2000
Lamont, Elizabeth; Siegler, M.
Paradoxes in cancer patients' advance care planning Journal Article
In: J Palliat Med, vol. 3, no. 1, pp. 27-35, 2000, ISSN: 1096-6218 (Print) 1557-7740 (Lin, ().
@article{Lamont2000,
title = {Paradoxes in cancer patients' advance care planning},
author = {Elizabeth Lamont and M. Siegler},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15859719},
issn = {1096-6218 (Print) 1557-7740 (Lin},
year = {2000},
date = {2000-00-01},
journal = {J Palliat Med},
volume = {3},
number = {1},
pages = {27-35},
abstract = {PURPOSE: To determine the frequency of advance care planning (ACP)
in hospitalized cancer patients and to assess their reactions to
a proposed policy in which medical housestaff would offer to discuss
ACP at the time of hospital admission. METHODS: Structured interviews
with 111 consecutively admitted cancer patients on the oncology inpatient
service of a tertiary care medical center. RESULTS: We found that
69% (77/111) of patients had discussed their advance care preferences
with someone, usually a family member, and 33% (37/111) had completed
at least one formal advance directive (e.g., a living will or durable
power of attorney for health care); 32% (36/111) had done both; and
30% (33/111) had done neither. However, only 9% (10/111) of patients
reported having discussed their advance care preferences with their
clinic oncologists and only 23% (23/101) of the remaining patients
stated that they wished to do so. By contrast, 58% (64/110) of patients
supported a policy in which medical housestaff would offer to discuss
these advance care preferences as a part of the admission history.
CONCLUSIONS: Our data suggest that while oncology inpatients frequently
have ACPs that they discuss with family and/or document in formal
advance directives, they rarely discuss or wish to discuss these
ACPs with clinic oncologists. We also show that most of the reticent
patients would nevertheless consider discussing the same ACPs with
admitting housestaff on the day of hospital admission.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine the frequency of advance care planning (ACP)
in hospitalized cancer patients and to assess their reactions to
a proposed policy in which medical housestaff would offer to discuss
ACP at the time of hospital admission. METHODS: Structured interviews
with 111 consecutively admitted cancer patients on the oncology inpatient
service of a tertiary care medical center. RESULTS: We found that
69% (77/111) of patients had discussed their advance care preferences
with someone, usually a family member, and 33% (37/111) had completed
at least one formal advance directive (e.g., a living will or durable
power of attorney for health care); 32% (36/111) had done both; and
30% (33/111) had done neither. However, only 9% (10/111) of patients
reported having discussed their advance care preferences with their
clinic oncologists and only 23% (23/101) of the remaining patients
stated that they wished to do so. By contrast, 58% (64/110) of patients
supported a policy in which medical housestaff would offer to discuss
these advance care preferences as a part of the admission history.
CONCLUSIONS: Our data suggest that while oncology inpatients frequently
have ACPs that they discuss with family and/or document in formal
advance directives, they rarely discuss or wish to discuss these
ACPs with clinic oncologists. We also show that most of the reticent
patients would nevertheless consider discussing the same ACPs with
admitting housestaff on the day of hospital admission.
in hospitalized cancer patients and to assess their reactions to
a proposed policy in which medical housestaff would offer to discuss
ACP at the time of hospital admission. METHODS: Structured interviews
with 111 consecutively admitted cancer patients on the oncology inpatient
service of a tertiary care medical center. RESULTS: We found that
69% (77/111) of patients had discussed their advance care preferences
with someone, usually a family member, and 33% (37/111) had completed
at least one formal advance directive (e.g., a living will or durable
power of attorney for health care); 32% (36/111) had done both; and
30% (33/111) had done neither. However, only 9% (10/111) of patients
reported having discussed their advance care preferences with their
clinic oncologists and only 23% (23/101) of the remaining patients
stated that they wished to do so. By contrast, 58% (64/110) of patients
supported a policy in which medical housestaff would offer to discuss
these advance care preferences as a part of the admission history.
CONCLUSIONS: Our data suggest that while oncology inpatients frequently
have ACPs that they discuss with family and/or document in formal
advance directives, they rarely discuss or wish to discuss these
ACPs with clinic oncologists. We also show that most of the reticent
patients would nevertheless consider discussing the same ACPs with
admitting housestaff on the day of hospital admission.
1999
Spear, M. A.; Dupuy, D. E.; Park, J. J.; Halpern, Elkan F.; Spiro, I. J.
Tolerance of autologous and allogeneic bone grafts to therapeutic radiation in humans Journal Article
In: Int J Radiat Oncol Biol Phys, vol. 45, no. 5, pp. 1275-80, 1999, ISSN: 0360-3016 (Print) 0360-3016 (Lin, ().
@article{Spear1999,
title = {Tolerance of autologous and allogeneic bone grafts to therapeutic radiation in humans},
author = {M. A. Spear and D. E. Dupuy and J. J. Park and Elkan F. Halpern and I. J. Spiro},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10613323},
issn = {0360-3016 (Print) 0360-3016 (Lin},
year = {1999},
date = {1999-12-01},
urldate = {1999-12-01},
journal = {Int J Radiat Oncol Biol Phys},
volume = {45},
number = {5},
pages = {1275-80},
abstract = {PURPOSE: To examine the effect of perioperative irradiation on bone
graft healing and functional integrity. METHODS AND MATERIALS: Fifty-five
bone grafts (10 autologous and 45 allogeneic) performed between 1978
and 1995 were evaluated retrospectively. Sixteen received preoperative
radiation, 11 received postoperative, and 13 were treated with a
combination of pre- and postoperative radiation. Fifteen nonirradiated
grafts were randomly selected to serve as controls. Twenty-three
of the grafts were placed in patients who received chemotherapy in
the perioperative period. Functional graft survival and radiographic
healing quality were evaluated. RESULTS: Overall rates of graft survival
at 1 year were 89% for autografts and 79% for allografts. Graft survival
rates were 86% and 68% at 1 and 5 years for the irradiated group,
and 67% and 58% for the control group. No significant difference
was seen in the Kaplan-Meier graft survival curves of the two groups.
There was a nonsignificant trend toward improved radiographic healing
quality in the control group. No significant differences in outcome
based on treatment chronology were found with survival rates of 88%
for preoperative treatment and 100% for postoperative treatment.
No relation between outcome and bone dose (preoperative + postoperative
dose), graft dose (postoperative dose), or mean dose/day was found. There was a trend (p = 0.0525) toward worse outcome seen in the Kaplan-Meier
curves of patients who received chemotherapy. This difference, however,
was not seen in the 1-year survival rates or healing quality. Tobacco
use tended toward predicting failure, with 63% graft survival compared to 85% in nonsmokers (p = 0.09). Healing quality was significantly
lower in the smoking group. CONCLUSION: The low failure rate of grafts
in irradiated sites, overall and compared to controls from this study
and relevant literature, as well as the lack of dose and time effects,
does not support significant deviation from the indicated treatment
regimen for patients who have received or are expected to receive
a graft. The trend toward decreased quality of radiographic bone
healing, and data published in relevant literature indicating improved
healing when radiation is withheld until 3-4 weeks postoperatively
suggest this delay should be attempted when not expected to otherwise
compromise patient outcome. A nonsignificant trend only for the effect
of chemotherapy on bone grafts was seen, thus we do not recommend
changes in its use as appropriate for disease management other than
a preference against use during the immediate perioperative period.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To examine the effect of perioperative irradiation on bone
graft healing and functional integrity. METHODS AND MATERIALS: Fifty-five
bone grafts (10 autologous and 45 allogeneic) performed between 1978
and 1995 were evaluated retrospectively. Sixteen received preoperative
radiation, 11 received postoperative, and 13 were treated with a
combination of pre- and postoperative radiation. Fifteen nonirradiated
grafts were randomly selected to serve as controls. Twenty-three
of the grafts were placed in patients who received chemotherapy in
the perioperative period. Functional graft survival and radiographic
healing quality were evaluated. RESULTS: Overall rates of graft survival
at 1 year were 89% for autografts and 79% for allografts. Graft survival
rates were 86% and 68% at 1 and 5 years for the irradiated group,
and 67% and 58% for the control group. No significant difference
was seen in the Kaplan-Meier graft survival curves of the two groups.
There was a nonsignificant trend toward improved radiographic healing
quality in the control group. No significant differences in outcome
based on treatment chronology were found with survival rates of 88%
for preoperative treatment and 100% for postoperative treatment.
No relation between outcome and bone dose (preoperative + postoperative
dose), graft dose (postoperative dose), or mean dose/day was found. There was a trend (p = 0.0525) toward worse outcome seen in the Kaplan-Meier
curves of patients who received chemotherapy. This difference, however,
was not seen in the 1-year survival rates or healing quality. Tobacco
use tended toward predicting failure, with 63% graft survival compared to 85% in nonsmokers (p = 0.09). Healing quality was significantly
lower in the smoking group. CONCLUSION: The low failure rate of grafts
in irradiated sites, overall and compared to controls from this study
and relevant literature, as well as the lack of dose and time effects,
does not support significant deviation from the indicated treatment
regimen for patients who have received or are expected to receive
a graft. The trend toward decreased quality of radiographic bone
healing, and data published in relevant literature indicating improved
healing when radiation is withheld until 3-4 weeks postoperatively
suggest this delay should be attempted when not expected to otherwise
compromise patient outcome. A nonsignificant trend only for the effect
of chemotherapy on bone grafts was seen, thus we do not recommend
changes in its use as appropriate for disease management other than
a preference against use during the immediate perioperative period.
graft healing and functional integrity. METHODS AND MATERIALS: Fifty-five
bone grafts (10 autologous and 45 allogeneic) performed between 1978
and 1995 were evaluated retrospectively. Sixteen received preoperative
radiation, 11 received postoperative, and 13 were treated with a
combination of pre- and postoperative radiation. Fifteen nonirradiated
grafts were randomly selected to serve as controls. Twenty-three
of the grafts were placed in patients who received chemotherapy in
the perioperative period. Functional graft survival and radiographic
healing quality were evaluated. RESULTS: Overall rates of graft survival
at 1 year were 89% for autografts and 79% for allografts. Graft survival
rates were 86% and 68% at 1 and 5 years for the irradiated group,
and 67% and 58% for the control group. No significant difference
was seen in the Kaplan-Meier graft survival curves of the two groups.
There was a nonsignificant trend toward improved radiographic healing
quality in the control group. No significant differences in outcome
based on treatment chronology were found with survival rates of 88%
for preoperative treatment and 100% for postoperative treatment.
No relation between outcome and bone dose (preoperative + postoperative
dose), graft dose (postoperative dose), or mean dose/day was found. There was a trend (p = 0.0525) toward worse outcome seen in the Kaplan-Meier
curves of patients who received chemotherapy. This difference, however,
was not seen in the 1-year survival rates or healing quality. Tobacco
use tended toward predicting failure, with 63% graft survival compared to 85% in nonsmokers (p = 0.09). Healing quality was significantly
lower in the smoking group. CONCLUSION: The low failure rate of grafts
in irradiated sites, overall and compared to controls from this study
and relevant literature, as well as the lack of dose and time effects,
does not support significant deviation from the indicated treatment
regimen for patients who have received or are expected to receive
a graft. The trend toward decreased quality of radiographic bone
healing, and data published in relevant literature indicating improved
healing when radiation is withheld until 3-4 weeks postoperatively
suggest this delay should be attempted when not expected to otherwise
compromise patient outcome. A nonsignificant trend only for the effect
of chemotherapy on bone grafts was seen, thus we do not recommend
changes in its use as appropriate for disease management other than
a preference against use during the immediate perioperative period.
Wittenberg, Eve; Nelson, T. F.; Graham, J. D.
The effect of passenger airbags on child seating behavior in motor vehicles Journal Article
In: Pediatrics, vol. 104, no. 6, pp. 1247-50, 1999, ISSN: 1098-4275 (Electronic) 0031-4005, ().
@article{Wittenberg1999,
title = {The effect of passenger airbags on child seating behavior in motor vehicles},
author = {Eve Wittenberg and T. F. Nelson and J. D. Graham},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10585973},
issn = {1098-4275 (Electronic) 0031-4005},
year = {1999},
date = {1999-12-01},
urldate = {1999-12-01},
journal = {Pediatrics},
volume = {104},
number = {6},
pages = {1247-50},
abstract = {Objective. The purpose of this study was to determine the effect of
the presence of passenger airbags on places where children sit when
traveling in motor vehicles. Methodology. An observational and driver
interview survey of 503 passenger vehicles was conducted in five
New England states at randomly selected long- and short-distance
travel sites during the summer of 1998. Each vehicle was occupied
by at least 1 child \<13 years of age. Seating position, vehicle information,
and driver and passenger characteristics were collected. Logistic
regression analysis was used to identify the association between
the presence of passenger airbags in vehicles and the seating positions
of children. Results. Controlling for the effects of the driver and
vehicle characteristics, children \<13 years of age were less likely
to be observed riding in the front right seat when a passenger airbag
was present in the vehicle (odds ratio:.34; 95% confidence interval:.19-.61).
Of the vehicles carrying children, 23% had at least 1 child riding
in the front seat. Children rode in the front seat in 17% of vehicles
with a passenger airbag, and in 30% of those without a passenger
airbag. Half of all vehicles without a teenage or adult passenger
carried a child in the front seat. In 91% of vehicles with a child
riding in the front seat, there was at least one available seat in
the rear. Driver safety belt use, younger child age, and the presence
of an adult passenger in the vehicle were all associated with children
being seated in the rear. Conclusions. Some New England drivers are
protecting children from the risks of passenger airbags by seating
them in the rear. There remains, however, a substantial number of
children who are being exposed to the risk of passenger airbag deployment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objective. The purpose of this study was to determine the effect of
the presence of passenger airbags on places where children sit when
traveling in motor vehicles. Methodology. An observational and driver
interview survey of 503 passenger vehicles was conducted in five
New England states at randomly selected long- and short-distance
travel sites during the summer of 1998. Each vehicle was occupied
by at least 1 child <13 years of age. Seating position, vehicle information,
and driver and passenger characteristics were collected. Logistic
regression analysis was used to identify the association between
the presence of passenger airbags in vehicles and the seating positions
of children. Results. Controlling for the effects of the driver and
vehicle characteristics, children <13 years of age were less likely
to be observed riding in the front right seat when a passenger airbag
was present in the vehicle (odds ratio:.34; 95% confidence interval:.19-.61).
Of the vehicles carrying children, 23% had at least 1 child riding
in the front seat. Children rode in the front seat in 17% of vehicles
with a passenger airbag, and in 30% of those without a passenger
airbag. Half of all vehicles without a teenage or adult passenger
carried a child in the front seat. In 91% of vehicles with a child
riding in the front seat, there was at least one available seat in
the rear. Driver safety belt use, younger child age, and the presence
of an adult passenger in the vehicle were all associated with children
being seated in the rear. Conclusions. Some New England drivers are
protecting children from the risks of passenger airbags by seating
them in the rear. There remains, however, a substantial number of
children who are being exposed to the risk of passenger airbag deployment.
the presence of passenger airbags on places where children sit when
traveling in motor vehicles. Methodology. An observational and driver
interview survey of 503 passenger vehicles was conducted in five
New England states at randomly selected long- and short-distance
travel sites during the summer of 1998. Each vehicle was occupied
by at least 1 child <13 years of age. Seating position, vehicle information,
and driver and passenger characteristics were collected. Logistic
regression analysis was used to identify the association between
the presence of passenger airbags in vehicles and the seating positions
of children. Results. Controlling for the effects of the driver and
vehicle characteristics, children <13 years of age were less likely
to be observed riding in the front right seat when a passenger airbag
was present in the vehicle (odds ratio:.34; 95% confidence interval:.19-.61).
Of the vehicles carrying children, 23% had at least 1 child riding
in the front seat. Children rode in the front seat in 17% of vehicles
with a passenger airbag, and in 30% of those without a passenger
airbag. Half of all vehicles without a teenage or adult passenger
carried a child in the front seat. In 91% of vehicles with a child
riding in the front seat, there was at least one available seat in
the rear. Driver safety belt use, younger child age, and the presence
of an adult passenger in the vehicle were all associated with children
being seated in the rear. Conclusions. Some New England drivers are
protecting children from the risks of passenger airbags by seating
them in the rear. There remains, however, a substantial number of
children who are being exposed to the risk of passenger airbag deployment.
Goldberg, S. N.; Mallery, S.; Gazelle, G. Scott; Brugge, W. R.
EUS-guided radiofrequency ablation in the pancreas: results in a porcine model Journal Article
In: Gastrointest Endosc, vol. 50, no. 3, pp. 392-401, 1999, ISSN: 0016-5107 (Print) 0016-5107 (Lin, ().
@article{Goldberg1999b,
title = {EUS-guided radiofrequency ablation in the pancreas: results in a
porcine model},
author = {S. N. Goldberg and S. Mallery and G. Scott Gazelle and W. R. Brugge},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10462663},
issn = {0016-5107 (Print) 0016-5107 (Lin},
year = {1999},
date = {1999-09-01},
journal = {Gastrointest Endosc},
volume = {50},
number = {3},
pages = {392-401},
abstract = {BACKGROUND: Our aim in this study was to investigate the feasibility
and safety of performing radiofrequency (RF) ablation in the pancreas
with endoscopic ultrasound (EUS). METHODS: RF was applied to normal
pancreatic tissue in 13 anesthetized Yorkshire pigs with specially
modified 19-gauge needle electrodes (1.0 to 1.5 cm tip). The pancreas
was localized with EUS and punctured through a transgastric approach.
RF current (285 +/- 120 mA) was delivered for 6 minutes. Diagnostic
imaging (EUS and CT) and serum amylase and lipase levels were obtained
at baseline, immediately after ablation, and 1 to 14 days after the procedure. Pigs were killed immediately (n = 5), 1 to 2 days after ablation (n = 2), and 2 weeks after the procedure (n = 6). Pathologic
examination was performed. RESULTS: Sixteen ablations were performed.
During ablation, round hyperechoic foci (diameter to 1.0 cm) gradually
surrounded the tip of the electrode. Immediately after the procedure
CT demonstrated 1 cm hypodense foci that did not enhance with iodinated
contrast. In pigs killed immediately and 1 to 2 days after ablation,
pathologic examination showed discrete, well-demarcated spherical
foci of coagulation necrosis measuring 8 to 12 mm in diameter surrounded
by a 1 to 2 mm rim of hemorrhage. Radiologic-pathologic correlation
was within 2 mm. In 4 of 6 (67%) pigs killed on day 14, retraction
of the coagulated focus was observed. A 1 to 3 mm fibrotic capsule
surrounded the coagulated tissue in the remaining 2 pigs. One pig
had mild hyperlipasemia, a focal zone of pancreatitis (\<1 cm), and
later a pancreatic fluid collection. Biochemical parameters were
normal in the remaining pigs. Other complications included three
gastric and one intestinal burn caused by improper electrode placement.
CONCLUSIONS: EUS-guided RF ablation can be used safely to produce
discrete zones of coagulation necrosis in the porcine pancreas. Potential
clinical uses of this technology include management of small neuroendocrine
tumors and possibly palliation of unresectable pancreatic adenocarcinoma.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Our aim in this study was to investigate the feasibility
and safety of performing radiofrequency (RF) ablation in the pancreas
with endoscopic ultrasound (EUS). METHODS: RF was applied to normal
pancreatic tissue in 13 anesthetized Yorkshire pigs with specially
modified 19-gauge needle electrodes (1.0 to 1.5 cm tip). The pancreas
was localized with EUS and punctured through a transgastric approach.
RF current (285 +/- 120 mA) was delivered for 6 minutes. Diagnostic
imaging (EUS and CT) and serum amylase and lipase levels were obtained
at baseline, immediately after ablation, and 1 to 14 days after the procedure. Pigs were killed immediately (n = 5), 1 to 2 days after ablation (n = 2), and 2 weeks after the procedure (n = 6). Pathologic
examination was performed. RESULTS: Sixteen ablations were performed.
During ablation, round hyperechoic foci (diameter to 1.0 cm) gradually
surrounded the tip of the electrode. Immediately after the procedure
CT demonstrated 1 cm hypodense foci that did not enhance with iodinated
contrast. In pigs killed immediately and 1 to 2 days after ablation,
pathologic examination showed discrete, well-demarcated spherical
foci of coagulation necrosis measuring 8 to 12 mm in diameter surrounded
by a 1 to 2 mm rim of hemorrhage. Radiologic-pathologic correlation
was within 2 mm. In 4 of 6 (67%) pigs killed on day 14, retraction
of the coagulated focus was observed. A 1 to 3 mm fibrotic capsule
surrounded the coagulated tissue in the remaining 2 pigs. One pig
had mild hyperlipasemia, a focal zone of pancreatitis (<1 cm), and
later a pancreatic fluid collection. Biochemical parameters were
normal in the remaining pigs. Other complications included three
gastric and one intestinal burn caused by improper electrode placement.
