31 results on '"Sigel B"'
Search Results
2. Value of intraoperative sonography
- Author
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Hölscher, A. H., Jakimowicz, J. J., Makuuchi, M., Rothmund, M., and Sigel, B.
- Published
- 1990
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3. Oiling of American white pelicans, common loons, and northern gannets in the winter following the Deepwater Horizon (MC252) oil spill
- Author
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Paruk, J. D., primary, Stenhouse, I. J., additional, Sigel, B. J., additional, Adams, E. M., additional, Montevecchi, W. A., additional, Evers, D. C., additional, Gilbert, A. T., additional, Duron, M., additional, Long, D., additional, Hemming, J., additional, and Tuttle, P., additional
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- 2019
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4. Beausite und Bellevue in einem: der Bonstettenpark der Campagne Bellerive in Gwatt am Thunersee
- Author
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Sigel, Brigitt, Sigel, B ( Brigitt ), Freivogel, Thomas, Sigel, Brigitt, Sigel, B ( Brigitt ), and Freivogel, Thomas
- Published
- 2006
5. Value of intraoperative sonography.
- Author
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Hölscher, A., Jakimowicz, J., Makuuchi, M., Rothmund, M., and Sigel, B.
- Abstract
Use of intraoperative ultrasonography during biliary tract surgery offers several advantages. It is highly reliable in detecting and localizing pathology in the common bile duct and papillary area, it provides important information with regard to the anatomy and has a potential for wide application. The use of intraoperative ultrasonography is costeffective and with proper equipment and training the method can be easily learned and performed reliably. It is a valuable diagnostic tool, supporting the surgeon in operative decision making and worth to be recommended as an alternative and even a substitute for intraoperative radiography. We need to abandon often retoric debates on the role and place of intraoperative cholangiography and manometry in biliary surgery, become less dogmatic and more open minded dare to enter the age of technological advances not only in diagnostics but also in surgical techniques.[/p] [ABSTRACT FROM AUTHOR]
- Published
- 1990
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6. DOUBLE-BLIND ULTRASONOGRAPHIC DEMONSTRATION OF MORPHINE-INDUCED SPASM OF THE COMMON BILE DUCT
- Author
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Vieira, Z. G., primary, Duarte, B., additional, Renigers, S. A., additional, Sigel, B., additional, and Zsigmond, E. K., additional
- Published
- 1988
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7. DOUBLE-BLIND ULTRASONOGRAPHIC STUDY OF THE EFFECT OF FIVE ANALGESICS ON THE COMMON BILE DUCT
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Vieira, Z. G., primary, Duarte, B., additional, Renigers, S. A., additional, Sigel, B., additional, and Zsigmond, E. K., additional
- Published
- 1989
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8. Cost-effectiveness of preventive aspirin use and intensive downstaging polypectomy in patients with familial adenomatous polyposis: A microsimulation modeling study.
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Saito E, Mutoh M, Ishikawa H, Kamo K, Fukui K, Hori M, Ito Y, Chen Y, Sigel B, Sekiguchi M, Hemmi O, and Katanoda K
- Subjects
- Humans, Aspirin therapeutic use, Cost-Benefit Analysis, Japan, Adenomatous Polyposis Coli drug therapy, Adenomatous Polyposis Coli surgery, Proctocolectomy, Restorative adverse effects, Proctocolectomy, Restorative methods
- Abstract
Objective: Although there is increasing evidence to suggest the cost-effectiveness of aspirin use to prevent colorectal cancer (CRC) in the general population, no study has assessed cost-effectiveness in patients with familial adenomatous polyposis (FAP), who are at high risk of developing CRC. We examined the cost-effectiveness of preventive use of low-dose aspirin in FAP patients who had undergone polypectomy in comparison with current treatment practice., Design: We developed a microsimulation model that simulates a hypothetical cohort of the Japanese population with FAP for 40 years. Three scenarios were created based on three intervention strategies for comparison with no intervention, namely intensive downstaging polypectomy (IDP) of colorectal polyps at least 5.0 mm in diameter, IDP combined with low-dose aspirin, and total proctocolectomy with ileal pouch-anal anastomosis (IPAA). Cost-effective strategies were identified using a willingness-to-pay threshold of USD 50,000 per QALY gained., Results: Compared with no intervention, all strategies resulted in extended QALYs (21.01-21.43 QALYs per individual) and showed considerably reduced colorectal cancer mortality (23.35-53.62 CRC deaths per 1000 individuals). Based on the willingness-to-pay threshold, IDP with low-dose aspirin was more cost-effective than the other strategies, with an incremental cost-effectiveness ratio of $57 compared with no preventive intervention. These findings were confirmed in both one-way sensitivity analyses and probabilistic sensitivity analyses., Conclusion: This study suggests that the strategy of low-dose aspirin with IDP may be cost-effective compared with IDP-only or IPAA under the national fee schedule of Japan., (© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)
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- 2023
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9. Salt intake reduction using umami substance-incorporated food: a secondary analysis of NHANES 2017-2018 data.
