32 results on '"JOEL A WIRTH"'
Search Results
2. Pulmonary hypertension subjects exhibit right ventricular transient exertional dilation during supine exercise stress echocardiography
- Author
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Dennis Atherton, Melkon Hacobian, David Rancourt, Mylan Cohen, Rama El-Yafawi, and Joel A. Wirth
- Subjects
lcsh:RC705-779 ,Pulmonary and Respiratory Medicine ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Supine position ,exercise ,Screening test ,diagnosis ,business.industry ,lcsh:Diseases of the respiratory system ,medicine.disease ,Pulmonary hypertension ,Pathophysiology ,High morbidity ,lcsh:RC666-701 ,pulmonary arterial hypertension ,Internal medicine ,Cardiology ,echocardiography ,Medicine ,Dilation (morphology) ,Exercise stress echocardiography ,business ,pathophysiology ,Research Article - Abstract
Pulmonary hypertension is a condition with high morbidity and mortality. Resting transthoracic echocardiography is a pivotal diagnostic and screening test for pulmonary hypertension. The role of exercise stress echocardiography in the diagnosis of pulmonary hypertension is not well-established. We studied right ventricular size changes during exercise using exercise stress echocardiography to assess differences between normal and pulmonary hypertension patients and evaluate test safety, feasibility, and reproducibility. Healthy control and pulmonary hypertension patients performed recumbent exercise using a bicycle ergometer. Experienced echocardiography sonographers recorded the following resting and peak exercise right ventricular parameters using the apical four chamber view: end-diastolic area; end-systolic area; mid-diameter; basal diameter; and longitudinal diameter. Two cardiologists masked to clinical information subsequently analyzed the recordings. Parameters with acceptable inter-rater reliability were analyzed for statistical differences between the normal and pulmonary hypertension patient groups and their association with pulmonary hypertension. We enrolled 38 healthy controls and 40 pulmonary hypertension patients. Exercise stress echocardiography testing was found to be safe and feasible. Right ventricular size parameters were all readily obtainable and all had acceptable inter-observer reliability except for right ventricular longitudinal diameter. During exercise, healthy controls demonstrated a decrease in right ventricular end-systolic area, end-diastolic area, mid-diameter, and basal diameter ( P
- Published
- 2019
3. Update on the PHA Pulmonary Hypertension Care Center Network: Early Experience With the National Accreditation Program
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Olivia Onyeador, Joel A. Wirth, and Michael P. Gray
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medicine.medical_specialty ,business.industry ,Care center ,General Medicine ,medicine.disease ,Pulmonary hypertension ,World health ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Internal medicine ,Medicine ,Chronic thromboembolic pulmonary hypertension ,030212 general & internal medicine ,business ,Accreditation ,Rare disease - Abstract
World Health Organization (WHO) Group 1 pulmonary hypertension (PH) (PAH, pulmonary arterial hypertension) and WHO Group 4 PH (CTEPH, chronic thromboembolic pulmonary hypertension) are rare diseases of the pulmonary vascular system characterized by elevated pulmonary artery pressure and pulmonary vascular resistance in the absence of elevated left ventricular filling pressures, which may progress to right heart failure and death.1 Left untreated, the median survival for idiopathic (IPAH) and heritable (HPAH) disease is about 2.8 years from diagnosis.2 Adherence to expert consensus guidelines on PH diagnosis and management is of critical importance to correctly target therapy and improve patient outcomes.
