2000
McMahon, Pamela M.; Araki, S. S.; Neumann, P. J.; Harris, G. J.; Gazelle, G. Scott
Cost-effectiveness of functional imaging tests in the diagnosis of Alzheimer disease Journal Article
In: Radiology, vol. 217, no. 1, pp. 58-68, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{McMahon2000a,
title = {Cost-effectiveness of functional imaging tests in the diagnosis of
Alzheimer disease},
author = {Pamela M. McMahon and S. S. Araki and P. J. Neumann and G. J. Harris and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11012424},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-10-01},
journal = {Radiology},
volume = {217},
number = {1},
pages = {58-68},
abstract = {PURPOSE: To evaluate the cost-effectiveness of functional neuroimaging
in the work-up of patients at specialized Alzheimer disease clinics.
MATERIALS AND METHODS: A decision model was used to calculate costs
and benefits (in quality-adjusted life-years [QALYs]) that accrued
to hypothetical cohorts of patients at presentation to an Alzheimer
disease center. Sensitivity analysis was performed to examine the
effects of diagnostic test characteristics, therapeutic efficacy,
disease severity, and costs on cost-effectiveness. RESULTS: The incremental
cost-effectiveness ratio of dynamic susceptibility contrast material-enhanced
magnetic resonance (MR) imaging was $479,500 per QALY (compared with
the usual diagnostic work-up), while visual or quantitative single
photon emission computed tomography (SPECT) was dominated (higher
costs, lower effectiveness) by the usual diagnostic work-up. These
results depend critically on the sensitivity and specificity of the
standard diagnostic work-up, the effectiveness of drug treatment,
and the disease severity. Varying these parameters resulted in estimates
of incremental cost-effectiveness for dynamic susceptibility contrast-enhanced
MR imaging of $24,680 to $8.6 million per QALY. SPECT either was
dominated by the usual diagnostic work-up or had cost-effectiveness
ratios of $180,200 to $6 million per QALY. CONCLUSION: The addition
of functional neuroimaging to the usual diagnostic regimen at Alzheimer
disease clinics is not cost-effective given the effectiveness of
currently available therapies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To evaluate the cost-effectiveness of functional neuroimaging
in the work-up of patients at specialized Alzheimer disease clinics.
MATERIALS AND METHODS: A decision model was used to calculate costs
and benefits (in quality-adjusted life-years [QALYs]) that accrued
to hypothetical cohorts of patients at presentation to an Alzheimer
disease center. Sensitivity analysis was performed to examine the
effects of diagnostic test characteristics, therapeutic efficacy,
disease severity, and costs on cost-effectiveness. RESULTS: The incremental
cost-effectiveness ratio of dynamic susceptibility contrast material-enhanced
magnetic resonance (MR) imaging was $479,500 per QALY (compared with
the usual diagnostic work-up), while visual or quantitative single
photon emission computed tomography (SPECT) was dominated (higher
costs, lower effectiveness) by the usual diagnostic work-up. These
results depend critically on the sensitivity and specificity of the
standard diagnostic work-up, the effectiveness of drug treatment,
and the disease severity. Varying these parameters resulted in estimates
of incremental cost-effectiveness for dynamic susceptibility contrast-enhanced
MR imaging of $24,680 to $8.6 million per QALY. SPECT either was
dominated by the usual diagnostic work-up or had cost-effectiveness
ratios of $180,200 to $6 million per QALY. CONCLUSION: The addition
of functional neuroimaging to the usual diagnostic regimen at Alzheimer
disease clinics is not cost-effective given the effectiveness of
currently available therapies.
in the work-up of patients at specialized Alzheimer disease clinics.
MATERIALS AND METHODS: A decision model was used to calculate costs
and benefits (in quality-adjusted life-years [QALYs]) that accrued
to hypothetical cohorts of patients at presentation to an Alzheimer
disease center. Sensitivity analysis was performed to examine the
effects of diagnostic test characteristics, therapeutic efficacy,
disease severity, and costs on cost-effectiveness. RESULTS: The incremental
cost-effectiveness ratio of dynamic susceptibility contrast material-enhanced
magnetic resonance (MR) imaging was $479,500 per QALY (compared with
the usual diagnostic work-up), while visual or quantitative single
photon emission computed tomography (SPECT) was dominated (higher
costs, lower effectiveness) by the usual diagnostic work-up. These
results depend critically on the sensitivity and specificity of the
standard diagnostic work-up, the effectiveness of drug treatment,
and the disease severity. Varying these parameters resulted in estimates
of incremental cost-effectiveness for dynamic susceptibility contrast-enhanced
MR imaging of $24,680 to $8.6 million per QALY. SPECT either was
dominated by the usual diagnostic work-up or had cost-effectiveness
ratios of $180,200 to $6 million per QALY. CONCLUSION: The addition
of functional neuroimaging to the usual diagnostic regimen at Alzheimer
disease clinics is not cost-effective given the effectiveness of
currently available therapies.
McMahon, Pamela M.; Gazelle, G. Scott
The case for colorectal cancer screening Journal Article
In: Semin Roentgenol, vol. 35, no. 4, pp. 325-32, 2000, ISSN: 0037-198X (Print) 0037-198X (Lin, ().
@article{McMahon2000,
title = {The case for colorectal cancer screening},
author = {Pamela M. McMahon and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11060919},
issn = {0037-198X (Print) 0037-198X (Lin},
year = {2000},
date = {2000-10-01},
urldate = {2000-10-01},
journal = {Semin Roentgenol},
volume = {35},
number = {4},
pages = {325-32},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Goldberg, S. N.; Solbiati, L.; Halpern, Elkan F.; Gazelle, G. Scott
Variables affecting proper system grounding for radiofrequency ablation in an animal model Journal Article
In: J Vasc Interv Radiol, vol. 11, no. 8, pp. 1069-75, 2000, ISSN: 1051-0443 (Print) 1051-0443 (Lin, ().
@article{Goldberg2000a,
title = {Variables affecting proper system grounding for radiofrequency ablation
in an animal model},
author = {S. N. Goldberg and L. Solbiati and Elkan F. Halpern and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10997473},
issn = {1051-0443 (Print) 1051-0443 (Lin},
year = {2000},
date = {2000-09-01},
journal = {J Vasc Interv Radiol},
volume = {11},
number = {8},
pages = {1069-75},
abstract = {PURPOSE: The authors sought to determine which factors contribute
to excessive thermal deposition and burns at the grounding pad site
after high-current percutaneous, image-guided radiofrequency (RF)
ablation. MATERIALS AND METHODS: Radiofrequency (1,000-2,000 mA)
was applied for 10 minutes with use of an internally-cooled electrode placed into in vivo pig livers (n = 88). In separate experiments,
the number of pads (1, 2, or 4), orientation of pads (horizontal,
vertical, or diagonal), and distance between the pads and the electrode
(10-50 cm) of mesh or foil grounding pads (12.5 x 8 cm; 100 cm2)
were varied. Thermistors measured skin surface temperatures during
ablation. Pathologic analysis of skin changes was performed. RESULTS:
Temperature elevations at the grounding pad were observed for every trial, with a temperature elevation \> or =12 degrees C (as high as
45 degrees C) observed in 60 of 88 trials (68.2%). Temperatures at
the grounding site pad were dependent on all variables studied, including
the grounding pad surface area, the amount of current deposited in
the liver, the orientation of the pad, and the pad's distance from
the electrode. Second-degree burns were seen with temperatures exceeding
47 degrees C and third-degree burns were observed when a temperature \> or = 52 degrees C was noted. For a given set of RF parameters,
reduced heating was observed for trials in which foil grounding pads
were used (P \< .001). Grounding pad burns did not occur at 2,000
mA (maximum generator output) when four foil pads were placed horizontally \> or = 25 cm from the electrode. CONCLUSIONS: High-current RF ablation
can induce severe burns at the grounding pad site if inadequate precautions
are taken. To minimize the risk of burns, multiple large-surface-area
foil pads should be placed on well-prepared skin and oriented with
the longest surface edge facing the RF electrode.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: The authors sought to determine which factors contribute
to excessive thermal deposition and burns at the grounding pad site
after high-current percutaneous, image-guided radiofrequency (RF)
ablation. MATERIALS AND METHODS: Radiofrequency (1,000-2,000 mA)
was applied for 10 minutes with use of an internally-cooled electrode placed into in vivo pig livers (n = 88). In separate experiments,
the number of pads (1, 2, or 4), orientation of pads (horizontal,
vertical, or diagonal), and distance between the pads and the electrode
(10-50 cm) of mesh or foil grounding pads (12.5 x 8 cm; 100 cm2)
were varied. Thermistors measured skin surface temperatures during
ablation. Pathologic analysis of skin changes was performed. RESULTS:
Temperature elevations at the grounding pad were observed for every trial, with a temperature elevation > or =12 degrees C (as high as
45 degrees C) observed in 60 of 88 trials (68.2%). Temperatures at
the grounding site pad were dependent on all variables studied, including
the grounding pad surface area, the amount of current deposited in
the liver, the orientation of the pad, and the pad's distance from
the electrode. Second-degree burns were seen with temperatures exceeding
47 degrees C and third-degree burns were observed when a temperature > or = 52 degrees C was noted. For a given set of RF parameters,
reduced heating was observed for trials in which foil grounding pads
were used (P < .001). Grounding pad burns did not occur at 2,000
mA (maximum generator output) when four foil pads were placed horizontally > or = 25 cm from the electrode. CONCLUSIONS: High-current RF ablation
can induce severe burns at the grounding pad site if inadequate precautions
are taken. To minimize the risk of burns, multiple large-surface-area
foil pads should be placed on well-prepared skin and oriented with
the longest surface edge facing the RF electrode.
to excessive thermal deposition and burns at the grounding pad site
after high-current percutaneous, image-guided radiofrequency (RF)
ablation. MATERIALS AND METHODS: Radiofrequency (1,000-2,000 mA)
was applied for 10 minutes with use of an internally-cooled electrode placed into in vivo pig livers (n = 88). In separate experiments,
the number of pads (1, 2, or 4), orientation of pads (horizontal,
vertical, or diagonal), and distance between the pads and the electrode
(10-50 cm) of mesh or foil grounding pads (12.5 x 8 cm; 100 cm2)
were varied. Thermistors measured skin surface temperatures during
ablation. Pathologic analysis of skin changes was performed. RESULTS:
Temperature elevations at the grounding pad were observed for every trial, with a temperature elevation > or =12 degrees C (as high as
45 degrees C) observed in 60 of 88 trials (68.2%). Temperatures at
the grounding site pad were dependent on all variables studied, including
the grounding pad surface area, the amount of current deposited in
the liver, the orientation of the pad, and the pad's distance from
the electrode. Second-degree burns were seen with temperatures exceeding
47 degrees C and third-degree burns were observed when a temperature > or = 52 degrees C was noted. For a given set of RF parameters,
reduced heating was observed for trials in which foil grounding pads
were used (P < .001). Grounding pad burns did not occur at 2,000
mA (maximum generator output) when four foil pads were placed horizontally > or = 25 cm from the electrode. CONCLUSIONS: High-current RF ablation
can induce severe burns at the grounding pad site if inadequate precautions
are taken. To minimize the risk of burns, multiple large-surface-area
foil pads should be placed on well-prepared skin and oriented with
the longest surface edge facing the RF electrode.
