm +/- 0.6 of coagulation around the instillation needle (not significant).
Significantly increased coagulation of 10.1 mm +/- 0.9 (P: <.001)
was observed with the combined therapy of PEI followed by RF. RF
followed by PEI did not increase coagulation (6.4 mm +/- 0.8 around
the needle; not significant). CONCLUSION: PEI followed by RF ablation
therapy increases the extent of induced coagulation necrosis in rat
breast tumors, as compared with either therapy alone.
Angerer, P.; Siebert, Uwe; Kothny, W.; Muhlbauer, D.; Mudra, H.; Schacky, C.
Impact of social support, cynical hostility and anger expression on progression of coronary atherosclerosis Journal Article
In: J Am Coll Cardiol, vol. 36, no. 6, pp. 1781-8, 2000, ISSN: 0735-1097 (Print) 0735-1097 (Lin, ().
@article{Angerer2000,
title = {Impact of social support, cynical hostility and anger expression on progression of coronary atherosclerosis},
author = {P. Angerer and Uwe Siebert and W. Kothny and D. Muhlbauer and H. Mudra and C. Schacky},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11092644},
issn = {0735-1097 (Print) 0735-1097 (Lin},
year = {2000},
date = {2000-11-01},
urldate = {2000-11-01},
journal = {J Am Coll Cardiol},
volume = {36},
number = {6},
pages = {1781-8},
abstract = {OBJECTIVES: This prospective cohort study of patients with coronary
artery disease (CAD) sought to determine the impact of social support,
anger expression and cynical hostility on progression of coronary
atherosclerosis as shown by angiography. BACKGROUND: Low social support,
high levels of expressed anger and cynical hostility are correlated
to increased CAD morbidity and mortality. However, the impact of
these factors, alone or together, on progression of human coronary
atherosclerosis is unknown. METHODS: Of 223 patients with CAD documented
by standardized angiography at baseline, 162 had a second angiogram
after two years. An expert panel who had no knowledge of the patients'
characteristics evaluated the films pairwise to determine disease
progression. At baseline, all patients were asked to answer three
self-report questionnaires: questions concerning emotional social
support, the State-Trait-Anger-Expression Inventory (STAXI) and the
Cook-Medley cynical hostility scale. Each patient's clinical and
laboratory status was followed. RESULTS: Questionnaires and angiographic
follow-up data were available for 150 patients. Bivariate analysis
of the psychological variables showed a higher risk of progression
only for patients who scored high on STAXI anger-out or low on social
support. In the multivariate analysis, when adjusting for confounding
variables and examining the interaction between psychological variables,
only patients with both high anger-out and low social support were
at highly increased risk for progression (odds ratio 30, confidence
interval [CI] 5.5 to 165.1; RR 3.19). CONCLUSIONS: Patients with
CAD and low emotional social support who express anger outwardly
are at a highly increased risk of disease progression, independent
of medication or other risk factors.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: This prospective cohort study of patients with coronary
artery disease (CAD) sought to determine the impact of social support,
anger expression and cynical hostility on progression of coronary
atherosclerosis as shown by angiography. BACKGROUND: Low social support,
high levels of expressed anger and cynical hostility are correlated
to increased CAD morbidity and mortality. However, the impact of
these factors, alone or together, on progression of human coronary
atherosclerosis is unknown. METHODS: Of 223 patients with CAD documented
by standardized angiography at baseline, 162 had a second angiogram
after two years. An expert panel who had no knowledge of the patients'
characteristics evaluated the films pairwise to determine disease
progression. At baseline, all patients were asked to answer three
self-report questionnaires: questions concerning emotional social
support, the State-Trait-Anger-Expression Inventory (STAXI) and the
Cook-Medley cynical hostility scale. Each patient's clinical and
laboratory status was followed. RESULTS: Questionnaires and angiographic
follow-up data were available for 150 patients. Bivariate analysis
of the psychological variables showed a higher risk of progression
only for patients who scored high on STAXI anger-out or low on social
support. In the multivariate analysis, when adjusting for confounding
variables and examining the interaction between psychological variables,
only patients with both high anger-out and low social support were
at highly increased risk for progression (odds ratio 30, confidence
interval [CI] 5.5 to 165.1; RR 3.19). CONCLUSIONS: Patients with
CAD and low emotional social support who express anger outwardly
are at a highly increased risk of disease progression, independent
of medication or other risk factors.
artery disease (CAD) sought to determine the impact of social support,
anger expression and cynical hostility on progression of coronary
atherosclerosis as shown by angiography. BACKGROUND: Low social support,
high levels of expressed anger and cynical hostility are correlated
to increased CAD morbidity and mortality. However, the impact of
these factors, alone or together, on progression of human coronary
atherosclerosis is unknown. METHODS: Of 223 patients with CAD documented
by standardized angiography at baseline, 162 had a second angiogram
after two years. An expert panel who had no knowledge of the patients'
characteristics evaluated the films pairwise to determine disease
progression. At baseline, all patients were asked to answer three
self-report questionnaires: questions concerning emotional social
support, the State-Trait-Anger-Expression Inventory (STAXI) and the
Cook-Medley cynical hostility scale. Each patient's clinical and
laboratory status was followed. RESULTS: Questionnaires and angiographic
follow-up data were available for 150 patients. Bivariate analysis
of the psychological variables showed a higher risk of progression
only for patients who scored high on STAXI anger-out or low on social
support. In the multivariate analysis, when adjusting for confounding
variables and examining the interaction between psychological variables,
only patients with both high anger-out and low social support were
at highly increased risk for progression (odds ratio 30, confidence
interval [CI] 5.5 to 165.1; RR 3.19). CONCLUSIONS: Patients with
CAD and low emotional social support who express anger outwardly
are at a highly increased risk of disease progression, independent
of medication or other risk factors.
McMahon, Pamela M.; Araki, S. S.; Neumann, P. J.; Harris, G. J.; Gazelle, G. Scott
Cost-effectiveness of functional imaging tests in the diagnosis of Alzheimer disease Journal Article
In: Radiology, vol. 217, no. 1, pp. 58-68, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{McMahon2000a,
title = {Cost-effectiveness of functional imaging tests in the diagnosis of
Alzheimer disease},
author = {Pamela M. McMahon and S. S. Araki and P. J. Neumann and G. J. Harris and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11012424},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-10-01},
journal = {Radiology},
volume = {217},
number = {1},
pages = {58-68},
abstract = {PURPOSE: To evaluate the cost-effectiveness of functional neuroimaging
in the work-up of patients at specialized Alzheimer disease clinics.
MATERIALS AND METHODS: A decision model was used to calculate costs
and benefits (in quality-adjusted life-years [QALYs]) that accrued
to hypothetical cohorts of patients at presentation to an Alzheimer
disease center. Sensitivity analysis was performed to examine the
effects of diagnostic test characteristics, therapeutic efficacy,
disease severity, and costs on cost-effectiveness. RESULTS: The incremental
cost-effectiveness ratio of dynamic susceptibility contrast material-enhanced
magnetic resonance (MR) imaging was $479,500 per QALY (compared with
the usual diagnostic work-up), while visual or quantitative single
photon emission computed tomography (SPECT) was dominated (higher
costs, lower effectiveness) by the usual diagnostic work-up. These
results depend critically on the sensitivity and specificity of the
standard diagnostic work-up, the effectiveness of drug treatment,
and the disease severity. Varying these parameters resulted in estimates
of incremental cost-effectiveness for dynamic susceptibility contrast-enhanced
MR imaging of $24,680 to $8.6 million per QALY. SPECT either was
dominated by the usual diagnostic work-up or had cost-effectiveness
ratios of $180,200 to $6 million per QALY. CONCLUSION: The addition
of functional neuroimaging to the usual diagnostic regimen at Alzheimer
disease clinics is not cost-effective given the effectiveness of
currently available therapies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To evaluate the cost-effectiveness of functional neuroimaging
in the work-up of patients at specialized Alzheimer disease clinics.
MATERIALS AND METHODS: A decision model was used to calculate costs
and benefits (in quality-adjusted life-years [QALYs]) that accrued
to hypothetical cohorts of patients at presentation to an Alzheimer
disease center. Sensitivity analysis was performed to examine the
effects of diagnostic test characteristics, therapeutic efficacy,
disease severity, and costs on cost-effectiveness. RESULTS: The incremental
cost-effectiveness ratio of dynamic susceptibility contrast material-enhanced
magnetic resonance (MR) imaging was $479,500 per QALY (compared with
the usual diagnostic work-up), while visual or quantitative single
photon emission computed tomography (SPECT) was dominated (higher
costs, lower effectiveness) by the usual diagnostic work-up. These
results depend critically on the sensitivity and specificity of the
standard diagnostic work-up, the effectiveness of drug treatment,
and the disease severity. Varying these parameters resulted in estimates
of incremental cost-effectiveness for dynamic susceptibility contrast-enhanced
MR imaging of $24,680 to $8.6 million per QALY. SPECT either was
dominated by the usual diagnostic work-up or had cost-effectiveness
ratios of $180,200 to $6 million per QALY. CONCLUSION: The addition
of functional neuroimaging to the usual diagnostic regimen at Alzheimer
disease clinics is not cost-effective given the effectiveness of
currently available therapies.
in the work-up of patients at specialized Alzheimer disease clinics.