- Published
- 2018
4. A systematic review of transition studies of pulmonary arterial hypertension specific medications
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Wassim H. Fares, Joel A. Wirth, Avraham Sofer, Michael J. Ryan, and Ryan J. Tedford
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Ambrisentan ,Sildenafil ,030204 cardiovascular system & hematology ,pharmacotherapy ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Pharmacotherapy ,pulmonary arterial hypertension ,pulmonary hypertension ,Sitaxentan ,medicine ,Intensive care medicine ,Review Articles ,business.industry ,digestive, oral, and skin physiology ,transition ,medicine.disease ,Pulmonary hypertension ,Tadalafil ,Bosentan ,030228 respiratory system ,chemistry ,pulmonary vascular disease ,business ,medicine.drug ,Treprostinil - Abstract
Pulmonary arterial hypertension (PAH) is a progressive potentially fatal disease. Multiple pharmacologic options are now available, which facilitated transitions between different therapeutic options, although the evidence for such transitions has not been well described. We sought to review the evidence supporting the safety and/or efficacy of transitioning between PAH-specific medications. We performed a systematic review of all published studies in the Medline database between 1 January 2000 and 30 June 2016 reporting on any transition between the currently Food and Drug Administration (FDA)-approved PAH-specific medications. Studies reporting on three or more adult patients published in the English language reporting on transitions between FDA-approved PAH medications were extracted and tabulated. Forty-one studies met the selection criteria, nine of which included less than eight patients (and thus were reported separately in the supplement), for a total of 32 studies. Transitioning from parenteral epoprostenol to parenteral treprostinil appears to be safe and efficacious in patients who have less severe disease and more favorable hemodynamics. Transitioning from a prostacyclin analogue to an oral medication may be successful in patients who have favorable hemodynamics and stable disease. There is conflicting evidence supporting the transition from a parenteral to an inhaled prostacyclin analogue, even in patients who are on background oral therapy. Currently, the only evidence in support of transitioning between oral PDE5 inhibitors is from sildenafil to tadalafil. Patients on higher doses of sildenafil are more likely to fail. In patients with liver abnormalities due to bosentan or sitaxentan, the transition to ambrisentan appears to be safe and can result in clinical improvement. Studies regarding PAH medication transitions are limited. Patients who have less severe disease, better functional status, and are on lower medications doses may be more successful at transitioning.
- Published
- 2017
5. Prostacyclin Therapy for Pulmonary Arterial Hypertension Evolves Again With the Development of an Implantable Delivery System
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Harold I. Palevsky and Joel A. Wirth
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Hypertension, Pulmonary ,MEDLINE ,Prostacyclin ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Epoprostenol ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Internal medicine ,medicine ,Cardiology ,Humans ,Familial Primary Pulmonary Hypertension ,Familial primary pulmonary hypertension ,Delivery system ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Published
- 2017
6. Managing the Patient with Pulmonary Hypertension
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Joel A. Wirth, Maribeth Duncan, and Murali M. Chakinala
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medicine.medical_specialty ,education.field_of_study ,business.industry ,Population ,Specialty ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Pulmonary hypertension ,03 medical and health sciences ,Patient support ,0302 clinical medicine ,Ambulatory care ,Multidisciplinary approach ,Cardiac Care Facilities ,Emergency medicine ,polycyclic compounds ,Medicine ,030212 general & internal medicine ,Disease management (health) ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,education - Abstract
Pulmonary hypertension remains a challenging condition to diagnose and manage. Decentralized care for pulmonary arterial hypertension (PAH) has led to shortcomings in the diagnosis and management of PAH. The Pulmonary Hypertension Association-sponsored Pulmonary Hypertension Care Center program is designed to recognize specialty centers capable of providing multidisciplinary and comprehensive care of PAH. Ideally, Pulmonary Hypertension Care Centers will comanage PAH patients with community-based practitioners and address the growing needs of this emerging population of long-term PAH patients.
- Published
- 2016
7. DOES RIGHT VENTRICULAR EXERCISE STRESS ECHOCARDIOGRAPHY PREDICT SURVIVAL IN PAH?
- Author
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Dennis Atherton, Mylan C. Cohen, Rama El-Yafawi, and Joel A. Wirth
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Exercise stress echocardiography ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,business - Published
- 2020
8. OBSOLETE: Pulmonary Arterial Hypertension
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Joel A. Wirth, K. Stokem, M. Elizabeth Knauft, J.M. Palminteri, and R. El Yafawi
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medicine.medical_specialty ,business.industry ,Epidemiology ,polycyclic compounds ,medicine ,Intensive care medicine ,business ,medicine.disease ,Pulmonary hypertension ,Surgical interventions - Abstract
The field of pulmonary arterial hypertension (PAH) has significantly evolved in recent years through greater understanding of pulmonary vascular pathophysiology and pathobiology with associated development of multiple PAH-specific medications. This article reviews the updated 2013 clinical classification of pulmonary hypertension (PH) along with our current understanding of the epidemiology and genetics of PAH. An approach to the diagnosis of PH and an overview of concepts in the contemporary medical management of PAH are discussed. Surgical interventions for medically refractory PAH, emerging PAH therapies, and new approaches to PAH management are briefly examined.