Bosch, Johanna; Haaring, C.; Meyerovitz, M. F.; Cullen, K. A.; Hunink, M. G.
Cost-effectiveness of percutaneous treatment of iliac artery occlusive disease in the United States Journal Article
In: AJR Am J Roentgenol, vol. 175, no. 2, pp. 517-21, 2000, ISSN: 0361-803X (Print) 0361-803X (Lin, ().
@article{Bosch2000,
title = {Cost-effectiveness of percutaneous treatment of iliac artery occlusive
disease in the United States},
author = {Johanna Bosch and C. Haaring and M. F. Meyerovitz and K. A. Cullen and M. G. Hunink},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10915706},
issn = {0361-803X (Print) 0361-803X (Lin},
year = {2000},
date = {2000-08-01},
journal = {AJR Am J Roentgenol},
volume = {175},
number = {2},
pages = {517-21},
abstract = {OBJECTIVE: The costs of percutaneous transluminal angioplasty and
stent placement for iliac artery occlusive disease in the United
States were assessed and the cost-effectiveness was evaluated. MATERIALS
AND METHODS: Lifetime costs and quality-adjusted life expectancy
were estimated using a Markov decision model for a hypothetic cohort
of patients with life-style-limiting claudication caused by an iliac
artery stenosis for whom a percutaneous intervention was indicated.
Various percutaneous treatment strategies were evaluated, each consisting
of an initial intervention followed by a secondary intervention.
Procedures considered were angioplasty alone and angioplasty with
selective stent placement. RESULTS: From the perspective of the interventional
radiology department, angioplasty with selective stent placement
costs more than angioplasty alone ($2926 versus $2106). Taking into
account follow-up costs and procedures for long-term failures, the
cost differential was reduced because of a lower failure rate of
selective stent placement ($13,158 versus $12,458, respectively).
Treatment strategies using angioplasty with selective stent placement
(as an initial procedure or including reintervention) dominated treatment
strategies using angioplasty alone (incremental cost-effectiveness
ratio was $7,624-8,519 per quality-adjusted life-year gained). CONCLUSION:
Angioplasty with selective stent placement is a cost-effective treatment
strategy compared with angioplasty alone in the treatment of intermittent
claudication in the United States.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: The costs of percutaneous transluminal angioplasty and
stent placement for iliac artery occlusive disease in the United
States were assessed and the cost-effectiveness was evaluated. MATERIALS
AND METHODS: Lifetime costs and quality-adjusted life expectancy
were estimated using a Markov decision model for a hypothetic cohort
of patients with life-style-limiting claudication caused by an iliac
artery stenosis for whom a percutaneous intervention was indicated.
Various percutaneous treatment strategies were evaluated, each consisting
of an initial intervention followed by a secondary intervention.
Procedures considered were angioplasty alone and angioplasty with
selective stent placement. RESULTS: From the perspective of the interventional
radiology department, angioplasty with selective stent placement
costs more than angioplasty alone ($2926 versus $2106). Taking into
account follow-up costs and procedures for long-term failures, the
cost differential was reduced because of a lower failure rate of
selective stent placement ($13,158 versus $12,458, respectively).
Treatment strategies using angioplasty with selective stent placement
(as an initial procedure or including reintervention) dominated treatment
strategies using angioplasty alone (incremental cost-effectiveness
ratio was $7,624-8,519 per quality-adjusted life-year gained). CONCLUSION:
Angioplasty with selective stent placement is a cost-effective treatment
strategy compared with angioplasty alone in the treatment of intermittent
claudication in the United States.
stent placement for iliac artery occlusive disease in the United
States were assessed and the cost-effectiveness was evaluated. MATERIALS
AND METHODS: Lifetime costs and quality-adjusted life expectancy
were estimated using a Markov decision model for a hypothetic cohort
of patients with life-style-limiting claudication caused by an iliac
artery stenosis for whom a percutaneous intervention was indicated.
Various percutaneous treatment strategies were evaluated, each consisting
of an initial intervention followed by a secondary intervention.
Procedures considered were angioplasty alone and angioplasty with
selective stent placement. RESULTS: From the perspective of the interventional
radiology department, angioplasty with selective stent placement
costs more than angioplasty alone ($2926 versus $2106). Taking into
account follow-up costs and procedures for long-term failures, the
cost differential was reduced because of a lower failure rate of
selective stent placement ($13,158 versus $12,458, respectively).
Treatment strategies using angioplasty with selective stent placement
(as an initial procedure or including reintervention) dominated treatment
strategies using angioplasty alone (incremental cost-effectiveness
ratio was $7,624-8,519 per quality-adjusted life-year gained). CONCLUSION:
Angioplasty with selective stent placement is a cost-effective treatment
strategy compared with angioplasty alone in the treatment of intermittent
claudication in the United States.
O'Malley, M. E.; Halpern, Elkan F.; Mueller, P. R.; Gazelle, G. Scott
Helical CT protocols for the abdomen and pelvis: a survey Journal Article
In: AJR Am J Roentgenol, vol. 175, no. 1, pp. 109–113, 2000, ().
@article{OMalley2000,
title = {Helical CT protocols for the abdomen and pelvis: a survey},
author = {M. E. O'Malley and Elkan F. Halpern and P. R. Mueller and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10882257},
doi = {10.2214/ajr.175.1.1750109},
year = {2000},
date = {2000-07-01},
urldate = {2000-07-01},
journal = {AJR Am J Roentgenol},
volume = {175},
number = {1},
pages = {109--113},
institution = {Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston 02114, USA.},
abstract = {We surveyed members of the Society of Computed Body Tomography/Magnetic
Resonance to evaluate current techniques used for helical CT in the
abdomen and pelvis.The survey was distributed to 70 members (36 institutions)
of the Society of Computed Body Tomography/Magnetic Resonance. The
survey included general questions related to abdominal and pelvic
helical CT and also asked the members to write a protocol for 12
hypothetical requisitions.Thirty-two members (46%) responded, representing
28 institutions (78%). The number of protocols for helical CT of
the abdomen and pelvis at each institution ranges from 2 to 35 (median,
11). IV contrast material is administered for 90% (median) of abdominal
and pelvic CT examinations. Nonionic contrast material is used for
68% (median) of these examinations. IV contrast material is used
by 100% of institutions for tumor staging protocols except for one
institution that does not use IV contrast material for lymphoma staging.
Fifty percent of the institutions obtain two- or three-phases of
liver images for breast cancer staging. For all protocols, the average
collimation and reconstruction interval is 7 mm except for renal
(5 mm) and adrenal (4 mm) protocols. Rectal contrast material is
administered most commonly for colon cancer staging (39% of institutions).There
is a wide range in the number of protocols used for helical CT in
the abdomen and pelvis among the responding institutions. Most protocols
include use of nonionic IV contrast material injected at a rate of
3 ml/sec and a collimation of 7 mm.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
We surveyed members of the Society of Computed Body Tomography/Magnetic
Resonance to evaluate current techniques used for helical CT in the
abdomen and pelvis.The survey was distributed to 70 members (36 institutions)
of the Society of Computed Body Tomography/Magnetic Resonance. The
survey included general questions related to abdominal and pelvic
helical CT and also asked the members to write a protocol for 12
hypothetical requisitions.Thirty-two members (46%) responded, representing
28 institutions (78%). The number of protocols for helical CT of
the abdomen and pelvis at each institution ranges from 2 to 35 (median,
11). IV contrast material is administered for 90% (median) of abdominal
and pelvic CT examinations. Nonionic contrast material is used for
68% (median) of these examinations. IV contrast material is used
by 100% of institutions for tumor staging protocols except for one
institution that does not use IV contrast material for lymphoma staging.
Fifty percent of the institutions obtain two- or three-phases of
liver images for breast cancer staging. For all protocols, the average
collimation and reconstruction interval is 7 mm except for renal
(5 mm) and adrenal (4 mm) protocols. Rectal contrast material is
administered most commonly for colon cancer staging (39% of institutions).There
is a wide range in the number of protocols used for helical CT in
the abdomen and pelvis among the responding institutions. Most protocols
include use of nonionic IV contrast material injected at a rate of
3 ml/sec and a collimation of 7 mm.
Resonance to evaluate current techniques used for helical CT in the
abdomen and pelvis.The survey was distributed to 70 members (36 institutions)
of the Society of Computed Body Tomography/Magnetic Resonance. The
survey included general questions related to abdominal and pelvic
helical CT and also asked the members to write a protocol for 12
hypothetical requisitions.Thirty-two members (46%) responded, representing
28 institutions (78%). The number of protocols for helical CT of
the abdomen and pelvis at each institution ranges from 2 to 35 (median,
11). IV contrast material is administered for 90% (median) of abdominal
and pelvic CT examinations. Nonionic contrast material is used for
68% (median) of these examinations. IV contrast material is used
by 100% of institutions for tumor staging protocols except for one
institution that does not use IV contrast material for lymphoma staging.
Fifty percent of the institutions obtain two- or three-phases of
liver images for breast cancer staging. For all protocols, the average
collimation and reconstruction interval is 7 mm except for renal
(5 mm) and adrenal (4 mm) protocols. Rectal contrast material is
administered most commonly for colon cancer staging (39% of institutions).There
is a wide range in the number of protocols used for helical CT in
the abdomen and pelvis among the responding institutions. Most protocols
include use of nonionic IV contrast material injected at a rate of
3 ml/sec and a collimation of 7 mm.
Lewis, K. P.; Appadurai, I. R.; Pierce, E. T.; Halpern, Elkan F.; Bode, Jr. R. H.
Prophylactic amrinone for weaning from cardiopulmonary bypass Journal Article
In: Anaesthesia, vol. 55, no. 7, pp. 627-33, 2000, ISSN: 0003-2409 (Print) 0003-2409 (Lin, ().
@article{Lewis2000,
title = {Prophylactic amrinone for weaning from cardiopulmonary bypass},
author = {K. P. Lewis and I. R. Appadurai and E. T. Pierce and Elkan F. Halpern and Jr. R. H. Bode},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10919416},
issn = {0003-2409 (Print) 0003-2409 (Lin},
year = {2000},
date = {2000-07-01},
journal = {Anaesthesia},
volume = {55},
number = {7},
pages = {627-33},
abstract = {This prospective, randomised, double-blind, controlled clinical study
was performed at a single tertiary referral centre to test the hypothesis
that the prophylactic administration of amrinone before separation
of a patient from cardiopulmonary bypass decreases the incidence
of failure to wean, and to identify those patients who could be predicted
to benefit from such pre-emptive management. Two hundred and thirty-four
patients, scheduled to undergo elective cardiac surgery, were randomly
allocated to receive either a bolus dose of 1.5 mg x kg(-1) amrinone
over 15 min, followed by an infusion of 10 microg x kg(-1) x min(-1),
or a bolus of placebo of equal volume followed by an infusion of
placebo. Treatment with amrinone or placebo was initiated upon release
of the aortic cross-clamp, before weaning from cardiopulmonary bypass.