- Author
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Nomura S, Tanaka S, Eguchi A, Kawashima T, Nakamura H, Lwin KS, Yamasaki L, Yoneoka D, Tanoe Y, Adachi M, Hayabuchi H, Koganemaru S, Nishimura T, Sigel B, Uneyama H, and Shibuya K
- Abstract
Objective: Excessive salt intake raises blood pressure and increases the risk of non-communicable diseases (NCD), such as CVD, chronic kidney disease and stomach cancer. Reducing the Na content of food is an important public health measure to control the NCD. This study quantifies the amount of salt reduced by using umami substances, i.e. glutamate, inosinate and guanylate, for adults in the USA., Design: The secondary data analysis was performed using data of the US nationally representative cross-sectional dietary survey, the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Per capita daily salt intake corresponding to the NHANES food groups was calculated in the four hypothetical scenarios of 0 %, 30 %, 60 % and 90 % market share of low-Na foods in the country. The salt reduction rates by using umami substances were estimated based on the previous study results., Setting: The USA., Participants: 4139 individuals aged 20 years and older in the USA., Results: Replacing salt with umami substances could help the US adults reduce salt intake by 7·31-13·53 % (7·50-13·61 % for women and 7·18-13·53 % for men), which is equivalent to 0·61-1·13 g/d (0·54-0·98 g/d for women and 0·69-1·30 g/d for men) without compromising the taste. Approximately, 21·21-26·04 % of the US adults could keep their salt intake below 5 g/d, the WHO's recommendation in the scenario where there is no low-Na product on the market., Conclusions: This study provides essential information that the use of umami substances as a substitute for salt may help reduce the US adults' salt intake.
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- 2023
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10. Changes in the Characteristics and Initial Treatments of Pulmonary Hypertension Between 2008 and 2020 in Japan.
- Author
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Tamura Y, Kumamaru H, Inami T, Matsubara H, Hirata KI, Tsujino I, Suda R, Miyata H, Nishimura S, Sigel B, Takano M, and Tatsumi K
- Abstract
Background: Pulmonary arterial hypertension (PAH) is a rare, progressive disease. The treatment landscape for PAH in Japan has evolved considerably in recent years, but there is limited knowledge of the changes in treatment practices or patient characteristics., Objectives: The aim of this study was to evaluate the changes in characteristics and initial treatments for PAH in Japan over time., Methods: This study used data from the Japan Pulmonary Hypertension Registry (JAPHR) to compare patient characteristics and treatment practices between 2008-2015 (n = 316) and 2016-2020 (n = 315)., Results: The mean ± standard deviation age at diagnosis increased from 47.9 ± 16.7 years in 2008-2015 to 52.7 ± 16.9 years in 2016-2020. The mean pulmonary arterial pressure decreased from 45.4 ± 15.0 to 38.6 ± 13.1 mm Hg. Idiopathic/hereditary PAH was the most common etiology in both periods (50.0% and 51.1%, respectively). The proportion of patients prescribed oral/inhaled combination therapies increased from 47.8% to 57.5%. Oral/inhaled combination therapies were frequently prescribed to patients with congenital heart disease-related PAH (81.8%). There was no significant trend in prescribing practices based on French low-risk criteria: among patients with 0, 1, 2, 3, or 4 criteria, 53.8%, 68.8%, 52.8%, 66.7%, and 39.4% were prescribed oral/inhaled combination therapies, and 0%, 16.7%, 27.0%, 17.3%, and 15.2% were prescribed oral/inhaled monotherapies. Macitentan, tadalafil, selexipag, and epoprostenol were the most frequently prescribed drugs., Conclusions: The severity of PAH decreased over time in Japan. Oral/inhaled combination therapies were generally preferred. Physicians generally prescribed therapies after considering the patients' hemodynamics and clinical severity. (Japan Pulmonary Hypertension Registry [JAPHR]; UMIN000026680)., Competing Interests: This study was funded by a Health Labor Sciences Research Grant, Japan and AMED under grant number JP18lk1601003h0001. The funding body contributed to study design and data collection. Editorial support was funded by Janssen Pharmaceutical. Dr Tamura has received remuneration from Janssen and Daiichi Sankyo; research funds from Mochida; and is affiliated with the Pulmonary Hypertension Center, which is supported by an endowment from Nippon Shinyaku. Dr Kumamaru, Dr Miyata, and Ms Nishimura are affiliated with the Department of Health Quality Assessment at the University of Tokyo, a social collaboration department supported by the National Clinical Database, Johnson & Johnson, and Nipro. Dr Miyata is also affiliated with the Department of Health Policy and Management School of Medicine at Keio University that is conducting joint research with the National Clinical Database. Dr Matsubara has received remuneration from Janssen, Bayer, Pfizer Japan, Nippon Shinyaku, Kaneka Medix, GlaxoSmithKline, United Therapeutics, and Mochida; and research funds from Nippon Shinyaku. Dr Hirata has received remuneration from Takeda and Kowa; commissioned, joint, or physician-led research with Daiichi Sankyo, Janssen, Sysmex, and Terumo; scholarship donations from Merck Sharp & Dohme, Janssen, Abbott, Otsuka, Kowa, Sanofi, Takeda, Toa Eiyo, Nippon Shinyaku, Nippon Boehringer Ingelheim, Nihon Medi-Physics, Novartis, Bayer, Biotronik, and Fujifilm Toyama Chemical; and is affiliated with the Division of Cardiovascular Medicine Department of Internal Medicine, which is supported by endowments from Abbott, Medtronic, and Sysmex. Dr Tsujino has received remuneration from Nippon Shinyaku and Janssen; and is affiliated with the First Department of Medicine, which is supported by endowments from Nippon Shinyaku, Nippon Boehringer Ingelheim, and Mochida. Dr Suda is affiliated with the Department of Respirology, which is supported by endowments from Nippon Shinyaku and Janssen. Dr Tatsumi has received remuneration from Janssen. Mr Sigel and Mr Takano are employees of Janssen Pharmaceutical. Dr Inami has reported that he has no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)
- Published
- 2022
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11. Associations of lifestyle risk factors with overweight or obesity among adolescents: a multicountry analysis.