- Published
- 2018
9. What Is the Role of Oral Prostacyclin Pathway Medications in Pulmonary Arterial Hypertension Management?
- Author
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Rama El Yafawi and Joel A. Wirth
- Subjects
medicine.medical_specialty ,Hypertension, Pulmonary ,Prostacyclin ,030204 cardiovascular system & hematology ,Selexipag ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Acetamides ,Internal Medicine ,medicine ,Humans ,Dosing ,Intensive care medicine ,Antihypertensive Agents ,business.industry ,medicine.disease ,Epoprostenol ,Pulmonary hypertension ,Beraprost ,Clinical trial ,030228 respiratory system ,Tolerability ,chemistry ,Pyrazines ,Anesthesia ,business ,medicine.drug ,Treprostinil - Abstract
Prostacyclin pathway medications have been shown to be highly efficacious in the treatment of pulmonary arterial hypertension (PAH) through multiple prospective clinical trials and more than two decades of clinical experience. The strongest support for prostacyclin use in PAH management is with parenteral administration. Numerous risks and limitations of parenteral delivery systems as well as significant patient burdens restrict widespread parenteral use. Highly effective and tolerable oral prostacyclin preparations to manage PAH have long been sought. We review the development of the oral prostacyclin agents beraprost, treprostinil, and selexipag and including current indications and limitations. Research into new approaches to the management of PAH, expanding indications for existing agents, and development of novel agents are also discussed. Two oral prostacyclin pathway medications, oral treprostinil and selexipag, were FDA approved in December 2013 and 2015, respectively. Current guidelines recommend use of selexipag in WHO-FC II and III (class 1, level B recommendation) and oral treprostinil in WHO-FC III (class 2b, level B recommendation). The use of these medications is challenging due to complexity in dosing and their side effect profiles which limit patient tolerability and acceptance. There is a promising role for oral prostacyclin pathway medications in patients with PAH. Future investigations are underway of alternative dose regimens and transitioning from parenteral therapies in order to improve efficacy and tolerability.
- Published
- 2017
10. [Untitled]
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Jennifer Palminteri, Paul Kim, Sheila Rajan, Joel A. Wirth, and Geeta Godara
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medicine.medical_specialty ,business.industry ,Internal medicine ,Risk stratification ,Cardiology ,medicine ,Acute massive pulmonary embolism ,Radiology ,Critical Care and Intensive Care Medicine ,business - Published
- 2012
11. Successful outcomes following living donor liver transplantation for portopulmonary hypertension
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M. Elizabeth Knauft, Richard B. Freeman, Akmal Sarwar, Fredric D. Gordon, Elizabeth A. Pomfret, Mahesh Bandara, and Joel A. Wirth
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Transplantation ,medicine.medical_specialty ,Portopulmonary hypertension ,Hepatology ,business.industry ,medicine.medical_treatment ,Perioperative ,Liver transplantation ,medicine.disease ,Pulmonary hypertension ,Surgery ,Liver disease ,medicine ,Portal hypertension ,Intensive care medicine ,business ,Contraindication - Abstract
Pulmonary arterial hypertension (PAH) associated with portal hypertension [portopulmonary hypertension (PPHTN)] occurs in 2% to 10% of patients with advanced liver disease and carries a very poor prognosis without treatment. Most hepatic transplantation centers consider moderate to severe PPHTN to be a contraindication to liver transplantation because of the high rate of perioperative complications. We present 3 patients with PPHTN who were managed with intravenous prostacyclin therapy followed by living donor liver transplantation (LDLT). These individuals demonstrated subsequent resolution of their pulmonary hypertension and were weaned off all PAH-specific medical therapy. We present their demographics, clinical courses, and hemodynamics. We discuss the potential indications for LDLT and risks with respect to this patient population. Limitations of the Model for End-Stage Liver Disease scoring system and outcome data for this patient population are reviewed. Future studies should be directed toward better defining indications for LDLT in patients with PPHTN, improving medicosurgical management, and assessing long-term outcomes.