Anaesthetic technique, monitoring and myocardial preservation methods
were standardised for both groups. Significantly fewer patients failed
to wean in the group that received prophylactic amrinone than in the control group (7 vs. 21},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This prospective, randomised, double-blind, controlled clinical study
was performed at a single tertiary referral centre to test the hypothesis
that the prophylactic administration of amrinone before separation
of a patient from cardiopulmonary bypass decreases the incidence
of failure to wean, and to identify those patients who could be predicted
to benefit from such pre-emptive management. Two hundred and thirty-four
patients, scheduled to undergo elective cardiac surgery, were randomly
allocated to receive either a bolus dose of 1.5 mg x kg(-1) amrinone
over 15 min, followed by an infusion of 10 microg x kg(-1) x min(-1),
or a bolus of placebo of equal volume followed by an infusion of
placebo. Treatment with amrinone or placebo was initiated upon release
of the aortic cross-clamp, before weaning from cardiopulmonary bypass.
Anaesthetic technique, monitoring and myocardial preservation methods
were standardised for both groups. Significantly fewer patients failed
to wean in the group that received prophylactic amrinone than in the control group (7 vs. 21
was performed at a single tertiary referral centre to test the hypothesis
that the prophylactic administration of amrinone before separation
of a patient from cardiopulmonary bypass decreases the incidence
of failure to wean, and to identify those patients who could be predicted
to benefit from such pre-emptive management. Two hundred and thirty-four
patients, scheduled to undergo elective cardiac surgery, were randomly
allocated to receive either a bolus dose of 1.5 mg x kg(-1) amrinone
over 15 min, followed by an infusion of 10 microg x kg(-1) x min(-1),
or a bolus of placebo of equal volume followed by an infusion of
placebo. Treatment with amrinone or placebo was initiated upon release
of the aortic cross-clamp, before weaning from cardiopulmonary bypass.
Anaesthetic technique, monitoring and myocardial preservation methods
were standardised for both groups. Significantly fewer patients failed
to wean in the group that received prophylactic amrinone than in the control group (7 vs. 21
Athanasoulis, C. A.; Kaufman, J. A.; Halpern, Elkan F.; Waltman, A. C.; Geller, S. C.; Fan, C. M.
Inferior vena caval filters: review of a 26-year single-center clinical experience Journal Article
In: Radiology, vol. 216, no. 1, pp. 54-66, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Athanasoulis2000,
title = {Inferior vena caval filters: review of a 26-year single-center clinical experience},
author = {C. A. Athanasoulis and J. A. Kaufman and Elkan F. Halpern and A. C. Waltman and S. C. Geller and C. M. Fan},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10887228},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-07-01},
urldate = {2000-07-01},
journal = {Radiology},
volume = {216},
number = {1},
pages = {54-66},
abstract = {PURPOSE: To review a 26-year single-center clinical experience with
inferior vena caval filters. MATERIALS AND METHODS: During 1973-1998,
1,765 filters were implanted in 1,731 patients. Hospital files were
reviewed, and data were collected about the indications, safety,
effectiveness, numbers, and types of caval filters. Fatal post-filter
pulmonary embolism (PE) was considered the primary outcome. Morbidity
and mortality were determined as secondary outcomes. Survival and
morbidity-free survival curves were calculated. RESULTS: The prevalence
of observed post-filter PE was 5.6%. It was fatal in 3.7% of patients.
In most patients, fatal PE occurred soon after filter insertion (median,
4.0 days; 95% CI: 2.2, 5.8 days). Major complications occurred in
0.3% of procedures. The prevalence of observed post-filter caval
thrombosis was 2.7%. The 30-day mortality rate was 17.0% overall,
higher among patients with neoplasms (19.5%) as compared with those without neoplasms (14.3%; P =.004). Filter efficacy and associated
morbidity were not different in 46 patients with suprarenal filters.
The rate of filters placed for prophylaxis was 4.7% overall and increased
to 16.4% in 1998. From 1980 to 1996, there was a fivefold increase
in the number of caval filter implants. In recent years, more filters
were implanted in younger patients. CONCLUSION: Inferior vena caval
filters provide protection from life-threatening PE, with minimal
morbidity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To review a 26-year single-center clinical experience with
inferior vena caval filters. MATERIALS AND METHODS: During 1973-1998,
1,765 filters were implanted in 1,731 patients. Hospital files were
reviewed, and data were collected about the indications, safety,
effectiveness, numbers, and types of caval filters. Fatal post-filter
pulmonary embolism (PE) was considered the primary outcome. Morbidity
and mortality were determined as secondary outcomes. Survival and
morbidity-free survival curves were calculated. RESULTS: The prevalence
of observed post-filter PE was 5.6%. It was fatal in 3.7% of patients.
In most patients, fatal PE occurred soon after filter insertion (median,
4.0 days; 95% CI: 2.2, 5.8 days). Major complications occurred in
0.3% of procedures. The prevalence of observed post-filter caval
thrombosis was 2.7%. The 30-day mortality rate was 17.0% overall,
higher among patients with neoplasms (19.5%) as compared with those without neoplasms (14.3%; P =.004). Filter efficacy and associated
morbidity were not different in 46 patients with suprarenal filters.
The rate of filters placed for prophylaxis was 4.7% overall and increased
to 16.4% in 1998. From 1980 to 1996, there was a fivefold increase
in the number of caval filter implants. In recent years, more filters
were implanted in younger patients. CONCLUSION: Inferior vena caval
filters provide protection from life-threatening PE, with minimal
morbidity.
inferior vena caval filters. MATERIALS AND METHODS: During 1973-1998,
1,765 filters were implanted in 1,731 patients. Hospital files were
reviewed, and data were collected about the indications, safety,
effectiveness, numbers, and types of caval filters. Fatal post-filter
pulmonary embolism (PE) was considered the primary outcome. Morbidity
and mortality were determined as secondary outcomes. Survival and
morbidity-free survival curves were calculated. RESULTS: The prevalence
of observed post-filter PE was 5.6%. It was fatal in 3.7% of patients.
In most patients, fatal PE occurred soon after filter insertion (median,
4.0 days; 95% CI: 2.2, 5.8 days). Major complications occurred in
0.3% of procedures. The prevalence of observed post-filter caval
thrombosis was 2.7%. The 30-day mortality rate was 17.0% overall,
higher among patients with neoplasms (19.5%) as compared with those without neoplasms (14.3%; P =.004). Filter efficacy and associated
morbidity were not different in 46 patients with suprarenal filters.
The rate of filters placed for prophylaxis was 4.7% overall and increased
to 16.4% in 1998. From 1980 to 1996, there was a fivefold increase
in the number of caval filter implants. In recent years, more filters
were implanted in younger patients. CONCLUSION: Inferior vena caval
filters provide protection from life-threatening PE, with minimal
morbidity.
Schops, P.; Siebert, Uwe; Azad, S. C.; Friedle, A. M.; Beyer, A.
[Diagnostic criteria and new classification of the cervical spine syndrome] Journal Article
In: Schmerz, vol. 14, no. 3, pp. 160-74, 2000, ISSN: 0932-433X (Print) 0932-433X (Lin, ().
@article{Schops2000,
title = {[Diagnostic criteria and new classification of the cervical spine syndrome]},
author = {P. Schops and Uwe Siebert and S. C. Azad and A. M. Friedle and A. Beyer},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12800038},
issn = {0932-433X (Print) 0932-433X (Lin},
year = {2000},
date = {2000-06-01},
urldate = {2000-06-01},
journal = {Schmerz},
volume = {14},
number = {3},
pages = {160-74},
abstract = {OBJECTIVES: Pain and functional disorders of the neck are widely diagnosed
as "cervical spine syndrome". As this diagnosis is not able to sufficiently
specify the different symptoms, a new classification with five pain
syndromes, created empirically, was developed. The aim of this study
is to evaluate the predictive values of the diagnostic criteria respectively
clinical findings of patients diagnosed with cervical spine syndrome.
METHODS: Within the two year time frame of the study all patients
diagnosed with "cervical spine syndrome", which presented themselves
at the clinic, were included. The statistic analysis was performed
in multiple steps: univariate analyses, bivariate variable screening
and the use of the logistic regression model. RESULTS: Within two
years 653 patients previously diagnosed as suffering from cervical
spine syndrome presented at the clinic; 332 of them were included
in the study. According to the diagnostic criteria they were attached
to one of the five pain syndromes. The statistical analysis showed
in 17 of 35 evaluated diagnostic criteria a significant association
to one of the five subgroups of the cervical spine syndrome. CONCLUSION:
The statistical analyses revealed significant associations between
diagnostic criteria which were assessed by clinical examination and
the five subgroups of the cervical spine syndrome. The identified
predictors represent the typical syndrome-associated diagnostic criteria
of a certain syndrome-subgroup.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: Pain and functional disorders of the neck are widely diagnosed
as "cervical spine syndrome". As this diagnosis is not able to sufficiently
specify the different symptoms, a new classification with five pain
syndromes, created empirically, was developed. The aim of this study
is to evaluate the predictive values of the diagnostic criteria respectively
clinical findings of patients diagnosed with cervical spine syndrome.
METHODS: Within the two year time frame of the study all patients
diagnosed with "cervical spine syndrome", which presented themselves
at the clinic, were included. The statistic analysis was performed
in multiple steps: univariate analyses, bivariate variable screening
and the use of the logistic regression model. RESULTS: Within two
years 653 patients previously diagnosed as suffering from cervical
spine syndrome presented at the clinic; 332 of them were included
in the study. According to the diagnostic criteria they were attached
to one of the five pain syndromes. The statistical analysis showed
in 17 of 35 evaluated diagnostic criteria a significant association
to one of the five subgroups of the cervical spine syndrome. CONCLUSION:
The statistical analyses revealed significant associations between
diagnostic criteria which were assessed by clinical examination and
the five subgroups of the cervical spine syndrome. The identified
predictors represent the typical syndrome-associated diagnostic criteria
of a certain syndrome-subgroup.
as "cervical spine syndrome". As this diagnosis is not able to sufficiently
specify the different symptoms, a new classification with five pain
syndromes, created empirically, was developed. The aim of this study
is to evaluate the predictive values of the diagnostic criteria respectively
clinical findings of patients diagnosed with cervical spine syndrome.
METHODS: Within the two year time frame of the study all patients
diagnosed with "cervical spine syndrome", which presented themselves
at the clinic, were included. The statistic analysis was performed
in multiple steps: univariate analyses, bivariate variable screening
and the use of the logistic regression model. RESULTS: Within two
years 653 patients previously diagnosed as suffering from cervical
spine syndrome presented at the clinic; 332 of them were included
in the study. According to the diagnostic criteria they were attached
to one of the five pain syndromes. The statistical analysis showed
in 17 of 35 evaluated diagnostic criteria a significant association
to one of the five subgroups of the cervical spine syndrome. CONCLUSION:
The statistical analyses revealed significant associations between
diagnostic criteria which were assessed by clinical examination and
the five subgroups of the cervical spine syndrome. The identified
predictors represent the typical syndrome-associated diagnostic criteria
of a certain syndrome-subgroup.
Mueller, P. R.; Biswal, S.; Halpern, Elkan F.; Kaufman, J. A.; Lee, M. J.