MATERIALS AND METHODS: A decision model was used to calculate costs
and benefits (in quality-adjusted life-years [QALYs]) that accrued
to hypothetical cohorts of patients at presentation to an Alzheimer
disease center. Sensitivity analysis was performed to examine the
effects of diagnostic test characteristics, therapeutic efficacy,
disease severity, and costs on cost-effectiveness. RESULTS: The incremental
cost-effectiveness ratio of dynamic susceptibility contrast material-enhanced
magnetic resonance (MR) imaging was $479,500 per QALY (compared with
the usual diagnostic work-up), while visual or quantitative single
photon emission computed tomography (SPECT) was dominated (higher
costs, lower effectiveness) by the usual diagnostic work-up. These
results depend critically on the sensitivity and specificity of the
standard diagnostic work-up, the effectiveness of drug treatment,
and the disease severity. Varying these parameters resulted in estimates
of incremental cost-effectiveness for dynamic susceptibility contrast-enhanced
MR imaging of $24,680 to $8.6 million per QALY. SPECT either was
dominated by the usual diagnostic work-up or had cost-effectiveness
ratios of $180,200 to $6 million per QALY. CONCLUSION: The addition
of functional neuroimaging to the usual diagnostic regimen at Alzheimer
disease clinics is not cost-effective given the effectiveness of
currently available therapies.
McMahon, Pamela M.; Gazelle, G. Scott
The case for colorectal cancer screening Journal Article
In: Semin Roentgenol, vol. 35, no. 4, pp. 325-32, 2000, ISSN: 0037-198X (Print) 0037-198X (Lin, ().
@article{McMahon2000,
title = {The case for colorectal cancer screening},
author = {Pamela M. McMahon and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11060919},
issn = {0037-198X (Print) 0037-198X (Lin},
year = {2000},
date = {2000-10-01},
urldate = {2000-10-01},
journal = {Semin Roentgenol},
volume = {35},
number = {4},
pages = {325-32},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Goldberg, S. N.; Solbiati, L.; Halpern, Elkan F.; Gazelle, G. Scott
Variables affecting proper system grounding for radiofrequency ablation in an animal model Journal Article
In: J Vasc Interv Radiol, vol. 11, no. 8, pp. 1069-75, 2000, ISSN: 1051-0443 (Print) 1051-0443 (Lin, ().
@article{Goldberg2000a,
title = {Variables affecting proper system grounding for radiofrequency ablation
in an animal model},
author = {S. N. Goldberg and L. Solbiati and Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10997473},
issn = {1051-0443 (Print) 1051-0443 (Lin},
year = {2000},
date = {2000-09-01},
journal = {J Vasc Interv Radiol},
volume = {11},
number = {8},
pages = {1069-75},
abstract = {PURPOSE: The authors sought to determine which factors contribute
to excessive thermal deposition and burns at the grounding pad site
after high-current percutaneous, image-guided radiofrequency (RF)
ablation. MATERIALS AND METHODS: Radiofrequency (1,000-2,000 mA)
was applied for 10 minutes with use of an internally-cooled electrode placed into in vivo pig livers (n = 88). In separate experiments,
the number of pads (1, 2, or 4), orientation of pads (horizontal,
vertical, or diagonal), and distance between the pads and the electrode
(10-50 cm) of mesh or foil grounding pads (12.5 x 8 cm; 100 cm2)
were varied. Thermistors measured skin surface temperatures during
ablation. Pathologic analysis of skin changes was performed. RESULTS:
Temperature elevations at the grounding pad were observed for every trial, with a temperature elevation \> or =12 degrees C (as high as
45 degrees C) observed in 60 of 88 trials (68.2%). Temperatures at
the grounding site pad were dependent on all variables studied, including
the grounding pad surface area, the amount of current deposited in
the liver, the orientation of the pad, and the pad's distance from
the electrode. Second-degree burns were seen with temperatures exceeding
47 degrees C and third-degree burns were observed when a temperature \> or = 52 degrees C was noted. For a given set of RF parameters,
reduced heating was observed for trials in which foil grounding pads
were used (P \< .001). Grounding pad burns did not occur at 2,000
mA (maximum generator output) when four foil pads were placed horizontally \> or = 25 cm from the electrode. CONCLUSIONS: High-current RF ablation
can induce severe burns at the grounding pad site if inadequate precautions
are taken. To minimize the risk of burns, multiple large-surface-area
foil pads should be placed on well-prepared skin and oriented with
the longest surface edge facing the RF electrode.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: The authors sought to determine which factors contribute
to excessive thermal deposition and burns at the grounding pad site
after high-current percutaneous, image-guided radiofrequency (RF)
ablation. MATERIALS AND METHODS: Radiofrequency (1,000-2,000 mA)
was applied for 10 minutes with use of an internally-cooled electrode placed into in vivo pig livers (n = 88). In separate experiments,
the number of pads (1, 2, or 4), orientation of pads (horizontal,
vertical, or diagonal), and distance between the pads and the electrode
(10-50 cm) of mesh or foil grounding pads (12.5 x 8 cm; 100 cm2)
were varied. Thermistors measured skin surface temperatures during
ablation. Pathologic analysis of skin changes was performed. RESULTS:
Temperature elevations at the grounding pad were observed for every trial, with a temperature elevation > or =12 degrees C (as high as
45 degrees C) observed in 60 of 88 trials (68.2%). Temperatures at
the grounding site pad were dependent on all variables studied, including
the grounding pad surface area, the amount of current deposited in
the liver, the orientation of the pad, and the pad's distance from
the electrode. Second-degree burns were seen with temperatures exceeding
47 degrees C and third-degree burns were observed when a temperature > or = 52 degrees C was noted. For a given set of RF parameters,
reduced heating was observed for trials in which foil grounding pads
were used (P < .001). Grounding pad burns did not occur at 2,000
mA (maximum generator output) when four foil pads were placed horizontally > or = 25 cm from the electrode. CONCLUSIONS: High-current RF ablation
can induce severe burns at the grounding pad site if inadequate precautions
are taken. To minimize the risk of burns, multiple large-surface-area
foil pads should be placed on well-prepared skin and oriented with
the longest surface edge facing the RF electrode.
to excessive thermal deposition and burns at the grounding pad site
after high-current percutaneous, image-guided radiofrequency (RF)
ablation. MATERIALS AND METHODS: Radiofrequency (1,000-2,000 mA)
was applied for 10 minutes with use of an internally-cooled electrode placed into in vivo pig livers (n = 88). In separate experiments,
the number of pads (1, 2, or 4), orientation of pads (horizontal,
vertical, or diagonal), and distance between the pads and the electrode
(10-50 cm) of mesh or foil grounding pads (12.5 x 8 cm; 100 cm2)
were varied. Thermistors measured skin surface temperatures during
ablation. Pathologic analysis of skin changes was performed. RESULTS:
Temperature elevations at the grounding pad were observed for every trial, with a temperature elevation > or =12 degrees C (as high as
45 degrees C) observed in 60 of 88 trials (68.2%). Temperatures at
the grounding site pad were dependent on all variables studied, including
the grounding pad surface area, the amount of current deposited in
the liver, the orientation of the pad, and the pad's distance from
the electrode. Second-degree burns were seen with temperatures exceeding
47 degrees C and third-degree burns were observed when a temperature > or = 52 degrees C was noted. For a given set of RF parameters,
reduced heating was observed for trials in which foil grounding pads
were used (P < .001). Grounding pad burns did not occur at 2,000
mA (maximum generator output) when four foil pads were placed horizontally > or = 25 cm from the electrode. CONCLUSIONS: High-current RF ablation
can induce severe burns at the grounding pad site if inadequate precautions
are taken. To minimize the risk of burns, multiple large-surface-area
foil pads should be placed on well-prepared skin and oriented with
the longest surface edge facing the RF electrode.
Bosch, Johanna; Haaring, C.; Meyerovitz, M. F.; Cullen, K. A.; Hunink, M. G.
Cost-effectiveness of percutaneous treatment of iliac artery occlusive disease in the United States Journal Article
In: AJR Am J Roentgenol, vol. 175, no. 2, pp. 517-21, 2000, ISSN: 0361-803X (Print) 0361-803X (Lin, ().
@article{Bosch2000,
title = {Cost-effectiveness of percutaneous treatment of iliac artery occlusive
disease in the United States},
author = {Johanna Bosch and C. Haaring and M. F. Meyerovitz and K. A. Cullen and M. G. Hunink},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10915706},
issn = {0361-803X (Print) 0361-803X (Lin},
year = {2000},
date = {2000-08-01},
journal = {AJR Am J Roentgenol},
volume = {175},
number = {2},
pages = {517-21},
abstract = {OBJECTIVE: The costs of percutaneous transluminal angioplasty and
stent placement for iliac artery occlusive disease in the United
States were assessed and the cost-effectiveness was evaluated. MATERIALS
AND METHODS: Lifetime costs and quality-adjusted life expectancy
were estimated using a Markov decision model for a hypothetic cohort
of patients with life-style-limiting claudication caused by an iliac
artery stenosis for whom a percutaneous intervention was indicated.
Various percutaneous treatment strategies were evaluated, each consisting
of an initial intervention followed by a secondary intervention.
Procedures considered were angioplasty alone and angioplasty with
selective stent placement. RESULTS: From the perspective of the interventional
radiology department, angioplasty with selective stent placement
costs more than angioplasty alone ($2926 versus $2106). Taking into
account follow-up costs and procedures for long-term failures, the
cost differential was reduced because of a lower failure rate of
selective stent placement ($13,158 versus $12,458, respectively).