- Author
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Sultana S, Rahman MM, Sigel B, and Hashizume M
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- Adolescent, Humans, Risk Factors, Tobacco Use, Diet, Exercise, Global Health, Life Style, Overweight epidemiology, Overweight etiology
- Abstract
Background: About 35% of the global burden of disease has roots in adolescence. Health in adolescence is an important determinant of health in adulthood., Objectives: This study aimed to generate risk scores for lifestyle behaviors among adolescents and to estimate the country-specific prevalence of these risk scores. The study also examined the relations of lifestyle risk scores with overweight or obesity among adolescents., Methods: We used the most recent data available from 20 nationally representative Global School-based Student Health Surveys. Our analytical sample size was 51,597. The outcome of interest was overweight or obesity. We developed 4 lifestyle risk scores (dietary habits, physical activity, sedentary behavior, and tobacco use), which were used as the exposure variables in this study. Multilevel logistic regression models were used to estimate adjusted ORs with 95% CIs., Results: In total, 18.2% of the participants were overweight or obese. Across countries, the percentage of adolescents with unhealthy dietary habits ranged from 76.7% (the Cook Islands) to 94.2% (Timor-Leste), physical inactivity ranged from 47.5% (Bangladesh) to 90.1% (the Philippines), and sedentary behavior ranged from 34.5% (Nepal) to 88.2% (Kuwait). Girls engaged in less physical activity than did boys. Increased odds of overweight or obesity were found among participants with high risk scores for physical inactivity (OR: 1.19; 95% CI: 1.11, 1.27) and for unhealthy sedentary behavior (OR: 1.25; 95% CI: 1.16, 1.35) compared with participants with low risk scores. Girls with high tobacco risk scores had higher odds (OR: 1.30; 95% CI: 1.02, 1.65) of overweight or obesity than did girls with low risk scores for tobacco use, whereas there were no significant differences in risk in boys., Conclusions: Unhealthy lifestyle behaviors were quite prevalent among adolescents, and higher lifestyle risk scores increased the risk of overweight or obesity., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Society for Nutrition.)
- Published
- 2021
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12. Increasing hepatitis virus screening uptake at worksites in Japan using nudge theory and full subsidies.
- Author
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Fukuyoshi J, Korenaga M, Yoshii Y, Hong L, Kashihara S, Sigel B, and Takebayashi T
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- Adult, Aged, Aged, 80 and over, Female, Humans, Japan, Male, Mass Screening economics, Middle Aged, Cost-Benefit Analysis, Hepatitis Viruses isolation & purification, Mass Screening instrumentation, Workplace
- Abstract
Background: Despite the importance of hepatitis screening for decreasing liver cancer mortality, screening rates remain low in Japan. Previous studies show that full subsidies increase screening uptake, but full subsidies are costly and difficult to implement in low-resource settings. Alternatively, applying nudge theory to the message design could increase screening at lower costs. This study examined the effects of both methods in increasing hepatitis virus screening rates at worksites., Methods: 1496 employees from a Japanese transportation company received client reminders for an optional hepatitis virus screening before their general health checkups. Groups A and B received a client reminder designed based on the principles of "Easy" and "Attractive," while the control group received a client reminder not developed using nudge theory. Additionally, hepatitis virus screening was offered to the control group and group A for a co-payment of JPY 612, but was fully subsidized for group B. The hepatitis virus screening rates among the groups were compared using a Chi-square test with Bonferroni correction, and the risk ratios of group A and group B to the control group were also calculated. To adjust for unobservable heterogeneity per cluster, the regression analysis was performed using generalized linear mixed models., Results: The screening rate was 21.2%, 37.1%, and 86.3% for the control group, group A, and group B, respectively. And the risk ratio for group A was 1.75 (95% confidence interval [CI] 1.45-2.12) and that of group B was 4.08 (95% CI 3.44-4.83). The parameters of group A and group B also were significant when estimated using generalized linear mixed models. However, the cost-effectiveness (incremental cost-effectiveness ratio (ICER)) of the nudge-based reminder with the full subsidies was lower than that of only the nudge-based reminder., Conclusions: While fully subsidized screening led to the highest hepatitis screening rates, modifying client reminders using nudge theory significantly increased hepatitis screening uptake at lower costs per person.