In: Radiology, vol. 215, no. 3, pp. 684-8, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Mueller2000,
title = {Interventional radiologic procedures: patient anxiety, perception of pain, understanding of procedure, and satisfaction with medication--a prospective study},
author = {P. R. Mueller and S. Biswal and Elkan F. Halpern and J. A. Kaufman and M. J. Lee},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10831684},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-06-01},
urldate = {2000-06-01},
journal = {Radiology},
volume = {215},
number = {3},
pages = {684-8},
abstract = {PURPOSE: To prospectively assess patient anxiety, understanding of
the procedure being performed, perception of pain level, and satisfaction
with medication given for a variety of diagnostic and therapeutic
vascular and visceral (nonvascular) interventional procedures. MATERIALS
AND METHODS: The authors interviewed 204 patients before and after
they underwent an interventional radiologic procedure. Patients responded
to a series of questions by using a visual analog scale. Patients
were grouped according to (a) their level of experience with the
procedure and (b) the type of procedure performed (diagnostic or
therapeutic visceral procedure or diagnostic or therapeutic vascular
procedure). RESULTS: Patients who had previous experience with a
procedure, whether visceral or vascular, were less anxious, had more
understanding, and anticipated less pain than did those who did not
have experience with a procedure. Patients who had only local anesthesia
for visceral biopsy experienced greater pain than did those who had
both local and intravenous anesthesia. Satisfaction scores, however,
were similar throughout all groups. CONCLUSION: Patients have a moderate
amount of anxiety about interventional procedures and anticipate
some discomfort. Most patients have a high level of satisfaction
despite the amount of pain they experience during the procedure.
Patients experienced with a procedure tend to have a greater understanding
of the procedure and less anxiety.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To prospectively assess patient anxiety, understanding of
the procedure being performed, perception of pain level, and satisfaction
with medication given for a variety of diagnostic and therapeutic
vascular and visceral (nonvascular) interventional procedures. MATERIALS
AND METHODS: The authors interviewed 204 patients before and after
they underwent an interventional radiologic procedure. Patients responded
to a series of questions by using a visual analog scale. Patients
were grouped according to (a) their level of experience with the
procedure and (b) the type of procedure performed (diagnostic or
therapeutic visceral procedure or diagnostic or therapeutic vascular
procedure). RESULTS: Patients who had previous experience with a
procedure, whether visceral or vascular, were less anxious, had more
understanding, and anticipated less pain than did those who did not
have experience with a procedure. Patients who had only local anesthesia
for visceral biopsy experienced greater pain than did those who had
both local and intravenous anesthesia. Satisfaction scores, however,
were similar throughout all groups. CONCLUSION: Patients have a moderate
amount of anxiety about interventional procedures and anticipate
some discomfort. Most patients have a high level of satisfaction
despite the amount of pain they experience during the procedure.
Patients experienced with a procedure tend to have a greater understanding
of the procedure and less anxiety.
the procedure being performed, perception of pain level, and satisfaction
with medication given for a variety of diagnostic and therapeutic
vascular and visceral (nonvascular) interventional procedures. MATERIALS
AND METHODS: The authors interviewed 204 patients before and after
they underwent an interventional radiologic procedure. Patients responded
to a series of questions by using a visual analog scale. Patients
were grouped according to (a) their level of experience with the
procedure and (b) the type of procedure performed (diagnostic or
therapeutic visceral procedure or diagnostic or therapeutic vascular
procedure). RESULTS: Patients who had previous experience with a
procedure, whether visceral or vascular, were less anxious, had more
understanding, and anticipated less pain than did those who did not
have experience with a procedure. Patients who had only local anesthesia
for visceral biopsy experienced greater pain than did those who had
both local and intravenous anesthesia. Satisfaction scores, however,
were similar throughout all groups. CONCLUSION: Patients have a moderate
amount of anxiety about interventional procedures and anticipate
some discomfort. Most patients have a high level of satisfaction
despite the amount of pain they experience during the procedure.
Patients experienced with a procedure tend to have a greater understanding
of the procedure and less anxiety.
Goldberg, S. N.; Gazelle, G. Scott; Compton, C. C.; Mueller, P. R.; Tanabe, K. K.
Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation Journal Article
In: Cancer, vol. 88, no. 11, pp. 2452-63, 2000, ISSN: 0008-543X (Print) 0008-543X (Lin, ().
@article{Goldberg2000,
title = {Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation},
author = {S. N. Goldberg and G. Scott Gazelle and C. C. Compton and P. R. Mueller and K. K. Tanabe},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10861420},
issn = {0008-543X (Print) 0008-543X (Lin},
year = {2000},
date = {2000-06-01},
urldate = {2000-06-01},
journal = {Cancer},
volume = {88},
number = {11},
pages = {2452-63},
abstract = {BACKGROUND: Radiofrequency (RF)-induced tissue coagulation represents
a new approach for the thermal destruction of tumors within the liver.
The purpose of the current study was to 1) assess technique safety;
2) determine the extent and evolution of induced cellular damage;
and 3) correlate the observed pathologic effects with radiologic studies. METHODS: Twenty-three tumors measuring \</= 8 cm (19 colorectal
metastases and 4 hepatomas) in 22 patients were treated with RF (range,
500-1550 milliamperes) using internally cooled electrodes. All treated
tumors were resected to allow pathologic analysis. Eleven tumors
were treated intraoperatively under ultrasonographic guidance and
excised immediately. Twelve tumors were treated percutaneously using
ultrasound or computed tomography (CT) guidance and subsequently were excised 3-7 days after ablation. Contrast-enhanced CT (n = 12) and magnetic resonance imaging (MRI) (n = 2) were performed after
ablation of all percutaneously treated patients. RESULTS: Tumors
treated intraoperatively did not demonstrate definitive coagulative
necrosis. However, pathologic abnormalities suggestive of tissue
injury were observed with hematoxylin and eosin staining, and absent
cytosolic and mitochondrial enzyme activity suggested irreversible
cellular damage. In contrast, specimens removed \> 3 days after ablation
showed definite, contiguous coagulative necrosis without intervening
areas of viable tumor. CT and MRI scans demonstrated circumscribed
hypodense, nonenhancing regions surrounding the electrode tract as
early as 15 minutes after ablation. These corresponded within 2 mm
to measurements of coagulation at pathology. CONCLUSIONS: RF ablation
is a minimally invasive and safe approach to the treatment of tumors
in the liver. Tumors treated with RF energy do not immediately demonstrate
coagulative necrosis, but do show evidence of irreversible cellular
damage. The extent of tumor necrosis correlates closely with findings
at contrast-enhanced imaging.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Radiofrequency (RF)-induced tissue coagulation represents
a new approach for the thermal destruction of tumors within the liver.
The purpose of the current study was to 1) assess technique safety;
2) determine the extent and evolution of induced cellular damage;
and 3) correlate the observed pathologic effects with radiologic studies. METHODS: Twenty-three tumors measuring </= 8 cm (19 colorectal
metastases and 4 hepatomas) in 22 patients were treated with RF (range,
500-1550 milliamperes) using internally cooled electrodes. All treated
tumors were resected to allow pathologic analysis. Eleven tumors
were treated intraoperatively under ultrasonographic guidance and
excised immediately. Twelve tumors were treated percutaneously using
ultrasound or computed tomography (CT) guidance and subsequently were excised 3-7 days after ablation. Contrast-enhanced CT (n = 12) and magnetic resonance imaging (MRI) (n = 2) were performed after
ablation of all percutaneously treated patients. RESULTS: Tumors
treated intraoperatively did not demonstrate definitive coagulative
necrosis. However, pathologic abnormalities suggestive of tissue
injury were observed with hematoxylin and eosin staining, and absent
cytosolic and mitochondrial enzyme activity suggested irreversible
cellular damage. In contrast, specimens removed > 3 days after ablation
showed definite, contiguous coagulative necrosis without intervening
areas of viable tumor. CT and MRI scans demonstrated circumscribed
hypodense, nonenhancing regions surrounding the electrode tract as
early as 15 minutes after ablation. These corresponded within 2 mm
to measurements of coagulation at pathology. CONCLUSIONS: RF ablation
is a minimally invasive and safe approach to the treatment of tumors
in the liver. Tumors treated with RF energy do not immediately demonstrate
coagulative necrosis, but do show evidence of irreversible cellular
damage. The extent of tumor necrosis correlates closely with findings
at contrast-enhanced imaging.
a new approach for the thermal destruction of tumors within the liver.
The purpose of the current study was to 1) assess technique safety;
2) determine the extent and evolution of induced cellular damage;
and 3) correlate the observed pathologic effects with radiologic studies. METHODS: Twenty-three tumors measuring </= 8 cm (19 colorectal
metastases and 4 hepatomas) in 22 patients were treated with RF (range,
500-1550 milliamperes) using internally cooled electrodes. All treated
tumors were resected to allow pathologic analysis. Eleven tumors
were treated intraoperatively under ultrasonographic guidance and
excised immediately. Twelve tumors were treated percutaneously using
ultrasound or computed tomography (CT) guidance and subsequently were excised 3-7 days after ablation. Contrast-enhanced CT (n = 12) and magnetic resonance imaging (MRI) (n = 2) were performed after
ablation of all percutaneously treated patients. RESULTS: Tumors
treated intraoperatively did not demonstrate definitive coagulative
necrosis. However, pathologic abnormalities suggestive of tissue
injury were observed with hematoxylin and eosin staining, and absent
cytosolic and mitochondrial enzyme activity suggested irreversible
cellular damage. In contrast, specimens removed > 3 days after ablation
showed definite, contiguous coagulative necrosis without intervening
areas of viable tumor. CT and MRI scans demonstrated circumscribed
hypodense, nonenhancing regions surrounding the electrode tract as
early as 15 minutes after ablation. These corresponded within 2 mm
to measurements of coagulation at pathology. CONCLUSIONS: RF ablation
is a minimally invasive and safe approach to the treatment of tumors
in the liver. Tumors treated with RF energy do not immediately demonstrate
coagulative necrosis, but do show evidence of irreversible cellular
damage. The extent of tumor necrosis correlates closely with findings
at contrast-enhanced imaging.
Gazelle, G. Scott; McMahon, Pamela M.; Scholz, F. J.
Screening for colorectal cancer Journal Article
In: Radiology, vol. 215, no. 2, pp. 327-35, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Gazelle2000,
title = {Screening for colorectal cancer},
author = {G. Scott Gazelle and Pamela M. McMahon and F. J. Scholz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10796903},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-05-01},
journal = {Radiology},
volume = {215},
number = {2},
pages = {327-35},
abstract = {Colorectal cancer is the third most commonly diagnosed cancer and
the second leading cause of cancer deaths in the United States. Fortunately,
both the incidence and mortality associated with the disease have
declined during the past 2 decades. This is likely due, at least
in part, to improved efforts at screening and more aggressive removal
of adenomatous polyps. However, colorectal cancer screening is still
generally underutilized. This article reviews the current status
and future outlook for colorectal cancer screening, including a discussion
of risk factors for the disease, its anatomic distribution, proposed
mechanisms of development from adenomatous polyps, rationale for
screening, and screening options. Published literature concerning
the cost-effectiveness of colorectal cancer screening is also summarized.