- Published
- 2010
12. Influence of Gender on Rates of Hospitalization, Hospital Course, and Hypercapnea in High-Risk Patients Admitted for Asthma
- Author
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Joel A. Wirth, Carole Holm, and David R. Trawick
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Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,High risk patients ,business.industry ,medicine.medical_treatment ,Respiratory disease ,Retrospective cohort study ,Critical Care and Intensive Care Medicine ,medicine.disease ,Medical icu ,Male patient ,Female patient ,Medicine ,Intubation ,Cardiology and Cardiovascular Medicine ,business ,Asthma - Abstract
Study objectives: To compare the relative numbers andhospital course of men vs women admitted at least twice with asthma orstatus asthmaticus to Yale-New Haven Hospital (YNHH) during the periodfrom 1985 to 1994. Design: A retrospective chartreview. Setting: YNHH. Patients: High-risk men and women (age range, 18 to 50 years) admitted at leasttwice during the study period with the discharge diagnosis of asthma orstatus asthmaticus. Results: Of 561 adult asthmapatients admitted during the study period, 188 were admitted at leasttwice and accounted for 68% of the total asthma admissions. Onehundred three of the 188 patients were randomly selected, and all oftheir asthma admissions were retrospectively reviewed. The 103 patientsaccounted for 382 admissions. Seventy-two percent of these patients and68.6% of the admissions were women. The proportions of each genderrequiring admission to the medical ICU (15.65% women vs 11.67% men)or intubation (8.00% women vs 5.80% men) were not significantlydifferent. Women did exhibit a definite trend toward longer admissions(4.92 days vs 4.04 days; p co 2 levels (p co 2 levels than women (48.73 mm Hg vs41.04 mm Hg; p co 2 levels than their respective femalecounterparts (p Conclusions: At YNHH, 68% of all admissions for asthma in this age group are attributable tohigh-risk patients. High-risk female patients are admitted twice asoften as high-risk male patients and tend to have longer admissions. Once admitted, however, the proportion of men and women requiring themedical MICU or intubation were similar. High-risk male patients onpresentation are consistently more hypercapneic than high-risk femalepatients. Therefore, the mechanisms contributing to the genderdifferences in asthma admissions may include differences in theventilatory response to hypercapnea or in the tolerance to airwayobstruction.
- Published
- 2001
13. Diffuse Pulmonary Arteriovenous Malformations
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Donald A. Redelmeier, Joel A. Wirth, Robert H. Hyland, Robert I. White, Robyn A. Pugash, Yvonne W. Lui, and Marie E. Faughnan
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Respiratory disease ,Arteriovenous malformation ,Retrospective cohort study ,Perioperative ,Critical Care and Intensive Care Medicine ,medicine.disease ,Surgery ,Medicine ,Lung transplantation ,Antibiotic prophylaxis ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Brain abscess - Abstract
Objective: To study the clinical characteristics and prognosis of patients with diffuse pulmonary arteriovenous malformations (AVMs). Design: Retrospective chart review of all patients (n 5 16) with diffuse pulmonary AVMs seen at Yale New Haven Hospital, Johns Hopkins Hospital, and St. Michael’s Hospital. Up-to-date follow-up information was obtained in all living patients. Results: All patients were severely hypoxic. Neurologic complications (stroke or brain abscess) had occurred in 70% of patients by the time of diagnosis. During the follow-up period (mean, 6 years), three patients died and two others developed new neurologic complications. One of the deaths occurred perioperatively during lung transplantation. All patients underwent transcatheter embolotherapy of any large pulmonary AVMs. A selected group underwent pulmonary flow redistribution, a novel technique. Oxygenation did not improve significantly with embolotherapy of the larger AVMs, but there was a small significant improvement in those patients who underwent pulmonary flow redistribution. The majority (85%) of the living patients are currently working or studying full-time. Conclusions: Patients with diffuse pulmonary AVMs are at increased risk of neurologic complications. Transcatheter embolotherapy does not significantly improve the profound hypoxia, but it may reduce the risk of neurologic complications. Antibiotic prophylaxis is recommended for bacteremic procedures to prevent brain abscess. These patients can live for many years and lead productive lives. We do not recommend lung transplantation because survival with disease is difficult to predict and we have observed a perioperative transplant death. (CHEST 2000; 117:31‐38)
- Published
- 2000
14. PH Professional Network: Filtering the Facts: Management of Portopulmonary Hypertension
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Traci Stewart and Joel A. Wirth
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medicine.medical_specialty ,Portopulmonary hypertension ,business.industry ,medicine ,General Medicine ,Intensive care medicine ,medicine.disease ,business - Abstract
Summary of PHPN Symposium Session by Joel Wirth, MD, and Traci Stewart, RN, MSN
- Published
- 2015
15. Embolotherapy of Large Pulmonary Arteriovenous Malformations: Long-Term Results
- Author
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Thomas K. Egglin, Jeffrey Pollak, Kevin W. Dickey, Catherine M. Burdge, Daniel W. Lee, Robert I. White, Pierre B. Fayad, Melvin Rosenblatt, and Joel A. Wirth