Treatment strategies using angioplasty with selective stent placement
(as an initial procedure or including reintervention) dominated treatment
strategies using angioplasty alone (incremental cost-effectiveness
ratio was $7,624-8,519 per quality-adjusted life-year gained). CONCLUSION:
Angioplasty with selective stent placement is a cost-effective treatment
strategy compared with angioplasty alone in the treatment of intermittent
claudication in the United States.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: The costs of percutaneous transluminal angioplasty and
stent placement for iliac artery occlusive disease in the United
States were assessed and the cost-effectiveness was evaluated. MATERIALS
AND METHODS: Lifetime costs and quality-adjusted life expectancy
were estimated using a Markov decision model for a hypothetic cohort
of patients with life-style-limiting claudication caused by an iliac
artery stenosis for whom a percutaneous intervention was indicated.
Various percutaneous treatment strategies were evaluated, each consisting
of an initial intervention followed by a secondary intervention.
Procedures considered were angioplasty alone and angioplasty with
selective stent placement. RESULTS: From the perspective of the interventional
radiology department, angioplasty with selective stent placement
costs more than angioplasty alone ($2926 versus $2106). Taking into
account follow-up costs and procedures for long-term failures, the
cost differential was reduced because of a lower failure rate of
selective stent placement ($13,158 versus $12,458, respectively).
Treatment strategies using angioplasty with selective stent placement
(as an initial procedure or including reintervention) dominated treatment
strategies using angioplasty alone (incremental cost-effectiveness
ratio was $7,624-8,519 per quality-adjusted life-year gained). CONCLUSION:
Angioplasty with selective stent placement is a cost-effective treatment
strategy compared with angioplasty alone in the treatment of intermittent
claudication in the United States.
stent placement for iliac artery occlusive disease in the United
States were assessed and the cost-effectiveness was evaluated. MATERIALS
AND METHODS: Lifetime costs and quality-adjusted life expectancy
were estimated using a Markov decision model for a hypothetic cohort
of patients with life-style-limiting claudication caused by an iliac
artery stenosis for whom a percutaneous intervention was indicated.
Various percutaneous treatment strategies were evaluated, each consisting
of an initial intervention followed by a secondary intervention.
Procedures considered were angioplasty alone and angioplasty with
selective stent placement. RESULTS: From the perspective of the interventional
radiology department, angioplasty with selective stent placement
costs more than angioplasty alone ($2926 versus $2106). Taking into
account follow-up costs and procedures for long-term failures, the
cost differential was reduced because of a lower failure rate of
selective stent placement ($13,158 versus $12,458, respectively).
Treatment strategies using angioplasty with selective stent placement
(as an initial procedure or including reintervention) dominated treatment
strategies using angioplasty alone (incremental cost-effectiveness
ratio was $7,624-8,519 per quality-adjusted life-year gained). CONCLUSION:
Angioplasty with selective stent placement is a cost-effective treatment
strategy compared with angioplasty alone in the treatment of intermittent
claudication in the United States.
O'Malley, M. E.; Halpern, Elkan F.; Mueller, P. R.; Gazelle, G. Scott
Helical CT protocols for the abdomen and pelvis: a survey Journal Article
In: AJR Am J Roentgenol, vol. 175, no. 1, pp. 109–113, 2000, ().
@article{OMalley2000,
title = {Helical CT protocols for the abdomen and pelvis: a survey},
author = {M. E. O'Malley and Elkan F. Halpern and P. R. Mueller and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10882257},
doi = {10.2214/ajr.175.1.1750109},
year = {2000},
date = {2000-07-01},
urldate = {2000-07-01},
journal = {AJR Am J Roentgenol},
volume = {175},
number = {1},
pages = {109--113},
institution = {Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston 02114, USA.},
abstract = {We surveyed members of the Society of Computed Body Tomography/Magnetic
Resonance to evaluate current techniques used for helical CT in the
abdomen and pelvis.The survey was distributed to 70 members (36 institutions)
of the Society of Computed Body Tomography/Magnetic Resonance. The
survey included general questions related to abdominal and pelvic
helical CT and also asked the members to write a protocol for 12
hypothetical requisitions.Thirty-two members (46%) responded, representing
28 institutions (78%). The number of protocols for helical CT of
the abdomen and pelvis at each institution ranges from 2 to 35 (median,
11). IV contrast material is administered for 90% (median) of abdominal
and pelvic CT examinations. Nonionic contrast material is used for
68% (median) of these examinations. IV contrast material is used
by 100% of institutions for tumor staging protocols except for one
institution that does not use IV contrast material for lymphoma staging.
Fifty percent of the institutions obtain two- or three-phases of
liver images for breast cancer staging. For all protocols, the average
collimation and reconstruction interval is 7 mm except for renal
(5 mm) and adrenal (4 mm) protocols. Rectal contrast material is
administered most commonly for colon cancer staging (39% of institutions).There
is a wide range in the number of protocols used for helical CT in
the abdomen and pelvis among the responding institutions. Most protocols
include use of nonionic IV contrast material injected at a rate of
3 ml/sec and a collimation of 7 mm.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
We surveyed members of the Society of Computed Body Tomography/Magnetic
Resonance to evaluate current techniques used for helical CT in the
abdomen and pelvis.The survey was distributed to 70 members (36 institutions)
of the Society of Computed Body Tomography/Magnetic Resonance. The
survey included general questions related to abdominal and pelvic
helical CT and also asked the members to write a protocol for 12
hypothetical requisitions.Thirty-two members (46%) responded, representing
28 institutions (78%). The number of protocols for helical CT of
the abdomen and pelvis at each institution ranges from 2 to 35 (median,
11). IV contrast material is administered for 90% (median) of abdominal
and pelvic CT examinations. Nonionic contrast material is used for
68% (median) of these examinations. IV contrast material is used
by 100% of institutions for tumor staging protocols except for one
institution that does not use IV contrast material for lymphoma staging.
Fifty percent of the institutions obtain two- or three-phases of
liver images for breast cancer staging. For all protocols, the average
collimation and reconstruction interval is 7 mm except for renal
(5 mm) and adrenal (4 mm) protocols. Rectal contrast material is
administered most commonly for colon cancer staging (39% of institutions).There
is a wide range in the number of protocols used for helical CT in
the abdomen and pelvis among the responding institutions. Most protocols
include use of nonionic IV contrast material injected at a rate of
3 ml/sec and a collimation of 7 mm.
Resonance to evaluate current techniques used for helical CT in the
abdomen and pelvis.The survey was distributed to 70 members (36 institutions)
of the Society of Computed Body Tomography/Magnetic Resonance. The
survey included general questions related to abdominal and pelvic
helical CT and also asked the members to write a protocol for 12
hypothetical requisitions.Thirty-two members (46%) responded, representing
28 institutions (78%). The number of protocols for helical CT of
the abdomen and pelvis at each institution ranges from 2 to 35 (median,
11). IV contrast material is administered for 90% (median) of abdominal
and pelvic CT examinations. Nonionic contrast material is used for
68% (median) of these examinations. IV contrast material is used
by 100% of institutions for tumor staging protocols except for one
institution that does not use IV contrast material for lymphoma staging.
Fifty percent of the institutions obtain two- or three-phases of
liver images for breast cancer staging. For all protocols, the average
collimation and reconstruction interval is 7 mm except for renal
(5 mm) and adrenal (4 mm) protocols. Rectal contrast material is
administered most commonly for colon cancer staging (39% of institutions).There
is a wide range in the number of protocols used for helical CT in
the abdomen and pelvis among the responding institutions. Most protocols
include use of nonionic IV contrast material injected at a rate of
3 ml/sec and a collimation of 7 mm.
Lewis, K. P.; Appadurai, I. R.; Pierce, E. T.; Halpern, Elkan F.; Bode, Jr. R. H.
Prophylactic amrinone for weaning from cardiopulmonary bypass Journal Article
In: Anaesthesia, vol. 55, no. 7, pp. 627-33, 2000, ISSN: 0003-2409 (Print) 0003-2409 (Lin, ().
@article{Lewis2000,
title = {Prophylactic amrinone for weaning from cardiopulmonary bypass},
author = {K. P. Lewis and I. R. Appadurai and E. T. Pierce and Elkan F. Halpern and Jr. R. H. Bode},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10919416},
issn = {0003-2409 (Print) 0003-2409 (Lin},
year = {2000},
date = {2000-07-01},
journal = {Anaesthesia},
volume = {55},
number = {7},
pages = {627-33},
abstract = {This prospective, randomised, double-blind, controlled clinical study
was performed at a single tertiary referral centre to test the hypothesis
that the prophylactic administration of amrinone before separation
of a patient from cardiopulmonary bypass decreases the incidence
of failure to wean, and to identify those patients who could be predicted
to benefit from such pre-emptive management. Two hundred and thirty-four
patients, scheduled to undergo elective cardiac surgery, were randomly
allocated to receive either a bolus dose of 1.5 mg x kg(-1) amrinone
over 15 min, followed by an infusion of 10 microg x kg(-1) x min(-1),
or a bolus of placebo of equal volume followed by an infusion of
placebo. Treatment with amrinone or placebo was initiated upon release
of the aortic cross-clamp, before weaning from cardiopulmonary bypass.
Anaesthetic technique, monitoring and myocardial preservation methods
were standardised for both groups. Significantly fewer patients failed
to wean in the group that received prophylactic amrinone than in the control group (7 vs. 21},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This prospective, randomised, double-blind, controlled clinical study
was performed at a single tertiary referral centre to test the hypothesis
that the prophylactic administration of amrinone before separation
of a patient from cardiopulmonary bypass decreases the incidence
of failure to wean, and to identify those patients who could be predicted
to benefit from such pre-emptive management. Two hundred and thirty-four
patients, scheduled to undergo elective cardiac surgery, were randomly
allocated to receive either a bolus dose of 1.5 mg x kg(-1) amrinone
over 15 min, followed by an infusion of 10 microg x kg(-1) x min(-1),
or a bolus of placebo of equal volume followed by an infusion of
placebo. Treatment with amrinone or placebo was initiated upon release
of the aortic cross-clamp, before weaning from cardiopulmonary bypass.
