February 4th, 2010 / No Comments » / by Meyer SA, Gandhi CD, Johnson DM, Winn HR, Patel AB
Outcomes of Carotid Artery Stenting in High-Risk Patients With Carotid Artery Stenosis: A Single Neurovascular Center Retrospective Review of 101 Consecutive Patients.
Neurosurgery. 2010 Jan 28;
Authors: Meyer SA, Gandhi CD, Johnson DM, Winn HR, Patel AB
OBJECTIVE: Various large studies show that carotid artery angioplasty and carotid artery stenting (CAS) offer a viable alternative to carotid endarterectomy for symptomatic and asymptomatic patients. However, more recent reports suggest that the complication rates associated with CAS may be higher than previously documented. We evaluated the safety and efficacy of CAS in high surgical risk patients in a single neurovascular center retrospective review to determine whether differences in our patient sample compared with those of published series. METHODS: An institutional review board-approved retrospective review of the clinical variables and treatment outcomes of 101 consecutive patients (109 stents) from July 2001 to March 2007 with carotid stenosis were analyzed. Both symptomatic and asymptomatic stenoses were studied in high surgical risk patients as defined by the SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High-Risk for Endarterectomy) trial. Specifically, those patients with clinically significant cardiac disease (congestive heart failure, abnormal stress test, or need for open-heart surgery), severe pulmonary disease, contralateral carotid occlusion, contralateral laryngeal nerve palsy, recurrent stenosis after carotid endarterectomy, previous radical neck surgery, or radiation therapy to the neck, and an age older than 80. RESULTS: Seventy-four percent of the patients were symptomatic (n = 81), and the mean stenosis in symptomatic patients was 83%. Reasons for stenting included cardiac/pulmonary/medical risk (60%), contralateral internal carotid artery occlusion (8%), recurrent stenosis after carotid endarterectomy (11%), carotid dissection (6%), age older than 80 (7%), previous radical neck surgery (7%), and previous neck radiation (1%). Stent deployment was achieved in 108 of 109 vessels (99%). Distal embolic protection devices were used in 72% of cases treated. The overall rate of in-hospital adverse events (transient ischemic attack, intracranial hemorrhage, minor stroke, major stroke, myocardial infarction, and death) was 8.3% (9 of 109). Of these events, 2 patients (1.8%) experienced a hemispheric transient ischemic attack (neurological symptoms that resolved within 24 hours), 2 others (1.8%) had transiently symptomatic acute reperfusion syndrome. The 30-day stroke/death/myocardial infarction risk was 4.6% (n = 5). Of these patients, 3 had minor strokes (2.7%) defined as a modified Rankin Scale score less than 3 at 1-year follow-up, 1 had a major stroke (0.9%) defined as a modified Rankin Scale score of 3 or more at 1-year follow-up, and 1 patient died after a periprocedural myocardial infarction (0.9%). CONCLUSION: CAS can be performed with a low 30-day complication rate, even with a higher percentage of symptomatic lesions in our series when compared with other published series. These results support the use of CAS in high surgical risk patients with both significant symptomatic and asymptomatic carotid artery disease.
PMID: 20124935 [PubMed - as supplied by publisher]
Posted in: Neurosurgery
February 4th, 2010 / No Comments » / by Meyer SA, Gandhi CD, Johnson DM, Winn HR, Patel AB
Outcomes of Carotid Artery Stenting in High-Risk Patients With Carotid Artery Stenosis: A Single Neurovascular Center Retrospective Review of 101 Consecutive Patients.