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Pulmonary Artery ,Arteriovenous Malformations ,Angina ,Outcome Assessment, Health Care ,Occlusion ,medicine ,Humans ,Embolization ,Aged ,Vascular disease ,business.industry ,Respiratory disease ,Long term results ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Surgery ,medicine.anatomical_structure ,Pulmonary Veins ,Pleurisy ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Artery - Abstract
Background . The purpose of this study was to document the long-term results of transcatheter embolotherapy of large pulmonary arteriovenous malformations (PAVMs). Methods . From a data base of 221 consecutive patients with PAVMs treated by embolotherapy between 1978 and 1995, 45 patients with 52 PAVMs, supplied by feeding arteries 8 mm in diameter or larger, were selected for a retrospective investigation. Results . Of 45 patients with 52 large PAVMs, 38 patients (84%) with 44 PAVMs (85%) were cured by the first embolotherapy (mean follow-up, 4.7 years). Acute periprocedural complications included self-limited pleurisy (31%), angina secondary to air embolus (2%), and paradoxical embolization of a device during deployment (4%). None of these events led to short- or long-term sequelae. Seven patients (16%) had persistence of the PAVM attributable to either recanalization (n = 4) or interim accessory artery growth (n = 3). Two of these patients presented with ischemic stroke several years after the initial treatment. Persistent PAVMs (n = 8) were retreated successfully by a second procedure (n = 7), or a third procedure (n = 1) (mean follow-up, 5.9 and 5.3 years, respectively). Conclusions . Embolotherapy of large PAVMs results in permanent occlusion in an overwhelming majority of patients. Continued patency due to recanalization or accessory artery growth is easily detected and treated.
- Published
- 1997
16. Pulmonary Arteriovenous Malformations: Diagnosis and Transcatheter Embolotherapy
- Author
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Jeffrey Pollak, Joel A. Wirth, and Robert I. White
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Investigational device exemption ,Pulmonary Artery ,Balloon ,Catheterization ,Arteriovenous Malformations ,Aneurysm ,Occlusion ,medicine ,Pulmonary angiography ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,medicine.diagnostic_test ,business.industry ,Angiography ,Prostheses and Implants ,Digital subtraction angiography ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Pulmonary Veins ,Female ,Telangiectasia, Hereditary Hemorrhagic ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
The recent long-term studies from England, France, and the Netherlands, as well as our own, indicate that transcatheter embolotherapy is definitive treatment for PAVM. More recently, Puskas et al have questioned transcatheter embolotherapy as a primary treatment for patients with PAVM (4,56). Their opinion was based on two recurrences among five patients treated with transcatheter embolotherapy. It is not clear why one of the late recurrences in the series by Puskas et al happened, and the other recurrence could have been dut to early deflation of the balloon. Nevertheless, we believe that the collective experience in the larger series reporting on transcatheter embolotherapy of PAVM supports the use of embolotherapy as a primary modality of treatment. Because many patients have bilateral pulmonary malformations and many pulmonary malformations will grow with time, repeated surgical intervention is not ideal therapy. The recurrence rate of 8% reported by Remy et al using coils, and 2% reported by Pollak et al using balloons and coils supports our contention that transcatheter embolotherapy is durable and should be the initial treatment. Also, recurrences are easily retreated by transcatheter embolotherapy with durable results (54). We favor detachable balloons over coils for occluding PAVMs because immediate cross-sectional occlusion of the segmental artery is obtained in a position that preserves the most normal branches. The necessity for repeated introduction of coils, when using the coil method, contributes to longer procedure times with an increased risk of air introduction and, in our experience, a greater risk of postprocedure pleurisy. At the same time, we appreciate that approximately 70% of PAVMs can be occluded equally well with balloons or coils. We also believe that coils have unique advantages over balloons in specific anatomic situations including oversized arteries (where coils are the only option) and for occlusion of the aneurysm of a PAVM. As with all forms of embolotherapy, the interventionalist is best served by having more than one option of treatment, which for PAVM includes both balloons and coils. In summary, PAVMs are effectively managed by means of transcatheter embolotherapy. This therapy has been demonstrated to be safe and durable. Careful technique with modifications depending on the angioarchitecture of the PAVM is required. Patients with PAVMs require follow-up at 1 month and 1 year. While observations documenting serial growth of small PAVMs are somewhat limited, there is published evidence to support their growth with time (35,36). Because of these reports and our unpublished observations, we believe that patients with treated PAVM need long-term follow-up every 5 years to detect growth of small PAVMs that will ultimately reach a size where they may cause paradoxical embolization and stroke (1).