CONCLUSIONS: EUS-guided RF ablation can be used safely to produce
discrete zones of coagulation necrosis in the porcine pancreas. Potential
clinical uses of this technology include management of small neuroendocrine
tumors and possibly palliation of unresectable pancreatic adenocarcinoma.
and safety of performing radiofrequency (RF) ablation in the pancreas
with endoscopic ultrasound (EUS). METHODS: RF was applied to normal
pancreatic tissue in 13 anesthetized Yorkshire pigs with specially
modified 19-gauge needle electrodes (1.0 to 1.5 cm tip). The pancreas
was localized with EUS and punctured through a transgastric approach.
RF current (285 +/- 120 mA) was delivered for 6 minutes. Diagnostic
imaging (EUS and CT) and serum amylase and lipase levels were obtained
at baseline, immediately after ablation, and 1 to 14 days after the procedure. Pigs were killed immediately (n = 5), 1 to 2 days after ablation (n = 2), and 2 weeks after the procedure (n = 6). Pathologic
examination was performed. RESULTS: Sixteen ablations were performed.
During ablation, round hyperechoic foci (diameter to 1.0 cm) gradually
surrounded the tip of the electrode. Immediately after the procedure
CT demonstrated 1 cm hypodense foci that did not enhance with iodinated
contrast. In pigs killed immediately and 1 to 2 days after ablation,
pathologic examination showed discrete, well-demarcated spherical
foci of coagulation necrosis measuring 8 to 12 mm in diameter surrounded
by a 1 to 2 mm rim of hemorrhage. Radiologic-pathologic correlation
was within 2 mm. In 4 of 6 (67%) pigs killed on day 14, retraction
of the coagulated focus was observed. A 1 to 3 mm fibrotic capsule
surrounded the coagulated tissue in the remaining 2 pigs. One pig
had mild hyperlipasemia, a focal zone of pancreatitis (<1 cm), and
later a pancreatic fluid collection. Biochemical parameters were
normal in the remaining pigs. Other complications included three
gastric and one intestinal burn caused by improper electrode placement.
CONCLUSIONS: EUS-guided RF ablation can be used safely to produce
discrete zones of coagulation necrosis in the porcine pancreas. Potential
clinical uses of this technology include management of small neuroendocrine
tumors and possibly palliation of unresectable pancreatic adenocarcinoma.
Michaelson, J. S.; Halpern, Elkan F.; Kopans, D. B.
Breast cancer: computer simulation method for estimating optimal intervals for screening Journal Article
In: Radiology, vol. 212, no. 2, pp. 551-60, 1999, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Michaelson1999,
title = {Breast cancer: computer simulation method for estimating optimal
intervals for screening},
author = {J. S. Michaelson and Elkan F. Halpern and D. B. Kopans},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10429717},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1999},
date = {1999-08-01},
journal = {Radiology},
volume = {212},
number = {2},
pages = {551-60},
abstract = {PURPOSE: To develop and evaluate a mathematic method that can be used
to determine the optimal screening interval for detection of breast
cancer prior to distant metastatic spread. MATERIALS AND METHODS:
A computer simulation was developed with the use of biologically
based data from the literature on the rates of tumor growth and spread,
which can be used to calculate the course of breast cancer growth
and metastasis. RESULTS: On the basis of the data available at this
time, the results of the simulations suggested that a screening interval
of 2 years would result in a 22% reduction in the rate of distant
metastatic disease, an interval of 1 year would result in a 51% reduction,
and an interval of 6 months would result in an 80% reduction. CONCLUSION:
These findings suggest that more frequent screening could dramatically
reduce the death rate from breast cancer.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To develop and evaluate a mathematic method that can be used
to determine the optimal screening interval for detection of breast
cancer prior to distant metastatic spread. MATERIALS AND METHODS:
A computer simulation was developed with the use of biologically
based data from the literature on the rates of tumor growth and spread,
which can be used to calculate the course of breast cancer growth
and metastasis. RESULTS: On the basis of the data available at this
time, the results of the simulations suggested that a screening interval
of 2 years would result in a 22% reduction in the rate of distant
metastatic disease, an interval of 1 year would result in a 51% reduction,
and an interval of 6 months would result in an 80% reduction. CONCLUSION:
These findings suggest that more frequent screening could dramatically
reduce the death rate from breast cancer.
to determine the optimal screening interval for detection of breast
cancer prior to distant metastatic spread. MATERIALS AND METHODS:
A computer simulation was developed with the use of biologically
based data from the literature on the rates of tumor growth and spread,
which can be used to calculate the course of breast cancer growth
and metastasis. RESULTS: On the basis of the data available at this
time, the results of the simulations suggested that a screening interval
of 2 years would result in a 22% reduction in the rate of distant
metastatic disease, an interval of 1 year would result in a 51% reduction,
and an interval of 6 months would result in an 80% reduction. CONCLUSION:
These findings suggest that more frequent screening could dramatically
reduce the death rate from breast cancer.
Cave, D. R.; Zanten, S. V.; Carter, E.; Halpern, Elkan F.; Klein, S.; Prather, C.; Stolte, M.; Laine, L.
In: Aliment Pharmacol Ther, vol. 13, no. 6, pp. 747-52, 1999, ISSN: 0269-2813 (Print) 0269-2813 (Lin, ().
@article{Cave1999,
title = {A multicentre evaluation of the laser assisted ratio analyser (LARA): a novel device for measurement of 13CO2 in the 13C-urea breath test for the detection of Helicobacter pylori infection},
author = {D. R. Cave and S. V. Zanten and E. Carter and Elkan F. Halpern and S. Klein and C. Prather and M. Stolte and L. Laine},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10383503},
issn = {0269-2813 (Print) 0269-2813 (Lin},
year = {1999},
date = {1999-06-01},
urldate = {1999-06-01},
journal = {Aliment Pharmacol Ther},
volume = {13},
number = {6},
pages = {747-52},
abstract = {BACKGROUND: The laser assisted ratio analyser (LARA) was developed
as a novel device to measure 13CO2 in the urea breath test for the
detection of H. pylori infection. The analyser was tested in a prospective
multicentre study in 444 patients in North America (Phase 1) followed
by second study involving 160 patients (Phase 2). METHODS: Patients
undergoing endoscopy for clinical indications had antral and gastric
biopsies taken for histological examination, culture and CLO test.
One hour after endoscopy, a baseline breath sample was obtained,
100 mg of 13C-urea were ingested and breath samples were obtained
at 30 and 60 min post ingestion. Data obtained with the LARA were
compared with the results of culture, rapid urease testing and central
pathology in two different combinations reference standards. The
study was conducted in two phases: in Phase 2, a modification was
made to the LARA that improved the removal of water vapour from the
breath sample. RESULTS: In Phase I, data from 331 patients were analysed
using a cut off of (delta) 7.8 +/- 0.8, the sensitivity of the method
was 91.7% and the specificity was 86.5%, using the reference standard
of 2 of 3 tests (CLO, culture or histology) being positive. Positive
and negative predictive values were, respectively, 85.2% and 92.5%.
In Phase 2 of the study, 160 patients were enrolled and 141 patients
were analysed using the same standards. We used the same reference
standards but with a cut off of (delta) 6.1 +/- 0.6. The sensitivity
and specificity increased to 96.8% and 98.6%, respectively. Positive
and negative predictive values were, respectively, 98.4% and 97.3%.
The detection rates for H. pylori were similar in patients with peptic
ulcer or H. pylori associated gastritis. CONCLUSIONS: The LARA provides
an accurate non-invasive means of detecting 13CO2 in the 13C-urea
breath test for H. pylori in a multicentre clinical environment that
compares well with invasive 'gold standard' methods.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The laser assisted ratio analyser (LARA) was developed
as a novel device to measure 13CO2 in the urea breath test for the
detection of H. pylori infection. The analyser was tested in a prospective
multicentre study in 444 patients in North America (Phase 1) followed
by second study involving 160 patients (Phase 2). METHODS: Patients
undergoing endoscopy for clinical indications had antral and gastric
biopsies taken for histological examination, culture and CLO test.
One hour after endoscopy, a baseline breath sample was obtained,
100 mg of 13C-urea were ingested and breath samples were obtained
at 30 and 60 min post ingestion. Data obtained with the LARA were
compared with the results of culture, rapid urease testing and central
pathology in two different combinations reference standards. The
study was conducted in two phases: in Phase 2, a modification was
made to the LARA that improved the removal of water vapour from the
breath sample. RESULTS: In Phase I, data from 331 patients were analysed
using a cut off of (delta) 7.8 +/- 0.8, the sensitivity of the method
was 91.7% and the specificity was 86.5%, using the reference standard
of 2 of 3 tests (CLO, culture or histology) being positive. Positive
and negative predictive values were, respectively, 85.2% and 92.5%.
In Phase 2 of the study, 160 patients were enrolled and 141 patients
were analysed using the same standards. We used the same reference
standards but with a cut off of (delta) 6.1 +/- 0.6. The sensitivity
and specificity increased to 96.8% and 98.6%, respectively. Positive
and negative predictive values were, respectively, 98.4% and 97.3%.
The detection rates for H. pylori were similar in patients with peptic
ulcer or H. pylori associated gastritis. CONCLUSIONS: The LARA provides
an accurate non-invasive means of detecting 13CO2 in the 13C-urea
breath test for H. pylori in a multicentre clinical environment that
compares well with invasive 'gold standard' methods.
as a novel device to measure 13CO2 in the urea breath test for the
detection of H. pylori infection. The analyser was tested in a prospective
multicentre study in 444 patients in North America (Phase 1) followed
by second study involving 160 patients (Phase 2). METHODS: Patients
undergoing endoscopy for clinical indications had antral and gastric
biopsies taken for histological examination, culture and CLO test.
One hour after endoscopy, a baseline breath sample was obtained,
100 mg of 13C-urea were ingested and breath samples were obtained
at 30 and 60 min post ingestion. Data obtained with the LARA were
compared with the results of culture, rapid urease testing and central
pathology in two different combinations reference standards. The
study was conducted in two phases: in Phase 2, a modification was
made to the LARA that improved the removal of water vapour from the
breath sample. RESULTS: In Phase I, data from 331 patients were analysed
using a cut off of (delta) 7.8 +/- 0.8, the sensitivity of the method
was 91.7% and the specificity was 86.5%, using the reference standard
of 2 of 3 tests (CLO, culture or histology) being positive. Positive
and negative predictive values were, respectively, 85.2% and 92.5%.
In Phase 2 of the study, 160 patients were enrolled and 141 patients
were analysed using the same standards. We used the same reference
standards but with a cut off of (delta) 6.1 +/- 0.6. The sensitivity
and specificity increased to 96.8% and 98.6%, respectively. Positive
and negative predictive values were, respectively, 98.4% and 97.3%.
The detection rates for H. pylori were similar in patients with peptic
ulcer or H. pylori associated gastritis. CONCLUSIONS: The LARA provides
an accurate non-invasive means of detecting 13CO2 in the 13C-urea
breath test for H. pylori in a multicentre clinical environment that
compares well with invasive 'gold standard' methods.
Manoach, D. S.; Press, D. Z.; Thangaraj, V.; Searl, M. M.; Goff, D. C.; Halpern, E.; Saper, C. B.; Warach, S.
Schizophrenic subjects activate dorsolateral prefrontal cortex during a working memory task, as measured by fMRI. Journal Article
In: Biological psychiatry, vol. 45, pp. 1128–1137, 1999, ISSN: 0006-3223, ().
@article{Manoach1999,
title = {Schizophrenic subjects activate dorsolateral prefrontal cortex during a working memory task, as measured by fMRI.},
author = {D. S. Manoach and D. Z. Press and V. Thangaraj and M. M. Searl and D. C. Goff and E. Halpern and C. B. Saper and S. Warach},
url = {https://pubmed.ncbi.nlm.nih.gov/10331104/},
doi = {10.1016/s0006-3223(98)00318-7},
issn = {0006-3223},
year = {1999},
date = {1999-05-01},
journal = {Biological psychiatry},
volume = {45},
pages = {1128--1137},
abstract = {Neuroimaging studies of schizophrenic subjects performing working memory (WM) tasks have demonstrated a relative hypoactivity of prefrontal cortex compared with normal subjects. Using functional magnetic resonance imaging (fMRI), we compared dorsolateral prefrontal cortex (DLPFC) activation in 12 schizophrenic and 10 normal subjects during rewarded performance of a WM task. Subjects performed a modified version of the Sternberg Item Recognition Paradigm (SIRP), a continuous performance, choice reaction time (RT) task that requires WM. We compared a high WM load condition with a nonWM choice RT condition and with a low WM load condition. Schizophrenic subjects performed the tasks better than chance but worse than normal subjects. They showed greater activation than normal subjects in the left DLPFC but did not differ in the right DLPFC or in the control region. In the schizophrenic group, left DLPFC activation was inversely correlated with task performance, as measured by errors. These findings contrast with previous studies that demonstrated task-related hypofrontality in schizophrenia. Task parameters that may contribute to this difference are discussed. We hypothesize that the performance and activation differences we observed are also manifestations of prefrontal dysfunction in schizophrenia. They reflect inefficient functioning of the neural circuitry involved in WM.},
keywords = {},
pubstate = {ppublish},
tppubtype = {article}
}
Neuroimaging studies of schizophrenic subjects performing working memory (WM) tasks have demonstrated a relative hypoactivity of prefrontal cortex compared with normal subjects. Using functional magnetic resonance imaging (fMRI), we compared dorsolateral prefrontal cortex (DLPFC) activation in 12 schizophrenic and 10 normal subjects during rewarded performance of a WM task. Subjects performed a modified version of the Sternberg Item Recognition Paradigm (SIRP), a continuous performance, choice reaction time (RT) task that requires WM. We compared a high WM load condition with a nonWM choice RT condition and with a low WM load condition. Schizophrenic subjects performed the tasks better than chance but worse than normal subjects. They showed greater activation than normal subjects in the left DLPFC but did not differ in the right DLPFC or in the control region. In the schizophrenic group, left DLPFC activation was inversely correlated with task performance, as measured by errors. These findings contrast with previous studies that demonstrated task-related hypofrontality in schizophrenia. Task parameters that may contribute to this difference are discussed. We hypothesize that the performance and activation differences we observed are also manifestations of prefrontal dysfunction in schizophrenia. They reflect inefficient functioning of the neural circuitry involved in WM.
Livraghi, T.; Goldberg, S. N.; Lazzaroni, S.; Meloni, F.; Solbiati, L.; Gazelle, G. Scott
Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection Journal Article
In: Radiology, vol. 210, no. 3, pp. 655-61, 1999, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Livraghi1999,
title = {Small hepatocellular carcinoma: treatment with radio-frequency ablation
versus ethanol injection},
author = {T. Livraghi and S. N. Goldberg and S. Lazzaroni and F. Meloni and L. Solbiati and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10207464},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1999},
date = {1999-03-01},
journal = {Radiology},
volume = {210},
number = {3},
pages = {655-61},
abstract = {PURPOSE: To compare the effectiveness of radio-frequency (RF) ablation
with that of percutaneous ethanol injection in the treatment of small
hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Eighty-six patients with 112 small (\< or = 3-cm-diameter) HCCs underwent RF
ablation (42 patients with 52 tumors) or percutaneous ethanol injection
(44 patients with 60 tumors). Therapeutic efficacy was evaluated
with dual-phase spiral computed tomography performed at least 4 months
after treatment. RESULTS: Complete necrosis was achieved in 47 of
52 tumors with RF ablation (90%) and in 48 of 60 tumors with percutaneous
ethanol injection (80%). These results were obtained with an average
of 1.2 sessions per tumor with RF ablation and 4.8 sessions per tumor
with percutaneous ethanol injection. One major complication (hemothorax
that required drainage) and four minor complications (intraperitoneal
bleeding, hemobilia, pleural effusion, cholecystitis) occurred in
patients treated with RF ablation; no complications occurred in patients
treated with percutaneous ethanol injection. CONCLUSION: RF ablation
results in a higher rate of complete necrosis and requires fewer
treatment sessions than percutaneous ethanol injection. However,
the complication rate is higher with RF ablation than with percutaneous
ethanol injection. RF ablation is the treatment of choice for most
patients with HCC.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To compare the effectiveness of radio-frequency (RF) ablation
with that of percutaneous ethanol injection in the treatment of small
hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Eighty-six patients with 112 small (< or = 3-cm-diameter) HCCs underwent RF
ablation (42 patients with 52 tumors) or percutaneous ethanol injection
(44 patients with 60 tumors). Therapeutic efficacy was evaluated
with dual-phase spiral computed tomography performed at least 4 months
after treatment. RESULTS: Complete necrosis was achieved in 47 of
52 tumors with RF ablation (90%) and in 48 of 60 tumors with percutaneous
ethanol injection (80%). These results were obtained with an average
of 1.2 sessions per tumor with RF ablation and 4.8 sessions per tumor
with percutaneous ethanol injection. One major complication (hemothorax
that required drainage) and four minor complications (intraperitoneal
bleeding, hemobilia, pleural effusion, cholecystitis) occurred in
patients treated with RF ablation; no complications occurred in patients
treated with percutaneous ethanol injection. CONCLUSION: RF ablation
results in a higher rate of complete necrosis and requires fewer
treatment sessions than percutaneous ethanol injection. However,
the complication rate is higher with RF ablation than with percutaneous
ethanol injection. RF ablation is the treatment of choice for most
patients with HCC.
with that of percutaneous ethanol injection in the treatment of small
hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Eighty-six patients with 112 small (< or = 3-cm-diameter) HCCs underwent RF
ablation (42 patients with 52 tumors) or percutaneous ethanol injection
(44 patients with 60 tumors). Therapeutic efficacy was evaluated
with dual-phase spiral computed tomography performed at least 4 months
after treatment. RESULTS: Complete necrosis was achieved in 47 of
52 tumors with RF ablation (90%) and in 48 of 60 tumors with percutaneous
ethanol injection (80%). These results were obtained with an average
of 1.2 sessions per tumor with RF ablation and 4.8 sessions per tumor
with percutaneous ethanol injection. One major complication (hemothorax
that required drainage) and four minor complications (intraperitoneal
bleeding, hemobilia, pleural effusion, cholecystitis) occurred in
patients treated with RF ablation; no complications occurred in patients
treated with percutaneous ethanol injection. CONCLUSION: RF ablation
results in a higher rate of complete necrosis and requires fewer
treatment sessions than percutaneous ethanol injection. However,
the complication rate is higher with RF ablation than with percutaneous
ethanol injection. RF ablation is the treatment of choice for most
patients with HCC.
Swan, S. K.; Baker, J. F.; Free, R.; Tucker, R. M.; Barron, B.; Barr, R.; Seltzer, S.; Gazelle, G. Scott; Maravilla, K. R.; Barr, W.; Stevens, G. R.; Lambrecht, L. J.; Pierro, J. A.
In: J Magn Reson Imaging, vol. 9, no. 2, pp. 317-21, 1999, ISSN: 1053-1807 (Print) 1053-1807 (Lin, ().
@article{Swan1999,
title = {Pharmacokinetics, safety, and tolerability of gadoversetamide injection
(OptiMARK) in subjects with central nervous system or liver pathology
and varying degrees of renal function},
author = {S. K. Swan and J. F. Baker and R. Free and R. M. Tucker and B. Barron and R. Barr and S. Seltzer and G. Scott Gazelle and K. R. Maravilla and W. Barr and G. R. Stevens and L. J. Lambrecht and J. A. Pierro},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10077031},
issn = {1053-1807 (Print) 1053-1807 (Lin},
year = {1999},
date = {1999-02-01},
journal = {J Magn Reson Imaging},
volume = {9},
number = {2},
pages = {317-21},
abstract = {The pharmacokinetic parameters, safety, and tolerability of OptiMARK
(gadoversetamide injection), a gadolinium-based magnetic resonance
imaging (MRI) contrast agent, were evaluated in 163 subjects with
either central nervous system (CNS) or liver pathology with and without
renal insufficiency, for which a contrast-enhanced MRI was indicated.
A multicenter, double-blind, randomized, placebo-controlled, parallel-group
design was used in which subjects received 0.1, 0.3, or 0.5 mmol/kg
of OptiMARK or placebo intravenously. Samples were analyzed for total
gadolinium by inductively coupled plasma/mass spectrometry. Gadolinium
pharmacokinetics were affected by renal impairment: area under the
curve, half-life, and steady-state distribution volume significantly
increased with declining renal function, while total body clearance
decreased. In subjects with normal renal function, neither age, gender,
nor liver versus CNS pathology altered gadolinium pharmacokinetics.
No clinically significant changes from baseline were noted in vital
signs, laboratory measures, electrocardiograms, or physical examinations.
OptiMARK is safe and well-tolerated following a single intravenous
injection in subjects with either liver or CNS pathology despite
a prolonged elimination half-life in subjects with renal impairment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The pharmacokinetic parameters, safety, and tolerability of OptiMARK
(gadoversetamide injection), a gadolinium-based magnetic resonance
imaging (MRI) contrast agent, were evaluated in 163 subjects with
either central nervous system (CNS) or liver pathology with and without
renal insufficiency, for which a contrast-enhanced MRI was indicated.