The article concludes with a discussion of the emerging consensus
regarding the importance of and approaches to screening.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Colorectal cancer is the third most commonly diagnosed cancer and
the second leading cause of cancer deaths in the United States. Fortunately,
both the incidence and mortality associated with the disease have
declined during the past 2 decades. This is likely due, at least
in part, to improved efforts at screening and more aggressive removal
of adenomatous polyps. However, colorectal cancer screening is still
generally underutilized. This article reviews the current status
and future outlook for colorectal cancer screening, including a discussion
of risk factors for the disease, its anatomic distribution, proposed
mechanisms of development from adenomatous polyps, rationale for
screening, and screening options. Published literature concerning
the cost-effectiveness of colorectal cancer screening is also summarized.
The article concludes with a discussion of the emerging consensus
regarding the importance of and approaches to screening.
the second leading cause of cancer deaths in the United States. Fortunately,
both the incidence and mortality associated with the disease have
declined during the past 2 decades. This is likely due, at least
in part, to improved efforts at screening and more aggressive removal
of adenomatous polyps. However, colorectal cancer screening is still
generally underutilized. This article reviews the current status
and future outlook for colorectal cancer screening, including a discussion
of risk factors for the disease, its anatomic distribution, proposed
mechanisms of development from adenomatous polyps, rationale for
screening, and screening options. Published literature concerning
the cost-effectiveness of colorectal cancer screening is also summarized.
The article concludes with a discussion of the emerging consensus
regarding the importance of and approaches to screening.
Regar, E.; Werner, F.; Siebert, Uwe; Rieber, J.; Theisen, K.; Mudra, H.; Klauss, V.
Reproducibility of neointima quantification with motorized intravascular ultrasound pullback in stented coronary arteries Journal Article
In: Am Heart J, vol. 139, no. 4, pp. 632-7, 2000, ISSN: 0002-8703 (Print) 0002-8703 (Lin, ().
@article{Regar2000,
title = {Reproducibility of neointima quantification with motorized intravascular
ultrasound pullback in stented coronary arteries},
author = {E. Regar and F. Werner and Uwe Siebert and J. Rieber and K. Theisen and H. Mudra and V. Klauss},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10740144},
issn = {0002-8703 (Print) 0002-8703 (Lin},
year = {2000},
date = {2000-04-01},
journal = {Am Heart J},
volume = {139},
number = {4},
pages = {632-7},
abstract = {BACKGROUND: Intravascular ultrasound (IVUS) imaging has shown excellent
reproducibility immediately after coronary stent implantation. However,
the variability of measurements in lesions late after stent implantation,
when neointima formation is present, has not been studied. Neointimal
tissue is generally low echogenic and thus difficult to quantify.
We therefore sought to analyze the reproducibility of morphometric
measurements late after stent implantation. METHODS AND RESULTS:
Fifty consecutive patients were investigated 6 months after Palmaz-Schatz
stent implantation (motorized catheter pullback 0.5 mm/s). Two experienced
investigators independently identified the stent area, lumen area,
and neointimal area at different sites within the stent. Planimetric
measurements were performed with commercially available software.
Correlation coefficient and mean difference for corresponding measurements
were calculated for the intraobserver and interobserver comparisons.
Variability for the intraobserver and interobserver comparisons was
similar. Observer agreement regarding the presence of neointimal
hyperplasia was as high as 71% (interobserver comparison 62%). The
mean difference for neointima area was 0.06 +/- 1.5 mm(2) (-0.6 +/-
1.5 mm(2)); mean differences for lumen area were 0.02 +/- 0.19 mm(2)
(0.03 +/- 0.17 mm(2)) and for stent area 0.01 +/- 0.09 mm(2) (-0.02
+/- 0.12 mm(2)) (values for interobserver comparison are given in
parentheses). Correlation between measurements was high for all structures:
correlation coefficients were 0.66 (0.69) for neointima, 0.94 (0.95)
for lumen, and 0.95 (0. 91) for stent area. CONCLUSIONS: Morphometric
measurements of IVUS investigations with motorized IVUS pullback
late after stent placement show good reproducibility. Intraobserver
variability and interobserver variability are low. Differences for
corresponding measurements were more pronounced for neointima area.
Motorized catheter pullback guarantees high reliability of IVUS measurements
and should be used routinely for clinical IVUS studies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Intravascular ultrasound (IVUS) imaging has shown excellent
reproducibility immediately after coronary stent implantation. However,
the variability of measurements in lesions late after stent implantation,
when neointima formation is present, has not been studied. Neointimal
tissue is generally low echogenic and thus difficult to quantify.
We therefore sought to analyze the reproducibility of morphometric
measurements late after stent implantation. METHODS AND RESULTS:
Fifty consecutive patients were investigated 6 months after Palmaz-Schatz
stent implantation (motorized catheter pullback 0.5 mm/s). Two experienced
investigators independently identified the stent area, lumen area,
and neointimal area at different sites within the stent. Planimetric
measurements were performed with commercially available software.
Correlation coefficient and mean difference for corresponding measurements
were calculated for the intraobserver and interobserver comparisons.
Variability for the intraobserver and interobserver comparisons was
similar. Observer agreement regarding the presence of neointimal
hyperplasia was as high as 71% (interobserver comparison 62%). The
mean difference for neointima area was 0.06 +/- 1.5 mm(2) (-0.6 +/-
1.5 mm(2)); mean differences for lumen area were 0.02 +/- 0.19 mm(2)
(0.03 +/- 0.17 mm(2)) and for stent area 0.01 +/- 0.09 mm(2) (-0.02
+/- 0.12 mm(2)) (values for interobserver comparison are given in
parentheses). Correlation between measurements was high for all structures:
correlation coefficients were 0.66 (0.69) for neointima, 0.94 (0.95)
for lumen, and 0.95 (0. 91) for stent area. CONCLUSIONS: Morphometric
measurements of IVUS investigations with motorized IVUS pullback
late after stent placement show good reproducibility. Intraobserver
variability and interobserver variability are low. Differences for
corresponding measurements were more pronounced for neointima area.
Motorized catheter pullback guarantees high reliability of IVUS measurements
and should be used routinely for clinical IVUS studies.
reproducibility immediately after coronary stent implantation. However,
the variability of measurements in lesions late after stent implantation,
when neointima formation is present, has not been studied. Neointimal
tissue is generally low echogenic and thus difficult to quantify.
We therefore sought to analyze the reproducibility of morphometric
measurements late after stent implantation. METHODS AND RESULTS:
Fifty consecutive patients were investigated 6 months after Palmaz-Schatz
stent implantation (motorized catheter pullback 0.5 mm/s). Two experienced
investigators independently identified the stent area, lumen area,
and neointimal area at different sites within the stent. Planimetric
measurements were performed with commercially available software.
Correlation coefficient and mean difference for corresponding measurements
were calculated for the intraobserver and interobserver comparisons.
Variability for the intraobserver and interobserver comparisons was
similar. Observer agreement regarding the presence of neointimal
hyperplasia was as high as 71% (interobserver comparison 62%). The
mean difference for neointima area was 0.06 +/- 1.5 mm(2) (-0.6 +/-
1.5 mm(2)); mean differences for lumen area were 0.02 +/- 0.19 mm(2)
(0.03 +/- 0.17 mm(2)) and for stent area 0.01 +/- 0.09 mm(2) (-0.02
+/- 0.12 mm(2)) (values for interobserver comparison are given in
parentheses). Correlation between measurements was high for all structures:
correlation coefficients were 0.66 (0.69) for neointima, 0.94 (0.95)
for lumen, and 0.95 (0. 91) for stent area. CONCLUSIONS: Morphometric
measurements of IVUS investigations with motorized IVUS pullback
late after stent placement show good reproducibility. Intraobserver
variability and interobserver variability are low. Differences for
corresponding measurements were more pronounced for neointima area.
Motorized catheter pullback guarantees high reliability of IVUS measurements
and should be used routinely for clinical IVUS studies.
Livraghi, T.; Goldberg, S. N.; Lazzaroni, S.; Meloni, F.; Ierace, T.; Solbiati, L.; Gazelle, G. Scott
Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions Journal Article
In: Radiology, vol. 214, no. 3, pp. 761-8, 2000, ISSN: 0033-8419 (Print) 0033-8419 (Lin, ().
@article{Livraghi2000,
title = {Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions},
author = {T. Livraghi and S. N. Goldberg and S. Lazzaroni and F. Meloni and T. Ierace and L. Solbiati and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10715043},
issn = {0033-8419 (Print) 0033-8419 (Lin},
year = {2000},
date = {2000-03-01},
urldate = {2000-03-01},
journal = {Radiology},
volume = {214},
number = {3},
pages = {761-8},
abstract = {PURPOSE: To study local therapeutic efficacy, side effects, and complications
of radio-frequency (RF) ablation in the treatment of medium and large
hepatocellular carcinoma (HCC) lesions in patients with cirrhosis
or chronic hepatitis. MATERIALS AND METHODS: One-hundred fourteen
patients who were under conscious sedation or general anesthesia
had 126 HCCs greater than 3.0 cm in diameter treated with RF by using
an internally cooled electrode. Eighty tumors were medium (3.1-5.0
cm), and 46 were large (5.1-9.5 cm). The mean diameter for all tumors
was 5.4 cm. At imaging, 75 tumors were considered noninfiltrating,
and 51 were considered infiltrating. RESULTS: Complete necrosis was
attained in 60 lesions (47.6%), nearly complete (90%-99%) necrosis
in 40 lesions (31.7%), and partial (50%-89%) necrosis in the remaining
26 lesions (20.6%). Medium and/or noninfiltrating tumors were treated
successfully significantly more often than large and/or infiltrating
tumors. Two major complications (death, hemorrhage requiring laparotomy)
and five minor complications (self-limited hemorrhage, persistent
pain) were observed. The single death was due to a break in sterile
technique rather than to the RF procedure itself. CONCLUSION: RF
ablation appears to be an effective, safe, and relatively simple
procedure for the treatment of medium and large HCCs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To study local therapeutic efficacy, side effects, and complications
of radio-frequency (RF) ablation in the treatment of medium and large
hepatocellular carcinoma (HCC) lesions in patients with cirrhosis
or chronic hepatitis. MATERIALS AND METHODS: One-hundred fourteen
patients who were under conscious sedation or general anesthesia
had 126 HCCs greater than 3.0 cm in diameter treated with RF by using
an internally cooled electrode. Eighty tumors were medium (3.1-5.0
cm), and 46 were large (5.1-9.5 cm). The mean diameter for all tumors
was 5.4 cm. At imaging, 75 tumors were considered noninfiltrating,
and 51 were considered infiltrating. RESULTS: Complete necrosis was
attained in 60 lesions (47.6%), nearly complete (90%-99%) necrosis
in 40 lesions (31.7%), and partial (50%-89%) necrosis in the remaining
26 lesions (20.6%). Medium and/or noninfiltrating tumors were treated
successfully significantly more often than large and/or infiltrating
tumors. Two major complications (death, hemorrhage requiring laparotomy)
and five minor complications (self-limited hemorrhage, persistent
pain) were observed. The single death was due to a break in sterile
technique rather than to the RF procedure itself. CONCLUSION: RF
ablation appears to be an effective, safe, and relatively simple
procedure for the treatment of medium and large HCCs.
of radio-frequency (RF) ablation in the treatment of medium and large
hepatocellular carcinoma (HCC) lesions in patients with cirrhosis
or chronic hepatitis. MATERIALS AND METHODS: One-hundred fourteen
patients who were under conscious sedation or general anesthesia
had 126 HCCs greater than 3.0 cm in diameter treated with RF by using
an internally cooled electrode. Eighty tumors were medium (3.1-5.0
cm), and 46 were large (5.1-9.5 cm). The mean diameter for all tumors
was 5.4 cm. At imaging, 75 tumors were considered noninfiltrating,
and 51 were considered infiltrating. RESULTS: Complete necrosis was
attained in 60 lesions (47.6%), nearly complete (90%-99%) necrosis
in 40 lesions (31.7%), and partial (50%-89%) necrosis in the remaining
26 lesions (20.6%). Medium and/or noninfiltrating tumors were treated
successfully significantly more often than large and/or infiltrating
tumors. Two major complications (death, hemorrhage requiring laparotomy)
and five minor complications (self-limited hemorrhage, persistent
pain) were observed. The single death was due to a break in sterile
technique rather than to the RF procedure itself. CONCLUSION: RF
ablation appears to be an effective, safe, and relatively simple
procedure for the treatment of medium and large HCCs.