Anaesthetic technique, monitoring and myocardial preservation methods
were standardised for both groups. Significantly fewer patients failed
to wean in the group that received prophylactic amrinone than in the control group (7 vs. 21
was performed at a single tertiary referral centre to test the hypothesis
that the prophylactic administration of amrinone before separation
of a patient from cardiopulmonary bypass decreases the incidence
of failure to wean, and to identify those patients who could be predicted
to benefit from such pre-emptive management. Two hundred and thirty-four
patients, scheduled to undergo elective cardiac surgery, were randomly
allocated to receive either a bolus dose of 1.5 mg x kg(-1) amrinone
over 15 min, followed by an infusion of 10 microg x kg(-1) x min(-1),
or a bolus of placebo of equal volume followed by an infusion of
placebo. Treatment with amrinone or placebo was initiated upon release
of the aortic cross-clamp, before weaning from cardiopulmonary bypass.
Anaesthetic technique, monitoring and myocardial preservation methods
were standardised for both groups. Significantly fewer patients failed
to wean in the group that received prophylactic amrinone than in the control group (7 vs. 21
Athanasoulis, C. A.; Kaufman, J. A.; Halpern, Elkan F.; Waltman, A. C.; Geller, S. C.; Fan, C. M.
Inferior vena caval filters: review of a 26-year single-center clinical experience Journal Article
In: Radiology, vol. 216, no. 1, pp. 54-66, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Athanasoulis2000,
title = {Inferior vena caval filters: review of a 26-year single-center clinical experience},
author = {C. A. Athanasoulis and J. A. Kaufman and Elkan F. Halpern and A. C. Waltman and S. C. Geller and C. M. Fan},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10887228},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-07-01},
urldate = {2000-07-01},
journal = {Radiology},
volume = {216},
number = {1},
pages = {54-66},
abstract = {PURPOSE: To review a 26-year single-center clinical experience with
inferior vena caval filters. MATERIALS AND METHODS: During 1973-1998,
1,765 filters were implanted in 1,731 patients. Hospital files were
reviewed, and data were collected about the indications, safety,
effectiveness, numbers, and types of caval filters. Fatal post-filter
pulmonary embolism (PE) was considered the primary outcome. Morbidity
and mortality were determined as secondary outcomes. Survival and
morbidity-free survival curves were calculated. RESULTS: The prevalence
of observed post-filter PE was 5.6%. It was fatal in 3.7% of patients.
In most patients, fatal PE occurred soon after filter insertion (median,
4.0 days; 95% CI: 2.2, 5.8 days). Major complications occurred in
0.3% of procedures. The prevalence of observed post-filter caval
thrombosis was 2.7%. The 30-day mortality rate was 17.0% overall,
higher among patients with neoplasms (19.5%) as compared with those without neoplasms (14.3%; P =.004). Filter efficacy and associated
morbidity were not different in 46 patients with suprarenal filters.
The rate of filters placed for prophylaxis was 4.7% overall and increased
to 16.4% in 1998. From 1980 to 1996, there was a fivefold increase
in the number of caval filter implants. In recent years, more filters
were implanted in younger patients. CONCLUSION: Inferior vena caval
filters provide protection from life-threatening PE, with minimal
morbidity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To review a 26-year single-center clinical experience with
inferior vena caval filters. MATERIALS AND METHODS: During 1973-1998,
1,765 filters were implanted in 1,731 patients. Hospital files were
reviewed, and data were collected about the indications, safety,
effectiveness, numbers, and types of caval filters. Fatal post-filter
pulmonary embolism (PE) was considered the primary outcome. Morbidity
and mortality were determined as secondary outcomes. Survival and
morbidity-free survival curves were calculated. RESULTS: The prevalence
of observed post-filter PE was 5.6%. It was fatal in 3.7% of patients.
In most patients, fatal PE occurred soon after filter insertion (median,
4.0 days; 95% CI: 2.2, 5.8 days). Major complications occurred in
0.3% of procedures. The prevalence of observed post-filter caval
thrombosis was 2.7%. The 30-day mortality rate was 17.0% overall,
higher among patients with neoplasms (19.5%) as compared with those without neoplasms (14.3%; P =.004). Filter efficacy and associated
morbidity were not different in 46 patients with suprarenal filters.
The rate of filters placed for prophylaxis was 4.7% overall and increased
to 16.4% in 1998. From 1980 to 1996, there was a fivefold increase
in the number of caval filter implants. In recent years, more filters
were implanted in younger patients. CONCLUSION: Inferior vena caval
filters provide protection from life-threatening PE, with minimal
morbidity.
inferior vena caval filters. MATERIALS AND METHODS: During 1973-1998,
1,765 filters were implanted in 1,731 patients. Hospital files were
reviewed, and data were collected about the indications, safety,
effectiveness, numbers, and types of caval filters. Fatal post-filter
pulmonary embolism (PE) was considered the primary outcome. Morbidity
and mortality were determined as secondary outcomes. Survival and
morbidity-free survival curves were calculated. RESULTS: The prevalence
of observed post-filter PE was 5.6%. It was fatal in 3.7% of patients.
In most patients, fatal PE occurred soon after filter insertion (median,
4.0 days; 95% CI: 2.2, 5.8 days). Major complications occurred in
0.3% of procedures. The prevalence of observed post-filter caval
thrombosis was 2.7%. The 30-day mortality rate was 17.0% overall,
higher among patients with neoplasms (19.5%) as compared with those without neoplasms (14.3%; P =.004). Filter efficacy and associated
morbidity were not different in 46 patients with suprarenal filters.
The rate of filters placed for prophylaxis was 4.7% overall and increased
to 16.4% in 1998. From 1980 to 1996, there was a fivefold increase
in the number of caval filter implants. In recent years, more filters
were implanted in younger patients. CONCLUSION: Inferior vena caval
filters provide protection from life-threatening PE, with minimal
morbidity.
Schops, P.; Siebert, Uwe; Azad, S. C.; Friedle, A. M.; Beyer, A.
[Diagnostic criteria and new classification of the cervical spine syndrome] Journal Article
In: Schmerz, vol. 14, no. 3, pp. 160-74, 2000, ISSN: 0932-433X (Print) 0932-433X (Lin, ().
@article{Schops2000,
title = {[Diagnostic criteria and new classification of the cervical spine syndrome]},
author = {P. Schops and Uwe Siebert and S. C. Azad and A. M. Friedle and A. Beyer},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12800038},
issn = {0932-433X (Print) 0932-433X (Lin},
year = {2000},
date = {2000-06-01},
urldate = {2000-06-01},
journal = {Schmerz},
volume = {14},
number = {3},
pages = {160-74},
abstract = {OBJECTIVES: Pain and functional disorders of the neck are widely diagnosed
as "cervical spine syndrome". As this diagnosis is not able to sufficiently
specify the different symptoms, a new classification with five pain
syndromes, created empirically, was developed. The aim of this study
is to evaluate the predictive values of the diagnostic criteria respectively
clinical findings of patients diagnosed with cervical spine syndrome.
METHODS: Within the two year time frame of the study all patients
diagnosed with "cervical spine syndrome", which presented themselves
at the clinic, were included. The statistic analysis was performed
in multiple steps: univariate analyses, bivariate variable screening
and the use of the logistic regression model. RESULTS: Within two
years 653 patients previously diagnosed as suffering from cervical
spine syndrome presented at the clinic; 332 of them were included
in the study. According to the diagnostic criteria they were attached
to one of the five pain syndromes. The statistical analysis showed
in 17 of 35 evaluated diagnostic criteria a significant association
to one of the five subgroups of the cervical spine syndrome. CONCLUSION:
The statistical analyses revealed significant associations between
diagnostic criteria which were assessed by clinical examination and
the five subgroups of the cervical spine syndrome. The identified
predictors represent the typical syndrome-associated diagnostic criteria
of a certain syndrome-subgroup.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: Pain and functional disorders of the neck are widely diagnosed
as "cervical spine syndrome". As this diagnosis is not able to sufficiently
specify the different symptoms, a new classification with five pain
syndromes, created empirically, was developed. The aim of this study
is to evaluate the predictive values of the diagnostic criteria respectively
clinical findings of patients diagnosed with cervical spine syndrome.
METHODS: Within the two year time frame of the study all patients
diagnosed with "cervical spine syndrome", which presented themselves
at the clinic, were included. The statistic analysis was performed
in multiple steps: univariate analyses, bivariate variable screening
and the use of the logistic regression model. RESULTS: Within two
years 653 patients previously diagnosed as suffering from cervical
spine syndrome presented at the clinic; 332 of them were included
in the study. According to the diagnostic criteria they were attached
to one of the five pain syndromes. The statistical analysis showed
in 17 of 35 evaluated diagnostic criteria a significant association
to one of the five subgroups of the cervical spine syndrome. CONCLUSION:
The statistical analyses revealed significant associations between
diagnostic criteria which were assessed by clinical examination and
the five subgroups of the cervical spine syndrome. The identified
predictors represent the typical syndrome-associated diagnostic criteria
of a certain syndrome-subgroup.
as "cervical spine syndrome". As this diagnosis is not able to sufficiently
specify the different symptoms, a new classification with five pain
syndromes, created empirically, was developed. The aim of this study
is to evaluate the predictive values of the diagnostic criteria respectively
clinical findings of patients diagnosed with cervical spine syndrome.