A multicenter, double-blind, randomized, placebo-controlled, parallel-group
design was used in which subjects received 0.1, 0.3, or 0.5 mmol/kg
of OptiMARK or placebo intravenously. Samples were analyzed for total
gadolinium by inductively coupled plasma/mass spectrometry. Gadolinium
pharmacokinetics were affected by renal impairment: area under the
curve, half-life, and steady-state distribution volume significantly
increased with declining renal function, while total body clearance
decreased. In subjects with normal renal function, neither age, gender,
nor liver versus CNS pathology altered gadolinium pharmacokinetics.
No clinically significant changes from baseline were noted in vital
signs, laboratory measures, electrocardiograms, or physical examinations.
OptiMARK is safe and well-tolerated following a single intravenous
injection in subjects with either liver or CNS pathology despite
a prolonged elimination half-life in subjects with renal impairment.
(gadoversetamide injection), a gadolinium-based magnetic resonance
imaging (MRI) contrast agent, were evaluated in 163 subjects with
either central nervous system (CNS) or liver pathology with and without
renal insufficiency, for which a contrast-enhanced MRI was indicated.
A multicenter, double-blind, randomized, placebo-controlled, parallel-group
design was used in which subjects received 0.1, 0.3, or 0.5 mmol/kg
of OptiMARK or placebo intravenously. Samples were analyzed for total
gadolinium by inductively coupled plasma/mass spectrometry. Gadolinium
pharmacokinetics were affected by renal impairment: area under the
curve, half-life, and steady-state distribution volume significantly
increased with declining renal function, while total body clearance
decreased. In subjects with normal renal function, neither age, gender,
nor liver versus CNS pathology altered gadolinium pharmacokinetics.
No clinically significant changes from baseline were noted in vital
signs, laboratory measures, electrocardiograms, or physical examinations.
OptiMARK is safe and well-tolerated following a single intravenous
injection in subjects with either liver or CNS pathology despite
a prolonged elimination half-life in subjects with renal impairment.
Hoch, J. R.; Kennell, T. W.; Hollister, M. S.; Sproat, I. A.; Swan, J. Shannon; Acher, C. W.; Burks, J.; Heisey, D. M.
Comparison of treatment plans for lower extremity arterial occlusive disease made with electrocardiography-triggered two-dimensional time-of- flight magnetic resonance angiography and digital subtraction angiography Journal Article
In: Am J Surg, vol. 178, no. 2, pp. 166-72., 1999, ().
@article{Hoch1999,
title = {Comparison of treatment plans for lower extremity arterial occlusive disease made with electrocardiography-triggered two-dimensional time-of- flight magnetic resonance angiography and digital subtraction angiography},
author = {J. R. Hoch and T. W. Kennell and M. S. Hollister and I. A. Sproat and J. Shannon Swan and C. W. Acher and J. Burks and D. M. Heisey},
year = {1999},
date = {1999-01-01},
journal = {Am J Surg},
volume = {178},
number = {2},
pages = {166-72.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Solbiati, L.; Goldberg, S. N.; Ierace, T.; Dellanoce, M.; Livraghi, T.; Gazelle, G. Scott
Radio-frequency ablation of hepatic metastases: postprocedural assessment with a US microbubble contrast agent--early experience Journal Article
In: Radiology, vol. 211, pp. 643-9, 1999, ().
@article{Solbiati1999,
title = {Radio-frequency ablation of hepatic metastases: postprocedural assessment
with a US microbubble contrast agent--early experience},
author = {L. Solbiati and S. N. Goldberg and T. Ierace and M. Dellanoce and T. Livraghi and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10352586},
year = {1999},
date = {1999-01-01},
journal = {Radiology},
volume = {211},
pages = {643-9},
abstract = {PURPOSE: To evaluate contrast agent-enhanced ultrasonography (US)
in the detection of untreated tumor after radio-frequency (RF) ablation
of hepatic metastases. MATERIALS AND METHODS: Twenty patients with
solitary colorectal liver metastases underwent percutaneous RF tumor
ablation. Pre- and postablation imaging was performed with nonenhanced
and enhanced color and power Doppler US and contrast-enhanced helical
computed tomography (CT). Initial follow-up CT and US were performed
24 hours after ablation. The findings at US and CT were compared.
RESULTS: Nonenhanced US demonstrated intratumoral signal in 15 of
20 metastases before ablation. This signal increased after contrast
agent administration. Contrast-enhanced US performed 24 hours after
ablation demonstrated residual foci of enhancement in three tumors,
whereas no US signals were seen in any tumor on nonenhanced scans.
CT demonstrated small (textless 3-mm) persistent foci of residual
enhancement in these three tumors and in three additional lesions
that were not seen at US (US sensitivity, 50 specificity, 100 diagnostic
agreement with CT, 85. All six patients with evidence of residual
tumor underwent repeat RF ablation. CONCLUSION: Contrast-enhanced
US may depict residual tumor after RF application and thereby enable
additional directed therapy. The potential reduction in treatment
sessions and/or ancillary imaging procedures might increase the ease
and practicality of percutaneous ablation of focal hepatic metastases.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To evaluate contrast agent-enhanced ultrasonography (US)
in the detection of untreated tumor after radio-frequency (RF) ablation
of hepatic metastases. MATERIALS AND METHODS: Twenty patients with
solitary colorectal liver metastases underwent percutaneous RF tumor
ablation. Pre- and postablation imaging was performed with nonenhanced
and enhanced color and power Doppler US and contrast-enhanced helical
computed tomography (CT). Initial follow-up CT and US were performed
24 hours after ablation. The findings at US and CT were compared.
RESULTS: Nonenhanced US demonstrated intratumoral signal in 15 of
20 metastases before ablation. This signal increased after contrast
agent administration. Contrast-enhanced US performed 24 hours after
ablation demonstrated residual foci of enhancement in three tumors,
whereas no US signals were seen in any tumor on nonenhanced scans.
CT demonstrated small (textless 3-mm) persistent foci of residual
enhancement in these three tumors and in three additional lesions
that were not seen at US (US sensitivity, 50 specificity, 100 diagnostic
agreement with CT, 85. All six patients with evidence of residual
tumor underwent repeat RF ablation. CONCLUSION: Contrast-enhanced
US may depict residual tumor after RF application and thereby enable
additional directed therapy. The potential reduction in treatment
sessions and/or ancillary imaging procedures might increase the ease
and practicality of percutaneous ablation of focal hepatic metastases.
in the detection of untreated tumor after radio-frequency (RF) ablation
of hepatic metastases. MATERIALS AND METHODS: Twenty patients with
solitary colorectal liver metastases underwent percutaneous RF tumor
ablation. Pre- and postablation imaging was performed with nonenhanced
and enhanced color and power Doppler US and contrast-enhanced helical
computed tomography (CT). Initial follow-up CT and US were performed
24 hours after ablation. The findings at US and CT were compared.
RESULTS: Nonenhanced US demonstrated intratumoral signal in 15 of
20 metastases before ablation. This signal increased after contrast
agent administration. Contrast-enhanced US performed 24 hours after
ablation demonstrated residual foci of enhancement in three tumors,
whereas no US signals were seen in any tumor on nonenhanced scans.
CT demonstrated small (textless 3-mm) persistent foci of residual
enhancement in these three tumors and in three additional lesions
that were not seen at US (US sensitivity, 50 specificity, 100 diagnostic
agreement with CT, 85. All six patients with evidence of residual
tumor underwent repeat RF ablation. CONCLUSION: Contrast-enhanced
US may depict residual tumor after RF application and thereby enable
additional directed therapy. The potential reduction in treatment
sessions and/or ancillary imaging procedures might increase the ease
and practicality of percutaneous ablation of focal hepatic metastases.
Kopans, D. B.; Halpern, Elkan F.
Re: Benefits and risks of screening mammography for women in their forties: a statistical appraisal Journal Article
In: J Natl Cancer Inst, vol. 91, pp. 382-4, 1999, ().
@article{Kopans1999,
title = {Re: Benefits and risks of screening mammography for women in their
forties: a statistical appraisal},
author = {D. B. Kopans and Elkan F. Halpern},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10050875},
year = {1999},
date = {1999-01-01},
journal = {J Natl Cancer Inst},
volume = {91},
pages = {382-4},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Goldberg, S. N.; Walovitch, R. C.; Straub, J. A.; Shore, M. T.; Gazelle, G. Scott
Radio-frequency-induced coagulation necrosis in rabbits: immediate detection at US with a synthetic microsphere contrast agent Journal Article
In: Radiology, vol. 213, pp. 438-44, 1999, ().
@article{Goldberg1999,
title = {Radio-frequency-induced coagulation necrosis in rabbits: immediate
detection at US with a synthetic microsphere contrast agent},
author = {S. N. Goldberg and R. C. Walovitch and J. A. Straub and M. T. Shore and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10551224},
year = {1999},
date = {1999-01-01},
journal = {Radiology},
volume = {213},
pages = {438-44},
abstract = {PURPOSE: To determine whether a synthetic ultrasonographic (US) contrast
agent can be used to differentiate coagulation necrosis from untreated
tumor immediately after radio-frequency ablative therapy. MATERIALS
AND METHODS: VX2 (adenocarcinoma) tumors (0.8-1.5-cm diameter) were
implanted into 12 rabbits. Gray-scale and color Doppler US were performed
with or without intravenous injection of a US contrast agent composed
of poly-lactide-co-glycolic acid polymeric (PLGA) microspheres (2-micron
diameter) filled with perfluorocarbon gas. Radio frequency was applied
to each nodule for 6 minutes at 127 mA +/- 33 (mean +/- SD) (tip
temperature, 92 degrees C +/- 2). Repeat US with a second dose of
the contrast agent was performed immediately after ablation. In four
animals, a third dose was administered 30-120 minutes after ablation.
Radiologic-histopathologic correlation was performed and included
in vivo staining and studies of mitochondrial function. RESULTS:
Intense contrast agent enhancement was seen throughout the tumor
prior to ablation. At gray-scale US, ablation produced hyperechoic
foci, which were within 1 mm of the foci identified at histopathologic
examination in seven of 12 animals (58. After the administration
of contrast material, foci devoid of previously visualized enhancement,
which measured 7.3-15.0 mm, were identified. These were within 1
mm of the size of the foci identified at histopathologic examination
in 11 of 12 animals (92 P textless .01). In two animals, enhancement
depicted viable tumor, which appeared hyperechoic, on nonenhanced
images. On delayed images, hyperechoic areas decreased in size, whereas
the nonenhanced region remained unchanged. CONCLUSION: A PLGA microspherical
US contrast agent enabled the immediate detection of coagulation
necrosis as a region devoid of contrast enhancement after radio-frequency
ablation in rabbit hepatic tumors. Therefore, this agent could provide
real-time guidance during complex ablative procedures and may provide
an efficient technique for postprocedural assessment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine whether a synthetic ultrasonographic (US) contrast
agent can be used to differentiate coagulation necrosis from untreated
tumor immediately after radio-frequency ablative therapy. MATERIALS
AND METHODS: VX2 (adenocarcinoma) tumors (0.8-1.5-cm diameter) were
implanted into 12 rabbits. Gray-scale and color Doppler US were performed
with or without intravenous injection of a US contrast agent composed
of poly-lactide-co-glycolic acid polymeric (PLGA) microspheres (2-micron
diameter) filled with perfluorocarbon gas. Radio frequency was applied
to each nodule for 6 minutes at 127 mA +/- 33 (mean +/- SD) (tip
temperature, 92 degrees C +/- 2). Repeat US with a second dose of
the contrast agent was performed immediately after ablation. In four
animals, a third dose was administered 30-120 minutes after ablation.
Radiologic-histopathologic correlation was performed and included
in vivo staining and studies of mitochondrial function. RESULTS:
Intense contrast agent enhancement was seen throughout the tumor
prior to ablation. At gray-scale US, ablation produced hyperechoic
foci, which were within 1 mm of the foci identified at histopathologic
examination in seven of 12 animals (58. After the administration
of contrast material, foci devoid of previously visualized enhancement,
which measured 7.3-15.0 mm, were identified. These were within 1
mm of the size of the foci identified at histopathologic examination
in 11 of 12 animals (92 P textless .01). In two animals, enhancement
depicted viable tumor, which appeared hyperechoic, on nonenhanced
images. On delayed images, hyperechoic areas decreased in size, whereas
the nonenhanced region remained unchanged. CONCLUSION: A PLGA microspherical
US contrast agent enabled the immediate detection of coagulation
necrosis as a region devoid of contrast enhancement after radio-frequency
ablation in rabbit hepatic tumors. Therefore, this agent could provide
real-time guidance during complex ablative procedures and may provide
an efficient technique for postprocedural assessment.
agent can be used to differentiate coagulation necrosis from untreated
tumor immediately after radio-frequency ablative therapy. MATERIALS
AND METHODS: VX2 (adenocarcinoma) tumors (0.8-1.5-cm diameter) were
implanted into 12 rabbits. Gray-scale and color Doppler US were performed
with or without intravenous injection of a US contrast agent composed
of poly-lactide-co-glycolic acid polymeric (PLGA) microspheres (2-micron
diameter) filled with perfluorocarbon gas. Radio frequency was applied
to each nodule for 6 minutes at 127 mA +/- 33 (mean +/- SD) (tip
temperature, 92 degrees C +/- 2). Repeat US with a second dose of
the contrast agent was performed immediately after ablation. In four
animals, a third dose was administered 30-120 minutes after ablation.
Radiologic-histopathologic correlation was performed and included
in vivo staining and studies of mitochondrial function. RESULTS:
Intense contrast agent enhancement was seen throughout the tumor
prior to ablation. At gray-scale US, ablation produced hyperechoic
foci, which were within 1 mm of the foci identified at histopathologic
examination in seven of 12 animals (58. After the administration
of contrast material, foci devoid of previously visualized enhancement,
which measured 7.3-15.0 mm, were identified. These were within 1
mm of the size of the foci identified at histopathologic examination
in 11 of 12 animals (92 P textless .01). In two animals, enhancement
depicted viable tumor, which appeared hyperechoic, on nonenhanced
images. On delayed images, hyperechoic areas decreased in size, whereas
the nonenhanced region remained unchanged. CONCLUSION: A PLGA microspherical
US contrast agent enabled the immediate detection of coagulation
necrosis as a region devoid of contrast enhancement after radio-frequency
ablation in rabbit hepatic tumors. Therefore, this agent could provide
real-time guidance during complex ablative procedures and may provide
an efficient technique for postprocedural assessment.
Goldberg, S. N.; Stein, M. C.; Gazelle, G. Scott; Sheiman, R. G.; Kruskal, J. B.; Clouse, M. E.
Percutaneous radiofrequency tissue ablation: optimization of pulsed-radiofrequency technique to increase coagulation necrosis Journal Article
In: J Vasc Interv Radiol, vol. 10, no. 7, pp. 907-16, 1999, ISSN: 1051-0443 (Print) 1051-0443 (Lin, ().
@article{Goldberg1999a,
title = {Percutaneous radiofrequency tissue ablation: optimization of pulsed-radiofrequency
technique to increase coagulation necrosis},
author = {S. N. Goldberg and M. C. Stein and G. Scott Gazelle and R. G. Sheiman and J. B. Kruskal and M. E. Clouse},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10435709},
issn = {1051-0443 (Print) 1051-0443 (Lin},
year = {1999},
date = {1999-00-01},
journal = {J Vasc Interv Radiol},
volume = {10},
number = {7},
pages = {907-16},
abstract = {PURPOSE: To develop a computerized algorithm for pulsed, high-current
percutaneous radiofrequency (RF) ablation, which maximally increases
the extent of induced coagulation necrosis. MATERIALS AND METHODS:
An automated, programmable algorithm for pulsed-RF deposition was
designed to permit high-current deposition by periodically reducing
current for 5-30 seconds during RF application. Two strategies for
pulsed-RF deposition were evaluated: (i) constant peak current (900-1,800
mA) of variable duration and (ii) variable peak current (1,200-2,000
mA) for a specified minimum duration. The extent of induced coagulation
was compared to results obtained with continuous (lower current) RF application. Trials were performed in ex vivo calf liver (n = 115) and in vivo porcine liver (n = 30) and muscle (n = 18) with
use of 2-4-cm tip, internally cooled electrodes. RESULTS: For 3-cm
electrodes in ex vivo liver, applying pulsed-RF with constant peak
current for 12 minutes produced 3.5 cm +/- 0.2 of necrosis. Greater
necrosis was produced with use of the variable current strategy,
in which 4.5 cm +/- 0.2 of coagulation was achieved with use of an initial current \> or =1,500 mA (minimum peak-RF duration of 10 sec,
with 15 sec of reduced current to 100 mA between peaks; P \< .01).
This variable peak current algorithm also produced 3.7 cm +/- 0.6
of necrosis in in vivo liver, and 6.5 cm +/- 0.9 in in vivo muscle.
Without pulsing, a maximum of 750 mA, 1,100 mA, and 1,500 mA could
be applied in ex vivo liver, in vivo liver, and in vivo muscle, respectively,
which resulted in 2.9 cm +/- 0.2, 2.4 cm +/- 0.2, and 5.1 cm +/-
0.4 of coagulation (P \< .05, all comparisons). CONCLUSIONS: A variable
peak current algorithm for pulsed-RF deposition can increase coagulation
necrosis diameter over other ablation strategies. This innovation
may ultimately enable the percutaneous treatment of larger tumors.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To develop a computerized algorithm for pulsed, high-current
percutaneous radiofrequency (RF) ablation, which maximally increases
the extent of induced coagulation necrosis. MATERIALS AND METHODS:
An automated, programmable algorithm for pulsed-RF deposition was
designed to permit high-current deposition by periodically reducing
current for 5-30 seconds during RF application. Two strategies for
pulsed-RF deposition were evaluated: (i) constant peak current (900-1,800
mA) of variable duration and (ii) variable peak current (1,200-2,000
mA) for a specified minimum duration. The extent of induced coagulation
was compared to results obtained with continuous (lower current) RF application. Trials were performed in ex vivo calf liver (n = 115) and in vivo porcine liver (n = 30) and muscle (n = 18) with
use of 2-4-cm tip, internally cooled electrodes. RESULTS: For 3-cm
electrodes in ex vivo liver, applying pulsed-RF with constant peak
current for 12 minutes produced 3.5 cm +/- 0.2 of necrosis. Greater
necrosis was produced with use of the variable current strategy,
in which 4.5 cm +/- 0.2 of coagulation was achieved with use of an initial current > or =1,500 mA (minimum peak-RF duration of 10 sec,
with 15 sec of reduced current to 100 mA between peaks; P < .01).
This variable peak current algorithm also produced 3.7 cm +/- 0.6
of necrosis in in vivo liver, and 6.5 cm +/- 0.9 in in vivo muscle.
Without pulsing, a maximum of 750 mA, 1,100 mA, and 1,500 mA could
be applied in ex vivo liver, in vivo liver, and in vivo muscle, respectively,
which resulted in 2.9 cm +/- 0.2, 2.4 cm +/- 0.2, and 5.1 cm +/-
0.4 of coagulation (P < .05, all comparisons). CONCLUSIONS: A variable
peak current algorithm for pulsed-RF deposition can increase coagulation
necrosis diameter over other ablation strategies. This innovation
may ultimately enable the percutaneous treatment of larger tumors.
percutaneous radiofrequency (RF) ablation, which maximally increases
the extent of induced coagulation necrosis. MATERIALS AND METHODS:
An automated, programmable algorithm for pulsed-RF deposition was
designed to permit high-current deposition by periodically reducing
current for 5-30 seconds during RF application. Two strategies for
pulsed-RF deposition were evaluated: (i) constant peak current (900-1,800
mA) of variable duration and (ii) variable peak current (1,200-2,000
mA) for a specified minimum duration. The extent of induced coagulation
was compared to results obtained with continuous (lower current) RF application. Trials were performed in ex vivo calf liver (n = 115) and in vivo porcine liver (n = 30) and muscle (n = 18) with
use of 2-4-cm tip, internally cooled electrodes. RESULTS: For 3-cm
electrodes in ex vivo liver, applying pulsed-RF with constant peak
current for 12 minutes produced 3.5 cm +/- 0.2 of necrosis. Greater
necrosis was produced with use of the variable current strategy,
in which 4.5 cm +/- 0.2 of coagulation was achieved with use of an initial current > or =1,500 mA (minimum peak-RF duration of 10 sec,
with 15 sec of reduced current to 100 mA between peaks; P < .01).
This variable peak current algorithm also produced 3.7 cm +/- 0.6
of necrosis in in vivo liver, and 6.5 cm +/- 0.9 in in vivo muscle.