Neurosurgery. 2010 Jan 28;
Authors: Meyer SA, Gandhi CD, Johnson DM, Winn HR, Patel AB
OBJECTIVE: Various large studies show that carotid artery angioplasty and carotid artery stenting (CAS) offer a viable alternative to carotid endarterectomy for symptomatic and asymptomatic patients. However, more recent reports suggest that the complication rates associated with CAS may be higher than previously documented. We evaluated the safety and efficacy of CAS in high surgical risk patients in a single neurovascular center retrospective review to determine whether differences in our patient sample compared with those of published series. METHODS: An institutional review board-approved retrospective review of the clinical variables and treatment outcomes of 101 consecutive patients (109 stents) from July 2001 to March 2007 with carotid stenosis were analyzed. Both symptomatic and asymptomatic stenoses were studied in high surgical risk patients as defined by the SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High-Risk for Endarterectomy) trial. Specifically, those patients with clinically significant cardiac disease (congestive heart failure, abnormal stress test, or need for open-heart surgery), severe pulmonary disease, contralateral carotid occlusion, contralateral laryngeal nerve palsy, recurrent stenosis after carotid endarterectomy, previous radical neck surgery, or radiation therapy to the neck, and an age older than 80. RESULTS: Seventy-four percent of the patients were symptomatic (n = 81), and the mean stenosis in symptomatic patients was 83%. Reasons for stenting included cardiac/pulmonary/medical risk (60%), contralateral internal carotid artery occlusion (8%), recurrent stenosis after carotid endarterectomy (11%), carotid dissection (6%), age older than 80 (7%), previous radical neck surgery (7%), and previous neck radiation (1%). Stent deployment was achieved in 108 of 109 vessels (99%). Distal embolic protection devices were used in 72% of cases treated. The overall rate of in-hospital adverse events (transient ischemic attack, intracranial hemorrhage, minor stroke, major stroke, myocardial infarction, and death) was 8.3% (9 of 109). Of these events, 2 patients (1.8%) experienced a hemispheric transient ischemic attack (neurological symptoms that resolved within 24 hours), 2 others (1.8%) had transiently symptomatic acute reperfusion syndrome. The 30-day stroke/death/myocardial infarction risk was 4.6% (n = 5). Of these patients, 3 had minor strokes (2.7%) defined as a modified Rankin Scale score less than 3 at 1-year follow-up, 1 had a major stroke (0.9%) defined as a modified Rankin Scale score of 3 or more at 1-year follow-up, and 1 patient died after a periprocedural myocardial infarction (0.9%). CONCLUSION: CAS can be performed with a low 30-day complication rate, even with a higher percentage of symptomatic lesions in our series when compared with other published series. These results support the use of CAS in high surgical risk patients with both significant symptomatic and asymptomatic carotid artery disease.
PMID: 20124935 [PubMed - as supplied by publisher]
Posted in: Uncategorized
February 2nd, 2010 / No Comments » / by Wassmuth R
Cardiac magnetic resonance imaging for myocarditis and nonischemic cardiomyopathies.
Minerva Cardioangiol. 2009 Aug;57(4):511-20
Authors: Wassmuth R
Cardiovascular magnetic resonance (CMR) is the gold standard for quantification of ventricular size, mass and function. Moreover, CMR can differentiate transient and permanent tissue damage. Therefore CMR is clinically useful to differentiate acute myocarditis from infarction. Various CMR markers for acute myocardial inflammation are reviewed. Moreover CMR can differentiate tissue changes in various nonischemic cardiomyopathies. This has a major clinical impact for diagnosis and risk stratification in these patients. Serial monitoring is feasible due to high reproducibility and the lack of radiation. The strengths and pitfalls in CMR imaging of nonischemic cardiomyopathies are reviewed in detail including an overview of the current literature.
PMID: 19763072 [PubMed - indexed for MEDLINE]
Posted in: Minerva Cardioangiol
January 27th, 2010 / No Comments » / by Liu Q, Cao J, Wang ZQ, Bai YS, Lü YM, Huang QL, Zhao WZ, Li J, Jiang LP, Tang WS, Fu BH, Fan FY
Dose estimation by chromosome aberration analysis and micronucleus assays in victims accidentally exposed to (60)Co radiation.