METHODS: Within the two year time frame of the study all patients
diagnosed with "cervical spine syndrome", which presented themselves
at the clinic, were included. The statistic analysis was performed
in multiple steps: univariate analyses, bivariate variable screening
and the use of the logistic regression model. RESULTS: Within two
years 653 patients previously diagnosed as suffering from cervical
spine syndrome presented at the clinic; 332 of them were included
in the study. According to the diagnostic criteria they were attached
to one of the five pain syndromes. The statistical analysis showed
in 17 of 35 evaluated diagnostic criteria a significant association
to one of the five subgroups of the cervical spine syndrome. CONCLUSION:
The statistical analyses revealed significant associations between
diagnostic criteria which were assessed by clinical examination and
the five subgroups of the cervical spine syndrome. The identified
predictors represent the typical syndrome-associated diagnostic criteria
of a certain syndrome-subgroup.
Mueller, P. R.; Biswal, S.; Halpern, Elkan F.; Kaufman, J. A.; Lee, M. J.
In: Radiology, vol. 215, no. 3, pp. 684-8, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Mueller2000,
title = {Interventional radiologic procedures: patient anxiety, perception of pain, understanding of procedure, and satisfaction with medication--a prospective study},
author = {P. R. Mueller and S. Biswal and Elkan F. Halpern and J. A. Kaufman and M. J. Lee},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10831684},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-06-01},
urldate = {2000-06-01},
journal = {Radiology},
volume = {215},
number = {3},
pages = {684-8},
abstract = {PURPOSE: To prospectively assess patient anxiety, understanding of
the procedure being performed, perception of pain level, and satisfaction
with medication given for a variety of diagnostic and therapeutic
vascular and visceral (nonvascular) interventional procedures. MATERIALS
AND METHODS: The authors interviewed 204 patients before and after
they underwent an interventional radiologic procedure. Patients responded
to a series of questions by using a visual analog scale. Patients
were grouped according to (a) their level of experience with the
procedure and (b) the type of procedure performed (diagnostic or
therapeutic visceral procedure or diagnostic or therapeutic vascular
procedure). RESULTS: Patients who had previous experience with a
procedure, whether visceral or vascular, were less anxious, had more
understanding, and anticipated less pain than did those who did not
have experience with a procedure. Patients who had only local anesthesia
for visceral biopsy experienced greater pain than did those who had
both local and intravenous anesthesia. Satisfaction scores, however,
were similar throughout all groups. CONCLUSION: Patients have a moderate
amount of anxiety about interventional procedures and anticipate
some discomfort. Most patients have a high level of satisfaction
despite the amount of pain they experience during the procedure.
Patients experienced with a procedure tend to have a greater understanding
of the procedure and less anxiety.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To prospectively assess patient anxiety, understanding of
the procedure being performed, perception of pain level, and satisfaction
with medication given for a variety of diagnostic and therapeutic
vascular and visceral (nonvascular) interventional procedures. MATERIALS
AND METHODS: The authors interviewed 204 patients before and after
they underwent an interventional radiologic procedure. Patients responded
to a series of questions by using a visual analog scale. Patients
were grouped according to (a) their level of experience with the
procedure and (b) the type of procedure performed (diagnostic or
therapeutic visceral procedure or diagnostic or therapeutic vascular
procedure). RESULTS: Patients who had previous experience with a
procedure, whether visceral or vascular, were less anxious, had more
understanding, and anticipated less pain than did those who did not
have experience with a procedure. Patients who had only local anesthesia
for visceral biopsy experienced greater pain than did those who had
both local and intravenous anesthesia. Satisfaction scores, however,
were similar throughout all groups. CONCLUSION: Patients have a moderate
amount of anxiety about interventional procedures and anticipate
some discomfort. Most patients have a high level of satisfaction
despite the amount of pain they experience during the procedure.
Patients experienced with a procedure tend to have a greater understanding
of the procedure and less anxiety.
the procedure being performed, perception of pain level, and satisfaction
with medication given for a variety of diagnostic and therapeutic
vascular and visceral (nonvascular) interventional procedures. MATERIALS
AND METHODS: The authors interviewed 204 patients before and after
they underwent an interventional radiologic procedure. Patients responded
to a series of questions by using a visual analog scale. Patients
were grouped according to (a) their level of experience with the
procedure and (b) the type of procedure performed (diagnostic or
therapeutic visceral procedure or diagnostic or therapeutic vascular
procedure). RESULTS: Patients who had previous experience with a
procedure, whether visceral or vascular, were less anxious, had more
understanding, and anticipated less pain than did those who did not
have experience with a procedure. Patients who had only local anesthesia
for visceral biopsy experienced greater pain than did those who had
both local and intravenous anesthesia. Satisfaction scores, however,
were similar throughout all groups. CONCLUSION: Patients have a moderate
amount of anxiety about interventional procedures and anticipate
some discomfort. Most patients have a high level of satisfaction
despite the amount of pain they experience during the procedure.
Patients experienced with a procedure tend to have a greater understanding
of the procedure and less anxiety.
Goldberg, S. N.; Gazelle, G. Scott; Compton, C. C.; Mueller, P. R.; Tanabe, K. K.
Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation Journal Article
In: Cancer, vol. 88, no. 11, pp. 2452-63, 2000, ISSN: 0008-543X (Print) 0008-543X (Lin, ().
@article{Goldberg2000,
title = {Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation},
author = {S. N. Goldberg and G. Scott Gazelle and C. C. Compton and P. R. Mueller and K. K. Tanabe},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10861420},
issn = {0008-543X (Print) 0008-543X (Lin},
year = {2000},
date = {2000-06-01},
urldate = {2000-06-01},
journal = {Cancer},
volume = {88},
number = {11},
pages = {2452-63},
abstract = {BACKGROUND: Radiofrequency (RF)-induced tissue coagulation represents
a new approach for the thermal destruction of tumors within the liver.
The purpose of the current study was to 1) assess technique safety;
2) determine the extent and evolution of induced cellular damage;
and 3) correlate the observed pathologic effects with radiologic studies. METHODS: Twenty-three tumors measuring \</= 8 cm (19 colorectal
metastases and 4 hepatomas) in 22 patients were treated with RF (range,
500-1550 milliamperes) using internally cooled electrodes. All treated
tumors were resected to allow pathologic analysis. Eleven tumors
were treated intraoperatively under ultrasonographic guidance and
excised immediately. Twelve tumors were treated percutaneously using
ultrasound or computed tomography (CT) guidance and subsequently were excised 3-7 days after ablation. Contrast-enhanced CT (n = 12) and magnetic resonance imaging (MRI) (n = 2) were performed after
ablation of all percutaneously treated patients. RESULTS: Tumors
treated intraoperatively did not demonstrate definitive coagulative
necrosis. However, pathologic abnormalities suggestive of tissue
injury were observed with hematoxylin and eosin staining, and absent
cytosolic and mitochondrial enzyme activity suggested irreversible
cellular damage. In contrast, specimens removed \> 3 days after ablation
showed definite, contiguous coagulative necrosis without intervening
areas of viable tumor. CT and MRI scans demonstrated circumscribed
hypodense, nonenhancing regions surrounding the electrode tract as
early as 15 minutes after ablation. These corresponded within 2 mm
to measurements of coagulation at pathology. CONCLUSIONS: RF ablation
is a minimally invasive and safe approach to the treatment of tumors
in the liver. Tumors treated with RF energy do not immediately demonstrate
coagulative necrosis, but do show evidence of irreversible cellular
damage. The extent of tumor necrosis correlates closely with findings
at contrast-enhanced imaging.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Radiofrequency (RF)-induced tissue coagulation represents
a new approach for the thermal destruction of tumors within the liver.
The purpose of the current study was to 1) assess technique safety;
2) determine the extent and evolution of induced cellular damage;
and 3) correlate the observed pathologic effects with radiologic studies. METHODS: Twenty-three tumors measuring </= 8 cm (19 colorectal
metastases and 4 hepatomas) in 22 patients were treated with RF (range,
500-1550 milliamperes) using internally cooled electrodes. All treated
tumors were resected to allow pathologic analysis. Eleven tumors
were treated intraoperatively under ultrasonographic guidance and
excised immediately. Twelve tumors were treated percutaneously using
ultrasound or computed tomography (CT) guidance and subsequently were excised 3-7 days after ablation. Contrast-enhanced CT (n = 12) and magnetic resonance imaging (MRI) (n = 2) were performed after
ablation of all percutaneously treated patients. RESULTS: Tumors
treated intraoperatively did not demonstrate definitive coagulative
necrosis. However, pathologic abnormalities suggestive of tissue
injury were observed with hematoxylin and eosin staining, and absent
cytosolic and mitochondrial enzyme activity suggested irreversible
cellular damage. In contrast, specimens removed > 3 days after ablation
showed definite, contiguous coagulative necrosis without intervening
areas of viable tumor. CT and MRI scans demonstrated circumscribed
hypodense, nonenhancing regions surrounding the electrode tract as
early as 15 minutes after ablation. These corresponded within 2 mm
to measurements of coagulation at pathology. CONCLUSIONS: RF ablation
is a minimally invasive and safe approach to the treatment of tumors
in the liver. Tumors treated with RF energy do not immediately demonstrate
coagulative necrosis, but do show evidence of irreversible cellular
damage. The extent of tumor necrosis correlates closely with findings
at contrast-enhanced imaging.
a new approach for the thermal destruction of tumors within the liver.