Without pulsing, a maximum of 750 mA, 1,100 mA, and 1,500 mA could
be applied in ex vivo liver, in vivo liver, and in vivo muscle, respectively,
which resulted in 2.9 cm +/- 0.2, 2.4 cm +/- 0.2, and 5.1 cm +/-
0.4 of coagulation (P < .05, all comparisons). CONCLUSIONS: A variable
peak current algorithm for pulsed-RF deposition can increase coagulation
necrosis diameter over other ablation strategies. This innovation
may ultimately enable the percutaneous treatment of larger tumors.
1998
Goldberg, S. N.; Hahn, P. F.; Halpern, Elkan F.; Fogle, R. M.; Gazelle, G. Scott
Radio-frequency tissue ablation: effect of pharmacologic modulation of blood flow on coagulation diameter Journal Article
In: Radiology, vol. 209, no. 3, pp. 761-7, 1998, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Goldberg1998d,
title = {Radio-frequency tissue ablation: effect of pharmacologic modulation
of blood flow on coagulation diameter},
author = {S. N. Goldberg and P. F. Hahn and Elkan F. Halpern and R. M. Fogle and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9844671},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1998},
date = {1998-12-01},
journal = {Radiology},
volume = {209},
number = {3},
pages = {761-7},
abstract = {PURPOSE: To determine whether vasoactive pharmacologic agents can
alter radio-frequency (RF)-induced coagulation necrosis by modulating
hepatic blood flow. MATERIALS AND METHODS: RF ablation was performed
in normal, in vivo porcine liver with 1.5-cm internally cooled electrodes
and a standardized RF application (i.e., 500 mA for 10 minutes). Ablation was performed without (n = 9) and with pharmacologic modulation of blood flow with halothane (n = 7), vasopressin (n = 6), or epinephrine (n = 7). Laser Doppler techniques were used to quantify changes in
hepatic blood flow. Remote thermometry was also performed. Blood
flow was correlated with both induced coagulation necrosis and tissue
temperatures. RESULTS: Halothane reduced mean blood flow (+/- SD)
to 46.1% +/- 8.5 of normal, and vasopressin increased mean blood
flow to 132.7% +/- 13.9. Epinephrine caused increased hepatic blood
flow centrally (171.1% +/- 31.7) but not peripherally (102.8% +/-
15.4). Mean coagulation diameter was 1.4 cm +/- 0.3 with vasopressin,
2.2 cm +/- 0.4 with normal blood flow, and 3.2 cm +/- 0.1 with halothane
(P \< .01). After epinephrine infusion, mean coagulation measured
2.3 cm +/- 0.3 peripherally and 1.4 cm +/- 0.5 centrally (P \< .01).
A linear correlation between coagulation diameter and blood flow was demonstrated (r2 = 0.78). Temperatures 10 and 15 mm from the
electrode correlated with both blood flow and coagulation diameter (r2 = 0.65 and 0.60, respectively). CONCLUSION: The coagulation necrosis
achieved for a standardized RF application correlates with relative
tissue perfusion. Pharmacologic reduction of blood flow during thermally
mediated percutaneous ablation may induce greater coagulation necrosis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine whether vasoactive pharmacologic agents can
alter radio-frequency (RF)-induced coagulation necrosis by modulating
hepatic blood flow. MATERIALS AND METHODS: RF ablation was performed
in normal, in vivo porcine liver with 1.5-cm internally cooled electrodes
and a standardized RF application (i.e., 500 mA for 10 minutes). Ablation was performed without (n = 9) and with pharmacologic modulation of blood flow with halothane (n = 7), vasopressin (n = 6), or epinephrine (n = 7). Laser Doppler techniques were used to quantify changes in
hepatic blood flow. Remote thermometry was also performed. Blood
flow was correlated with both induced coagulation necrosis and tissue
temperatures. RESULTS: Halothane reduced mean blood flow (+/- SD)
to 46.1% +/- 8.5 of normal, and vasopressin increased mean blood
flow to 132.7% +/- 13.9. Epinephrine caused increased hepatic blood
flow centrally (171.1% +/- 31.7) but not peripherally (102.8% +/-
15.4). Mean coagulation diameter was 1.4 cm +/- 0.3 with vasopressin,
2.2 cm +/- 0.4 with normal blood flow, and 3.2 cm +/- 0.1 with halothane
(P < .01). After epinephrine infusion, mean coagulation measured
2.3 cm +/- 0.3 peripherally and 1.4 cm +/- 0.5 centrally (P < .01).
A linear correlation between coagulation diameter and blood flow was demonstrated (r2 = 0.78). Temperatures 10 and 15 mm from the
electrode correlated with both blood flow and coagulation diameter (r2 = 0.65 and 0.60, respectively). CONCLUSION: The coagulation necrosis
achieved for a standardized RF application correlates with relative
tissue perfusion. Pharmacologic reduction of blood flow during thermally
mediated percutaneous ablation may induce greater coagulation necrosis.
alter radio-frequency (RF)-induced coagulation necrosis by modulating
hepatic blood flow. MATERIALS AND METHODS: RF ablation was performed
in normal, in vivo porcine liver with 1.5-cm internally cooled electrodes
and a standardized RF application (i.e., 500 mA for 10 minutes). Ablation was performed without (n = 9) and with pharmacologic modulation of blood flow with halothane (n = 7), vasopressin (n = 6), or epinephrine (n = 7). Laser Doppler techniques were used to quantify changes in
hepatic blood flow. Remote thermometry was also performed. Blood
flow was correlated with both induced coagulation necrosis and tissue
temperatures. RESULTS: Halothane reduced mean blood flow (+/- SD)
to 46.1% +/- 8.5 of normal, and vasopressin increased mean blood
flow to 132.7% +/- 13.9. Epinephrine caused increased hepatic blood
flow centrally (171.1% +/- 31.7) but not peripherally (102.8% +/-
15.4). Mean coagulation diameter was 1.4 cm +/- 0.3 with vasopressin,
2.2 cm +/- 0.4 with normal blood flow, and 3.2 cm +/- 0.1 with halothane
(P < .01). After epinephrine infusion, mean coagulation measured
2.3 cm +/- 0.3 peripherally and 1.4 cm +/- 0.5 centrally (P < .01).
A linear correlation between coagulation diameter and blood flow was demonstrated (r2 = 0.78). Temperatures 10 and 15 mm from the
electrode correlated with both blood flow and coagulation diameter (r2 = 0.65 and 0.60, respectively). CONCLUSION: The coagulation necrosis
achieved for a standardized RF application correlates with relative
tissue perfusion. Pharmacologic reduction of blood flow during thermally
mediated percutaneous ablation may induce greater coagulation necrosis.
Charous, B. L.; Halpern, Elkan F.; Steven, G. C.
Hydroxychloroquine improves airflow and lowers circulating IgE levels in subjects with moderate symptomatic asthma Journal Article
In: J Allergy Clin Immunol, vol. 102, no. 2, pp. 198-203, 1998, ISSN: 0091-6749 (Print) 0091-6749 (Lin, ().
@article{Charous1998,
title = {Hydroxychloroquine improves airflow and lowers circulating IgE levels in subjects with moderate symptomatic asthma},
author = {B. L. Charous and Elkan F. Halpern and G. C. Steven},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9723661},
issn = {0091-6749 (Print) 0091-6749 (Lin},
year = {1998},
date = {1998-08-01},
urldate = {1998-08-01},
journal = {J Allergy Clin Immunol},
volume = {102},
number = {2},
pages = {198-203},
abstract = {BACKGROUND: Although antiinflammatory therapy is accepted as the cornerstone
of asthma treatment, available systemic immunosuppressive agents
are not widely used because of justified concerns over potential
toxicity. Hydroxychloroquine (HCQ) is a well-tolerated, safe immunomodulating
drug, with proven efficacy in rheumatic diseases and known actions
that suggest potential utility in the treatment of asthma. OBJECTIVE:
We sought to assess the effectiveness of HCQ in subjects with moderate
symptomatic asthma. METHODS: Symptomatic asthmatic subjects receiving
stable doses of at least 6 puffs of inhaled corticosteroid per day
with daily need for beta2-adrenergic agonists were studied. After
baseline run-in, these subjects were randomized to 30 weeks of HCQ (n = 8) or placebo (n = 9). Objective measures included change from
baseline mean FEV1, morning and evening peak flows, beta2-agonist
use, IgE level, and need for rescue corticosteroids. Subjective symptom
scores from bidaily diaries were also obtained. RESULTS: In the treatment
group, mean FEV1 at the last 2 visits on therapy increased by 10.8%
(P \< .05), morning peak flows rose 16.2% (P \< .03), evening peak
flows rose 14.2% (P \< .04), and beta2-agonist use fell 18.6% (P \<
.03). Mean IgE level declined 48% from 240 to 125 IU/mL. (P \< .05).
In the placebo group no significant change in these parameters occurred.
Comparison of changes in these objective measures between the treatment
and placebo groups failed to reach significance in the small population
studied. Corticosteroid rescue interventions were required in 4 patients
receiving placebo and 2 receiving HCQ. HCQ was well tolerated without
notable side effects. CONCLUSIONS: Although the size of our sample
population precludes definitive conclusions, these findings extend
previous open-label observations. The late improvement in the HCQ
group is consistent with its known slow onset of action. Further
studies are warranted to confirm the antiasthmatic and antiallergic
effects of HCQ and to investigate its potential as a disease-modifying
agent.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Although antiinflammatory therapy is accepted as the cornerstone
of asthma treatment, available systemic immunosuppressive agents
are not widely used because of justified concerns over potential
toxicity. Hydroxychloroquine (HCQ) is a well-tolerated, safe immunomodulating
drug, with proven efficacy in rheumatic diseases and known actions
that suggest potential utility in the treatment of asthma. OBJECTIVE:
We sought to assess the effectiveness of HCQ in subjects with moderate
symptomatic asthma. METHODS: Symptomatic asthmatic subjects receiving
stable doses of at least 6 puffs of inhaled corticosteroid per day
with daily need for beta2-adrenergic agonists were studied. After
baseline run-in, these subjects were randomized to 30 weeks of HCQ (n = 8) or placebo (n = 9). Objective measures included change from
baseline mean FEV1, morning and evening peak flows, beta2-agonist
use, IgE level, and need for rescue corticosteroids. Subjective symptom
scores from bidaily diaries were also obtained. RESULTS: In the treatment
group, mean FEV1 at the last 2 visits on therapy increased by 10.8%
(P < .05), morning peak flows rose 16.2% (P < .03), evening peak
flows rose 14.2% (P < .04), and beta2-agonist use fell 18.6% (P <
.03). Mean IgE level declined 48% from 240 to 125 IU/mL. (P < .05).
In the placebo group no significant change in these parameters occurred.
Comparison of changes in these objective measures between the treatment
and placebo groups failed to reach significance in the small population
studied. Corticosteroid rescue interventions were required in 4 patients
receiving placebo and 2 receiving HCQ. HCQ was well tolerated without
notable side effects. CONCLUSIONS: Although the size of our sample
population precludes definitive conclusions, these findings extend
previous open-label observations. The late improvement in the HCQ
group is consistent with its known slow onset of action. Further
studies are warranted to confirm the antiasthmatic and antiallergic
effects of HCQ and to investigate its potential as a disease-modifying
agent.
of asthma treatment, available systemic immunosuppressive agents
are not widely used because of justified concerns over potential
toxicity. Hydroxychloroquine (HCQ) is a well-tolerated, safe immunomodulating
drug, with proven efficacy in rheumatic diseases and known actions
that suggest potential utility in the treatment of asthma. OBJECTIVE:
We sought to assess the effectiveness of HCQ in subjects with moderate
symptomatic asthma. METHODS: Symptomatic asthmatic subjects receiving
stable doses of at least 6 puffs of inhaled corticosteroid per day
with daily need for beta2-adrenergic agonists were studied. After
baseline run-in, these subjects were randomized to 30 weeks of HCQ (n = 8) or placebo (n = 9). Objective measures included change from
baseline mean FEV1, morning and evening peak flows, beta2-agonist
use, IgE level, and need for rescue corticosteroids. Subjective symptom
scores from bidaily diaries were also obtained. RESULTS: In the treatment
group, mean FEV1 at the last 2 visits on therapy increased by 10.8%
(P < .05), morning peak flows rose 16.2% (P < .03), evening peak
flows rose 14.2% (P < .04), and beta2-agonist use fell 18.6% (P <
.03). Mean IgE level declined 48% from 240 to 125 IU/mL. (P < .05).
In the placebo group no significant change in these parameters occurred.
Comparison of changes in these objective measures between the treatment
and placebo groups failed to reach significance in the small population
studied. Corticosteroid rescue interventions were required in 4 patients
receiving placebo and 2 receiving HCQ. HCQ was well tolerated without
notable side effects. CONCLUSIONS: Although the size of our sample
population precludes definitive conclusions, these findings extend
previous open-label observations. The late improvement in the HCQ
group is consistent with its known slow onset of action. Further
studies are warranted to confirm the antiasthmatic and antiallergic
effects of HCQ and to investigate its potential as a disease-modifying
agent.
Slanetz, P. J.; Giardino, A. A.; McCarthy, K. A.; Hall, D. A.; Halpern, Elkan F.; Moore, R. H.; Kopans, D. B.
Previous breast biopsy for benign disease rarely complicates or alters interpretation on screening mammography Journal Article
In: AJR Am J Roentgenol, vol. 170, no. 6, pp. 1539-41, 1998, ISSN: 0361-803X (Print) 0361-803X (Lin, ().
@article{Slanetz1998,
title = {Previous breast biopsy for benign disease rarely complicates or alters
interpretation on screening mammography},
author = {P. J. Slanetz and A. A. Giardino and K. A. McCarthy and D. A. Hall and Elkan F. Halpern and R. H. Moore and D. B. Kopans},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9609170},
issn = {0361-803X (Print) 0361-803X (Lin},
year = {1998},
date = {1998-06-01},
journal = {AJR Am J Roentgenol},
volume = {170},
number = {6},
pages = {1539-41},
abstract = {OBJECTIVE: It has been suggested that breast screening leads to too
many biopsies for benign disease that permanently scar the breast
and confuse the interpretation of subsequent mammograms. We undertook
retrospective and prospective studies to determine how often an excisional
biopsy for benign breast disease complicates or alters interpretation
of screening mammograms. MATERIALS AND METHODS: Retrospective review
of our screening center database yielded 31,025 asymptomatic patients
who had routine mammographic screening studies between 1993 and 1996.
Of the 58,538 examinations of these patients, 53,510 were of patients
who had no history of breast biopsy and 5028 were of patients who
had a history of breast biopsy for benign disease. Recall rates were
compared between the two groups. In the prospective study, radiologists
reviewed the mammograms of 1997 consecutive patients presenting to
the screening center, 173 of whom reported a prior breast biopsy
for benign disease. The radiologist interpreting the images determined
how often evidence of the biopsy site was apparent on the mammogram
and how often such changes necessitated additional imaging. RESULTS:
In the retrospective study, 3296 (6%) of the 53,510 studies done
in patients who did not have a biopsy for benign disease and 360
(7%) of the 5028 studies done in women who had a biopsy for benign
disease led to additional imaging. Eight recalls for further imaging
(0.16%) among the 5028 studies in women with a prior biopsy for benign
disease were related to the biopsy site. In the prospective study,
24 (14%) of the 173 women who had a biopsy for benign disease had
mammographic evidence of the biopsy site. Nine (5%) of the 173 women
who had previously had a biopsy for benign disease and 86 (5%) of
the 1824 patients without a prior biopsy were recalled for additional
imaging. No women were recalled because a previous breast biopsy
for benign disease led to confusion or diagnostic concern. CONCLUSION:
Changes in patients' breasts due to previous excisional biopsies
for benign breast disease rarely pose a diagnostic dilemma in the
interpretation of routine screening mammograms.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: It has been suggested that breast screening leads to too
many biopsies for benign disease that permanently scar the breast
and confuse the interpretation of subsequent mammograms. We undertook
retrospective and prospective studies to determine how often an excisional
biopsy for benign breast disease complicates or alters interpretation
of screening mammograms. MATERIALS AND METHODS: Retrospective review
of our screening center database yielded 31,025 asymptomatic patients
who had routine mammographic screening studies between 1993 and 1996.
Of the 58,538 examinations of these patients, 53,510 were of patients
who had no history of breast biopsy and 5028 were of patients who
had a history of breast biopsy for benign disease. Recall rates were
compared between the two groups. In the prospective study, radiologists
reviewed the mammograms of 1997 consecutive patients presenting to
the screening center, 173 of whom reported a prior breast biopsy
for benign disease. The radiologist interpreting the images determined
how often evidence of the biopsy site was apparent on the mammogram
and how often such changes necessitated additional imaging. RESULTS:
In the retrospective study, 3296 (6%) of the 53,510 studies done
in patients who did not have a biopsy for benign disease and 360
(7%) of the 5028 studies done in women who had a biopsy for benign
disease led to additional imaging. Eight recalls for further imaging
(0.16%) among the 5028 studies in women with a prior biopsy for benign
disease were related to the biopsy site. In the prospective study,
24 (14%) of the 173 women who had a biopsy for benign disease had
mammographic evidence of the biopsy site. Nine (5%) of the 173 women
who had previously had a biopsy for benign disease and 86 (5%) of
the 1824 patients without a prior biopsy were recalled for additional
imaging. No women were recalled because a previous breast biopsy
for benign disease led to confusion or diagnostic concern. CONCLUSION:
Changes in patients' breasts due to previous excisional biopsies
for benign breast disease rarely pose a diagnostic dilemma in the
interpretation of routine screening mammograms.
many biopsies for benign disease that permanently scar the breast
and confuse the interpretation of subsequent mammograms. We undertook
retrospective and prospective studies to determine how often an excisional
biopsy for benign breast disease complicates or alters interpretation
of screening mammograms. MATERIALS AND METHODS: Retrospective review
of our screening center database yielded 31,025 asymptomatic patients
who had routine mammographic screening studies between 1993 and 1996.
Of the 58,538 examinations of these patients, 53,510 were of patients
who had no history of breast biopsy and 5028 were of patients who
had a history of breast biopsy for benign disease. Recall rates were
compared between the two groups. In the prospective study, radiologists
reviewed the mammograms of 1997 consecutive patients presenting to
the screening center, 173 of whom reported a prior breast biopsy
for benign disease. The radiologist interpreting the images determined
how often evidence of the biopsy site was apparent on the mammogram
and how often such changes necessitated additional imaging. RESULTS:
In the retrospective study, 3296 (6%) of the 53,510 studies done
in patients who did not have a biopsy for benign disease and 360
(7%) of the 5028 studies done in women who had a biopsy for benign
disease led to additional imaging. Eight recalls for further imaging
(0.16%) among the 5028 studies in women with a prior biopsy for benign
disease were related to the biopsy site. In the prospective study,
24 (14%) of the 173 women who had a biopsy for benign disease had
mammographic evidence of the biopsy site. Nine (5%) of the 173 women
who had previously had a biopsy for benign disease and 86 (5%) of
the 1824 patients without a prior biopsy were recalled for additional
imaging. No women were recalled because a previous breast biopsy
for benign disease led to confusion or diagnostic concern. CONCLUSION:
Changes in patients' breasts due to previous excisional biopsies
for benign breast disease rarely pose a diagnostic dilemma in the
interpretation of routine screening mammograms.
Boland, G. W.; Gazelle, G. Scott; Girard, M. J.; Mueller, P. R.
Asymptomatic hydropneumothorax after therapeutic thoracentesis for malignant pleural effusions Journal Article
In: AJR Am J Roentgenol, vol. 170, no. 4, pp. 943-6, 1998, ISSN: 0361-803X (Print) 0361-803X (Lin, ().
@article{Boland1998a,
title = {Asymptomatic hydropneumothorax after therapeutic thoracentesis for malignant pleural effusions},
author = {G. W. Boland and G. Scott Gazelle and M. J. Girard and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9530040},
issn = {0361-803X (Print) 0361-803X (Lin},
year = {1998},
date = {1998-04-01},
urldate = {1998-04-01},
journal = {AJR Am J Roentgenol},
volume = {170},
number = {4},
pages = {943-6},
abstract = {OBJECTIVE: The purpose of this study was to document in a historical
cohort the incidence and clinical observations of pneumothorax ex
vacuo after therapeutic thoracentesis for malignant pleural effusions
in patients with underlying parenchymal lung disease. MATERIALS AND
METHODS: Forty pneumothoraces resulted from 512 therapeutic thoracentesis
performed for malignant pleural effusions over a 3-year period. Twenty-nine
patients with pneumothoraces underwent catheter placement in the
pleural space for treatment. Of these, 12 pneumothoraces resolved
and 17 remained unchanged. We reviewed the charts of these 17 patients
to document the cause of malignant pleural effusion, presence of
underlying malignant parenchymal disease, volume of fluid aspirated,
and improvement in symptoms. Clinical outcome was then evaluated,
including size of residual pneumothorax, duration of catheter drainage,
and reaccumulation of effusion. RESULTS: No patients' lungs reexpanded
despite insertion of large-bore (16- to 35-French) chest tubes. All
had pneumothoraces that occupied at least 30% of the hemithorax;
all were asymptomatic; all had underlying parenchymal disease and
noncompliant lungs. Pleural effusion reaccumulated in all 17 after
removal of the chest tube. CONCLUSION: A subgroup of patients with
malignant lung parenchymal disease who undergo therapeutic thoracentesis
will develop asymptomatic hydropneumothoraces due to poor lung compliance.