Br J Radiol. 2009 Dec;82(984):1027-32
Authors: Liu Q, Cao J, Wang ZQ, Bai YS, Lü YM, Huang QL, Zhao WZ, Li J, Jiang LP, Tang WS, Fu BH, Fan FY
The objective of this study was to assess the radiation exposure levels in victims of a (60)Co radiation accident using chromosome aberration analysis and the micronucleus assay. Peripheral blood samples were collected from three victims exposed to (60)Co 10 days after the accident and were used for the chromosome aberration and micronucleus assays. After in vitro culture of the lymphocytes, the frequencies of dicentric chromosomes and rings (dic+r) and the numbers of cytokinesis blocking micronuclei (CBMN) in the first mitotic division were determined and used to estimate radiation dosimetry. The Poisson distribution of the frequency of dic+r in lymphocytes was used to assess the uniformity of the exposure to (60)Co radiation. Based on the frequency of dic+r in lymphocytes, estimates of radiation exposure of the three victims were 5.61 Gy (A), 2.48 Gy (B) and 2.68 Gy (C). The values were estimated based on the frequencies of CBMN, which were 5.45 Gy (A), 2.78 Gy (B) and 2.84 Gy (C). The estimated radiation dosimetry demonstrated a critical role in estimating the radiation dose and facilitating an accurate clinical diagnosis. Furthermore, the frequencies of dir+r in victims A and B deviated significantly from a normal Poisson distribution. Chromosome aberration analysis offers a reliable means for estimating biological exposure to radiation. In the present study, the micronucleus assay demonstrated a high correlation with the chromosome aberration analysis in determining the radiation dosimetry 10 days after radiation exposure.
PMID: 19366736 [PubMed - indexed for MEDLINE]
Posted in: Br J Radiol
January 27th, 2010 / No Comments » / by Tomicic V, Fuentealba A, MartÃnez E, Graf J, Batista Borges J
[The basics on mechanical ventilation support in acute respiratory distress syndrome.]
Med Intensiva. 2010 Jan 22;
Authors: Tomicic V, Fuentealba A, Martínez E, Graf J, Batista Borges J
Acute Respiratory Distress Syndrome (ARDS) is understood as an inflammation-induced disruption of the alveolar endothelial-epithelial barrier that results in increased permeability and surfactant dysfunction followed by alveolar flooding and collapse. ARDS management relies on mechanical ventilation. The current challenge is to determine the optimal ventilatory strategies that minimize ventilator-induced lung injury (VILI) while providing a reasonable gas exchange. The data support that a tidal volume between 6-8ml/kg of predicted body weight providing a plateau pressure <30cmH(2)O should be used. High positive end expiratory pressure (PEEP) has not reduced mortality, nevertheless secondary endpoints are improved. The rationale used for high PEEP argues that it prevents cyclic opening and closing of airspaces, probably the major culprit of development of VILI. Chest computed tomography has contributed to our understanding of anatomic-functional distribution patterns in ARDS. Electric impedance tomography is a technique that is radiation-free, but still under development, that allows dynamic monitoring of ventilation distribution at bedside.
PMID: 20097448 [PubMed - as supplied by publisher]
Posted in: Med Intensiva
January 27th, 2010 / No Comments » / by Jacob A, Shah KG, Wu R, Wang P
Ghrelin as a Novel Therapy for Radiation Combined Injury.
Mol Med. 2010 Jan 24;
Authors: Jacob A, Shah KG, Wu R, Wang P
There is a growing concern in the world about the exposure to radiation due to the threat of nuclear terrorism. Acute radiation syndrome or radiation sickness develops after a whole body or a partial body irradiation with a high dose of radiation. In the terrorist radiation exposure scenario, however, radiation victims likely suffer from additional injuries such as trauma, burn, wound, or sepsis. This concern has resulted in the need to study whole-body radiation related injuries to intervene therapeutically if such need arises. Despite advances of our understanding of the pathophysiology of radiation injury, very little information is available on the therapeutic approaches of radiation combined injury. In this review, we describe briefly the pathological consequences of ionizing radiation and provide an overview of the animal models of radiation combined injury. We highlight the combined radiation and sepsis model we recently established and suggest the use of ghrelin, a novel gastrointestinal hormone, as a potential therapy for radiation combined injury.
PMID: 20101281 [PubMed - as supplied by publisher]
Posted in: Mol Med
January 24th, 2010 / No Comments » / by pubmed: acute radiation synd...