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- 2021
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13. Trends in Premature Deaths Among Adults in the United States and Latin America.
- Author
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Chen Y, Freedman ND, Rodriquez EJ, Shiels MS, Napoles AM, Withrow DR, Spillane S, Sigel B, Perez-Stable EJ, and Berrington de González A
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- Adult, Cross-Sectional Studies, Female, Humans, Latin America epidemiology, Male, Middle Aged, United States epidemiology, Young Adult, Mortality, Premature trends
- Abstract
Importance: Premature death rates vary in the United States by race/ethnicity. Despite their socioeconomic disadvantages, US Latino populations have lower premature mortality rates than do US white populations, a phenomenon termed the "Latino or Hispanic paradox.", Objective: To investigate whether there is a broader Latin American paradox by comparing premature mortality rates in the United States according to race/ethnicity with rates in Latin America and Puerto Rico from 2001 to 2015., Design, Setting, and Participants: This descriptive cross-sectional study used mortality data from the World Health Organization Mortality Database. All deaths occurring in individuals aged 20 to 64 years among US Latino, African American, white, and Puerto Rican and 12 other Latin American populations from January 2001 to December 2015 were selected. The data analysis began in October 2018., Exposures: Age, sex, race/ethnicity, and country., Main Outcomes and Measures: All-cause mortality, cause-specific mortality, age-standardized mortality rates (AMSRs), and average annual percentage change in mortality rates during 2001 to 2015., Results: During 2001 to 2015, 22 million deaths (8 million women and 14 million men) occurred among individuals aged 20 to 64 years in the selected populations. Among women, US Latina individuals had the lowest premature mortality rates (ASMR for 2015, 144 deaths per 100 000 population) and US African American women had the highest premature mortality rate (ASMR for 2015, 340 deaths per 100 000 population) of the 16 populations studied. Rates among US white women shifted from the sixth lowest in 2001 (ASMR, 231 deaths per 100 000 population) to the 12th lowest in 2015 (ASMR, 235 deaths per 100 000 population). Among men, Peru had the lowest premature mortality rates (ASMR for 2015, 219 deaths per 100 000 population), and Belize had the highest premature mortality rates (ASMR for 2015, 702 deaths per 100 000 population). White men in the United States shifted from the fifth lowest rates in 2001 (ASMR, 396 deaths per 100 000 population) to the eighth lowest rates in 2015 (ASMR, 394 deaths per 100 000 population). Rates for both women and men decreased in all the populations studied from 2001 to 2015 (average annual percentage change range, 0.4% to 3.8% per year) except among US white populations, for which the rate plateaued (average annual percentage change, 0.02% per year [95% CI, -0.3% to 0.2% per year] for women; -0.2% per year [95% CI, -0.4% to 0.0% per year] for men) and among Nicaraguan men, for whom the rates increased (0.6% per year [95% CI, 0.2% to 1.0% per year]). The populations with the lowest mortality rates in 2015 had lower rates from all major causes, but rates were particularly lower for heart disease (21 deaths per 100 000 population) and cancer (50 deaths per 100 000 population)., Conclusions and Relevance: Premature mortality rates are lower for US Latino populations and several Latin American countries than for US white populations, suggesting that there may be a broader Latin American paradox. This analysis also highlights the high premature mortality rates among US African American populations, especially women, compared with many Latin American populations.
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- 2020
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14. Determining the acuteness and stability of deep venous thrombosis by ultrasonic tissue characterization.
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Kolecki RV, Sigel B, Justin J, Feleppa EJ, Parsons RE, Kitamura H, Machi J, Hayashi J, Taylor P, and McGann L
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- Acute Disease, Chronic Disease, Diagnosis, Differential, Humans, Sensitivity and Specificity, Ultrasonography, Doppler, Color, Thrombophlebitis diagnostic imaging
- Abstract
Purpose: The intent of the study was to determine whether ultrasonic tissue characterization (UTC) could indicate acuteness and stability of deep venous thrombosis (DVT) of the lower extremities., Methods: Thrombi presenting as filling defects on color Doppler imaging in the common or superficial femoral or popliteal veins in 50 extremities in 45 patients with DVT were studied. Acute DVT was less than 4 days duration, and chronic DVT was greater than 21 days duration. UTC analysis of parameters from the normalized power spectrum of backscattered ultrasound signals from venous filling defects was performed. This spectrum approaches a straight line, and its basic parameters, slope, and Y-intercept are related to scatterer size, concentration, and the square of the scatterer-to-medium acoustic impedances. Ten of the DVT extremities were reexamined at 1 week to assess UTC changes that would indicate thrombus instability., Results: Acute DVT (19 of the 50 extremities) could be distinguished from chronic DVT, mainly on the basis of significantly higher intercept values for the acute group, which were 11.6 relative decibels (dBr) higher than those of the chronic DVT group. Discriminant linear analysis of the two parameters indicated a sensitivity of 94.7% and specificity of 90.3% in correctly diagnosing acute DVT. In a small sample of 10 extremities reexamined at 1 week, acute DVT extremities showed a mean 9.4 dBr decrease in intercept values with no significant change in slope., Conclusions: UTC distinguished clinically defined acute from chronic DVT. In a small series of extremities, UTC revealed significant instability of acute thrombi in a selected patient population.