These patients do not require further catheter drainage. Pleural
effusion will reaccumulate in the residual space over a variable
period of time.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: The purpose of this study was to document in a historical
cohort the incidence and clinical observations of pneumothorax ex
vacuo after therapeutic thoracentesis for malignant pleural effusions
in patients with underlying parenchymal lung disease. MATERIALS AND
METHODS: Forty pneumothoraces resulted from 512 therapeutic thoracentesis
performed for malignant pleural effusions over a 3-year period. Twenty-nine
patients with pneumothoraces underwent catheter placement in the
pleural space for treatment. Of these, 12 pneumothoraces resolved
and 17 remained unchanged. We reviewed the charts of these 17 patients
to document the cause of malignant pleural effusion, presence of
underlying malignant parenchymal disease, volume of fluid aspirated,
and improvement in symptoms. Clinical outcome was then evaluated,
including size of residual pneumothorax, duration of catheter drainage,
and reaccumulation of effusion. RESULTS: No patients' lungs reexpanded
despite insertion of large-bore (16- to 35-French) chest tubes. All
had pneumothoraces that occupied at least 30% of the hemithorax;
all were asymptomatic; all had underlying parenchymal disease and
noncompliant lungs. Pleural effusion reaccumulated in all 17 after
removal of the chest tube. CONCLUSION: A subgroup of patients with
malignant lung parenchymal disease who undergo therapeutic thoracentesis
will develop asymptomatic hydropneumothoraces due to poor lung compliance.
These patients do not require further catheter drainage. Pleural
effusion will reaccumulate in the residual space over a variable
period of time.
cohort the incidence and clinical observations of pneumothorax ex
vacuo after therapeutic thoracentesis for malignant pleural effusions
in patients with underlying parenchymal lung disease. MATERIALS AND
METHODS: Forty pneumothoraces resulted from 512 therapeutic thoracentesis
performed for malignant pleural effusions over a 3-year period. Twenty-nine
patients with pneumothoraces underwent catheter placement in the
pleural space for treatment. Of these, 12 pneumothoraces resolved
and 17 remained unchanged. We reviewed the charts of these 17 patients
to document the cause of malignant pleural effusion, presence of
underlying malignant parenchymal disease, volume of fluid aspirated,
and improvement in symptoms. Clinical outcome was then evaluated,
including size of residual pneumothorax, duration of catheter drainage,
and reaccumulation of effusion. RESULTS: No patients' lungs reexpanded
despite insertion of large-bore (16- to 35-French) chest tubes. All
had pneumothoraces that occupied at least 30% of the hemithorax;
all were asymptomatic; all had underlying parenchymal disease and
noncompliant lungs. Pleural effusion reaccumulated in all 17 after
removal of the chest tube. CONCLUSION: A subgroup of patients with
malignant lung parenchymal disease who undergo therapeutic thoracentesis
will develop asymptomatic hydropneumothoraces due to poor lung compliance.
These patients do not require further catheter drainage. Pleural
effusion will reaccumulate in the residual space over a variable
period of time.
Steiner, P.; Botnar, R.; Dubno, B.; Zimmermann, G. G.; Gazelle, G. Scott; Debatin, J. F.
Radio-frequency-induced thermoablation: monitoring with T1-weighted and proton-frequency-shift MR imaging in an interventional 0.5-T environment Journal Article
In: Radiology, vol. 206, no. 3, pp. 803-10, 1998, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Steiner1998,
title = {Radio-frequency-induced thermoablation: monitoring with T1-weighted and proton-frequency-shift MR imaging in an interventional 0.5-T environment},
author = {P. Steiner and R. Botnar and B. Dubno and G. G. Zimmermann and G. Scott Gazelle and J. F. Debatin},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9494505},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1998},
date = {1998-03-01},
urldate = {1998-03-01},
journal = {Radiology},
volume = {206},
number = {3},
pages = {803-10},
abstract = {PURPOSE: To evaluate the feasibility and accuracy of monitoring radio-frequency
(RF) ablation with an open-configuration, 0.5-T magnetic resonance
(MR) imager. MATERIALS AND METHODS: Thirty-six in vivo RF ablation experiments were performed in porcine paravertebral muscle (n = 24) and liver (n = 12). A 90 degrees C tip temperature was applied for
3-9 minutes. MR images were acquired after continuous or during intermittent
RF application. Temperature changes were monitored as signal intensity
and proton-frequency-shift (PFS) alterations in two T1-weighted gradient-echo
sequences. An update image was obtained every 2.5 seconds (20/10
[repetition time msec/echo time [TE] msec]) or every 5.0 seconds
(40/20). A color-coded subtraction technique enhanced the signal
intensity and PFS changes. Macroscopic coagulation size was compared
with MR image lesion size. RESULTS: The RF application mode had no
significant effect on coagulation size in muscle or liver (P \> .05).
Twenty-two of 24 coagulative lesions in muscle and nine of 12 in
liver were demonstrated with the PFS technique. Accuracy of lesion size determination depended on TE (TE = 20 mse},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To evaluate the feasibility and accuracy of monitoring radio-frequency
(RF) ablation with an open-configuration, 0.5-T magnetic resonance
(MR) imager. MATERIALS AND METHODS: Thirty-six in vivo RF ablation experiments were performed in porcine paravertebral muscle (n = 24) and liver (n = 12). A 90 degrees C tip temperature was applied for
3-9 minutes. MR images were acquired after continuous or during intermittent
RF application. Temperature changes were monitored as signal intensity
and proton-frequency-shift (PFS) alterations in two T1-weighted gradient-echo
sequences. An update image was obtained every 2.5 seconds (20/10
[repetition time msec/echo time [TE] msec]) or every 5.0 seconds
(40/20). A color-coded subtraction technique enhanced the signal
intensity and PFS changes. Macroscopic coagulation size was compared
with MR image lesion size. RESULTS: The RF application mode had no
significant effect on coagulation size in muscle or liver (P > .05).
Twenty-two of 24 coagulative lesions in muscle and nine of 12 in
liver were demonstrated with the PFS technique. Accuracy of lesion size determination depended on TE (TE = 20 mse
(RF) ablation with an open-configuration, 0.5-T magnetic resonance
(MR) imager. MATERIALS AND METHODS: Thirty-six in vivo RF ablation experiments were performed in porcine paravertebral muscle (n = 24) and liver (n = 12). A 90 degrees C tip temperature was applied for
3-9 minutes. MR images were acquired after continuous or during intermittent
RF application. Temperature changes were monitored as signal intensity
and proton-frequency-shift (PFS) alterations in two T1-weighted gradient-echo
sequences. An update image was obtained every 2.5 seconds (20/10
[repetition time msec/echo time [TE] msec]) or every 5.0 seconds
(40/20). A color-coded subtraction technique enhanced the signal
intensity and PFS changes. Macroscopic coagulation size was compared
with MR image lesion size. RESULTS: The RF application mode had no
significant effect on coagulation size in muscle or liver (P > .05).
Twenty-two of 24 coagulative lesions in muscle and nine of 12 in
liver were demonstrated with the PFS technique. Accuracy of lesion size determination depended on TE (TE = 20 mse
Swan, J. Shannon; Langlotz, C. P.
In: Invest Radiol, vol. 33, no. 9, pp. 553-9, 1998, ISSN: 0020-9996 (Print) 0020-9996 (Li, ().
@article{Swan1998,
title = {Patient preference for magnetic resonance versus conventional angiography. Assessment methods and implications for cost-effectiveness analysis: an overview},
author = {J. Shannon Swan and C. P. Langlotz},
url = {https://www.ncbi.nlm.nih.gov/pubmed/9766040},
doi = {10.1097/00004424-199809000-00011},
issn = {0020-9996 (Print)
0020-9996 (Li},
year = {1998},
date = {1998-01-01},
journal = {Invest Radiol},
volume = {33},
number = {9},
pages = {553-9},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Willig, D. S.; Turski, P. A.; Frayne, R.; Graves, V. B.; Korosec, F. R.; Swan, J. Shannon; Mistretta, C. A.; Grist, T. M.
In: Radiology, vol. 208, no. 2, pp. 447-51, 1998, ISSN: 0033-8419 (Print) 0033-8419 (Li, ().
@article{Willig1998,
title = {Contrast-enhanced 3D MR DSA of the carotid artery bifurcation: preliminary study of comparison with unenhanced 2D and 3D time-of-flight MR angiography},
author = {D. S. Willig and P. A. Turski and R. Frayne and V. B. Graves and F. R. Korosec and J. Shannon Swan and C. A. Mistretta and T. M. Grist},
url = {https://www.ncbi.nlm.nih.gov/pubmed/9680574},
doi = {10.1148/radiology.208.2.9680574},
issn = {0033-8419 (Print) 0033-8419 (Li},
year = {1998},
date = {1998-01-01},
urldate = {1998-01-01},
journal = {Radiology},
volume = {208},
number = {2},
pages = {447-51},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Westmoreland, S. V.; Halpern, Elkan F.; Lackner, A. A.
Simian immunodeficiency virus encephalitis in rhesus macaques is associated with rapid disease progression Journal Article
In: J Neurovirol, vol. 4, pp. 260-8, 1998, ().
@article{Westmoreland1998,
title = {Simian immunodeficiency virus encephalitis in rhesus macaques is
associated with rapid disease progression},
author = {S. V. Westmoreland and Elkan F. Halpern and A. A. Lackner},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9639069},
year = {1998},
date = {1998-01-01},
journal = {J Neurovirol},
volume = {4},
pages = {260-8},
abstract = {Central nervous system (CNS) disease is a major feature of simian
immunodeficiency virus (SIV) infection of macaques. To define the
spectrum of CNS lesions in SIV-infected macaques and the potential
associations with viral strain and disease course, we performed a
retrospective analysis of necropsies on 124 macaques with SIV-induced
AIDS. Histologic evidence of CNS disease was observed in 71 (57.3
of the 124 animals. SIV encephalitis was the most common CNS lesion
occurring in 43.7% (31/71) of the animals with CNS disease and 25%
of all animals. The incidence of SIVE correlated significantly with shortened survival (P=0.0207). In addition, SIVE was seen in 42.9%
(15/35) of rapid progressors (animals that died within 200 days)
compared to only 18% (16/89) of normal progressors (animals that lived longer than 200 days) (P=0.011). Animals with SIVE had higher
viral loads in peripheral blood than those that did not, but this
difference did not reach statistical significance. Similarly, while
animals infected with uncloned SIVmac251 had a higher incidence of
SIVE (27.5 14/51) than animals infected with molecularly cloned SIVmac239
and its T-cell tropic derivatives (18.5 10/54) this difference was
not statistically significant. In this study rapid disease progression
and SIVE were highly correlated making separation of viral determinants
of virulence from those of neurovirulence difficult.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Central nervous system (CNS) disease is a major feature of simian
immunodeficiency virus (SIV) infection of macaques. To define the
spectrum of CNS lesions in SIV-infected macaques and the potential
associations with viral strain and disease course, we performed a
retrospective analysis of necropsies on 124 macaques with SIV-induced
AIDS. Histologic evidence of CNS disease was observed in 71 (57.3
of the 124 animals. SIV encephalitis was the most common CNS lesion
occurring in 43.7% (31/71) of the animals with CNS disease and 25%
of all animals. The incidence of SIVE correlated significantly with shortened survival (P=0.0207). In addition, SIVE was seen in 42.9%
(15/35) of rapid progressors (animals that died within 200 days)
compared to only 18% (16/89) of normal progressors (animals that lived longer than 200 days) (P=0.011). Animals with SIVE had higher
viral loads in peripheral blood than those that did not, but this
difference did not reach statistical significance. Similarly, while
animals infected with uncloned SIVmac251 had a higher incidence of
SIVE (27.5 14/51) than animals infected with molecularly cloned SIVmac239
and its T-cell tropic derivatives (18.5 10/54) this difference was
not statistically significant. In this study rapid disease progression
and SIVE were highly correlated making separation of viral determinants
of virulence from those of neurovirulence difficult.
immunodeficiency virus (SIV) infection of macaques. To define the
spectrum of CNS lesions in SIV-infected macaques and the potential
associations with viral strain and disease course, we performed a
retrospective analysis of necropsies on 124 macaques with SIV-induced
AIDS. Histologic evidence of CNS disease was observed in 71 (57.3
of the 124 animals. SIV encephalitis was the most common CNS lesion
occurring in 43.7% (31/71) of the animals with CNS disease and 25%
of all animals. The incidence of SIVE correlated significantly with shortened survival (P=0.0207). In addition, SIVE was seen in 42.9%
(15/35) of rapid progressors (animals that died within 200 days)
compared to only 18% (16/89) of normal progressors (animals that lived longer than 200 days) (P=0.011). Animals with SIVE had higher
viral loads in peripheral blood than those that did not, but this
difference did not reach statistical significance. Similarly, while
animals infected with uncloned SIVmac251 had a higher incidence of
SIVE (27.5 14/51) than animals infected with molecularly cloned SIVmac239
and its T-cell tropic derivatives (18.5 10/54) this difference was
not statistically significant. In this study rapid disease progression
and SIVE were highly correlated making separation of viral determinants
of virulence from those of neurovirulence difficult.
Kong, Chung Yin; Muthukumar, M.
Monte Carlo Study of Adsorption of a Polyelectrolyte onto Charged Surfaces Journal Article
In: J. Chemical Physics, vol. 109, pp. 1522, 1998, ().
@article{Kong1998,
title = {Monte Carlo Study of Adsorption of a Polyelectrolyte onto Charged Surfaces},
author = {Chung Yin Kong and M. Muthukumar},
url = {http://scitation.aip.org/content/aip/journal/jcp/109/4/10.1063/1.476703},
year = {1998},
date = {1998-01-01},
journal = {J. Chemical Physics},
volume = {109},
pages = {1522},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Goldberg, S. N.; Gazelle, G. Scott; Solbiati, L.; Livraghi, T.; Tanabe, K. K.; Hahn, P. F.; Mueller, P. R.
Ablation of liver tumors using percutaneous RF therapy Journal Article
In: AJR Am J Roentgenol, vol. 170, pp. 1023-8, 1998, ().
@article{Goldberg1998,
title = {Ablation of liver tumors using percutaneous RF therapy},
author = {S. N. Goldberg and G. Scott Gazelle and L. Solbiati and T. Livraghi and K. K. Tanabe and P. F. Hahn and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9530053},
year = {1998},
date = {1998-01-01},
urldate = {1998-01-01},
journal = {AJR Am J Roentgenol},
volume = {170},
pages = {1023-8},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Goldberg, S. N.; Hahn, P. F.; McGovern, F. J.; Fogle, R. M.; Mueller, P. R.; Gazelle, G. Scott
Benign prostatic hyperplasia: US-guided transrectal urethral enlargement with radio frequency--initial results in a canine model Journal Article
In: Radiology, vol. 208, pp. 491-8, 1998, ().
@article{Goldberg1998c,
title = {Benign prostatic hyperplasia: US-guided transrectal urethral enlargement
with radio frequency--initial results in a canine model},
author = {S. N. Goldberg and P. F. Hahn and F. J. McGovern and R. M. Fogle and P. R. Mueller and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9680581},
year = {1998},
date = {1998-01-01},
journal = {Radiology},
volume = {208},
pages = {491-8},
abstract = {PURPOSE: To enlarge the prostatic urethra with thermal coagulation
with transrectal radio-frequency (RF) application in dogs. MATERIALS
AND METHODS: Eight aged dogs underwent RF ablation of periurethral
prostatic tissue for 6 minutes. Eighteen-gauge electrodes were placed
into the periurethral tissues with a transrectal approach and ultrasound
(US) guidance. Prostatic and rectal temperatures were measured during
RF application. US, conventional and computed tomographic (CT) retrograde urethrography (RUG), and CT were performed immediately (n = 8) and at 3-96 days (n = 6) after ablation. Histopathologic analysis was performed at sacrifice immediately (n = 2), at 28 days (n = 2), or at 3 months (n = 4) after treatment. RESULTS: All procedures were
successful with no complications and were performed in less than
30 minutes. Rectal mucosal temperature did not exceed 38 degrees
C. Immediately after treatment, CT and US demonstrated 1.2-cm foci
of altered periurethral tissue that corresponded to solid coagulated
tissue at histopathologic analysis. By day 3, CT, RUG, and US demonstrated
that these foci had begun to cavitate, resulting in enlargement of
the urethra. Complete cavitation was demonstrated by day 28. Minimal
reduction in the degree of urethral enlargement was noted by day
60, but narrowing, urethral strictures, or fistulas were not observed
at 3 months. At histopathologic analysis, focal cavitary enlargement
with at least doubling of the urethral diameter and with normal urothelium
was noted in all dogs surviving at least 28 days. CONCLUSION: Transrectal
RF urethral enlargement is feasible and safe in animals and merits
investigation for alleviating urethral obstruction due to benign
prostatic hyperplasia.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To enlarge the prostatic urethra with thermal coagulation
with transrectal radio-frequency (RF) application in dogs. MATERIALS
AND METHODS: Eight aged dogs underwent RF ablation of periurethral
prostatic tissue for 6 minutes. Eighteen-gauge electrodes were placed
into the periurethral tissues with a transrectal approach and ultrasound
(US) guidance. Prostatic and rectal temperatures were measured during
RF application. US, conventional and computed tomographic (CT) retrograde urethrography (RUG), and CT were performed immediately (n = 8) and at 3-96 days (n = 6) after ablation. Histopathologic analysis was performed at sacrifice immediately (n = 2), at 28 days (n = 2), or at 3 months (n = 4) after treatment. RESULTS: All procedures were
successful with no complications and were performed in less than
30 minutes. Rectal mucosal temperature did not exceed 38 degrees
C. Immediately after treatment, CT and US demonstrated 1.2-cm foci
of altered periurethral tissue that corresponded to solid coagulated
tissue at histopathologic analysis. By day 3, CT, RUG, and US demonstrated
that these foci had begun to cavitate, resulting in enlargement of
the urethra. Complete cavitation was demonstrated by day 28. Minimal
reduction in the degree of urethral enlargement was noted by day
60, but narrowing, urethral strictures, or fistulas were not observed
at 3 months. At histopathologic analysis, focal cavitary enlargement
with at least doubling of the urethral diameter and with normal urothelium
was noted in all dogs surviving at least 28 days. CONCLUSION: Transrectal
RF urethral enlargement is feasible and safe in animals and merits
investigation for alleviating urethral obstruction due to benign
prostatic hyperplasia.
with transrectal radio-frequency (RF) application in dogs. MATERIALS
AND METHODS: Eight aged dogs underwent RF ablation of periurethral
prostatic tissue for 6 minutes. Eighteen-gauge electrodes were placed
into the periurethral tissues with a transrectal approach and ultrasound
(US) guidance. Prostatic and rectal temperatures were measured during
RF application. US, conventional and computed tomographic (CT) retrograde urethrography (RUG), and CT were performed immediately (n = 8) and at 3-96 days (n = 6) after ablation. Histopathologic analysis was performed at sacrifice immediately (n = 2), at 28 days (n = 2), or at 3 months (n = 4) after treatment. RESULTS: All procedures were
successful with no complications and were performed in less than
30 minutes. Rectal mucosal temperature did not exceed 38 degrees
C. Immediately after treatment, CT and US demonstrated 1.2-cm foci
of altered periurethral tissue that corresponded to solid coagulated
tissue at histopathologic analysis. By day 3, CT, RUG, and US demonstrated
that these foci had begun to cavitate, resulting in enlargement of
the urethra. Complete cavitation was demonstrated by day 28. Minimal
reduction in the degree of urethral enlargement was noted by day
60, but narrowing, urethral strictures, or fistulas were not observed
at 3 months. At histopathologic analysis, focal cavitary enlargement
with at least doubling of the urethral diameter and with normal urothelium
was noted in all dogs surviving at least 28 days. CONCLUSION: Transrectal
RF urethral enlargement is feasible and safe in animals and merits
investigation for alleviating urethral obstruction due to benign
prostatic hyperplasia.
Goldberg, S. N.; Hahn, P. F.; Tanabe, K. K.; Mueller, P. R.; Schima, W.; Athanasoulis, C. A.; Compton, C. C.; Solbiati, L.; Gazelle, G. Scott
Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? Journal Article
In: J Vasc Interv Radiol, vol. 9, pp. 101-11, 1998, ().