The purpose of the current study was to 1) assess technique safety;
2) determine the extent and evolution of induced cellular damage;
and 3) correlate the observed pathologic effects with radiologic studies. METHODS: Twenty-three tumors measuring </= 8 cm (19 colorectal
metastases and 4 hepatomas) in 22 patients were treated with RF (range,
500-1550 milliamperes) using internally cooled electrodes. All treated
tumors were resected to allow pathologic analysis. Eleven tumors
were treated intraoperatively under ultrasonographic guidance and
excised immediately. Twelve tumors were treated percutaneously using
ultrasound or computed tomography (CT) guidance and subsequently were excised 3-7 days after ablation. Contrast-enhanced CT (n = 12) and magnetic resonance imaging (MRI) (n = 2) were performed after
ablation of all percutaneously treated patients. RESULTS: Tumors
treated intraoperatively did not demonstrate definitive coagulative
necrosis. However, pathologic abnormalities suggestive of tissue
injury were observed with hematoxylin and eosin staining, and absent
cytosolic and mitochondrial enzyme activity suggested irreversible
cellular damage. In contrast, specimens removed > 3 days after ablation
showed definite, contiguous coagulative necrosis without intervening
areas of viable tumor. CT and MRI scans demonstrated circumscribed
hypodense, nonenhancing regions surrounding the electrode tract as
early as 15 minutes after ablation. These corresponded within 2 mm
to measurements of coagulation at pathology. CONCLUSIONS: RF ablation
is a minimally invasive and safe approach to the treatment of tumors
in the liver. Tumors treated with RF energy do not immediately demonstrate
coagulative necrosis, but do show evidence of irreversible cellular
damage. The extent of tumor necrosis correlates closely with findings
at contrast-enhanced imaging.
Gazelle, G. Scott; McMahon, Pamela M.; Scholz, F. J.
Screening for colorectal cancer Journal Article
In: Radiology, vol. 215, no. 2, pp. 327-35, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Gazelle2000,
title = {Screening for colorectal cancer},
author = {G. Scott Gazelle and Pamela M. McMahon and F. J. Scholz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10796903},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-05-01},
journal = {Radiology},
volume = {215},
number = {2},
pages = {327-35},
abstract = {Colorectal cancer is the third most commonly diagnosed cancer and
the second leading cause of cancer deaths in the United States. Fortunately,
both the incidence and mortality associated with the disease have
declined during the past 2 decades. This is likely due, at least
in part, to improved efforts at screening and more aggressive removal
of adenomatous polyps. However, colorectal cancer screening is still
generally underutilized. This article reviews the current status
and future outlook for colorectal cancer screening, including a discussion
of risk factors for the disease, its anatomic distribution, proposed
mechanisms of development from adenomatous polyps, rationale for
screening, and screening options. Published literature concerning
the cost-effectiveness of colorectal cancer screening is also summarized.
The article concludes with a discussion of the emerging consensus
regarding the importance of and approaches to screening.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Colorectal cancer is the third most commonly diagnosed cancer and
the second leading cause of cancer deaths in the United States. Fortunately,
both the incidence and mortality associated with the disease have
declined during the past 2 decades. This is likely due, at least
in part, to improved efforts at screening and more aggressive removal
of adenomatous polyps. However, colorectal cancer screening is still
generally underutilized. This article reviews the current status
and future outlook for colorectal cancer screening, including a discussion
of risk factors for the disease, its anatomic distribution, proposed
mechanisms of development from adenomatous polyps, rationale for
screening, and screening options. Published literature concerning
the cost-effectiveness of colorectal cancer screening is also summarized.
The article concludes with a discussion of the emerging consensus
regarding the importance of and approaches to screening.
the second leading cause of cancer deaths in the United States. Fortunately,
both the incidence and mortality associated with the disease have
declined during the past 2 decades. This is likely due, at least
in part, to improved efforts at screening and more aggressive removal
of adenomatous polyps. However, colorectal cancer screening is still
generally underutilized. This article reviews the current status
and future outlook for colorectal cancer screening, including a discussion
of risk factors for the disease, its anatomic distribution, proposed
mechanisms of development from adenomatous polyps, rationale for
screening, and screening options. Published literature concerning
the cost-effectiveness of colorectal cancer screening is also summarized.
The article concludes with a discussion of the emerging consensus
regarding the importance of and approaches to screening.
Regar, E.; Werner, F.; Siebert, Uwe; Rieber, J.; Theisen, K.; Mudra, H.; Klauss, V.
Reproducibility of neointima quantification with motorized intravascular ultrasound pullback in stented coronary arteries Journal Article
In: Am Heart J, vol. 139, no. 4, pp. 632-7, 2000, ISSN: 0002-8703 (Print) 0002-8703 (Lin, ().
@article{Regar2000,
title = {Reproducibility of neointima quantification with motorized intravascular
ultrasound pullback in stented coronary arteries},
author = {E. Regar and F. Werner and Uwe Siebert and J. Rieber and K. Theisen and H. Mudra and V. Klauss},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10740144},
issn = {0002-8703 (Print) 0002-8703 (Lin},
year = {2000},
date = {2000-04-01},
journal = {Am Heart J},
volume = {139},
number = {4},
pages = {632-7},
abstract = {BACKGROUND: Intravascular ultrasound (IVUS) imaging has shown excellent
reproducibility immediately after coronary stent implantation. However,
the variability of measurements in lesions late after stent implantation,
when neointima formation is present, has not been studied. Neointimal
tissue is generally low echogenic and thus difficult to quantify.
We therefore sought to analyze the reproducibility of morphometric
measurements late after stent implantation. METHODS AND RESULTS:
Fifty consecutive patients were investigated 6 months after Palmaz-Schatz
stent implantation (motorized catheter pullback 0.5 mm/s). Two experienced
investigators independently identified the stent area, lumen area,
and neointimal area at different sites within the stent. Planimetric
measurements were performed with commercially available software.
Correlation coefficient and mean difference for corresponding measurements
were calculated for the intraobserver and interobserver comparisons.
Variability for the intraobserver and interobserver comparisons was
similar. Observer agreement regarding the presence of neointimal
hyperplasia was as high as 71% (interobserver comparison 62%). The
mean difference for neointima area was 0.06 +/- 1.5 mm(2) (-0.6 +/-
1.5 mm(2)); mean differences for lumen area were 0.02 +/- 0.19 mm(2)
(0.03 +/- 0.17 mm(2)) and for stent area 0.01 +/- 0.09 mm(2) (-0.02
+/- 0.12 mm(2)) (values for interobserver comparison are given in
parentheses). Correlation between measurements was high for all structures:
correlation coefficients were 0.66 (0.69) for neointima, 0.94 (0.95)
for lumen, and 0.95 (0. 91) for stent area. CONCLUSIONS: Morphometric
measurements of IVUS investigations with motorized IVUS pullback
late after stent placement show good reproducibility. Intraobserver
variability and interobserver variability are low. Differences for
corresponding measurements were more pronounced for neointima area.
Motorized catheter pullback guarantees high reliability of IVUS measurements
and should be used routinely for clinical IVUS studies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Intravascular ultrasound (IVUS) imaging has shown excellent
reproducibility immediately after coronary stent implantation. However,
the variability of measurements in lesions late after stent implantation,
when neointima formation is present, has not been studied. Neointimal
tissue is generally low echogenic and thus difficult to quantify.
We therefore sought to analyze the reproducibility of morphometric
measurements late after stent implantation. METHODS AND RESULTS:
Fifty consecutive patients were investigated 6 months after Palmaz-Schatz
stent implantation (motorized catheter pullback 0.5 mm/s). Two experienced
investigators independently identified the stent area, lumen area,
and neointimal area at different sites within the stent. Planimetric
measurements were performed with commercially available software.
Correlation coefficient and mean difference for corresponding measurements
were calculated for the intraobserver and interobserver comparisons.
Variability for the intraobserver and interobserver comparisons was
similar. Observer agreement regarding the presence of neointimal
hyperplasia was as high as 71% (interobserver comparison 62%). The
mean difference for neointima area was 0.06 +/- 1.5 mm(2) (-0.6 +/-
1.5 mm(2)); mean differences for lumen area were 0.02 +/- 0.19 mm(2)
(0.03 +/- 0.17 mm(2)) and for stent area 0.01 +/- 0.09 mm(2) (-0.02
+/- 0.12 mm(2)) (values for interobserver comparison are given in
parentheses). Correlation between measurements was high for all structures:
correlation coefficients were 0.66 (0.69) for neointima, 0.94 (0.95)
for lumen, and 0.95 (0. 91) for stent area. CONCLUSIONS: Morphometric
measurements of IVUS investigations with motorized IVUS pullback
late after stent placement show good reproducibility. Intraobserver
variability and interobserver variability are low. Differences for
corresponding measurements were more pronounced for neointima area.
Motorized catheter pullback guarantees high reliability of IVUS measurements
and should be used routinely for clinical IVUS studies.
reproducibility immediately after coronary stent implantation. However,
the variability of measurements in lesions late after stent implantation,
when neointima formation is present, has not been studied. Neointimal
tissue is generally low echogenic and thus difficult to quantify.
We therefore sought to analyze the reproducibility of morphometric
measurements late after stent implantation. METHODS AND RESULTS:
Fifty consecutive patients were investigated 6 months after Palmaz-Schatz
stent implantation (motorized catheter pullback 0.5 mm/s). Two experienced
investigators independently identified the stent area, lumen area,
and neointimal area at different sites within the stent. Planimetric
measurements were performed with commercially available software.