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- 1995
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15. Intimal hyperplasia producing thrombus organization in an experimental venous thrombosis model.
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Sigel B, Swami V, Can A, Parsons RE, Golub RM, Kolecki R, and Kitamura H
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- Animals, Collagen, Disease Models, Animal, Endothelium, Vascular pathology, Hyperplasia, Immunohistochemistry, Muscle, Smooth, Vascular pathology, Swine, Thrombosis pathology, Vascular Diseases pathology, Thrombosis etiology, Tunica Intima pathology, Vascular Diseases complications
- Abstract
Purpose: A venous thrombosis animal model demonstrated similarities between intimal hyperplasia and thrombus organization. This has prompted the evaluation of a hypothesis that intimal hyperplasia may be the mechanism for thrombus organization in veins with normal pressure., Methods: Thrombi were produced in surgically exposed jugular veins of anesthetized, 18 to 20 kg pigs. Thrombosis was induced by a combination of devascularization, electric injury produced by a low amperage, direct current, and permanent partial ligation (50% diameter reduction). Vein segments were harvested at 0, 1, 2, 7, 14, and 60 days and histologically examined for fibrin, red blood cells, platelets, smooth muscle cells, endothelial cells, elastic fibers, and collagen deposits., Results: Forty vein segments in 20 pigs were evaluated. Luminal thrombi with thickened walls developed in all specimens. All luminal thrombi demonstrated partial spontaneous thrombolysis over the period of observation. Intimal thickening consisting primarily of smooth muscle cells by day 2 was apparent and progressed until about 2 weeks, when collagen deposits became prominent within the neointima. The neointima frequently comprised half the cross-sectional area of the veins. Endothelial cells were present in the intima as single cells or as lining for clefts formed within the thickened intima., Conclusions: Smooth muscle cell proliferation with collagen deposition characteristic of intimal hyperplasia seemed to be the mechanism of thrombus organization in the experimental thrombosis model used in this study in which extensive stimulation was used to produce thrombosis.
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- 1994
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16. Age determination of experimental venous thrombi by ultrasonic tissue characterization.
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Parsons RE, Sigel B, Feleppa EJ, Golub RM, Kodama I, Loiacono LA, Justin J, Swami VK, Kimitsuki H, and Rorke M
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- Animals, Disease Models, Animal, Jugular Veins diagnostic imaging, Linear Models, Multivariate Analysis, Swine, Time Factors, Ultrasonography, Thrombophlebitis diagnostic imaging
- Abstract
Purpose: The ability of ultrasonic tissue characterization based on radiofrequency signal processing to detect compositional differences in thrombi of varying ages was evaluated in vivo., Methods: Thrombi were produced in 49 jugular veins of 26 anesthetized 18 to 20 kg pigs by partial ligation and application of direct electric current. Thrombi were imaged 30 minutes after formation and 1, 7, and 14 days later with a color Doppler ultrasound scanner that identified the thrombi, and acquired radio frequency data for ultrasonic tissue characterization analysis. Ultrasonic tissue characterization used two parameters from the normalized power spectrum, slope, and intercept, which are related to scatterer size, scatterer concentration, and acoustic-impedance differences between scatterers and surrounding medium. Previous in vitro studies demonstrated that lower slope and higher intercept values correlated with greater cellularity and more-dense fibrin mesh. Histologic examination was performed for each time period. The values of slope and intercept for each timed observation were compared by a multilinear discriminant analysis., Results: There were no statistical differences between day 0 and day 1. Statistically-significant differences in ultrasonic tissue characterization parameters were seen between all other time intervals with p values < 0.01. Older thrombi tended to demonstrate higher slope and lower intercept values. These ultrasonic tissue characterization changes correlated with a red cell and fibrin-mesh density reduction, which was confirmed by histologic findings and was indicative of partial spontaneous thrombolysis. The degree of spontaneous thrombolysis provides an estimate of the age of thrombi., Conclusion: Ultrasonic tissue characterization is capable of distinguishing age differences in thrombi in an animal model and has the potential for noninvasive application in clinical diagnosis.
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- 1993
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17. Development of surgery for hepatocellular carcinoma using operative ultrasound.