@article{Goldberg1998b,
title = {Percutaneous radiofrequency tissue ablation: does perfusion-mediated
tissue cooling limit coagulation necrosis?},
author = {S. N. Goldberg and P. F. Hahn and K. K. Tanabe and P. R. Mueller and W. Schima and C. A. Athanasoulis and C. C. Compton and L. Solbiati and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9468403},
year = {1998},
date = {1998-01-01},
journal = {J Vasc Interv Radiol},
volume = {9},
pages = {101-11},
abstract = {PURPOSE: To determine, by decreasing hepatic perfusion during radiofrequency
(RF) ablation, whether perfusion-mediated tissue cooling can explain
the reduced coagulation observed in in vivo studies compared to that
seen with RF application in ex vivo tissue. MATERIALS AND METHODS:
RF was applied in vivo with use of cooled-tip electrodes to normal porcine liver without (n = 8) and with balloon occlusion of the portal vein (n = 8), celiac artery (n = 3), or hepatic artery (n = 2), and to ex vivo calf liver (n = 10). In vivo trials of vasopressin (0.3-0.6 U/min) infusion during RF application with (n = 10) and without (n = 2) arterial balloon occlusion were also performed. Intraoperative
RF was subsequently performed in seven patients with hepatic colorectal
metastases with and without portal inflow occlusion. Remote thermometry
was performed in four patients. RESULTS: RF application (12 minutes)
during portal venous occlusion produced larger areas of coagulation
necrosis than RF with unaltered blood flow (2.9 cm +/- 0.1 vs 2.4
cm +/- 0.2 diameter; P textless .01). With celiac and hepatic artery
occlusion, coagulation diameter measured 2.7 cm +/- 0.2 and 2.5 cm
+/- 0.1, respectively. Infusion of vasopressin without vascular occlusion
reduced coagulation diameter to 1.1 cm. However, different methods
of hepatic or celiac arterial balloon occlusion with simultaneous
vasopressin infusion produced a mean 3.4 cm +/- 0.2 of necrosis.
Coagulation in ex vivo liver was 2.9 cm +/- 0.1 in diameter. Clinical
studies demonstrated greater coagulation diameter for metastases
treated during portal inflow occlusion (4.0 cm +/- 1.3) than for
tumors treated with normal blood flow (2.5 cm +/- 0.8; P textless
.05). Thermometry documented a 10 degrees C increase compared to
baseline at 10 mm and 20 mm from the electrode after 5 minutes of
portal inflow occlusion during constant RF application. CONCLUSIONS:
Perfusion-mediated tissue cooling reduces coagulation necrosis achievable
with RF ablation. Reduction of blood flow during RF application increases
coagulation in both an animal model and human liver metastases.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine, by decreasing hepatic perfusion during radiofrequency
(RF) ablation, whether perfusion-mediated tissue cooling can explain
the reduced coagulation observed in in vivo studies compared to that
seen with RF application in ex vivo tissue. MATERIALS AND METHODS:
RF was applied in vivo with use of cooled-tip electrodes to normal porcine liver without (n = 8) and with balloon occlusion of the portal vein (n = 8), celiac artery (n = 3), or hepatic artery (n = 2), and to ex vivo calf liver (n = 10). In vivo trials of vasopressin (0.3-0.6 U/min) infusion during RF application with (n = 10) and without (n = 2) arterial balloon occlusion were also performed. Intraoperative
RF was subsequently performed in seven patients with hepatic colorectal
metastases with and without portal inflow occlusion. Remote thermometry
was performed in four patients. RESULTS: RF application (12 minutes)
during portal venous occlusion produced larger areas of coagulation
necrosis than RF with unaltered blood flow (2.9 cm +/- 0.1 vs 2.4
cm +/- 0.2 diameter; P textless .01). With celiac and hepatic artery
occlusion, coagulation diameter measured 2.7 cm +/- 0.2 and 2.5 cm
+/- 0.1, respectively. Infusion of vasopressin without vascular occlusion
reduced coagulation diameter to 1.1 cm. However, different methods
of hepatic or celiac arterial balloon occlusion with simultaneous
vasopressin infusion produced a mean 3.4 cm +/- 0.2 of necrosis.
Coagulation in ex vivo liver was 2.9 cm +/- 0.1 in diameter. Clinical
studies demonstrated greater coagulation diameter for metastases
treated during portal inflow occlusion (4.0 cm +/- 1.3) than for
tumors treated with normal blood flow (2.5 cm +/- 0.8; P textless
.05). Thermometry documented a 10 degrees C increase compared to
baseline at 10 mm and 20 mm from the electrode after 5 minutes of
portal inflow occlusion during constant RF application. CONCLUSIONS:
Perfusion-mediated tissue cooling reduces coagulation necrosis achievable
with RF ablation. Reduction of blood flow during RF application increases
coagulation in both an animal model and human liver metastases.
(RF) ablation, whether perfusion-mediated tissue cooling can explain
the reduced coagulation observed in in vivo studies compared to that
seen with RF application in ex vivo tissue. MATERIALS AND METHODS:
RF was applied in vivo with use of cooled-tip electrodes to normal porcine liver without (n = 8) and with balloon occlusion of the portal vein (n = 8), celiac artery (n = 3), or hepatic artery (n = 2), and to ex vivo calf liver (n = 10). In vivo trials of vasopressin (0.3-0.6 U/min) infusion during RF application with (n = 10) and without (n = 2) arterial balloon occlusion were also performed. Intraoperative
RF was subsequently performed in seven patients with hepatic colorectal
metastases with and without portal inflow occlusion. Remote thermometry
was performed in four patients. RESULTS: RF application (12 minutes)
during portal venous occlusion produced larger areas of coagulation
necrosis than RF with unaltered blood flow (2.9 cm +/- 0.1 vs 2.4
cm +/- 0.2 diameter; P textless .01). With celiac and hepatic artery
occlusion, coagulation diameter measured 2.7 cm +/- 0.2 and 2.5 cm
+/- 0.1, respectively. Infusion of vasopressin without vascular occlusion
reduced coagulation diameter to 1.1 cm. However, different methods
of hepatic or celiac arterial balloon occlusion with simultaneous
vasopressin infusion produced a mean 3.4 cm +/- 0.2 of necrosis.
Coagulation in ex vivo liver was 2.9 cm +/- 0.1 in diameter. Clinical
studies demonstrated greater coagulation diameter for metastases
treated during portal inflow occlusion (4.0 cm +/- 1.3) than for
tumors treated with normal blood flow (2.5 cm +/- 0.8; P textless
.05). Thermometry documented a 10 degrees C increase compared to
baseline at 10 mm and 20 mm from the electrode after 5 minutes of
portal inflow occlusion during constant RF application. CONCLUSIONS:
Perfusion-mediated tissue cooling reduces coagulation necrosis achievable
with RF ablation. Reduction of blood flow during RF application increases
coagulation in both an animal model and human liver metastases.
Goldberg, S. N.; Solbiati, L.; Hahn, P. F.; Cosman, E.; Conrad, J. E.; Fogle, R.; Gazelle, G. Scott
In: Radiology, vol. 209, pp. 371-9, 1998, ().
@article{Goldberg1998a,
title = {Large-volume tissue ablation with radio frequency by using a clustered,
internally cooled electrode technique: laboratory and clinical experience
in liver metastases},
author = {S. N. Goldberg and L. Solbiati and P. F. Hahn and E. Cosman and J. E. Conrad and R. Fogle and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9807561},
year = {1998},
date = {1998-01-01},
journal = {Radiology},
volume = {209},
pages = {371-9},
abstract = {PURPOSE: To evaluate whether coagulation necrosis achievable with
radio-frequency (RF) ablation can be increased by using a cluster
of closely spaced electrodes. MATERIALS AND METHODS: RF was applied to ex vivo liver (n = 68), in vivo liver (n = 12), and in vivo muscle (n = 15) by using a cluster array of three separate internally cooled
electrodes spaced 0.5 cm apart. The diameter of coagulation necrosis
achieved with optimal RF deposition (1,400-2,150 peak mA) for 5-60
minutes of RF application was determined for electrode tip lengths
of 1.5-3.0 cm and compared with that obtained by using a single electrode
and otherwise similar technique. Ten patients with solitary intrahepatic
colorectal metastases were also treated by using cluster electrode
RF ablation. RESULTS: In ex vivo liver, simultaneous RF application
to electrode clusters for 15, 30, and 45 minutes produced 4.7 cm
+/- 0.1, 6.2 cm +/- 0.1, and 7.0 cm +/- 0.2 of coagulation necrosis,
respectively. In in vivo liver and muscle, RF applied to electrode
clusters for 12 minutes yielded 3.1 cm +/- 0.2 and 7.6 cm +/- 0.4
of coagulation, respectively. RF application to a single electrode
produced maximal coagulation of 2.9 cm in ex vivo liver, 1.8 cm in
in vivo liver, and 4.3 cm in muscle (P textless .01, all tissues).
In colorectal metastases, a single 12-15-minute application of RF
to an electrode cluster induced 4.5-7.0 cm of coagulation necrosis.
CONCLUSION: Simultaneous RF application to a cluster of three closely
spaced internally cooled electrodes enables a larger volume of coagulation
in ex vivo liver, in vivo tissues, and hepatic colorectal metastases
than previously reported.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To evaluate whether coagulation necrosis achievable with
radio-frequency (RF) ablation can be increased by using a cluster
of closely spaced electrodes. MATERIALS AND METHODS: RF was applied to ex vivo liver (n = 68), in vivo liver (n = 12), and in vivo muscle (n = 15) by using a cluster array of three separate internally cooled
electrodes spaced 0.5 cm apart. The diameter of coagulation necrosis
achieved with optimal RF deposition (1,400-2,150 peak mA) for 5-60
minutes of RF application was determined for electrode tip lengths
of 1.5-3.0 cm and compared with that obtained by using a single electrode
and otherwise similar technique. Ten patients with solitary intrahepatic
colorectal metastases were also treated by using cluster electrode
RF ablation. RESULTS: In ex vivo liver, simultaneous RF application
to electrode clusters for 15, 30, and 45 minutes produced 4.7 cm
+/- 0.1, 6.2 cm +/- 0.1, and 7.0 cm +/- 0.2 of coagulation necrosis,
respectively. In in vivo liver and muscle, RF applied to electrode
clusters for 12 minutes yielded 3.1 cm +/- 0.2 and 7.6 cm +/- 0.4
of coagulation, respectively. RF application to a single electrode
produced maximal coagulation of 2.9 cm in ex vivo liver, 1.8 cm in
in vivo liver, and 4.3 cm in muscle (P textless .01, all tissues).
In colorectal metastases, a single 12-15-minute application of RF
to an electrode cluster induced 4.5-7.0 cm of coagulation necrosis.
CONCLUSION: Simultaneous RF application to a cluster of three closely
spaced internally cooled electrodes enables a larger volume of coagulation
in ex vivo liver, in vivo tissues, and hepatic colorectal metastases
than previously reported.
radio-frequency (RF) ablation can be increased by using a cluster
of closely spaced electrodes. MATERIALS AND METHODS: RF was applied to ex vivo liver (n = 68), in vivo liver (n = 12), and in vivo muscle (n = 15) by using a cluster array of three separate internally cooled
electrodes spaced 0.5 cm apart. The diameter of coagulation necrosis
achieved with optimal RF deposition (1,400-2,150 peak mA) for 5-60
minutes of RF application was determined for electrode tip lengths
of 1.5-3.0 cm and compared with that obtained by using a single electrode
and otherwise similar technique. Ten patients with solitary intrahepatic
colorectal metastases were also treated by using cluster electrode
RF ablation. RESULTS: In ex vivo liver, simultaneous RF application
to electrode clusters for 15, 30, and 45 minutes produced 4.7 cm
+/- 0.1, 6.2 cm +/- 0.1, and 7.0 cm +/- 0.2 of coagulation necrosis,
respectively. In in vivo liver and muscle, RF applied to electrode
clusters for 12 minutes yielded 3.1 cm +/- 0.2 and 7.6 cm +/- 0.4
of coagulation, respectively. RF application to a single electrode
produced maximal coagulation of 2.9 cm in ex vivo liver, 1.8 cm in
in vivo liver, and 4.3 cm in muscle (P textless .01, all tissues).
In colorectal metastases, a single 12-15-minute application of RF
to an electrode cluster induced 4.5-7.0 cm of coagulation necrosis.
CONCLUSION: Simultaneous RF application to a cluster of three closely
spaced internally cooled electrodes enables a larger volume of coagulation
in ex vivo liver, in vivo tissues, and hepatic colorectal metastases
than previously reported.
Boland, G. W.; Lee, M. J.; Gazelle, G. Scott; Halpern, Elkan F.; McNicholas, M. M.; Mueller, P. R.
Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature Journal Article
In: AJR Am J Roentgenol, vol. 171, pp. 201-4, 1998, ().
@article{Boland1998,
title = {Characterization of adrenal masses using unenhanced CT: an analysis
of the CT literature},
author = {G. W. Boland and M. J. Lee and G. Scott Gazelle and Elkan F. Halpern and M. M. McNicholas and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9648789},
year = {1998},
date = {1998-01-01},
journal = {AJR Am J Roentgenol},
volume = {171},
pages = {201-4},
abstract = {OBJECTIVE: Unenhanced CT scanning can reliably characterize incidentally
detected adrenal masses when observers use density measurements of
the adrenal gland. However, controversy exists as to the optimal
density threshold required to differentiate benign from malignant
lesions. This study attempts to establish a consensus by performing
a pooled analysis of data found in the CT literature. MATERIALS AND
METHODS: Ten CT reports were analyzed, from which individual adrenal
lesion density measurements were obtained for 495 adrenal lesions
(272 benign lesions and 223 malignant lesions). Threshold analysis
generated a range of sensitivities and specificities for lesion characterization
at different density thresholds. RESULTS: Sensitivity for characterizing
a lesion as benign ranged from 47% at a threshold of 2 H to 88% at
a threshold of 20 H. Similarly, specificity varied from 100% at a
threshold of 2 H to 84% at a threshold of 20 H. CONCLUSION: The attempt
to be absolutely certain that an adrenal lesion is benign may lead
to an unacceptably low sensitivity for lesion characterization. The
threshold chosen will depend on the patient population and the cost-benefit
approach to patient care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: Unenhanced CT scanning can reliably characterize incidentally
detected adrenal masses when observers use density measurements of
the adrenal gland. However, controversy exists as to the optimal
density threshold required to differentiate benign from malignant
lesions. This study attempts to establish a consensus by performing
a pooled analysis of data found in the CT literature. MATERIALS AND
METHODS: Ten CT reports were analyzed, from which individual adrenal
lesion density measurements were obtained for 495 adrenal lesions
(272 benign lesions and 223 malignant lesions). Threshold analysis
generated a range of sensitivities and specificities for lesion characterization
at different density thresholds. RESULTS: Sensitivity for characterizing
a lesion as benign ranged from 47% at a threshold of 2 H to 88% at
a threshold of 20 H. Similarly, specificity varied from 100% at a
threshold of 2 H to 84% at a threshold of 20 H. CONCLUSION: The attempt
to be absolutely certain that an adrenal lesion is benign may lead
to an unacceptably low sensitivity for lesion characterization. The
threshold chosen will depend on the patient population and the cost-benefit
approach to patient care.
detected adrenal masses when observers use density measurements of
the adrenal gland. However, controversy exists as to the optimal
density threshold required to differentiate benign from malignant
lesions. This study attempts to establish a consensus by performing
a pooled analysis of data found in the CT literature. MATERIALS AND
METHODS: Ten CT reports were analyzed, from which individual adrenal
lesion density measurements were obtained for 495 adrenal lesions
(272 benign lesions and 223 malignant lesions). Threshold analysis
generated a range of sensitivities and specificities for lesion characterization
at different density thresholds. RESULTS: Sensitivity for characterizing
a lesion as benign ranged from 47% at a threshold of 2 H to 88% at
a threshold of 20 H. Similarly, specificity varied from 100% at a
threshold of 2 H to 84% at a threshold of 20 H. CONCLUSION: The attempt
to be absolutely certain that an adrenal lesion is benign may lead
to an unacceptably low sensitivity for lesion characterization. The
threshold chosen will depend on the patient population and the cost-benefit
approach to patient care.
Lewin, J. S.; Connell, C. F.; Duerk, J. L.; Chung, Y. C.; Clampitt, M. E.; Spisak, J.; Gazelle, G. Scott; Haaga, J. R.
Interactive MRI-guided radiofrequency interstitial thermal ablation of abdominal tumors: clinical trial for evaluation of safety and feasibility Journal Article
In: J Magn Reson Imaging, vol. 8, no. 1, pp. 40-7, 1998, ISSN: 1053-1807 (Print) 1053-1807 (Lin, ().
@article{Lewin1998,
title = {Interactive MRI-guided radiofrequency interstitial thermal ablation of abdominal tumors: clinical trial for evaluation of safety and feasibility},
author = {J. S. Lewin and C. F. Connell and J. L. Duerk and Y. C. Chung and M. E. Clampitt and J. Spisak and G. Scott Gazelle and J. R. Haaga},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9500259},
issn = {1053-1807 (Print) 1053-1807 (Lin},
year = {1998},
date = {1998-00-01},
urldate = {1998-00-01},
journal = {J Magn Reson Imaging},
volume = {8},
number = {1},
pages = {40-7},
abstract = {This clinical trial was performed to evaluate the safety and feasibility
of interactive MR-guided radiofrequency (RF) interstitial thermal
ablation (ITA) performed entirely within the MR imager. RF-ITA was
performed on 11 intra-abdominal metastatic tumors during 13 sessions.
The RF electrode was placed under MR guidance on a .2-T system using
rapid fast imaging with steady state precession (FISP) and true FISP
images. A custom 17-gauge electrode was used and was modified in
four sessions to allow circulation of iced saline for cooling during
ablation. Tissue necrosis monitoring and electrode repositioning
were based on rapid T2-weighted and short-inversion-time inversion
recovery (STIR) sequences. Morbidity and toxicity were assessed by
clinical and imaging criteria. The region of tissue destruction was
visible in all 11 tumors treated, as confirmed on subsequent contrast-enhanced
images. No significant morbidity was noted, and patient discomfort
was minimal. In conclusion, interactive MR-guided RF-ITA is feasible
on a clinical .2-T C-arm system with supplemental interventional
accessories with only minor patient morbidity. The ability to completely
ablate tumors with RF-ITA depends on tumor size and vascularity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This clinical trial was performed to evaluate the safety and feasibility
of interactive MR-guided radiofrequency (RF) interstitial thermal
ablation (ITA) performed entirely within the MR imager. RF-ITA was
performed on 11 intra-abdominal metastatic tumors during 13 sessions.
The RF electrode was placed under MR guidance on a .2-T system using
rapid fast imaging with steady state precession (FISP) and true FISP
images. A custom 17-gauge electrode was used and was modified in
four sessions to allow circulation of iced saline for cooling during
ablation. Tissue necrosis monitoring and electrode repositioning
were based on rapid T2-weighted and short-inversion-time inversion
recovery (STIR) sequences. Morbidity and toxicity were assessed by
clinical and imaging criteria. The region of tissue destruction was
visible in all 11 tumors treated, as confirmed on subsequent contrast-enhanced
images. No significant morbidity was noted, and patient discomfort
was minimal. In conclusion, interactive MR-guided RF-ITA is feasible
on a clinical .2-T C-arm system with supplemental interventional
accessories with only minor patient morbidity. The ability to completely
ablate tumors with RF-ITA depends on tumor size and vascularity.
of interactive MR-guided radiofrequency (RF) interstitial thermal
ablation (ITA) performed entirely within the MR imager. RF-ITA was
performed on 11 intra-abdominal metastatic tumors during 13 sessions.
The RF electrode was placed under MR guidance on a .2-T system using
rapid fast imaging with steady state precession (FISP) and true FISP
images. A custom 17-gauge electrode was used and was modified in
four sessions to allow circulation of iced saline for cooling during
ablation. Tissue necrosis monitoring and electrode repositioning
were based on rapid T2-weighted and short-inversion-time inversion
recovery (STIR) sequences. Morbidity and toxicity were assessed by
clinical and imaging criteria. The region of tissue destruction was
visible in all 11 tumors treated, as confirmed on subsequent contrast-enhanced
images. No significant morbidity was noted, and patient discomfort
was minimal. In conclusion, interactive MR-guided RF-ITA is feasible
on a clinical .2-T C-arm system with supplemental interventional
accessories with only minor patient morbidity. The ability to completely
ablate tumors with RF-ITA depends on tumor size and vascularity.