Christakis, N. A.; Lamont, Elizabeth
Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study Journal Article
In: BMJ, vol. 320, no. 7233, pp. 469-72, 2000, ISSN: 0959-8138 (Print) 0959-535X (Lin, ().
@article{Christakis2000,
title = {Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study},
author = {N. A. Christakis and Elizabeth Lamont},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10678857},
issn = {0959-8138 (Print) 0959-535X (Lin},
year = {2000},
date = {2000-02-01},
urldate = {2000-02-01},
journal = {BMJ},
volume = {320},
number = {7233},
pages = {469-72},
abstract = {OBJECTIVE: To describe doctors' prognostic accuracy in terminally
ill patients and to evaluate the determinants of that accuracy. DESIGN:
Prospective cohort study. SETTING: Five outpatient hospice programmes
in Chicago. PARTICIPANTS: 343 doctors provided survival estimates
for 468 terminally ill patients at the time of hospice referral.
MAIN OUTCOME MEASURES: Patients' estimated and actual survival. RESULTS:
Median survival was 24 days. Only 20% (92/468) of predictions were
accurate (within 33% of actual survival); 63% (295/468) were overoptimistic
and 17% (81/468) were overpessimistic. Overall, doctors overestimated
survival by a factor of 5.3. Few patient or doctor characteristics
were associated with prognostic accuracy. Male patients were 58%
less likely to have overpessimistic predictions. Non-oncology medical
specialists were 326% more likely than general internists to make
overpessimistic predictions. Doctors in the upper quartile of practice
experience were the most accurate. As duration of doctor-patient
relationship increased and time since last contact decreased, prognostic
accuracy decreased. CONCLUSION: Doctors are inaccurate in their prognoses
for terminally ill patients and the error is systematically optimistic.
The inaccuracy is, in general, not restricted to certain kinds of
doctors or patients. These phenomena may be adversely affecting the
quality of care given to patients near the end of life.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: To describe doctors' prognostic accuracy in terminally
ill patients and to evaluate the determinants of that accuracy. DESIGN:
Prospective cohort study. SETTING: Five outpatient hospice programmes
in Chicago. PARTICIPANTS: 343 doctors provided survival estimates
for 468 terminally ill patients at the time of hospice referral.
MAIN OUTCOME MEASURES: Patients' estimated and actual survival. RESULTS:
Median survival was 24 days. Only 20% (92/468) of predictions were
accurate (within 33% of actual survival); 63% (295/468) were overoptimistic
and 17% (81/468) were overpessimistic. Overall, doctors overestimated
survival by a factor of 5.3. Few patient or doctor characteristics
were associated with prognostic accuracy. Male patients were 58%
less likely to have overpessimistic predictions. Non-oncology medical
specialists were 326% more likely than general internists to make
overpessimistic predictions. Doctors in the upper quartile of practice
experience were the most accurate. As duration of doctor-patient
relationship increased and time since last contact decreased, prognostic
accuracy decreased. CONCLUSION: Doctors are inaccurate in their prognoses
for terminally ill patients and the error is systematically optimistic.
The inaccuracy is, in general, not restricted to certain kinds of
doctors or patients. These phenomena may be adversely affecting the
quality of care given to patients near the end of life.
ill patients and to evaluate the determinants of that accuracy. DESIGN:
Prospective cohort study. SETTING: Five outpatient hospice programmes
in Chicago. PARTICIPANTS: 343 doctors provided survival estimates
for 468 terminally ill patients at the time of hospice referral.
MAIN OUTCOME MEASURES: Patients' estimated and actual survival. RESULTS:
Median survival was 24 days. Only 20% (92/468) of predictions were
accurate (within 33% of actual survival); 63% (295/468) were overoptimistic
and 17% (81/468) were overpessimistic. Overall, doctors overestimated
survival by a factor of 5.3. Few patient or doctor characteristics
were associated with prognostic accuracy. Male patients were 58%
less likely to have overpessimistic predictions. Non-oncology medical
specialists were 326% more likely than general internists to make
overpessimistic predictions. Doctors in the upper quartile of practice
experience were the most accurate. As duration of doctor-patient
relationship increased and time since last contact decreased, prognostic
accuracy decreased. CONCLUSION: Doctors are inaccurate in their prognoses
for terminally ill patients and the error is systematically optimistic.
The inaccuracy is, in general, not restricted to certain kinds of
doctors or patients. These phenomena may be adversely affecting the
quality of care given to patients near the end of life.
Swan, J. Shannon; Kennell, T. W.; Acher, C. W.; Heisey, D. M.; Grist, T. M.; Korosec, F. R.; Hagenauer, M. E.
Magnetic resonance angiography of aorto-iliac disease Journal Article
In: Am J Surg, vol. 180, no. 1, pp. 6-12, 2000, ISSN: 0002-9610 (Print) 0002-9610 (Li, ().
@article{Swan2000a,
title = {Magnetic resonance angiography of aorto-iliac disease},
author = {J. Shannon Swan and T. W. Kennell and C. W. Acher and D. M. Heisey and T. M. Grist and F. R. Korosec and M. E. Hagenauer},
url = {https://www.ncbi.nlm.nih.gov/pubmed/11036131},
doi = {10.1016/s0002-9610(00)00412-8},
issn = {0002-9610 (Print)
0002-9610 (Li},
year = {2000},
date = {2000-01-01},
journal = {Am J Surg},
volume = {180},
number = {1},
pages = {6-12},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Carroll, T. J.; Korosec, F. R.; Swan, J. Shannon; Grist, T. M.; Frayne, R.; Mistretta, C. A.
Method for rapidly determining and reconstructing the peak arterial frame from a time-resolved CE-MRA exam Journal Article
In: Magn Reson Med, vol. 44, no. 5, pp. 817-20, 2000, ISSN: 0740-3194 (Print) 0740-3194 (Li, ().
@article{Carroll2000,
title = {Method for rapidly determining and reconstructing the peak arterial frame from a time-resolved CE-MRA exam},
author = {T. J. Carroll and F. R. Korosec and J. Shannon Swan and T. M. Grist and R. Frayne and C. A. Mistretta},
url = {https://www.ncbi.nlm.nih.gov/pubmed/11064419},
doi = {10.1002/1522-2594(200011)44:5\<817::aid-mrm22\>3.0.co;2-x},
issn = {0740-3194 (Print)
0740-3194 (Li},
year = {2000},
date = {2000-01-01},
journal = {Magn Reson Med},
volume = {44},
number = {5},
pages = {817-20},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Frayne, R.; Grist, T. M.; Swan, J. Shannon; Peters, D. C.; Korosec, F. R.; Mistretta, C. A.
3D MR DSA: effects of injection protocol and image masking Journal Article
In: J Magn Reson Imaging, vol. 12, no. 3, pp. 476-87, 2000, ISSN: 1053-1807 (Print) 1053-1807 (Li, ().
@article{Frayne2000,
title = {3D MR DSA: effects of injection protocol and image masking},
author = {R. Frayne and T. M. Grist and J. Shannon Swan and D. C. Peters and F. R. Korosec and C. A. Mistretta},
url = {https://www.ncbi.nlm.nih.gov/pubmed/10992316},
doi = {10.1002/1522-2586(200009)12:3\<476::aid-jmri14\>3.0.co;2-f},
issn = {1053-1807 (Print) 1053-1807 (Li},
year = {2000},
date = {2000-01-01},
urldate = {2000-01-01},
journal = {J Magn Reson Imaging},
volume = {12},
number = {3},
pages = {476-87},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Swan, J. Shannon; Fryback, D. G.; Lawrence, W. F.; Sainfort, F.; Hagenauer, M. E.; Heisey, D. M.
A time-tradeoff method for cost-effectiveness models applied to radiology Journal Article
In: Med Decis Making, vol. 20, no. 1, pp. 79-88, 2000, ISSN: 0272-989X (Print) 0272-989X (Li, ().
@article{Swan2000,
title = {A time-tradeoff method for cost-effectiveness models applied to radiology},
author = {J. Shannon Swan and D. G. Fryback and W. F. Lawrence and F. Sainfort and M. E. Hagenauer and D. M. Heisey},
url = {https://www.ncbi.nlm.nih.gov/pubmed/10638540},
doi = {10.1177/0272989X0002000110},
issn = {0272-989X (Print) 0272-989X (Li},
year = {2000},
date = {2000-01-01},
urldate = {2000-01-01},
journal = {Med Decis Making},
volume = {20},
number = {1},
pages = {79-88},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Sahani, D.; Saini, S.; Fatuga, G. A.; Halpern, Elkan F.; Lanser, M. E.; Zimmerman, J. B.; Fischman, A. J.
Quantitative measurements of medical images for pharmaceutical clinical trials: comparison between on-site and off-site assessments Journal Article
In: AJR Am J Roentgenol, vol. 174, pp. 1159-62, 2000, ().