Correlation coefficient and mean difference for corresponding measurements
were calculated for the intraobserver and interobserver comparisons.
Variability for the intraobserver and interobserver comparisons was
similar. Observer agreement regarding the presence of neointimal
hyperplasia was as high as 71% (interobserver comparison 62%). The
mean difference for neointima area was 0.06 +/- 1.5 mm(2) (-0.6 +/-
1.5 mm(2)); mean differences for lumen area were 0.02 +/- 0.19 mm(2)
(0.03 +/- 0.17 mm(2)) and for stent area 0.01 +/- 0.09 mm(2) (-0.02
+/- 0.12 mm(2)) (values for interobserver comparison are given in
parentheses). Correlation between measurements was high for all structures:
correlation coefficients were 0.66 (0.69) for neointima, 0.94 (0.95)
for lumen, and 0.95 (0. 91) for stent area. CONCLUSIONS: Morphometric
measurements of IVUS investigations with motorized IVUS pullback
late after stent placement show good reproducibility. Intraobserver
variability and interobserver variability are low. Differences for
corresponding measurements were more pronounced for neointima area.
Motorized catheter pullback guarantees high reliability of IVUS measurements
and should be used routinely for clinical IVUS studies.
Livraghi, T.; Goldberg, S. N.; Lazzaroni, S.; Meloni, F.; Ierace, T.; Solbiati, L.; Gazelle, G. Scott
Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions Journal Article
In: Radiology, vol. 214, no. 3, pp. 761-8, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Livraghi2000,
title = {Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions},
author = {T. Livraghi and S. N. Goldberg and S. Lazzaroni and F. Meloni and T. Ierace and L. Solbiati and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10715043},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-03-01},
urldate = {2000-03-01},
journal = {Radiology},
volume = {214},
number = {3},
pages = {761-8},
abstract = {PURPOSE: To study local therapeutic efficacy, side effects, and complications
of radio-frequency (RF) ablation in the treatment of medium and large
hepatocellular carcinoma (HCC) lesions in patients with cirrhosis
or chronic hepatitis. MATERIALS AND METHODS: One-hundred fourteen
patients who were under conscious sedation or general anesthesia
had 126 HCCs greater than 3.0 cm in diameter treated with RF by using
an internally cooled electrode. Eighty tumors were medium (3.1-5.0
cm), and 46 were large (5.1-9.5 cm). The mean diameter for all tumors
was 5.4 cm. At imaging, 75 tumors were considered noninfiltrating,
and 51 were considered infiltrating. RESULTS: Complete necrosis was
attained in 60 lesions (47.6%), nearly complete (90%-99%) necrosis
in 40 lesions (31.7%), and partial (50%-89%) necrosis in the remaining
26 lesions (20.6%). Medium and/or noninfiltrating tumors were treated
successfully significantly more often than large and/or infiltrating
tumors. Two major complications (death, hemorrhage requiring laparotomy)
and five minor complications (self-limited hemorrhage, persistent
pain) were observed. The single death was due to a break in sterile
technique rather than to the RF procedure itself. CONCLUSION: RF
ablation appears to be an effective, safe, and relatively simple
procedure for the treatment of medium and large HCCs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To study local therapeutic efficacy, side effects, and complications
of radio-frequency (RF) ablation in the treatment of medium and large
hepatocellular carcinoma (HCC) lesions in patients with cirrhosis
or chronic hepatitis. MATERIALS AND METHODS: One-hundred fourteen
patients who were under conscious sedation or general anesthesia
had 126 HCCs greater than 3.0 cm in diameter treated with RF by using
an internally cooled electrode. Eighty tumors were medium (3.1-5.0
cm), and 46 were large (5.1-9.5 cm). The mean diameter for all tumors
was 5.4 cm. At imaging, 75 tumors were considered noninfiltrating,
and 51 were considered infiltrating. RESULTS: Complete necrosis was
attained in 60 lesions (47.6%), nearly complete (90%-99%) necrosis
in 40 lesions (31.7%), and partial (50%-89%) necrosis in the remaining
26 lesions (20.6%). Medium and/or noninfiltrating tumors were treated
successfully significantly more often than large and/or infiltrating
tumors. Two major complications (death, hemorrhage requiring laparotomy)
and five minor complications (self-limited hemorrhage, persistent
pain) were observed. The single death was due to a break in sterile
technique rather than to the RF procedure itself. CONCLUSION: RF
ablation appears to be an effective, safe, and relatively simple
procedure for the treatment of medium and large HCCs.
of radio-frequency (RF) ablation in the treatment of medium and large
hepatocellular carcinoma (HCC) lesions in patients with cirrhosis
or chronic hepatitis. MATERIALS AND METHODS: One-hundred fourteen
patients who were under conscious sedation or general anesthesia
had 126 HCCs greater than 3.0 cm in diameter treated with RF by using
an internally cooled electrode. Eighty tumors were medium (3.1-5.0
cm), and 46 were large (5.1-9.5 cm). The mean diameter for all tumors
was 5.4 cm. At imaging, 75 tumors were considered noninfiltrating,
and 51 were considered infiltrating. RESULTS: Complete necrosis was
attained in 60 lesions (47.6%), nearly complete (90%-99%) necrosis
in 40 lesions (31.7%), and partial (50%-89%) necrosis in the remaining
26 lesions (20.6%). Medium and/or noninfiltrating tumors were treated
successfully significantly more often than large and/or infiltrating
tumors. Two major complications (death, hemorrhage requiring laparotomy)
and five minor complications (self-limited hemorrhage, persistent
pain) were observed. The single death was due to a break in sterile
technique rather than to the RF procedure itself. CONCLUSION: RF
ablation appears to be an effective, safe, and relatively simple
procedure for the treatment of medium and large HCCs.
Christakis, N. A.; Lamont, Elizabeth
Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study Journal Article
In: BMJ, vol. 320, no. 7233, pp. 469-72, 2000, ISSN: 0959-8138 (Print) 0959-535X (Lin, ().
@article{Christakis2000,
title = {Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study},
author = {N. A. Christakis and Elizabeth Lamont},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10678857},
issn = {0959-8138 (Print) 0959-535X (Lin},
year = {2000},
date = {2000-02-01},
urldate = {2000-02-01},
journal = {BMJ},
volume = {320},
number = {7233},
pages = {469-72},
abstract = {OBJECTIVE: To describe doctors' prognostic accuracy in terminally
ill patients and to evaluate the determinants of that accuracy. DESIGN:
Prospective cohort study. SETTING: Five outpatient hospice programmes
in Chicago. PARTICIPANTS: 343 doctors provided survival estimates
for 468 terminally ill patients at the time of hospice referral.
MAIN OUTCOME MEASURES: Patients' estimated and actual survival. RESULTS:
Median survival was 24 days. Only 20% (92/468) of predictions were
accurate (within 33% of actual survival); 63% (295/468) were overoptimistic
and 17% (81/468) were overpessimistic. Overall, doctors overestimated
survival by a factor of 5.3. Few patient or doctor characteristics
were associated with prognostic accuracy. Male patients were 58%
less likely to have overpessimistic predictions. Non-oncology medical
specialists were 326% more likely than general internists to make
overpessimistic predictions. Doctors in the upper quartile of practice
experience were the most accurate. As duration of doctor-patient
relationship increased and time since last contact decreased, prognostic
accuracy decreased. CONCLUSION: Doctors are inaccurate in their prognoses
for terminally ill patients and the error is systematically optimistic.
The inaccuracy is, in general, not restricted to certain kinds of
doctors or patients. These phenomena may be adversely affecting the
quality of care given to patients near the end of life.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: To describe doctors' prognostic accuracy in terminally
ill patients and to evaluate the determinants of that accuracy. DESIGN:
Prospective cohort study. SETTING: Five outpatient hospice programmes
in Chicago. PARTICIPANTS: 343 doctors provided survival estimates
for 468 terminally ill patients at the time of hospice referral.
MAIN OUTCOME MEASURES: Patients' estimated and actual survival. RESULTS:
Median survival was 24 days. Only 20% (92/468) of predictions were
accurate (within 33% of actual survival); 63% (295/468) were overoptimistic
and 17% (81/468) were overpessimistic. Overall, doctors overestimated
survival by a factor of 5.3. Few patient or doctor characteristics
were associated with prognostic accuracy. Male patients were 58%
less likely to have overpessimistic predictions. Non-oncology medical
specialists were 326% more likely than general internists to make
overpessimistic predictions. Doctors in the upper quartile of practice
experience were the most accurate. As duration of doctor-patient
relationship increased and time since last contact decreased, prognostic
accuracy decreased. CONCLUSION: Doctors are inaccurate in their prognoses
for terminally ill patients and the error is systematically optimistic.
The inaccuracy is, in general, not restricted to certain kinds of
doctors or patients. These phenomena may be adversely affecting the
quality of care given to patients near the end of life.
ill patients and to evaluate the determinants of that accuracy. DESIGN:
Prospective cohort study. SETTING: Five outpatient hospice programmes
in Chicago. PARTICIPANTS: 343 doctors provided survival estimates
for 468 terminally ill patients at the time of hospice referral.