- Published
- 1996
17. Right Ventricular Exercise Echocardiographic Predictors Of Worsened Clinical Status In Patients With Pulmonary Arterial Hypertension
- Author
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Melkon Hacobian, Mylan C. Cohen, Dennis Atherton, and Joel A. Wirth
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,In patient ,business - Published
- 2011
18. The Young Man With The Lung Cavity
- Author
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Joel A. Wirth and Polina K. Inkoulova
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Medicine ,Lung cavity ,business - Published
- 2010
19. Serum Advanced Glycation End-products (AGE) Are Elevated In Patients With Pulmonary Hypertension Associated With Left Ventricular Diastolic Dysfunction But Not Pulmonary Arterial Hypertension
- Author
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Kari E. Roberts, Joel A. Wirth, R El-Bizri, Ioana R. Preston, Mary E. Knauft, Nicholas S. Hill, Anne C. Breggia, and Katherine M. Nichols
- Subjects
medicine.medical_specialty ,Glycation ,business.industry ,Internal medicine ,Cardiology ,medicine ,In patient ,Left ventricular diastolic dysfunction ,business ,medicine.disease ,Pulmonary hypertension - Published
- 2010
20. Continuous Echocardiographic Assessment Of Right Ventricular Function During Recumbent Exercise In Patients With Pulmonary Arterial Hypertension
- Author
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Laurie L. Baker, Katherine M. Nichols, Tina S. Manley, Mylan Cohen, Dennis Atherton, Joel A. Wirth, and Mary E. Knauft
- Subjects
medicine.medical_specialty ,Ventricular function ,business.industry ,Internal medicine ,Cardiology ,medicine ,In patient ,business - Published
- 2010
21. A Cardiac Catheterization Laboratory Pulmonary Hypertension Protocol Significantly Improves the Quality of Clinical Data Available for Medical Decision-Making in Pulmonary Hypertension Patients
- Author
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DC Burkey, Tina S. Manley, Joel A. Wirth, Katherine M. Nichols, and TJ Ryan
- Subjects
Protocol (science) ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,media_common.quotation_subject ,Medical decision making ,medicine.disease ,Pulmonary hypertension ,medicine ,Quality (business) ,business ,Intensive care medicine ,Cardiac catheterization ,media_common - Published
- 2009
22. Osteopontin, a Mediator of Vascular Remodeling, Correlates with Clinical Markers in PAH Patients
- Author
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L Liaw, Tina S. Manley, Joel A. Wirth, A Ng, A Gurney, and Katherine M. Nichols
- Subjects
Mediator ,biology ,business.industry ,Cancer research ,biology.protein ,Medicine ,Osteopontin ,business - Published
- 2009
23. Pulmonary Hypertension Caused by Graves’ Thyrotoxicosis
- Author
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Inaam A. Nakchbandi, Joel A. Wirth, and Silvio E. Inzucchi
- Subjects
Pulmonary and Respiratory Medicine ,endocrine system ,medicine.medical_specialty ,Lung ,endocrine system diseases ,business.industry ,Graves' disease ,Respiratory disease ,Hemodynamics ,Critical Care and Intensive Care Medicine ,medicine.disease ,Pulmonary hypertension ,Pulmonary function testing ,Surgery ,medicine.anatomical_structure ,Internal medicine ,medicine.artery ,Pulmonary artery ,medicine ,Cardiology ,Endothelial dysfunction ,Cardiology and Cardiovascular Medicine ,business - Abstract
We describe a case of pulmonary hypertension, initially thought to be idiopathic, which resolved after treatment of Graves' hyperthyroidism. Results of pulmonary artery catheterization before and after treatment are reported, and the effects of thyrotoxicosis on hemodynamics and pulmonary function are briefly reviewed. Possible mechanisms for development of pulmonary hypertension caused by hyperthyroidism include pulmonary vascular endothelial dysfunction or damage because of autoimmunity or the high cardiac output state, or increased metabolism of intrinsic pulmonary vasodilators.