[Forensic medical identification of the immediate causes of death from acute radiation disease]
Sud Med Ekspert. 2009 Nov-Dec;52(6):17-9
Authors:
The objective of the present study was to perform retrospective thanatological analysis of reports on acute radiation disease in liquidators of the consequences of the accident at the Chernobyl nuclear power plant. It is shown that hemorrhagic syndrome was the main cause of death among the liquidators exposed to ionizing radiation.
PMID: 20088132 [PubMed - in process]
Posted in: Sud Med Ekspert
January 24th, 2010 / No Comments » / by pubmed: acute radiation synd...
[Forensic medical identification of the immediate causes of death from acute radiation disease]
Sud Med Ekspert. 2009 Nov-Dec;52(6):17-9
Authors:
The objective of the present study was to perform retrospective thanatological analysis of reports on acute radiation disease in liquidators of the consequences of the accident at the Chernobyl nuclear power plant. It is shown that hemorrhagic syndrome was the main cause of death among the liquidators exposed to ionizing radiation.
PMID: 20088132 [PubMed - in process]
Posted in: 5583
January 14th, 2010 / No Comments » / by Gougelet RM, Rea ME, Nicolalde RJ, Geiling JA, Swartz HM
The view from the trenches: part 1-emergency medical response plans and the need for EPR screening.
Health Phys. 2010 Feb;98(2):118-27
Authors: Gougelet RM, Rea ME, Nicolalde RJ, Geiling JA, Swartz HM
Few natural disasters or intentional acts of war or terrorism have the potential for such severe impact upon a population and infrastructure as the intentional detonation of a nuclear device within a major U.S. city. In stark contrast to other disasters or even a "dirty bomb," hundreds of thousands will be affected and potentially exposed to a clinically significant dose of ionizing radiation. This will result in immediate deaths and injuries and subsequently the development of Acute Radiation Syndrome (ARS). Additionally, millions more who are unlikely to develop ARS will seek medical evaluation and treatment, overwhelming the capacity of an already compromised medical system. In this paper, the authors propose that in vivo electron paramagnetic resonance (EPR) dosimetry be utilized to screen large numbers of potentially exposed victims, and that this screening process be incorporated into the medical-surge framework that is currently being implemented across the nation for other catastrophic public health emergencies. The National Incident Management System (NIMS), the National Response Framework (NRF), the Target Capabilities List (TCL), Homeland Security Presidential Directives (HSPD), as well as additional guidance from multiple federal agencies provide a solid framework for this response. The effective screening of potentially-exposed victims directly following a nuclear attack could decrease the number of patients seeking immediate medical care by greater than 90%.
PMID: 20065673 [PubMed - in process]
Posted in: Health Phys
January 14th, 2010 / No Comments » / by Gougelet RM, Rea ME, Nicolalde RJ, Geiling JA, Swartz HM
The view from the trenches: part 1-emergency medical response plans and the need for EPR screening.
Health Phys. 2010 Feb;98(2):118-27
Authors: Gougelet RM, Rea ME, Nicolalde RJ, Geiling JA, Swartz HM
Few natural disasters or intentional acts of war or terrorism have the potential for such severe impact upon a population and infrastructure as the intentional detonation of a nuclear device within a major U.S. city. In stark contrast to other disasters or even a "dirty bomb," hundreds of thousands will be affected and potentially exposed to a clinically significant dose of ionizing radiation. This will result in immediate deaths and injuries and subsequently the development of Acute Radiation Syndrome (ARS). Additionally, millions more who are unlikely to develop ARS will seek medical evaluation and treatment, overwhelming the capacity of an already compromised medical system. In this paper, the authors propose that in vivo electron paramagnetic resonance (EPR) dosimetry be utilized to screen large numbers of potentially exposed victims, and that this screening process be incorporated into the medical-surge framework that is currently being implemented across the nation for other catastrophic public health emergencies. The National Incident Management System (NIMS), the National Response Framework (NRF), the Target Capabilities List (TCL), Homeland Security Presidential Directives (HSPD), as well as additional guidance from multiple federal agencies provide a solid framework for this response. The effective screening of potentially-exposed victims directly following a nuclear attack could decrease the number of patients seeking immediate medical care by greater than 90%.
PMID: 20065673 [PubMed - in process]
Posted in: Health Phys