MAIN OUTCOME MEASURES: Patients' estimated and actual survival. RESULTS:
Median survival was 24 days. Only 20% (92/468) of predictions were
accurate (within 33% of actual survival); 63% (295/468) were overoptimistic
and 17% (81/468) were overpessimistic. Overall, doctors overestimated
survival by a factor of 5.3. Few patient or doctor characteristics
were associated with prognostic accuracy. Male patients were 58%
less likely to have overpessimistic predictions. Non-oncology medical
specialists were 326% more likely than general internists to make
overpessimistic predictions. Doctors in the upper quartile of practice
experience were the most accurate. As duration of doctor-patient
relationship increased and time since last contact decreased, prognostic
accuracy decreased. CONCLUSION: Doctors are inaccurate in their prognoses
for terminally ill patients and the error is systematically optimistic.
The inaccuracy is, in general, not restricted to certain kinds of
doctors or patients. These phenomena may be adversely affecting the
quality of care given to patients near the end of life.
Swan, J. Shannon; Kennell, T. W.; Acher, C. W.; Heisey, D. M.; Grist, T. M.; Korosec, F. R.; Hagenauer, M. E.
Magnetic resonance angiography of aorto-iliac disease Journal Article
In: Am J Surg, vol. 180, no. 1, pp. 6-12, 2000, ISSN: 0002-9610 (Print) 0002-9610 (Li, ().
@article{Swan2000a,
title = {Magnetic resonance angiography of aorto-iliac disease},
author = {J. Shannon Swan and T. W. Kennell and C. W. Acher and D. M. Heisey and T. M. Grist and F. R. Korosec and M. E. Hagenauer},
url = {https://www.ncbi.nlm.nih.gov/pubmed/11036131},
doi = {10.1016/s0002-9610(00)00412-8},
issn = {0002-9610 (Print)
0002-9610 (Li},
year = {2000},
date = {2000-01-01},
journal = {Am J Surg},
volume = {180},
number = {1},
pages = {6-12},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Carroll, T. J.; Korosec, F. R.; Swan, J. Shannon; Grist, T. M.; Frayne, R.; Mistretta, C. A.
Method for rapidly determining and reconstructing the peak arterial frame from a time-resolved CE-MRA exam Journal Article
In: Magn Reson Med, vol. 44, no. 5, pp. 817-20, 2000, ISSN: 0740-3194 (Print) 0740-3194 (Li, ().
@article{Carroll2000,
title = {Method for rapidly determining and reconstructing the peak arterial frame from a time-resolved CE-MRA exam},
author = {T. J. Carroll and F. R. Korosec and J. Shannon Swan and T. M. Grist and R. Frayne and C. A. Mistretta},
url = {https://www.ncbi.nlm.nih.gov/pubmed/11064419},
doi = {10.1002/1522-2594(200011)44:5\<817::aid-mrm22\>3.0.co;2-x},
issn = {0740-3194 (Print)
0740-3194 (Li},
year = {2000},
date = {2000-01-01},
journal = {Magn Reson Med},
volume = {44},
number = {5},
pages = {817-20},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Frayne, R.; Grist, T. M.; Swan, J. Shannon; Peters, D. C.; Korosec, F. R.; Mistretta, C. A.
3D MR DSA: effects of injection protocol and image masking Journal Article
In: J Magn Reson Imaging, vol. 12, no. 3, pp. 476-87, 2000, ISSN: 1053-1807 (Print) 1053-1807 (Li, ().
@article{Frayne2000,
title = {3D MR DSA: effects of injection protocol and image masking},
author = {R. Frayne and T. M. Grist and J. Shannon Swan and D. C. Peters and F. R. Korosec and C. A. Mistretta},
url = {https://www.ncbi.nlm.nih.gov/pubmed/10992316},
doi = {10.1002/1522-2586(200009)12:3\<476::aid-jmri14\>3.0.co;2-f},
issn = {1053-1807 (Print) 1053-1807 (Li},
year = {2000},
date = {2000-01-01},
urldate = {2000-01-01},
journal = {J Magn Reson Imaging},
volume = {12},
number = {3},
pages = {476-87},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Swan, J. Shannon; Fryback, D. G.; Lawrence, W. F.; Sainfort, F.; Hagenauer, M. E.; Heisey, D. M.
A time-tradeoff method for cost-effectiveness models applied to radiology Journal Article
In: Med Decis Making, vol. 20, no. 1, pp. 79-88, 2000, ISSN: 0272-989X (Print) 0272-989X (Li, ().
@article{Swan2000,
title = {A time-tradeoff method for cost-effectiveness models applied to radiology},
author = {J. Shannon Swan and D. G. Fryback and W. F. Lawrence and F. Sainfort and M. E. Hagenauer and D. M. Heisey},
url = {https://www.ncbi.nlm.nih.gov/pubmed/10638540},
doi = {10.1177/0272989X0002000110},
issn = {0272-989X (Print) 0272-989X (Li},
year = {2000},
date = {2000-01-01},
urldate = {2000-01-01},
journal = {Med Decis Making},
volume = {20},
number = {1},
pages = {79-88},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Sahani, D.; Saini, S.; Fatuga, G. A.; Halpern, Elkan F.; Lanser, M. E.; Zimmerman, J. B.; Fischman, A. J.
Quantitative measurements of medical images for pharmaceutical clinical trials: comparison between on-site and off-site assessments Journal Article
In: AJR Am J Roentgenol, vol. 174, pp. 1159-62, 2000, ().
@article{Sahani2000,
title = {Quantitative measurements of medical images for pharmaceutical clinical
trials: comparison between on-site and off-site assessments},
author = {D. Sahani and S. Saini and G. A. Fatuga and Elkan F. Halpern and M. E. Lanser and J. B. Zimmerman and A. J. Fischman},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10749269},
year = {2000},
date = {2000-01-01},
journal = {AJR Am J Roentgenol},
volume = {174},
pages = {1159-62},
abstract = {OBJECTIVE: In pharmaceutical clinical trials, quantitative measurements
on medical images are often conducted to confirm drug efficacy. This
study aims to compare the quantitative image analysis performance
of an off-site core laboratory with the performance of investigators
from multiple clinical sites. MATERIALS AND METHODS: In a phase I
clinical trial, 25 healthy subjects underwent dynamic brain single-photon
emission computed tomography (SPECT) scintigraphy with 123I-Altropane,
a cocaine analogue with high affinity and selectivity for dopamine
transporter sites in the striatum. In 20 patients examined on-site
and off-site, a total of 80 measurements were made to calculate the
drug's binding potential. A trained technologist off-site at a central
core laboratory and on-site investigators at different clinical sites
performed the image analysis. These results were compared with measurements
made by a subspecialty radiologist whose assessments were the reference
standard. Statistical analysis was performed using multiple regression
analysis. RESULTS: Measurements from the central core laboratory (off-site) highly correlated (r = 0.95) with measurements of the
reference standard. Measurements from the clinical sites (on-site) grouped together had lower correlation (r = 0.84) with the reference
standard. This difference was statistically significant (p textless
0.05). CONCLUSION: Training and experience in the specific type of
image analysis are critical in obtaining consistent data. Quantitative
analysis by dedicated personnel at a core laboratory provides highly
reproducible results. The findings support off-site assessment of
medical images in pharmaceutical clinical trials.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: In pharmaceutical clinical trials, quantitative measurements
on medical images are often conducted to confirm drug efficacy. This
study aims to compare the quantitative image analysis performance
of an off-site core laboratory with the performance of investigators
from multiple clinical sites. MATERIALS AND METHODS: In a phase I
clinical trial, 25 healthy subjects underwent dynamic brain single-photon
emission computed tomography (SPECT) scintigraphy with 123I-Altropane,
a cocaine analogue with high affinity and selectivity for dopamine
transporter sites in the striatum. In 20 patients examined on-site
and off-site, a total of 80 measurements were made to calculate the
drug's binding potential. A trained technologist off-site at a central
core laboratory and on-site investigators at different clinical sites
performed the image analysis. These results were compared with measurements
made by a subspecialty radiologist whose assessments were the reference
standard. Statistical analysis was performed using multiple regression
analysis. RESULTS: Measurements from the central core laboratory (off-site) highly correlated (r = 0.95) with measurements of the
reference standard. Measurements from the clinical sites (on-site) grouped together had lower correlation (r = 0.84) with the reference
standard. This difference was statistically significant (p textless
0.05). CONCLUSION: Training and experience in the specific type of
image analysis are critical in obtaining consistent data. Quantitative
analysis by dedicated personnel at a core laboratory provides highly
reproducible results. The findings support off-site assessment of
medical images in pharmaceutical clinical trials.
on medical images are often conducted to confirm drug efficacy. This
study aims to compare the quantitative image analysis performance
of an off-site core laboratory with the performance of investigators
from multiple clinical sites. MATERIALS AND METHODS: In a phase I
clinical trial, 25 healthy subjects underwent dynamic brain single-photon
emission computed tomography (SPECT) scintigraphy with 123I-Altropane,
a cocaine analogue with high affinity and selectivity for dopamine
transporter sites in the striatum. In 20 patients examined on-site
and off-site, a total of 80 measurements were made to calculate the
drug's binding potential. A trained technologist off-site at a central
core laboratory and on-site investigators at different clinical sites
performed the image analysis. These results were compared with measurements
made by a subspecialty radiologist whose assessments were the reference
standard. Statistical analysis was performed using multiple regression
analysis. RESULTS: Measurements from the central core laboratory (off-site) highly correlated (r = 0.95) with measurements of the
reference standard. Measurements from the clinical sites (on-site) grouped together had lower correlation (r = 0.84) with the reference
standard. This difference was statistically significant (p textless
0.05). CONCLUSION: Training and experience in the specific type of
image analysis are critical in obtaining consistent data. Quantitative
analysis by dedicated personnel at a core laboratory provides highly
reproducible results. The findings support off-site assessment of
medical images in pharmaceutical clinical trials.