- Published
- 1999
24. Clinical Timecourse in Acute Massive Pulmonary Embolism Does Not Predict Mortality
- Author
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Joel A. Wirth, Katie Stokem, and Jennifer Palminteri
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Acute massive pulmonary embolism ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,business - Published
- 2014
25. Clinical Worsening in Pulmonary Arterial Hypertension Is Predicted by Right Ventricular End-Systolic Area (RESA) and RV/LV Area Ratio During Recumbent Exercise Stress Echocardiography
- Author
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Julie Hopkins, Mylan C. Cohen, Joel A. Wirth, Geeta Godara, and Dennis Atherton
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,medicine ,Area ratio ,Exercise stress echocardiography ,Systole ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,business ,Recumbent body position - Published
- 2014
26. Airway isocyanate-adducts in asthma induced by exposure to hexamethylene diisocyanate
- Author
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Graham C, Carrie A. Redlich, Meryl H. Karol, Joel A. Wirth, Mark R. Cullen, Carole Holm, and Robert J. Homer
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Biopsy ,Bronchi ,Air Pollutants, Occupational ,Epithelium ,chemistry.chemical_compound ,Occupational Exposure ,medicine ,Humans ,Sensitization ,Cyanates ,Asthma ,business.industry ,Respiratory disease ,Public Health, Environmental and Occupational Health ,respiratory system ,Immunoglobulin E ,medicine.disease ,Isocyanate ,respiratory tract diseases ,Occupational Diseases ,medicine.anatomical_structure ,chemistry ,Immunology ,Hexamethylene diisocyanate ,Airway ,business ,Occupational asthma ,Respiratory tract ,Isocyanates - Abstract
Objectives The clinical features, airway histology, and detection of hexamethylene diisocyanate (HDI) protein adducts in endobronchial biopsies from a patient with HDI asthma are described. Methods Isocyanate asthma was diagnosed by history, methacholine challenge, and workplace HDI challenge. Bronchoscopy was performed 24 h after challenge and immunohistochemical staining was performed. Results Airway biopsies obtained at bronchoscopy demonstrated inflammatory changes typical for asthma, including increased airway eosinophils and T cells. Immunohistochemical staining with specific anti-HDI antibodies demonstrated the presence and localization of HDI adducts in human bronchial biopsies. Conclusion These studies confirm epithelial exposure to HDI following workplace challenge and demonstrate the feasibility of detecting and localizing isocyanate adducts in human lung tissue. Identifying and characterizing the airway macromolecules to which isocyanates bind in vivo are probably crucial to the understanding of how isocyanates cause sensitization and asthma. The ability to detect isocyanate adducts may also help characterize isocyanate exposure patterns and exposure-disease relationships.
- Published
- 1997
27. Vitamin A Chemoprevention of Lung Cancer
- Author
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Carrie A. Redlich, Darryl Carter, W S Blaner, L T Tanoue, A M Van Bennekum, Joel A. Wirth, Mark R. Cullen, and Carole Holm
- Subjects
Oncology ,Vitamin ,medicine.medical_specialty ,Lung ,medicine.diagnostic_test ,business.industry ,Retinol ,respiratory system ,medicine.disease ,respiratory tract diseases ,chemistry.chemical_compound ,Idiopathic pulmonary fibrosis ,Bronchoalveolar lavage ,medicine.anatomical_structure ,chemistry ,Fibrosis ,Internal medicine ,medicine ,Biomarker (medicine) ,business ,Lung cancer - Abstract
This article describes an ongoing short-term biomarker study of Vitamin A in subjects at high risk for lung cancer. Workers exposed to asbestos and cigarettes have a markedly increased risk of developing lung cancer and parenchymal fibrosis. Epidemiologic and experimental studies have shown that dietary vitamin A has significant anticancer and immunomodulatory effects (1-6). However, whether intervention with supplemental vitamin A can reduce the mortality or morbidity from either disease and the mechanisms involved remains unclear. Airway metaplasia on bronchial biopsy and inflammation on bronchoalveolar lavage (BAL) are considered potential markers for the development of lung cancer and parenchymal fibrosis respectively. Our prior clinical studies (see below) have shown an high incidence of both of these lesions in asbestos-exposed subjects, findings consistent with the idea that the processes of inflammation and carcinogenesis are linked. We have hypothesized that 1) the vitamin A intervention may reduce both bronchial metaplasia and lung inflammation, 2) the mechanism of this effect may be through modulation of relevant pulmonary cytokines, growth factors, and/or oncogenes, and 3) local lung vitamin A status may be a key modifiable host determinant or biomarker of susceptibility. We are performing a double-blind placebo controlled 6 month trial of combination 0-carotene and retinol in 50 subjects at high risk for both lung cancer and parenchymal fibrosis to address these hypotheses. This study should provide valuable data on whether vitamin A can modify potential early markers of lung cancer and fibrosis, the mechanisms involved, and the role of local vitamin A. The findings may lead to effective preventive strategies for lung cancer.