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Sigel B
- Subjects
- Humans, Liver diagnostic imaging, Liver surgery, Surgical Procedures, Operative methods, Ultrasonic Therapy, Ultrasonography, Carcinoma, Hepatocellular diagnostic imaging, Carcinoma, Hepatocellular surgery, Liver Neoplasms diagnostic imaging, Liver Neoplasms surgery
- Published
- 1992
18. Variable ultrasound echogenicity in flowing blood.
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Sigel B, Machi J, Beitler JC, Justin JR, and Coelho JC
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- Animals, Dogs, Portal Vein physiology, Vena Cava, Inferior physiology, Regional Blood Flow, Ultrasonics
- Abstract
Real-time ultrasound imaging of large abdominal veins revealed bloodstream echogenicity of variable intensity. This variability is largely due to the entrance and persistance of tributary blood currents that show different echogenicity. Red cell aggregation is probably an important cause of bloodstream echoes and their variable intensity.
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- 1982
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19. The significance for morbidity and mortality of Doppler-absent pedal pulses.
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Felix WR Jr, Sigel B, and Gunther L
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- Amputation, Surgical, Arterial Occlusive Diseases epidemiology, Arterial Occlusive Diseases mortality, Follow-Up Studies, Gangrene, Humans, Leg pathology, Muscular Atrophy diagnosis, Prognosis, Risk, Time Factors, Arterial Occlusive Diseases diagnosis, Foot blood supply, Pulse, Rheology
- Abstract
The 1-month prognosis of 91 limbs with a pulseless foot in 49 patients was determined and related to elements of the physical examination, including Doppler ultrasonography. The risk factors that could predict loss of limb and death in this group of patients were determined. Gangrene and atrophy coupled with absent ultrasound signals predicted a 75% risk of loss of limb; this occurred despite attempted surgical intervention. Absence of Doppler signals in both ankle arteries was the strongest risk factor for predicting death. This is probably because ultrasound signals are absent only when arterial disease is far advanced. We conclude that Doppler ultrasound examination of the pulseless foot yields useful prognostic information relative to the fate of the limb and the patient who possesses such a limb.
- Published
- 1987
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20. The role of imaging ultrasound during pancreatic surgery.
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Sigel B, Machi J, Ramos JR, Duarte B, and Donahue PE
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- Abscess surgery, Humans, Pancreatic Pseudocyst surgery, Adenocarcinoma surgery, Adenoma, Islet Cell surgery, Intraoperative Care, Pancreatic Neoplasms surgery, Pancreatitis surgery, Ultrasonography
- Abstract
Real-time ultrasound imaging was employed at 122 operations for the complications of pancreatitis, adenocarcinoma, and islet cell tumors. Ultrasound was found to be useful in 69% of the operations for pancreatitis and 66% of the operations for tumor. Assistance was provided in diagnosis or definition of pathology. Help in diagnosis consisted in detecting conditions that were not found on preoperative testing or at exploration and excluding conditions that were suspected on the basis of previous diagnostic studies or findings at operation. Better definition of pathology was provided by precise localization of structures, assessment of their size and surrounding anatomy, and distinction of tissue features that helped to recognize their identity. Ultrasound was usually more helpful in defining pathology than in diagnosis. Ultrasound enabled early orientation to important landmarks, reduced the need for contrast x-ray studies, and yielded unique information about the etiology of abnormalities. Although ultrasound has a slow learning curve, we believe that its use during pancreatic operations can significantly aid the surgeon and we recommend its wider application in surgical practice.
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- 1984
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21. Operative ultrasonography for lung cancer surgery.
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Machi J, Hayashida R, Kurohiji T, Nishimura Y, Edakuni S, Yamashita Y, Takeda J, Kakegawa T, and Sigel B
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- Adult, Aged, Aged, 80 and over, Carcinoma pathology, Carcinoma secondary, Cardiovascular System pathology, Female, Humans, Intraoperative Period, Liver Neoplasms diagnosis, Liver Neoplasms secondary, Lung Neoplasms diagnosis, Lung Neoplasms pathology, Lymphatic Metastasis diagnosis, Male, Middle Aged, Carcinoma surgery, Lung Neoplasms surgery, Ultrasonography
- Abstract
During 60 operations for lung cancer, high-resolution (7.5 MHz) operative ultrasonography was performed to evaluate direct cardiovascular invasion of tumor (24 operations), lymph node metastasis (30 operations), liver metastasis (13 operations). Immediately after thoracotomy or sternotomy but before tissue dissection, operative scanning enabled delineation and evaluation of the evaluation of the vessels and heart (atrium) behind or within the tumor and detection of regional lymph nodes. The accuracy of operative ultrasound in diagnosing the presence or the extent of cardiovascular invasion was 91.7% (22 of 24 operations), which was significantly (p less than 0.02) higher than preoperative studies (62.5%), including computed tomography and angiography. Of the 24 surgical procedures, 23 were consistent with operations proposed on the basis of operative ultrasound findings, whereas only 16 were consistent with preoperatively proposed (p less than 0.01). Operative ultrasound provided the capability of depicting lymph nodes as small as 3 mm. More lymph nodes (8.0 +/- 1.84 nodes per cancer) were detected with operative ultrasound than with computed tomography (4.8 +/- 1.56 nodes) (p less than 0.001); however, the sensitivity and specificity of operative ultrasound in determining lymph node metastasis were 82.4% and 67.3%, respectively. No liver metastasis was identified. The information provided by operative ultrasound regarding cardiovascular invasion and lymph node and liver metastasis was considered helpful in selecting the type of surgical procedure an in avoiding unnecessary tissue dissection.