@article{Sahani2000,
title = {Quantitative measurements of medical images for pharmaceutical clinical
trials: comparison between on-site and off-site assessments},
author = {D. Sahani and S. Saini and G. A. Fatuga and Elkan F. Halpern and M. E. Lanser and J. B. Zimmerman and A. J. Fischman},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10749269},
year = {2000},
date = {2000-01-01},
journal = {AJR Am J Roentgenol},
volume = {174},
pages = {1159-62},
abstract = {OBJECTIVE: In pharmaceutical clinical trials, quantitative measurements
on medical images are often conducted to confirm drug efficacy. This
study aims to compare the quantitative image analysis performance
of an off-site core laboratory with the performance of investigators
from multiple clinical sites. MATERIALS AND METHODS: In a phase I
clinical trial, 25 healthy subjects underwent dynamic brain single-photon
emission computed tomography (SPECT) scintigraphy with 123I-Altropane,
a cocaine analogue with high affinity and selectivity for dopamine
transporter sites in the striatum. In 20 patients examined on-site
and off-site, a total of 80 measurements were made to calculate the
drug's binding potential. A trained technologist off-site at a central
core laboratory and on-site investigators at different clinical sites
performed the image analysis. These results were compared with measurements
made by a subspecialty radiologist whose assessments were the reference
standard. Statistical analysis was performed using multiple regression
analysis. RESULTS: Measurements from the central core laboratory (off-site) highly correlated (r = 0.95) with measurements of the
reference standard. Measurements from the clinical sites (on-site) grouped together had lower correlation (r = 0.84) with the reference
standard. This difference was statistically significant (p textless
0.05). CONCLUSION: Training and experience in the specific type of
image analysis are critical in obtaining consistent data. Quantitative
analysis by dedicated personnel at a core laboratory provides highly
reproducible results. The findings support off-site assessment of
medical images in pharmaceutical clinical trials.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: In pharmaceutical clinical trials, quantitative measurements
on medical images are often conducted to confirm drug efficacy. This
study aims to compare the quantitative image analysis performance
of an off-site core laboratory with the performance of investigators
from multiple clinical sites. MATERIALS AND METHODS: In a phase I
clinical trial, 25 healthy subjects underwent dynamic brain single-photon
emission computed tomography (SPECT) scintigraphy with 123I-Altropane,
a cocaine analogue with high affinity and selectivity for dopamine
transporter sites in the striatum. In 20 patients examined on-site
and off-site, a total of 80 measurements were made to calculate the
drug's binding potential. A trained technologist off-site at a central
core laboratory and on-site investigators at different clinical sites
performed the image analysis. These results were compared with measurements
made by a subspecialty radiologist whose assessments were the reference
standard. Statistical analysis was performed using multiple regression
analysis. RESULTS: Measurements from the central core laboratory (off-site) highly correlated (r = 0.95) with measurements of the
reference standard. Measurements from the clinical sites (on-site) grouped together had lower correlation (r = 0.84) with the reference
standard. This difference was statistically significant (p textless
0.05). CONCLUSION: Training and experience in the specific type of
image analysis are critical in obtaining consistent data. Quantitative
analysis by dedicated personnel at a core laboratory provides highly
reproducible results. The findings support off-site assessment of
medical images in pharmaceutical clinical trials.
on medical images are often conducted to confirm drug efficacy. This
study aims to compare the quantitative image analysis performance
of an off-site core laboratory with the performance of investigators
from multiple clinical sites. MATERIALS AND METHODS: In a phase I
clinical trial, 25 healthy subjects underwent dynamic brain single-photon
emission computed tomography (SPECT) scintigraphy with 123I-Altropane,
a cocaine analogue with high affinity and selectivity for dopamine
transporter sites in the striatum. In 20 patients examined on-site
and off-site, a total of 80 measurements were made to calculate the
drug's binding potential. A trained technologist off-site at a central
core laboratory and on-site investigators at different clinical sites
performed the image analysis. These results were compared with measurements
made by a subspecialty radiologist whose assessments were the reference
standard. Statistical analysis was performed using multiple regression
analysis. RESULTS: Measurements from the central core laboratory (off-site) highly correlated (r = 0.95) with measurements of the
reference standard. Measurements from the clinical sites (on-site) grouped together had lower correlation (r = 0.84) with the reference
standard. This difference was statistically significant (p textless
0.05). CONCLUSION: Training and experience in the specific type of
image analysis are critical in obtaining consistent data. Quantitative
analysis by dedicated personnel at a core laboratory provides highly
reproducible results. The findings support off-site assessment of
medical images in pharmaceutical clinical trials.
Klauss, V.; Konig, A.; Spes, C.; Meiser, B.; Rieber, J.; Siebert, Uwe; Regar, E.; Pfeiffer, M.; Reichart, B.; Theisen, K.; Mudra, H.
Cyclosporine versus tacrolimus (FK 506) for prevention of cardiac allograft vasculopathy Journal Article
In: Am J Cardiol, vol. 85, no. 2, pp. 266-9, 2000, ISSN: 0002-9149 (Print) 0002-9149 (Lin, ().
@article{Klauss2000,
title = {Cyclosporine versus tacrolimus (FK 506) for prevention of cardiac
allograft vasculopathy},
author = {V. Klauss and A. Konig and C. Spes and B. Meiser and J. Rieber and Uwe Siebert and E. Regar and M. Pfeiffer and B. Reichart and K. Theisen and H. Mudra},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10955391},
issn = {0002-9149 (Print) 0002-9149 (Lin},
year = {2000},
date = {2000-01-01},
journal = {Am J Cardiol},
volume = {85},
number = {2},
pages = {266-9},
abstract = {This study prospectively compared the impact of cyclosporine A and
tacrolimus on the development of cardiac allograft vasculopathy.
By using serial intravascular ultrasound examinations, a trend toward
a more pronounced progression was noted in the tacrolimus group in
the first year after heart transplantation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This study prospectively compared the impact of cyclosporine A and
tacrolimus on the development of cardiac allograft vasculopathy.
By using serial intravascular ultrasound examinations, a trend toward
a more pronounced progression was noted in the tacrolimus group in
the first year after heart transplantation.
tacrolimus on the development of cardiac allograft vasculopathy.
By using serial intravascular ultrasound examinations, a trend toward
a more pronounced progression was noted in the tacrolimus group in
the first year after heart transplantation.
Leertouwer, T. C.; Gussenhoven, E. J.; Bosch, Johanna; Jaarsveld, B. C.; Dijk, L. C.; Deinum, J.; Veld, A. J. Man In
Stent placement for renal arterial stenosis: where do we stand? A meta-analysis Journal Article
In: Radiology, vol. 216, pp. 78-85, 2000, ().
@article{Leertouwer2000,
title = {Stent placement for renal arterial stenosis: where do we stand? A
meta-analysis},
author = {T. C. Leertouwer and E. J. Gussenhoven and Johanna Bosch and B. C. Jaarsveld and L. C. Dijk and J. Deinum and A. J. Man In Veld},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10887230},
year = {2000},
date = {2000-01-01},
journal = {Radiology},
volume = {216},
pages = {78-85},
abstract = {PURPOSE: To perform a meta-analysis of renal arterial stent placement
in comparison with renal percutaneous transluminal angioplasty (PTA)
in patients with renal arterial stenosis. MATERIALS AND METHODS:
Studies dealing with renal arterial stent placement (14 articles;
678 patients) and renal PTA (10 articles; 644 patients) published
up to August 1998 were selected. A random-effects model was used
to pool the data. RESULTS: Renal arterial stent placement proved
highly successful, with an initial adequate performance in 98% and
major complications in 11 The overall cure rate for hypertension
was 20 whereas hypertension was improved in 49 Renal function improved
in 30% and stabilized in 38% of patients. The restenosis rate at
follow-up of 6-29 months was 17 Stent placement had a higher technical
success rate and a lower restenosis rate than did renal PTA (98%
vs 77% and 17% vs 26 respectively; P textless.001). The complication
rate was not different between the two treatments. The cure rate
for hypertension was higher and the improvement rate for renal function
was lower after stent placement than after renal PTA (20% vs 10%
and 30% vs 38 respectively; P textless.001). CONCLUSION: Renal arterial
stent placement is technically superior and clinically comparable
to renal PTA alone.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: To perform a meta-analysis of renal arterial stent placement
in comparison with renal percutaneous transluminal angioplasty (PTA)
in patients with renal arterial stenosis. MATERIALS AND METHODS:
Studies dealing with renal arterial stent placement (14 articles;
678 patients) and renal PTA (10 articles; 644 patients) published
up to August 1998 were selected. A random-effects model was used
to pool the data. RESULTS: Renal arterial stent placement proved
highly successful, with an initial adequate performance in 98% and
major complications in 11 The overall cure rate for hypertension
was 20 whereas hypertension was improved in 49 Renal function improved
in 30% and stabilized in 38% of patients. The restenosis rate at
follow-up of 6-29 months was 17 Stent placement had a higher technical
success rate and a lower restenosis rate than did renal PTA (98%
vs 77% and 17% vs 26 respectively; P textless.001). The complication
rate was not different between the two treatments. The cure rate
for hypertension was higher and the improvement rate for renal function
was lower after stent placement than after renal PTA (20% vs 10%
and 30% vs 38 respectively; P textless.001). CONCLUSION: Renal arterial
stent placement is technically superior and clinically comparable
to renal PTA alone.
in comparison with renal percutaneous transluminal angioplasty (PTA)
in patients with renal arterial stenosis. MATERIALS AND METHODS:
Studies dealing with renal arterial stent placement (14 articles;
678 patients) and renal PTA (10 articles; 644 patients) published
up to August 1998 were selected. A random-effects model was used
to pool the data. RESULTS: Renal arterial stent placement proved
highly successful, with an initial adequate performance in 98% and
major complications in 11 The overall cure rate for hypertension
was 20 whereas hypertension was improved in 49 Renal function improved
in 30% and stabilized in 38% of patients. The restenosis rate at
follow-up of 6-29 months was 17 Stent placement had a higher technical
success rate and a lower restenosis rate than did renal PTA (98%
vs 77% and 17% vs 26 respectively; P textless.001). The complication
rate was not different between the two treatments. The cure rate
for hypertension was higher and the improvement rate for renal function
was lower after stent placement than after renal PTA (20% vs 10%
and 30% vs 38 respectively; P textless.001). CONCLUSION: Renal arterial
stent placement is technically superior and clinically comparable
to renal PTA alone.
Manoach, D. S.; Gollub, R. L.; Benson, E. S.; Searl, M. M.; Goff, D. C.; Halpern, Elkan F.; Saper, C. B.; Rauch, S. L.
Schizophrenic subjects show aberrant fMRI activation of dorsolateral prefrontal cortex and basal ganglia during working memory performance Journal Article
In: Biol Psychiatry, vol. 48, pp. 99-109, 2000, ().
@article{Manoach2000,
title = {Schizophrenic subjects show aberrant fMRI activation of dorsolateral
prefrontal cortex and basal ganglia during working memory performance},
author = {D. S. Manoach and R. L. Gollub and E. S. Benson and M. M. Searl and D. C. Goff and Elkan F. Halpern and C. B. Saper and S. L. Rauch},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10903406},
year = {2000},
date = {2000-01-01},
journal = {Biol Psychiatry},
volume = {48},
pages = {99-109},
abstract = {BACKGROUND: Working memory (WM) deficits in schizophrenia have been
associated with dorsolateral prefrontal cortex (DLPFC) dysfunction
in neuroimaging studies. We previously found increased DLPFC activation
in schizophrenic versus normal subjects during WM performance (Manoach
et al 1999b). We now have investigated whether schizophrenic subjects
recruit different brain regions, particularly the basal ganglia and
thalamus, components of frontostriatal circuitry thought to mediate
WM. METHODS: We examined regional brain activation in nine normal
and nine schizophrenic subjects during WM performance using functional
magnetic resonance imaging. Subjects performed a modified version
of the Sternberg Item Recognition Paradigm that included a monetary
reward for correct responses. We compared high and low WM load conditions
to each other and to a non-WM baseline condition. We examined activation
in both individual subjects and averaged group data. RESULTS: Relative
to normal subjects, schizophrenic subjects exhibited deficient WM
performance, at least an equal magnitude of right DLPFC activation,
significantly greater left DLPFC activation, and increased spatial
heterogeneity of DLPFC activation. Furthermore, only the schizophrenic
group activated the basal ganglia and thalamus, even when matched
for task performance with the normal group. CONCLUSIONS: Aberrant
WM performance and brain activation in schizophrenia may reflect
dysfunction of frontostriatal circuitry that subserves WM. Future
studies will elucidate the contribution of the anatomical components
of this circuitry to WM deficits.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Working memory (WM) deficits in schizophrenia have been
associated with dorsolateral prefrontal cortex (DLPFC) dysfunction
in neuroimaging studies. We previously found increased DLPFC activation
in schizophrenic versus normal subjects during WM performance (Manoach
et al 1999b). We now have investigated whether schizophrenic subjects
recruit different brain regions, particularly the basal ganglia and
thalamus, components of frontostriatal circuitry thought to mediate
WM. METHODS: We examined regional brain activation in nine normal
and nine schizophrenic subjects during WM performance using functional
magnetic resonance imaging. Subjects performed a modified version
of the Sternberg Item Recognition Paradigm that included a monetary
reward for correct responses. We compared high and low WM load conditions
to each other and to a non-WM baseline condition. We examined activation
in both individual subjects and averaged group data. RESULTS: Relative
to normal subjects, schizophrenic subjects exhibited deficient WM
performance, at least an equal magnitude of right DLPFC activation,
significantly greater left DLPFC activation, and increased spatial
heterogeneity of DLPFC activation. Furthermore, only the schizophrenic
group activated the basal ganglia and thalamus, even when matched
for task performance with the normal group. CONCLUSIONS: Aberrant
WM performance and brain activation in schizophrenia may reflect
dysfunction of frontostriatal circuitry that subserves WM. Future
studies will elucidate the contribution of the anatomical components
of this circuitry to WM deficits.