- Published
- 1995
28. Evaluation of a Clinical Protocol Using Tenecteplase for Acute Massive Pulmonary Embolism
- Author
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Jennifer Palminteri, Joel A. Wirth, Kathryn Smith, and Anne M. Andrle
- Subjects
Pulmonary and Respiratory Medicine ,business.industry ,Anesthesia ,Medicine ,Acute massive pulmonary embolism ,Tenecteplase ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,business ,medicine.drug - Published
- 2012
29. BICYCLE ERGOMETRY STRESS ECHOCARDIOGRAPHY IN PATIENTS WITH PAH: PROTOCOL FEASIBILITY, SAFETY AND RELIABILITY
- Author
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Mylan C. Cohen, Joel A. Wirth, Melkon Hacobian, and Dennis Atherton
- Subjects
Protocol (science) ,medicine.medical_specialty ,business.industry ,Physical therapy ,Stress Echocardiography ,Medicine ,In patient ,Bicycle ergometer ,Cardiology and Cardiovascular Medicine ,business ,Reliability (statistics) - Published
- 2011
30. Primary pulmonary hypertension in association with human immunodeficiency virus infection. A possible viral etiology for some forms of hypertensive pulmonary arteriopathy
- Author
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Elisabeth Bruder, Stephen A. Mette, Harold I. Palevsky, Giuseppe G. Pietra, Joel A. Wirth, Thomas M. Williams, Anthony Prestipino, and Amy M. Patrick
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,Pathology ,medicine.medical_specialty ,Hypertension, Pulmonary ,Pulmonary Artery ,Polymerase Chain Reaction ,Virus ,Pathogenesis ,Immunoenzyme Techniques ,medicine.artery ,Immunopathology ,Medicine ,Humans ,Pulmonary pathology ,Acquired Immunodeficiency Syndrome ,Lung ,business.industry ,Nucleic Acid Hybridization ,medicine.disease ,Pulmonary hypertension ,Microscopy, Electron ,medicine.anatomical_structure ,Pulmonary artery ,Immunology ,HIV-1 ,Viral disease ,Endothelium, Vascular ,business - Abstract
Recent reports have suggested a possible association between HIV-1 infection and primary pulmonary hypertension (PPH), but most of the patients described to date have either had acquired immunodeficiency syndrome (AIDS) with concurrent lung infections or have administered Factor VIII intravenously for hemophilia. We report three human immunodeficiency virus type 1 (HIV-1)-positive homosexual white males with clinical and hemodynamic diagnoses of PPH. None of the patients had any opportunistic lung infections or other pulmonary pathology, nor were they hemophiliacs. They had no histories of intravenous drug use. Lung tissue from two of the patients revealed hypertensive arteriopathy consistent with PPH and no other pulmonary pathology. Attempts at localizing HIV-1 infection to the vascular endothelium with electron microscopy, immunohistochemistry, DNA in situ hybridization, and polymerase chain reaction techniques did not reveal direct pulmonary artery infection with the virus. These data and the finding of tubuloreticular structures on electron microscopy suggest that HIV-1 may play a role in the pathogenesis of these cases of PPH through mediator release associated with HIV-1 infection rather than by direct endothelial infection.
- Published
- 1992
31. Primary Pulmonary Hypertension and Thyroid Disease
- Author
-
Inaam A. Nakchbandi, Joel A. Wirth, and Silvio E. Inzucchi
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Primary (chemistry) ,business.industry ,Thyroid disease ,Internal medicine ,medicine ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,medicine.disease ,business ,Pulmonary hypertension - Published
- 2000
32. PULMONARY VENO-OCCLUSIVE DISEASE IN ASSOCIATION WITH CREST SYNDROME (LIMITED SCLERODERMA): CLINICAL, RADIOLOGIC, HEMODYNAMIC AND PATHOLOGIC CHARACTERIZATION
- Author
-
Thomas E. Van der Kloot, Linda Allred, Joel A. Wirth, and William T. Mansfield
- Subjects
Pulmonary and Respiratory Medicine ,CREST Syndrome ,medicine.medical_specialty ,Pathology ,business.industry ,medicine ,Hemodynamics ,Radiology ,Pulmonary Veno-Occlusive Disease ,Limited scleroderma ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,business - Published
- 2005
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