- Published
- 1989
22. The epidemiology of lower extremity deep venous thrombosis in surgical patients.
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Sigel B, Ipsen J, and Felix WR Jr
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- Adult, Age Factors, Analysis of Variance, Body Height, Body Weight, Ethnicity, Female, Humans, Male, Medical History Taking, Middle Aged, Physical Examination, Prognosis, Prospective Studies, Pulmonary Embolism complications, Sex Factors, Smoking, Thrombophlebitis complications, Ultrasonography, Leg, Postoperative Complications epidemiology, Thrombophlebitis epidemiology
- Published
- 1974
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23. The fate of unrepaired minor technical defects detected by intraoperative ultrasonography during carotid endarterectomy.
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Sawchuk AP, Flanigan DP, Machi J, Schuler JJ, and Sigel B
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- Actuarial Analysis, Carotid Arteries surgery, Carotid Artery Diseases diagnosis, Carotid Artery Diseases surgery, Constriction, Pathologic diagnosis, Constriction, Pathologic surgery, Follow-Up Studies, Humans, Recurrence, Time Factors, Carotid Arteries pathology, Endarterectomy, Intraoperative Care, Ultrasonography methods
- Abstract
This report describes the natural history of unrepaired minor technical defects detected by intraoperative B-mode ultrasonography during carotid endarterectomy. Intraoperative ultrasonography was used to assess the technical adequacy of 80 carotid endarterectomies. Sixty-two arteries were normal on intraoperative ultrasound examination, whereas the remaining 18 arteries had a total of 21 minor residual technical defects. The 21 minor defects consisted of four internal carotid artery lesions, nine common carotid artery lesions, and eight external carotid artery lesions, 19 had 1 to 3 mm intimal flaps, and two had small stenoses. Sixteen of the 19 intimal flaps resolved before the first postoperative ultrasound study. These arteries had normal examination results, which indicated that these intimal flaps had healed. The two stenoses detected intraoperatively could not be detected by postoperative carotid duplex scanning at 1 month follow-up. No statistically significant relationship was found between the presence of a minor residual defect on intraoperative ultrasonography and the subsequent development of recurrent stenosis or occlusion in any of the arteries assessed. These data suggest that certain minor technical defects in the carotid artery that were detected by intraoperative ultrasonography are benign and may not require repeat exploration of the carotid artery for repair.
- Published
- 1989
- Full Text
- View/download PDF
24. Deterioration of venous function in normal lower extremities during daily activity.
- Author
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Bishara RA, Sigel B, Rocco K, Socha E, Schuler JJ, and Flanigan DP
- Subjects
- Adult, Female, Humans, Middle Aged, Plethysmography methods, Regional Blood Flow, Time Factors, Ultrasonics, Veins physiology, Venous Pressure, Leg blood supply
- Abstract
The change in venous function during the course of the day was studied noninvasively in 50 normal lower extremities of 25 physically active normal subjects. Venous refilling time, measured by photoplethysmography, was significantly shorter (p less than 0.0001), and venous capacitance, measured by impedance plethysmography, was significantly reduced (p less than 0.04) after 5 hours or more of daily activities performed in the upright position. Abnormally short venous refilling time (less than 18 seconds) developed in 21% of the extremities, which had a normal venous refilling time earlier in the same day. Lower extremity symptoms of ache, pain, or swelling were reported more frequently in extremities that developed an abnormal venous refilling time. There was a trend toward a greater change in venous refilling time during the day in symptomatic lower extremities than in asymptomatic limbs (p = 0.07).
- Published
- 1986
- Full Text
- View/download PDF
25. Detection of vascular defects during operation by imaging ultrasound.
- Author
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Sigel B, Coelho JC, Flanigan DP, Schuler JJ, Machi J, and Beitler JC
- Subjects
- Humans, Intraoperative Complications diagnosis, Intraoperative Period, Vascular Diseases diagnosis, Ultrasonography, Vascular Surgical Procedures methods
- Abstract
Real-time high resolution ultrasound imaging was employed during reconstructive vascular operation in 165 patients. The purpose of this diagnostic procedure was to detect unrecognized strictures, thrombi, and intimal flaps in order to permit their surgical correction at the primary operation. Defects were discovered in 48 patients (29%). In 34 patients (21%), because of size and location, defects were not considered sufficiently significant to warrant re-exploration. In 14 patients (8%), ultrasound revealed defects that prompted immediate re-exploration. Patients with ultrasound defects considered to be insignificant did as well as patients with no demonstrable defects. In the 14 patients who were re-explored, 12 had major defects that were corrected. These 12 patients also did well after operation. In two of the 14 patients, defects could not be found at re-exploration. Both these patients experienced early thrombosis of bypass grafts. In 56 patients, ultrasound was compared with arteriography at the same operation. The accuracy of operative ultrasound and operative arteriography was 96% and 85%, respectively. Operative ultrasound is more accurate, simpler and safer than arteriography and may be the preferred method for detection of vascular defects at reconstructive surgery.