associated with dorsolateral prefrontal cortex (DLPFC) dysfunction
in neuroimaging studies. We previously found increased DLPFC activation
in schizophrenic versus normal subjects during WM performance (Manoach
et al 1999b). We now have investigated whether schizophrenic subjects
recruit different brain regions, particularly the basal ganglia and
thalamus, components of frontostriatal circuitry thought to mediate
WM. METHODS: We examined regional brain activation in nine normal
and nine schizophrenic subjects during WM performance using functional
magnetic resonance imaging. Subjects performed a modified version
of the Sternberg Item Recognition Paradigm that included a monetary
reward for correct responses. We compared high and low WM load conditions
to each other and to a non-WM baseline condition. We examined activation
in both individual subjects and averaged group data. RESULTS: Relative
to normal subjects, schizophrenic subjects exhibited deficient WM
performance, at least an equal magnitude of right DLPFC activation,
significantly greater left DLPFC activation, and increased spatial
heterogeneity of DLPFC activation. Furthermore, only the schizophrenic
group activated the basal ganglia and thalamus, even when matched
for task performance with the normal group. CONCLUSIONS: Aberrant
WM performance and brain activation in schizophrenia may reflect
dysfunction of frontostriatal circuitry that subserves WM. Future
studies will elucidate the contribution of the anatomical components
of this circuitry to WM deficits.
Ellis, M.; Kong, Chung Yin; Muthukumar, M.
Polyelectrolyte Adsorption on Ħeterogeneously Charged Surfaces Journal Article
In: J. Chem Phys, vol. 112, pp. 8723-8729, 2000, ().
@article{Ellis2000,
title = {Polyelectrolyte Adsorption on {H}eterogeneously Charged Surfaces},
author = {M. Ellis and Chung Yin Kong and M. Muthukumar},
url = {http://scitation.aip.org/content/aip/journal/jcp/112/19/10.1063/1.481474},
year = {2000},
date = {2000-01-01},
booktitle = {J Chem Phys},
journal = {J. Chem Phys},
volume = {112},
pages = {8723-8729},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Halpern, Elkan F.; Weinstein, M. C.; Hunink, M. G.; Gazelle, G. Scott
Representing both first- and second-order uncertainties by Monte Carlo simulation for groups of patients Journal Article
In: Med Decis Making, vol. 20, pp. 314-22, 2000, ().
@article{Halpern2000,
title = {Representing both first- and second-order uncertainties by Monte
Carlo simulation for groups of patients},
author = {Elkan F. Halpern and M. C. Weinstein and M. G. Hunink and G. Scott Gazelle},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10929854},
year = {2000},
date = {2000-01-01},
journal = {Med Decis Making},
volume = {20},
pages = {314-22},
abstract = {Actual implementation of probabilistic sensitivity analysis may lead
to misleading or improper conclusions when it is applied to groups
of patients rather than individual patients. The practice of combining
first- and second-order simulations when modeling the outcome for
a group of more than one patient yields an erroneous marginal distribution
whenever the parameter values are randomly sampled for each patient
while the results are presented as simulated means for the group
of patients. This practice results in underrepresenting the second-order
uncertainty. It may also distort the shape (especially the symmetry
or extent of the tails) in the simulated distribution. As a result,
it may lead to premature or incorrect conclusions of superiority.
It may also result in inappropriate estimates of the value of further
research to inform parameter values.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Actual implementation of probabilistic sensitivity analysis may lead
to misleading or improper conclusions when it is applied to groups
of patients rather than individual patients. The practice of combining
first- and second-order simulations when modeling the outcome for
a group of more than one patient yields an erroneous marginal distribution
whenever the parameter values are randomly sampled for each patient
while the results are presented as simulated means for the group
of patients. This practice results in underrepresenting the second-order
uncertainty. It may also distort the shape (especially the symmetry
or extent of the tails) in the simulated distribution. As a result,
it may lead to premature or incorrect conclusions of superiority.
It may also result in inappropriate estimates of the value of further
research to inform parameter values.
to misleading or improper conclusions when it is applied to groups
of patients rather than individual patients. The practice of combining
first- and second-order simulations when modeling the outcome for
a group of more than one patient yields an erroneous marginal distribution
whenever the parameter values are randomly sampled for each patient
while the results are presented as simulated means for the group
of patients. This practice results in underrepresenting the second-order
uncertainty. It may also distort the shape (especially the symmetry
or extent of the tails) in the simulated distribution. As a result,
it may lead to premature or incorrect conclusions of superiority.
It may also result in inappropriate estimates of the value of further
research to inform parameter values.
Schops, P.; Pfingsten, M.; Siebert, Uwe
[Reliability of manual medical examination techniques of the cervical spine. Study of quality assurance in manual diagnosis] Journal Article
In: Z Orthop Ihre Grenzgeb, vol. 138, no. 1, pp. 2-7, 2000, ISSN: 0044-3220 (Print) 0044-3220 (Lin, ().
@article{Schops2000a,
title = {[Reliability of manual medical examination techniques of the cervical
spine. Study of quality assurance in manual diagnosis]},
author = {P. Schops and M. Pfingsten and Uwe Siebert},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10730356},
issn = {0044-3220 (Print) 0044-3220 (Lin},
year = {2000},
date = {2000-00-01},
journal = {Z Orthop Ihre Grenzgeb},
volume = {138},
number = {1},
pages = {2-7},
abstract = {OBJECTIVE: Chiropractic techniques are of particular importance for
the examination of the cervical spine. The aim of this study was
to assess interexaminer reliability of examination techniques of
the cervical spine in subjects with and without musculoskeletal distortions
of the neck. The interrater method was used with five independent
examiners. METHOD: Twenty patients suffering from neck diseases and
20 asymptomatic subjects of similar age and gender were randomized
and assessed by five examiners blind to patient histories. Statistical
analysis was carried out using multiple logistic regression and the
calculation of kappa. RESULTS: Compared to asymptomatic subjects,
patients experienced pain significantly often when pressure was applied
to the cervical zygapophysial joints and the superficial neck muscles (p \< or = 0.05 and p \< or = 0.01). In addition, segmental function
tests induced kinesialgia significantly more often in patients than in asymptomatic subjects (p \< or = 0.05 and p \< or = 0.01). A significant
relationship was not found between the patient's health status and
the findings from muscle palpation and functional examination of
the motion segments. The assessment of agreement within examiners
beyond chance had to be calculated, aside from for few exceptions, little to moderate (0.2 \< kappa \< or = 0.6). CONCLUSIONS: Chiropractic
techniques are an essential part of every examination of the cervical
spine. The clinical impact has not been scientifically established
until up to now. Based on our findings and literature, we conclude
that interexaminer reliability of manual diagnosis in the examination
of the cervical spine should be improved by standardizing the examination
process and setting guidelines for documentation and evaluation criteria.
Controlled and frequently repeated training sessions also contribute
to the reproducibility of findings from manual examinations.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: Chiropractic techniques are of particular importance for
the examination of the cervical spine. The aim of this study was
to assess interexaminer reliability of examination techniques of
the cervical spine in subjects with and without musculoskeletal distortions
of the neck. The interrater method was used with five independent
examiners. METHOD: Twenty patients suffering from neck diseases and
20 asymptomatic subjects of similar age and gender were randomized
and assessed by five examiners blind to patient histories. Statistical
analysis was carried out using multiple logistic regression and the
calculation of kappa. RESULTS: Compared to asymptomatic subjects,
patients experienced pain significantly often when pressure was applied
to the cervical zygapophysial joints and the superficial neck muscles (p < or = 0.05 and p < or = 0.01). In addition, segmental function
tests induced kinesialgia significantly more often in patients than in asymptomatic subjects (p < or = 0.05 and p < or = 0.01). A significant
relationship was not found between the patient's health status and
the findings from muscle palpation and functional examination of
the motion segments. The assessment of agreement within examiners
beyond chance had to be calculated, aside from for few exceptions, little to moderate (0.2 < kappa < or = 0.6). CONCLUSIONS: Chiropractic
techniques are an essential part of every examination of the cervical
spine. The clinical impact has not been scientifically established
until up to now. Based on our findings and literature, we conclude
that interexaminer reliability of manual diagnosis in the examination
of the cervical spine should be improved by standardizing the examination
process and setting guidelines for documentation and evaluation criteria.
Controlled and frequently repeated training sessions also contribute
to the reproducibility of findings from manual examinations.
the examination of the cervical spine. The aim of this study was
to assess interexaminer reliability of examination techniques of
the cervical spine in subjects with and without musculoskeletal distortions
of the neck. The interrater method was used with five independent
examiners. METHOD: Twenty patients suffering from neck diseases and
20 asymptomatic subjects of similar age and gender were randomized
and assessed by five examiners blind to patient histories. Statistical
analysis was carried out using multiple logistic regression and the
calculation of kappa. RESULTS: Compared to asymptomatic subjects,
patients experienced pain significantly often when pressure was applied
to the cervical zygapophysial joints and the superficial neck muscles (p < or = 0.05 and p < or = 0.01). In addition, segmental function
tests induced kinesialgia significantly more often in patients than in asymptomatic subjects (p < or = 0.05 and p < or = 0.01). A significant
relationship was not found between the patient's health status and
the findings from muscle palpation and functional examination of
the motion segments. The assessment of agreement within examiners
beyond chance had to be calculated, aside from for few exceptions, little to moderate (0.2 < kappa < or = 0.6). CONCLUSIONS: Chiropractic
techniques are an essential part of every examination of the cervical
spine. The clinical impact has not been scientifically established
until up to now. Based on our findings and literature, we conclude
that interexaminer reliability of manual diagnosis in the examination
of the cervical spine should be improved by standardizing the examination
process and setting guidelines for documentation and evaluation criteria.
Controlled and frequently repeated training sessions also contribute
to the reproducibility of findings from manual examinations.
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.