1997
Solbiati, L.; Goldberg, S. N.; Ierace, T.; Livraghi, T.; Meloni, F.; Dellanoce, M.; Sironi, S.; Gazelle, G. Scott
Hepatic metastases: percutaneous radio-frequency ablation with cooled-tip electrodes Journal Article
In: Radiology, vol. 205, no. 2, pp. 367-73, 1997, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Solbiati1997a,
title = {Hepatic metastases: percutaneous radio-frequency ablation with cooled-tip
electrodes},
author = {L. Solbiati and S. N. Goldberg and T. Ierace and T. Livraghi and F. Meloni and M. Dellanoce and S. Sironi and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9356616},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1997},
date = {1997-11-01},
journal = {Radiology},
volume = {205},
number = {2},
pages = {367-73},
abstract = {PURPOSE: To assess the feasibility and safety of using cooled-tip
electrodes to increase the volume of coagulation necrosis obtained
or reduce the number of treatment sessions necessary with percutaneous
tumor radio-frequency (RF) ablation. MATERIALS AND METHODS: Twenty-nine
patients with 44 hepatic metastases (1.3-5.1 cm diameter) from colorectal (n = 22), gastric (n = 5), pancreatic (n = 1), or breast (n = 1)
carcinoma were treated with RF ablation using cooled-tip, 18-gauge
electrodes with 2-3 cm tip exposure. Each tumor was treated in one
or two treatment sessions. RESULTS: Technical success, ablation of
all visualized tumor, was achieved in 40 (91%) metastases. Findings
at computed tomography (CT) and magnetic resonance (MR) imaging performed
3-6 months after treatment confirmed complete necrosis of the entire
metastasis in 66%. Disease-free survival was 50% at 12 months and
33% at 18 months, with localized progression of disease in 34% of
treated lesions. Overall survival was 100%, 94%, and 89% at 6, 12,
and 18 months, respectively. Only one complication, self-limited
hemorrhage, was seen. CONCLUSION: Use of cooled-tip electrodes was
a safe and feasible adjunct for tumor RF ablation therapy that produced
larger volumes of coagulation necrosis with fewer electrode insertions
than is produced with other RF ablation techniques.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To assess the feasibility and safety of using cooled-tip
electrodes to increase the volume of coagulation necrosis obtained
or reduce the number of treatment sessions necessary with percutaneous
tumor radio-frequency (RF) ablation. MATERIALS AND METHODS: Twenty-nine
patients with 44 hepatic metastases (1.3-5.1 cm diameter) from colorectal (n = 22), gastric (n = 5), pancreatic (n = 1), or breast (n = 1)
carcinoma were treated with RF ablation using cooled-tip, 18-gauge
electrodes with 2-3 cm tip exposure. Each tumor was treated in one
or two treatment sessions. RESULTS: Technical success, ablation of
all visualized tumor, was achieved in 40 (91%) metastases. Findings
at computed tomography (CT) and magnetic resonance (MR) imaging performed
3-6 months after treatment confirmed complete necrosis of the entire
metastasis in 66%. Disease-free survival was 50% at 12 months and
33% at 18 months, with localized progression of disease in 34% of
treated lesions. Overall survival was 100%, 94%, and 89% at 6, 12,
and 18 months, respectively. Only one complication, self-limited
hemorrhage, was seen. CONCLUSION: Use of cooled-tip electrodes was
a safe and feasible adjunct for tumor RF ablation therapy that produced
larger volumes of coagulation necrosis with fewer electrode insertions
than is produced with other RF ablation techniques.
electrodes to increase the volume of coagulation necrosis obtained
or reduce the number of treatment sessions necessary with percutaneous
tumor radio-frequency (RF) ablation. MATERIALS AND METHODS: Twenty-nine
patients with 44 hepatic metastases (1.3-5.1 cm diameter) from colorectal (n = 22), gastric (n = 5), pancreatic (n = 1), or breast (n = 1)
carcinoma were treated with RF ablation using cooled-tip, 18-gauge
electrodes with 2-3 cm tip exposure. Each tumor was treated in one
or two treatment sessions. RESULTS: Technical success, ablation of
all visualized tumor, was achieved in 40 (91%) metastases. Findings
at computed tomography (CT) and magnetic resonance (MR) imaging performed
3-6 months after treatment confirmed complete necrosis of the entire
metastasis in 66%. Disease-free survival was 50% at 12 months and
33% at 18 months, with localized progression of disease in 34% of
treated lesions. Overall survival was 100%, 94%, and 89% at 6, 12,
and 18 months, respectively. Only one complication, self-limited
hemorrhage, was seen. CONCLUSION: Use of cooled-tip electrodes was
a safe and feasible adjunct for tumor RF ablation therapy that produced
larger volumes of coagulation necrosis with fewer electrode insertions
than is produced with other RF ablation techniques.
Steiner, P.; Botnar, R.; Goldberg, S. N.; Gazelle, G. Scott; Debatin, J. F.
Monitoring of radio frequency tissue ablation in an interventional magnetic resonance environment. Preliminary ex vivo and in vivo results Journal Article
In: Invest Radiol, vol. 32, no. 11, pp. 671-8, 1997, ISSN: 0020-9996 (Print) 0020-9996 (Lin, ().
@article{Steiner1997,
title = {Monitoring of radio frequency tissue ablation in an interventional
magnetic resonance environment. Preliminary ex vivo and in vivo results},
author = {P. Steiner and R. Botnar and S. N. Goldberg and G. Scott Gazelle and J. F. Debatin},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9387054},
issn = {0020-9996 (Print) 0020-9996 (Lin},
year = {1997},
date = {1997-11-01},
journal = {Invest Radiol},
volume = {32},
number = {11},
pages = {671-8},
abstract = {RATIONALE AND OBJECTIVES: The authors evaluate the feasibility of
monitoring radio frequency (RF) ablation in an interventional, open-configuration,
0.5-tesla magnetic resonance (MR) environment. METHODS: Ex vivo and
in vivo RF coagulation necrosis were induced in porcine paraspinal
muscle tissue using a 300 kHz monopolar RF generator applying 5 to
20 W over 3 to 9 minutes. Images were acquired simultaneous to RF
application, after RF application, and in an intermittent mode (60
seconds of RF followed by 15 seconds of MR imaging). Temperature
changes were monitored based on amplitude (ex vivo) and phase alterations
(in vivo) of a T1-weighted graded refocused echo (GRE) sequence enabling
an update every 2.5 seconds. A standardized color-coded subtraction
technique enhanced signal changes. Additionally, T2- and T1-weighted
spin echo (SE) images were acquired with and without intravenous
contrast. Macroscopic coagulation size was compared with lesion size
seen on MR images. RESULTS: Although lesion diameters were related
directly to applied RF power, the application mode had no significant
impact on coagulation size (P \> 0.05). As could be expected, MR imaging
during RF ablation resulted in major image distortion. Radio frequency
effects were seen on images acquired in the continuous and intermittent
modes. Coagulation size seen on GRE images correlated well with macroscopy both ex vivo (r = 0.89) and in vivo (r = 0.92). Poorer correlation was found with postinterventional SE sequences (r = 0.78-0.84). CONCLUSIONS:
Magnetic resonance monitoring of RF effects is feasible both ex vivo
as well as in vivo using temperature-sensitive sequences in an open-configuration
MR environment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
RATIONALE AND OBJECTIVES: The authors evaluate the feasibility of
monitoring radio frequency (RF) ablation in an interventional, open-configuration,
0.5-tesla magnetic resonance (MR) environment. METHODS: Ex vivo and
in vivo RF coagulation necrosis were induced in porcine paraspinal
muscle tissue using a 300 kHz monopolar RF generator applying 5 to
20 W over 3 to 9 minutes. Images were acquired simultaneous to RF
application, after RF application, and in an intermittent mode (60
seconds of RF followed by 15 seconds of MR imaging). Temperature
changes were monitored based on amplitude (ex vivo) and phase alterations
(in vivo) of a T1-weighted graded refocused echo (GRE) sequence enabling
an update every 2.5 seconds. A standardized color-coded subtraction
technique enhanced signal changes. Additionally, T2- and T1-weighted
spin echo (SE) images were acquired with and without intravenous
contrast. Macroscopic coagulation size was compared with lesion size
seen on MR images. RESULTS: Although lesion diameters were related
directly to applied RF power, the application mode had no significant
impact on coagulation size (P > 0.05). As could be expected, MR imaging
during RF ablation resulted in major image distortion. Radio frequency
effects were seen on images acquired in the continuous and intermittent
modes. Coagulation size seen on GRE images correlated well with macroscopy both ex vivo (r = 0.89) and in vivo (r = 0.92). Poorer correlation was found with postinterventional SE sequences (r = 0.78-0.84). CONCLUSIONS:
Magnetic resonance monitoring of RF effects is feasible both ex vivo
as well as in vivo using temperature-sensitive sequences in an open-configuration
MR environment.
monitoring radio frequency (RF) ablation in an interventional, open-configuration,
0.5-tesla magnetic resonance (MR) environment. METHODS: Ex vivo and
in vivo RF coagulation necrosis were induced in porcine paraspinal
muscle tissue using a 300 kHz monopolar RF generator applying 5 to
20 W over 3 to 9 minutes. Images were acquired simultaneous to RF
application, after RF application, and in an intermittent mode (60
seconds of RF followed by 15 seconds of MR imaging). Temperature
changes were monitored based on amplitude (ex vivo) and phase alterations
(in vivo) of a T1-weighted graded refocused echo (GRE) sequence enabling
an update every 2.5 seconds. A standardized color-coded subtraction
technique enhanced signal changes. Additionally, T2- and T1-weighted
spin echo (SE) images were acquired with and without intravenous
contrast. Macroscopic coagulation size was compared with lesion size
seen on MR images. RESULTS: Although lesion diameters were related
directly to applied RF power, the application mode had no significant
impact on coagulation size (P > 0.05). As could be expected, MR imaging
during RF ablation resulted in major image distortion. Radio frequency
effects were seen on images acquired in the continuous and intermittent
modes. Coagulation size seen on GRE images correlated well with macroscopy both ex vivo (r = 0.89) and in vivo (r = 0.92). Poorer correlation was found with postinterventional SE sequences (r = 0.78-0.84). CONCLUSIONS:
Magnetic resonance monitoring of RF effects is feasible both ex vivo
as well as in vivo using temperature-sensitive sequences in an open-configuration
MR environment.
Hahn, P. F.; Gazelle, G. Scott; Jiang, D. Y.; Compton, C. C.; Goldberg, S. N.; Mueller, P. R.
Liver tumor ablation: real-time monitoring with dynamic CT Journal Article
In: Acad Radiol, vol. 4, no. 9, pp. 634-8, 1997, ISSN: 1076-6332 (Print) 1076-6332 (Lin, ().
@article{Hahn1997,
title = {Liver tumor ablation: real-time monitoring with dynamic CT},
author = {P. F. Hahn and G. Scott Gazelle and D. Y. Jiang and C. C. Compton and S. N. Goldberg and P. R. Mueller},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9288191},
issn = {1076-6332 (Print) 1076-6332 (Lin},
year = {1997},
date = {1997-09-01},
journal = {Acad Radiol},
volume = {4},
number = {9},
pages = {634-8},
abstract = {RATIONALE AND OBJECTIVES: To determine whether incomplete contact
of ethanol with tumor limits the success of percutaneous ethanol
injection therapy. MATERIALS AND METHODS: Percutaneous ethanol injection
was performed in seven normal New Zealand white rabbits and 18 rabbits
with 1-3-cm liver tumors 10-14 days after percutaneous implantation
of suspended tumor cells. A 3-5 mL dose of ethanol was injected at
a rate of 0.2 mL/sec either into normal liver remote from large vessels
or directly into tumor. During and immediately after injection, axial,
2-mm-thick, contrast material-enhanced computed tomography scans
were obtained at reach of three levels every 9 seconds. RESULTS:
In normal animals, virtually all injected ethanol tracked to the
hepatic capsule. As ethanol was injected into tumors, peripheral
tracking, similar to that seen in normal livers, or extratumoral
puddling was observed. Ethanol-tumor contact was incomplete in 16
of 18 animals (89%). Histopathologic analysis showed incomplete tumor
necrosis. CONCLUSION: In this model of hepatic carcinoma metastasis,
the tumor failed to hold sufficient ethanol for successful ablation
by means of percutaneous ethanol injection therapy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
RATIONALE AND OBJECTIVES: To determine whether incomplete contact
of ethanol with tumor limits the success of percutaneous ethanol
injection therapy. MATERIALS AND METHODS: Percutaneous ethanol injection
was performed in seven normal New Zealand white rabbits and 18 rabbits
with 1-3-cm liver tumors 10-14 days after percutaneous implantation
of suspended tumor cells. A 3-5 mL dose of ethanol was injected at
a rate of 0.2 mL/sec either into normal liver remote from large vessels
or directly into tumor. During and immediately after injection, axial,
2-mm-thick, contrast material-enhanced computed tomography scans
were obtained at reach of three levels every 9 seconds. RESULTS:
In normal animals, virtually all injected ethanol tracked to the
hepatic capsule. As ethanol was injected into tumors, peripheral
tracking, similar to that seen in normal livers, or extratumoral
puddling was observed. Ethanol-tumor contact was incomplete in 16
of 18 animals (89%). Histopathologic analysis showed incomplete tumor
necrosis. CONCLUSION: In this model of hepatic carcinoma metastasis,
the tumor failed to hold sufficient ethanol for successful ablation
by means of percutaneous ethanol injection therapy.
of ethanol with tumor limits the success of percutaneous ethanol
injection therapy. MATERIALS AND METHODS: Percutaneous ethanol injection
was performed in seven normal New Zealand white rabbits and 18 rabbits
with 1-3-cm liver tumors 10-14 days after percutaneous implantation
of suspended tumor cells. A 3-5 mL dose of ethanol was injected at
a rate of 0.2 mL/sec either into normal liver remote from large vessels
or directly into tumor. During and immediately after injection, axial,
2-mm-thick, contrast material-enhanced computed tomography scans
were obtained at reach of three levels every 9 seconds. RESULTS:
In normal animals, virtually all injected ethanol tracked to the
hepatic capsule. As ethanol was injected into tumors, peripheral
tracking, similar to that seen in normal livers, or extratumoral
puddling was observed. Ethanol-tumor contact was incomplete in 16
of 18 animals (89%). Histopathologic analysis showed incomplete tumor
necrosis. CONCLUSION: In this model of hepatic carcinoma metastasis,
the tumor failed to hold sufficient ethanol for successful ablation
by means of percutaneous ethanol injection therapy.
Lazor, M. A.; Pierce, E. T.; Stanley, G. D.; Cass, J. L.; Halpern, Elkan F.; Bode, Jr. R. H.
Evaluation of the accuracy and response time of STAT-mode continuous cardiac output Journal Article
In: J Cardiothorac Vasc Anesth, vol. 11, no. 4, pp. 432-6, 1997, ISSN: 1053-0770 (Print) 1053-0770 (Lin, ().
@article{Lazor1997,
title = {Evaluation of the accuracy and response time of STAT-mode continuous
cardiac output},
author = {M. A. Lazor and E. T. Pierce and G. D. Stanley and J. L. Cass and Elkan F. Halpern and Jr. R. H. Bode},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9187990},
issn = {1053-0770 (Print) 1053-0770 (Lin},
year = {1997},
date = {1997-06-01},
journal = {J Cardiothorac Vasc Anesth},
volume = {11},
number = {4},
pages = {432-6},
abstract = {OBJECTIVES: This study was conducted to compare continuous cardiac
output (CCO) with bolus thermodilution cardiac output (BTD) at steady
state, and to compare the response time of STAT CCO with that of
trend CCO, mean arterial pressure, and mixed venous oxygen saturation
[SvO2] during an acute hemodynamic change. DESIGN: Prospective study.
SETTING: University hospital. PARTICIPANTS: Twenty-nine patients
undergoing cardiac surgery or liver transplantation. INTERVENTIONS:
STAT and trend CCO were compared with BTD cardiac output during steady
state intraoperatively and postoperatively in the intensive care
unit. Ten patients, who required epicardial pacing after cardiac
surgery, were studied to compare the response time of STAT CCO with
that of trend CCO, mean arterial pressure, and BvO2 after a 10% to
20% increase in pacing rate. MEASUREMENTS AND MAIN RESULTS: A total
of 108 cardiac output data sets were analyzed at steady state. Steady
state was defined as stable heart rate and mean arterial pressure
(+/- 5%) and stable central venous pressure (+/- 2 mmHg) measured
immediately before and after each data set. Cardiac output ranged
from 2.3 to 8.5 L/min. The correlation between STAT CCO and BTD was r = 0.94, and for trend CCO and BTD was r = 0.94. The bies and precision
for STAT CCO versus BTD were 0.06 L/min (Cl 95%: -0.08 to 0.18) and
0.61 L/min. The bias and precision for trend CCO versus BTD were
0.06 L/min (Cl 95%: -0.04 to 0.16) and 0.49 L/min. Eleven data sets
were analyzed to study response time of STAT CCO, which was defined
as the first time the percent change of the mean of each variable
was significantly increased from baseline. Significant increases
in mean arterial pressure and SvO2 were detected after 30 seconds (2.5},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: This study was conducted to compare continuous cardiac
output (CCO) with bolus thermodilution cardiac output (BTD) at steady
state, and to compare the response time of STAT CCO with that of
trend CCO, mean arterial pressure, and mixed venous oxygen saturation
[SvO2] during an acute hemodynamic change. DESIGN: Prospective study.
SETTING: University hospital. PARTICIPANTS: Twenty-nine patients
undergoing cardiac surgery or liver transplantation. INTERVENTIONS:
STAT and trend CCO were compared with BTD cardiac output during steady
state intraoperatively and postoperatively in the intensive care
unit. Ten patients, who required epicardial pacing after cardiac
surgery, were studied to compare the response time of STAT CCO with
that of trend CCO, mean arterial pressure, and BvO2 after a 10% to
20% increase in pacing rate. MEASUREMENTS AND MAIN RESULTS: A total
of 108 cardiac output data sets were analyzed at steady state. Steady
state was defined as stable heart rate and mean arterial pressure
(+/- 5%) and stable central venous pressure (+/- 2 mmHg) measured
immediately before and after each data set. Cardiac output ranged
from 2.3 to 8.5 L/min. The correlation between STAT CCO and BTD was r = 0.94, and for trend CCO and BTD was r = 0.94. The bies and precision
for STAT CCO versus BTD were 0.06 L/min (Cl 95%: -0.08 to 0.18) and
0.61 L/min. The bias and precision for trend CCO versus BTD were
0.06 L/min (Cl 95%: -0.04 to 0.16) and 0.49 L/min. Eleven data sets
were analyzed to study response time of STAT CCO, which was defined
as the first time the percent change of the mean of each variable
was significantly increased from baseline. Significant increases
in mean arterial pressure and SvO2 were detected after 30 seconds (2.5
output (CCO) with bolus thermodilution cardiac output (BTD) at steady
state, and to compare the response time of STAT CCO with that of
trend CCO, mean arterial pressure, and mixed venous oxygen saturation
[SvO2] during an acute hemodynamic change. DESIGN: Prospective study.
SETTING: University hospital. PARTICIPANTS: Twenty-nine patients
undergoing cardiac surgery or liver transplantation. INTERVENTIONS:
STAT and trend CCO were compared with BTD cardiac output during steady
state intraoperatively and postoperatively in the intensive care
unit. Ten patients, who required epicardial pacing after cardiac
surgery, were studied to compare the response time of STAT CCO with
that of trend CCO, mean arterial pressure, and BvO2 after a 10% to
20% increase in pacing rate. MEASUREMENTS AND MAIN RESULTS: A total
of 108 cardiac output data sets were analyzed at steady state. Steady
state was defined as stable heart rate and mean arterial pressure
(+/- 5%) and stable central venous pressure (+/- 2 mmHg) measured
immediately before and after each data set. Cardiac output ranged
from 2.3 to 8.5 L/min. The correlation between STAT CCO and BTD was r = 0.94, and for trend CCO and BTD was r = 0.94. The bies and precision
for STAT CCO versus BTD were 0.06 L/min (Cl 95%: -0.08 to 0.18) and
0.61 L/min. The bias and precision for trend CCO versus BTD were
0.06 L/min (Cl 95%: -0.04 to 0.16) and 0.49 L/min. Eleven data sets
were analyzed to study response time of STAT CCO, which was defined
as the first time the percent change of the mean of each variable
was significantly increased from baseline. Significant increases
in mean arterial pressure and SvO2 were detected after 30 seconds (2.5
Slanetz, P. J.; Moore, R. H.; Hulka, C. A.; Halpern, Elkan F.; Habunek, D. A.; Whitman, G. J.; McCarthy, K. A.; Hall, D. A.; Kopans, D. B.