- Published
- 1982
- Full Text
- View/download PDF
26. Venous thrombosis in surgical patients diagnosed by clinical and Doppler ultrasound techniques.
- Author
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Sigel B, Ipsen J, and Felix WR Jr
- Subjects
- Autopsy, Blood Flow Velocity, Female, Hospitalization, Humans, Leg anatomy & histology, Leg blood supply, Methods, Phlebography, Postoperative Complications diagnosis, Preoperative Care, Time Factors, Surgical Procedures, Operative, Thrombophlebitis diagnosis, Ultrasonography
- Published
- 1972
27. Resection of the Superior Mesenteric Vein and Replacement with a Venous Autograft During Pancreaticoduodenectomy: Case Report.
- Author
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Sigel B, Bassett JG, Cooper DR, and Dunn MR
- Published
- 1965
- Full Text
- View/download PDF
28. Clinical investigation of the portacaval shunt. IV. A report of early survival from the emergency operation.
- Author
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Edmondson HT, Jackson FC, Juler GL, Sigel B, and Perrin EB
- Subjects
- Adult, Aged, Alcoholism complications, Blood Transfusion, Esophageal and Gastric Varices etiology, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage surgery, Humans, Male, Middle Aged, Postoperative Complications mortality, Tampons, Surgical, Therapeutic Irrigation, Time Factors, Vasopressins therapeutic use, Esophageal and Gastric Varices surgery, Liver Cirrhosis complications, Portacaval Shunt, Surgical mortality
- Published
- 1971
- Full Text
- View/download PDF
29. Tracheal fenestration: a critical evaluation.
- Author
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WOLCOTT MW, KIERNAN TJ, SIGEL B, and BAUM GL
- Subjects
- Humans, Emphysema, Pulmonary Emphysema surgery, Pulmonary Surgical Procedures, Trachea surgery
- Published
- 1961
- Full Text
- View/download PDF
30. Persistence of acinar zone function in liver autotransplants with totally reversed blood supply.
- Author
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Sigel B, Baldia LB, and Dunn MR
- Subjects
- Animals, Atrophy, Carotid Arteries surgery, Dogs, Glycogen metabolism, Jugular Veins surgery, Lipid Metabolism, Liver cytology, Liver physiology, Liver Regeneration, Methenamine, Transplantation, Autologous, Liver Circulation, Liver Transplantation, Regional Blood Flow
- Published
- 1967
- Full Text
- View/download PDF
31. Effect of blood flow reversal in liver autotransplants upon the site of hepatocyte regeneration.
- Author
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Sigel B, Baldia LB, Brightman SA, Dunn MR, and Price RI
- Subjects
- Animals, Autoradiography, Biopsy, Carotid Arteries surgery, DNA biosynthesis, Dogs, Female, Histological Techniques, Jugular Veins surgery, Liver cytology, Liver pathology, Male, Neck surgery, Necrosis, Portal Vein cytology, Portal Vein surgery, Thymidine metabolism, Transplantation, Autologous, Tritium, Liver Circulation physiology, Liver Regeneration, Liver Transplantation
- Abstract
We studied the role of the direction of intrahepatic blood flow upon the location of hepatocyte formation in regenerating liver. Single liver lobes in the dog were autotransplanted to the region of the neck with the blood supply reestablished in a manner to perfuse the hepatic lobule from portal tract to central vein or, in a reverse direction, from central vein to portal tract. Partial resection of the nontransplanted liver was later performed to induce regeneration in the grafts by humoral means. Tritiated thymidine was administered, and radioautographs were prepared from excised graft and nontransplanted liver. In the "straight" blood flow grafts, as well as in all nontransplanted livers, labeled hepatocytes indicating DNA synthesis were found predominantly in the vicinity of the portal tracts. In the "reverse" blood flow grafts, labeled hepatocytes were more prevalent about the central veins. Thus, the localization of hepatocyte formation in the lobule during active liver regeneration cannot be attributed to an inherently greater capacity of periportal liver cells to divide but is probably related to their preferential exposure to blood constituent changes (humoral mechanisms). Hepatocyte regeneration in the presence of abnormal directional circulation might lead to lobular disorganization resulting in consequent biochemical aberrations despite the formation of new cells.
- Published
- 1968
- Full Text
- View/download PDF
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