Screening mammography: effect of national guidelines on current physician practice Journal Article
In: Radiology, vol. 203, no. 2, pp. 335-8, 1997, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Slanetz1997a,
title = {Screening mammography: effect of national guidelines on current physician
practice},
author = {P. J. Slanetz and R. H. Moore and C. A. Hulka and Elkan F. Halpern and D. A. Habunek and G. J. Whitman and K. A. McCarthy and D. A. Hall and D. B. Kopans},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9114084},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1997},
date = {1997-05-01},
journal = {Radiology},
volume = {203},
number = {2},
pages = {335-8},
abstract = {PURPOSE: To evaluate the effect of national breast cancer screening
guidelines on current physician attitudes toward and practice of
screening mammography. MATERIALS AND METHODS: Questionnaire responses
from 278 physicians were analyzed. The questionnaire had four sections:
general information on physician practice and experience, current
use of breast cancer screening, perceptions of screening mammography,
and physician awareness of and response to the controversy in breast
cancer screening. RESULTS: In women aged 40-49 years, 144 (52%) of
278 physicians performed annual clinical breast examination and screening
mammography every 2 years; 57 (21%) favored annual mammography and
clinical breast examination. In women aged 50 years and older, 232
(83%) physicians screened patients annually with clinical breast
examination and mammography. Two hundred seventeen (78%) physicians
were aware of the recommended changes in screening guidelines; 54
(19%) were not aware of the changes. Of those aware of the changes,
56 (26%) changed to the new guidelines, 150 (69%) did not change,
and six (3%) modified their practice somewhat. CONCLUSION: Physician
practice as regards screening mammography is influenced by national
guidelines.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To evaluate the effect of national breast cancer screening
guidelines on current physician attitudes toward and practice of
screening mammography. MATERIALS AND METHODS: Questionnaire responses
from 278 physicians were analyzed. The questionnaire had four sections:
general information on physician practice and experience, current
use of breast cancer screening, perceptions of screening mammography,
and physician awareness of and response to the controversy in breast
cancer screening. RESULTS: In women aged 40-49 years, 144 (52%) of
278 physicians performed annual clinical breast examination and screening
mammography every 2 years; 57 (21%) favored annual mammography and
clinical breast examination. In women aged 50 years and older, 232
(83%) physicians screened patients annually with clinical breast
examination and mammography. Two hundred seventeen (78%) physicians
were aware of the recommended changes in screening guidelines; 54
(19%) were not aware of the changes. Of those aware of the changes,
56 (26%) changed to the new guidelines, 150 (69%) did not change,
and six (3%) modified their practice somewhat. CONCLUSION: Physician
practice as regards screening mammography is influenced by national
guidelines.
guidelines on current physician attitudes toward and practice of
screening mammography. MATERIALS AND METHODS: Questionnaire responses
from 278 physicians were analyzed. The questionnaire had four sections:
general information on physician practice and experience, current
use of breast cancer screening, perceptions of screening mammography,
and physician awareness of and response to the controversy in breast
cancer screening. RESULTS: In women aged 40-49 years, 144 (52%) of
278 physicians performed annual clinical breast examination and screening
mammography every 2 years; 57 (21%) favored annual mammography and
clinical breast examination. In women aged 50 years and older, 232
(83%) physicians screened patients annually with clinical breast
examination and mammography. Two hundred seventeen (78%) physicians
were aware of the recommended changes in screening guidelines; 54
(19%) were not aware of the changes. Of those aware of the changes,
56 (26%) changed to the new guidelines, 150 (69%) did not change,
and six (3%) modified their practice somewhat. CONCLUSION: Physician
practice as regards screening mammography is influenced by national
guidelines.
Hamm, B.; Mahfouz, A. E.; Taupitz, M.; Mitchell, D. G.; Nelson, R.; Halpern, Elkan F.; Speidel, A.; Wolf, K. J.; Saini, S.
Liver metastases: improved detection with dynamic gadolinium-enhanced MR imaging? Journal Article
In: Radiology, vol. 202, no. 3, pp. 677-82, 1997, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Hamm1997,
title = {Liver metastases: improved detection with dynamic gadolinium-enhanced
MR imaging?},
author = {B. Hamm and A. E. Mahfouz and M. Taupitz and D. G. Mitchell and R. Nelson and Elkan F. Halpern and A. Speidel and K. J. Wolf and S. Saini},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9051015},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1997},
date = {1997-03-01},
journal = {Radiology},
volume = {202},
number = {3},
pages = {677-82},
abstract = {PURPOSE: To compare dynamic gadolinium-enhanced with unenhanced magnetic
resonance (MR) imaging in detection of liver metastases. MATERIALS
AND METHODS: Two groups of patients were prospectively examined with
unenhanced and dynamic gadolinium-enhanced MR imaging. The first group (n = 48) had proved liver metastases; the second group (n =
49) did not. One set of unenhanced and one set of gadolinium-enhanced
MR images were selected per patient. Three independent, blinded readers
assessed the images for presence, number, location, and conspicuity
of lesions. Data were analyzed with receiver operating characteristic
curves, and contrast-to-noise ratios were calculated for the images.
RESULTS: There was no statistically significant difference between
the use of unenhanced and gadolinium-enhanced MR images in the differentiation
of patients with from patients without metastases. The numbers of
false-positive and false-negative diagnoses of individual lesions
were higher (not statistically significant) with dynamic MR images
than with unenhanced MR images. At dynamic MR imaging, contrast-to-noise
ratio was highest in the early phase (30 seconds after injection
of the contrast agent) but was not significantly different from the
contrast-to noise ratio of the T2-weighted images. CONCLUSION: Dynamic
gadolinium-enhanced MR imaging showed no improvement over unenhanced
MR imaging in detectability of liver metastases.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To compare dynamic gadolinium-enhanced with unenhanced magnetic
resonance (MR) imaging in detection of liver metastases. MATERIALS
AND METHODS: Two groups of patients were prospectively examined with
unenhanced and dynamic gadolinium-enhanced MR imaging. The first group (n = 48) had proved liver metastases; the second group (n =
49) did not. One set of unenhanced and one set of gadolinium-enhanced
MR images were selected per patient. Three independent, blinded readers
assessed the images for presence, number, location, and conspicuity
of lesions. Data were analyzed with receiver operating characteristic
curves, and contrast-to-noise ratios were calculated for the images.
RESULTS: There was no statistically significant difference between
the use of unenhanced and gadolinium-enhanced MR images in the differentiation
of patients with from patients without metastases. The numbers of
false-positive and false-negative diagnoses of individual lesions
were higher (not statistically significant) with dynamic MR images
than with unenhanced MR images. At dynamic MR imaging, contrast-to-noise
ratio was highest in the early phase (30 seconds after injection
of the contrast agent) but was not significantly different from the
contrast-to noise ratio of the T2-weighted images. CONCLUSION: Dynamic
gadolinium-enhanced MR imaging showed no improvement over unenhanced
MR imaging in detectability of liver metastases.
resonance (MR) imaging in detection of liver metastases. MATERIALS
AND METHODS: Two groups of patients were prospectively examined with
unenhanced and dynamic gadolinium-enhanced MR imaging. The first group (n = 48) had proved liver metastases; the second group (n =
49) did not. One set of unenhanced and one set of gadolinium-enhanced
MR images were selected per patient. Three independent, blinded readers
assessed the images for presence, number, location, and conspicuity
of lesions. Data were analyzed with receiver operating characteristic
curves, and contrast-to-noise ratios were calculated for the images.
RESULTS: There was no statistically significant difference between
the use of unenhanced and gadolinium-enhanced MR images in the differentiation
of patients with from patients without metastases. The numbers of
false-positive and false-negative diagnoses of individual lesions
were higher (not statistically significant) with dynamic MR images
than with unenhanced MR images. At dynamic MR imaging, contrast-to-noise
ratio was highest in the early phase (30 seconds after injection
of the contrast agent) but was not significantly different from the
contrast-to noise ratio of the T2-weighted images. CONCLUSION: Dynamic
gadolinium-enhanced MR imaging showed no improvement over unenhanced
MR imaging in detectability of liver metastases.
Swan, J. Shannon; Fryback, D. G.; Lawrence, W. F.; Katz, D. A.; Heisey, D. M.; Hagenauer, M. E.; Selzer, P. M.; Jacobson, B. K.
MR and conventional angiography: work in progress toward assessing utility in radiology Journal Article
In: Acad Radiol, vol. 4, no. 7, pp. 475-82, 1997, ISSN: 1076-6332 (Print) 1076-6332 (Li, ().
@article{Swan1997,
title = {MR and conventional angiography: work in progress toward assessing utility in radiology},
author = {J. Shannon Swan and D. G. Fryback and W. F. Lawrence and D. A. Katz and D. M. Heisey and M. E. Hagenauer and P. M. Selzer and B. K. Jacobson},
url = {https://www.ncbi.nlm.nih.gov/pubmed/9232166},
doi = {10.1016/s1076-6332(97)80231-0},
issn = {1076-6332 (Print)
1076-6332 (Li},
year = {1997},
date = {1997-01-01},
journal = {Acad Radiol},
volume = {4},
number = {7},
pages = {475-82},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Solbiati, L.; Ierace, T.; Goldberg, S. N.; Sironi, S.; Livraghi, T.; Fiocca, R.; Servadio, G.; Rizzatto, G.; Mueller, P. R.; Maschio, A. Del; Gazelle, G. Scott
Percutaneous US-guided radio-frequency tissue ablation of liver metastases: treatment and follow-up in 16 patients Journal Article
In: Radiology, vol. 202, no. 1, pp. 195-203, 1997, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Solbiati1997,
title = {Percutaneous US-guided radio-frequency tissue ablation of liver metastases:
treatment and follow-up in 16 patients},
author = {L. Solbiati and T. Ierace and S. N. Goldberg and S. Sironi and T. Livraghi and R. Fiocca and G. Servadio and G. Rizzatto and P. R. Mueller and A. Del Maschio and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/8988211},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {1997},
date = {1997-01-01},
journal = {Radiology},
volume = {202},
number = {1},
pages = {195-203},
abstract = {PURPOSE: To determine the potential efficacy of radio-frequency (RF)
ablation of liver metastases during long-term follow-up. MATERIALS
AND METHODS: Sixteen patients with 31 hepatic metastases were treated
with percutaneous, ultrasound-guided RF ablation. RF was applied
to monopolar electrodes (2-3-cm tip exposure) either individually
or within a multiprobe array (two to four probes) for 6 minutes at
90 degrees C over one to four treatment sessions per metastasis.
RESULTS: In only one of 75 sessions, a moderate complication, self-limited
intraperitoneal hemorrhage, was observed. Four patients (four lesions)
underwent surgical resection 15-60 days after RF treatment. Residual,
viable tumor was seen in all of these patients. The remaining 12
patients were followed up for 9-29 months (mean, 18.1 months). In
these patients, 18 of 27 lesions remained stable or decreased in
size and showed no enhancement at computed tomography and/or magnetic
resonance imaging for at least 9 months. Two patients died of disseminated
disease at 13 months and one at 16 months. Disease-free survival
was achieved in eight patients. CONCLUSIONS: RF ablation appears
to be a simple, safe, and potentially effective treatment for selected
patients with liver metastases and may become a less invasive alternative
to surgical therapy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To determine the potential efficacy of radio-frequency (RF)
ablation of liver metastases during long-term follow-up. MATERIALS
AND METHODS: Sixteen patients with 31 hepatic metastases were treated
with percutaneous, ultrasound-guided RF ablation. RF was applied
to monopolar electrodes (2-3-cm tip exposure) either individually
or within a multiprobe array (two to four probes) for 6 minutes at
90 degrees C over one to four treatment sessions per metastasis.
RESULTS: In only one of 75 sessions, a moderate complication, self-limited
intraperitoneal hemorrhage, was observed. Four patients (four lesions)
underwent surgical resection 15-60 days after RF treatment. Residual,
viable tumor was seen in all of these patients. The remaining 12
patients were followed up for 9-29 months (mean, 18.1 months). In
these patients, 18 of 27 lesions remained stable or decreased in
size and showed no enhancement at computed tomography and/or magnetic
resonance imaging for at least 9 months. Two patients died of disseminated
disease at 13 months and one at 16 months. Disease-free survival
was achieved in eight patients. CONCLUSIONS: RF ablation appears
to be a simple, safe, and potentially effective treatment for selected
patients with liver metastases and may become a less invasive alternative
to surgical therapy.
ablation of liver metastases during long-term follow-up. MATERIALS
AND METHODS: Sixteen patients with 31 hepatic metastases were treated
with percutaneous, ultrasound-guided RF ablation. RF was applied
to monopolar electrodes (2-3-cm tip exposure) either individually
or within a multiprobe array (two to four probes) for 6 minutes at
90 degrees C over one to four treatment sessions per metastasis.
RESULTS: In only one of 75 sessions, a moderate complication, self-limited
intraperitoneal hemorrhage, was observed. Four patients (four lesions)
underwent surgical resection 15-60 days after RF treatment. Residual,
viable tumor was seen in all of these patients. The remaining 12
patients were followed up for 9-29 months (mean, 18.1 months). In
these patients, 18 of 27 lesions remained stable or decreased in
size and showed no enhancement at computed tomography and/or magnetic
resonance imaging for at least 9 months. Two patients died of disseminated
disease at 13 months and one at 16 months. Disease-free survival
was achieved in eight patients. CONCLUSIONS: RF ablation appears
to be a simple, safe, and potentially effective treatment for selected
patients with liver metastases and may become a less invasive alternative
to surgical therapy.
Trubetskoy, V. S.; Gazelle, G. Scott; Wolf, G. L.; Torchilin, V. P.
In: J Drug Target, vol. 4, pp. 381-8, 1997, ().
@article{Trubetskoy1997,
title = {Block-copolymer of polyethylene glycol and polylysine as a carrier
of organic iodine: design of long-circulating particulate contrast
medium for X-ray computed tomography},
author = {V. S. Trubetskoy and G. Scott Gazelle and G. L. Wolf and V. P. Torchilin},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9239578},
year = {1997},
date = {1997-01-01},
journal = {J Drug Target},
volume = {4},
pages = {381-8},
abstract = {In order to obtain small, polymer-stabilized particulate carriers
for organic iodine to serve as a contrast agent for X-ray computed
tomography (CT) an attempt was made to design a carrier based on
polymeric micelles. Here we describe the synthesis of an iodine-containing
amphiphilic block-copolymer which can micellize in aqueous solutions.
The two blocks of the copolymer consisted of methoxypoly(ethyleneglycol)
and poly[epsilon,N-(triiodobenzoyl)-L-lysine]. Upon dispersion in
water, the block copolymer formed particles with average diameter
80 nm and iodine content up to 44.7 The particles start to dissociate
to the individual polymeric chains in the concentration range of
0.05-0.5 microM in water at 23 degrees C. Upon intravenous injection
at 250 mg of iodine/kg (570 mg of the agent/kg) in rabbits the medium
demonstrated exceptional 24 hr half-life in the blood substantiating
corona/core structure of the particles with PEG chains protecting
the iodine-containing core. The possible use of these particulates
as contrast medium for X-ray computed tomography is discussed.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In order to obtain small, polymer-stabilized particulate carriers
for organic iodine to serve as a contrast agent for X-ray computed
tomography (CT) an attempt was made to design a carrier based on
polymeric micelles. Here we describe the synthesis of an iodine-containing
amphiphilic block-copolymer which can micellize in aqueous solutions.
The two blocks of the copolymer consisted of methoxypoly(ethyleneglycol)
and poly[epsilon,N-(triiodobenzoyl)-L-lysine]. Upon dispersion in
water, the block copolymer formed particles with average diameter
80 nm and iodine content up to 44.7 The particles start to dissociate
to the individual polymeric chains in the concentration range of
0.05-0.5 microM in water at 23 degrees C. Upon intravenous injection
at 250 mg of iodine/kg (570 mg of the agent/kg) in rabbits the medium
demonstrated exceptional 24 hr half-life in the blood substantiating
corona/core structure of the particles with PEG chains protecting
the iodine-containing core. The possible use of these particulates
as contrast medium for X-ray computed tomography is discussed.
for organic iodine to serve as a contrast agent for X-ray computed
tomography (CT) an attempt was made to design a carrier based on
polymeric micelles. Here we describe the synthesis of an iodine-containing
amphiphilic block-copolymer which can micellize in aqueous solutions.
The two blocks of the copolymer consisted of methoxypoly(ethyleneglycol)
and poly[epsilon,N-(triiodobenzoyl)-L-lysine]. Upon dispersion in
water, the block copolymer formed particles with average diameter
80 nm and iodine content up to 44.7 The particles start to dissociate
to the individual polymeric chains in the concentration range of
0.05-0.5 microM in water at 23 degrees C. Upon intravenous injection
at 250 mg of iodine/kg (570 mg of the agent/kg) in rabbits the medium
demonstrated exceptional 24 hr half-life in the blood substantiating
corona/core structure of the particles with PEG chains protecting
the iodine-containing core. The possible use of these particulates
as contrast medium for X-ray computed tomography is discussed.
Pauker, S. G.; Stahl, James
Medical informatics: where the action is Journal Article
In: West J Med, vol. 166, pp. 148-50, 1997, ().
@article{Pauker1997,
title = {Medical informatics: where the action is},
author = {S. G. Pauker and James Stahl},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9109336},
year = {1997},
date = {1997-01-01},
journal = {West J Med},
volume = {166},
pages = {148-50},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Pierce, E. T.; Pomposelli, F. B.; Stanley, G. D.; Lewis, K. P.; Cass, J. L.; LoGerfo, F. W.; Gibbons, G. W.; Campbell, D. R.; Freeman, D. V.; Halpern, Elkan F.; Bode, R. H.
Anesthesia type does not influence early graft patency or limb salvage rates of lower extremity arterial bypass Journal Article
In: J Vasc Surg, vol. 25, pp. 226, 1997, ().
@article{Pierce1997,
title = {Anesthesia type does not influence early graft patency or limb salvage
rates of lower extremity arterial bypass},
author = {E. T. Pierce and F. B. Pomposelli and G. D. Stanley and K. P. Lewis and J. L. Cass and F. W. LoGerfo and G. W. Gibbons and D. R. Campbell and D. V. Freeman and Elkan F. Halpern and R. H. Bode},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9052557},
year = {1997},
date = {1997-01-01},
journal = {J Vasc Surg},
volume = {25},
pages = {226},
abstract = {PURPOSE: The effect of anesthesia type on 30-day graft patency and
limb salvage rates was evaluated in patients who underwent femoral
to distal artery bypass. METHODS: Of 423 patients randomly assigned
to receive general, spinal, or epidural anesthetic, 76 did not meet
protocol standards and 32 had inadequate anesthesia. A chart review
of the remaining 315 patients was undertaken to obtain surgical information
not recorded in the original study. All patients were monitored with
radial and pulmonary artery catheters. After surgery, patients were
in a monitored setting for 48 to 72 hours and had graft function
assessments hourly during the first 24 hours and then every 8 hours
until discharge. RESULTS: Fifty-one patients were lost to follow-up
(15 general, 22 spinal, 14 epidural). Baseline clinical characteristics
were similar for the three groups except prior carotid artery surgery,
which was more common in the spinal group. Indications for surgery
were also similar except for a higher incidence of nonhealing ulcer
in the epidural group. There were no differences among groups for
30-day graft patency with or without reoperation, 30-day graft occlusion,
death, amputation, or length of hospital stay. CONCLUSION: These
results suggest that the type of anesthetic given for femoral to
distal artery bypass does not significantly affect 30-day occlusion
rate, limb salvage rate, or hospital length of stay.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: The effect of anesthesia type on 30-day graft patency and
limb salvage rates was evaluated in patients who underwent femoral
to distal artery bypass. METHODS: Of 423 patients randomly assigned
to receive general, spinal, or epidural anesthetic, 76 did not meet
protocol standards and 32 had inadequate anesthesia. A chart review
of the remaining 315 patients was undertaken to obtain surgical information
not recorded in the original study. All patients were monitored with
radial and pulmonary artery catheters. After surgery, patients were
in a monitored setting for 48 to 72 hours and had graft function
assessments hourly during the first 24 hours and then every 8 hours
until discharge. RESULTS: Fifty-one patients were lost to follow-up
(15 general, 22 spinal, 14 epidural). Baseline clinical characteristics
were similar for the three groups except prior carotid artery surgery,
which was more common in the spinal group. Indications for surgery
were also similar except for a higher incidence of nonhealing ulcer
in the epidural group. There were no differences among groups for
30-day graft patency with or without reoperation, 30-day graft occlusion,
death, amputation, or length of hospital stay. CONCLUSION: These
results suggest that the type of anesthetic given for femoral to
distal artery bypass does not significantly affect 30-day occlusion
rate, limb salvage rate, or hospital length of stay.
limb salvage rates was evaluated in patients who underwent femoral
to distal artery bypass. METHODS: Of 423 patients randomly assigned
to receive general, spinal, or epidural anesthetic, 76 did not meet
protocol standards and 32 had inadequate anesthesia. A chart review
of the remaining 315 patients was undertaken to obtain surgical information
not recorded in the original study. All patients were monitored with
radial and pulmonary artery catheters. After surgery, patients were
in a monitored setting for 48 to 72 hours and had graft function
assessments hourly during the first 24 hours and then every 8 hours
until discharge. RESULTS: Fifty-one patients were lost to follow-up
(15 general, 22 spinal, 14 epidural). Baseline clinical characteristics
were similar for the three groups except prior carotid artery surgery,
which was more common in the spinal group. Indications for surgery
were also similar except for a higher incidence of nonhealing ulcer
in the epidural group. There were no differences among groups for
30-day graft patency with or without reoperation, 30-day graft occlusion,
death, amputation, or length of hospital stay. CONCLUSION: These
results suggest that the type of anesthetic given for femoral to
distal artery bypass does not significantly affect 30-day occlusion
rate, limb salvage rate, or hospital length of stay.