251 results on '"Clifford J. Eskey"'
Search Results
2. Quantifying Tumor and Vasculature Deformations during Laryngoscopy
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Xiaotian Wu, David A. Pastel, Rihan Khan, Clifford J. Eskey, Yuan Shi, Michael Sramek, Joseph A. Paydarfar, and Ryan J. Halter
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Microsurgery ,Laryngoscopy ,Neoplasms ,Biomedical Engineering ,Humans ,Pharynx ,Larynx ,Article - Abstract
Retractors and scopes used in head and neck surgery to provide adequate surgical exposure also deform critical structures in the region. Surgeons typically use preoperative imaging to plan and guide their tumor resections, however the large tissue deformation resulting from placement of retractors and scopes reduces the utility of preoperative imaging as a reliable roadmap. We quantify the extent of tumor and vasculature deformation in patients with tumors of the larynx and pharynx undergoing diagnostic laryngoscopy. A mean tumor displacement of 1.02 cm was observed between the patients’ pre- and intra-operative states. Mean vasculature displacement at key bifurcation points was 0.99 cm. Registration to the hyoid bone can reduce tumor displacement to 0.67 cm and improve carotid stem angle deviations but increase overall vasculature displacement. The large deformation results suggest limitations in reliance on preoperative imaging and that using specific landmarks intraoperatively or having more intraoperative information could help to compensate for these deviations and ultimately improve surgical success.
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- 2022
3. Sensitizing brain metastases to stereotactic radiosurgery using hyperbaric oxygen: A proof-of-principle study
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Alan C. Hartford, Gobind S. Gill, Divya Ravi, Tor D. Tosteson, Zhongze Li, Gregory Russo, Clifford J. Eskey, Lesley A. Jarvis, Nathan E. Simmons, Linton T. Evans, Benjamin B. Williams, David J. Gladstone, David W. Roberts, and Jay C. Buckey
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Oncology ,Radiology, Nuclear Medicine and imaging ,Hematology - Abstract
Increased oxygen levels may enhance the radiosensitivity of brain metastases treated with stereotactic radiosurgery (SRS). This project administered hyperbaric oxygen (HBO) prior to SRS to assess feasibility, safety, and response.38 patients were studied, 19 with 25 brain metastases treated with HBO prior to SRS, and 19 historical controls with 27 metastases, matched for histology, GPA, resection status, and lesion size. Outcomes included time from HBO to SRS, quality-of-life (QOL) measures, local control, distant (brain) metastases, radionecrosis, and overall survival.The average time from HBO chamber to SRS beam-on was 8.3 ± 1.7 minutes. Solicited adverse events (AEs) were comparable between HBO and control patients; no grade III or IV serious AEs were observed. Radionecrosis-free survival (RNFS), radionecrosis-free survival before whole-brain radiation therapy (WBRT) (RNBWFS), local recurrence-free survival before WBRT (LRBWFS), distant recurrence-free survival before WBRT (DRBWFS), and overall survival (OS) were not significantly different for HBO patients and controls on Kaplan-Meier analysis, though at 1-year estimated survival rates trended in favor of SRS + HBO: RNFS - 83% vs 60%; RNBWFS - 78% vs 60%; LRBWFS - 95% vs 78%; DRBWFS - 61% vs 57%; and OS - 73% vs 56%. Multivariate Cox models indicated no significant association between HBO treatment and hazards of RN, local or distant recurrence, or mortality; however, these did show statistically significant associations (p 0.05) for: local recurrence with higher volume, radionecrosis with tumor resection, overall survival with resection, and overall survival with higher GPA.Addition of HBO to SRS for brain metastases is feasible without evident decrement in radiation necrosis and other clinical outcomes.
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- 2021
4. Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic
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Ajit S. Puri, Allan Taylor, Huynh Le Vu, Tatemi Todaka, Teddy Y. Wu, Octavio M. Pontes-Neto, Eytan Raz, Pedro Lylyk, Jasmine Johann, Roberta Novakovic, Hormuzdiyar H. Dasenbrock, Francisco Mont’Alverne, Nobuyuki Sakai, Melanie Walker, Hugh Stephen Winters, Ossama Mansour, Yohei Takenobu, Gregory Walker, Miki Fujimura, Saif Bushnaq, Odysseas Kargiotis, Nabeel Herial, Markus A Möhlenbruch, Malveeka Sharma, Hiroshi Tokimura, Maxim Mokin, Jean Raymond, Michael D. Hill, Amal Abou-Hamden, Leonardo Renieri, Serdar Geyik, Yuri Sugiura, Luisa Fonseca, Roberto Crosa, Fabricio O Lima, Ameer E Hassan, Viet Quy Nguyen, Jane G. Morris, Steven W. Hetts, Jawad F. Kirmani, Matthew S. Tenser, Muhammad M. Qureshi, Gianmarco Bernava, Mahmoud H Mohammaden, Verónica V. Olavarría, Jun Deguchi, André Beer-Furlan, Steve M. Cordina, Hiroshi Yamagami, Mohamad Abdalkader, Toshiyuki Fujinaka, Clifford J. Eskey, Rotem Sivan-Hoffmann, Hao Zhang, Anirudh Kulkarni, Brendan Steinfort, Özlem Aykaç, Barbara Voetsch, Alex Brehm, Italo Linfante, Wenguo Huang, Omer Eker, M. Luis Silva, Pascal Jabbour, Lissa Peeling, Mollie McDermott, Pascale Lavoie, Kazutaka Sonoda, Thomas Devlin, Alicia C. Castonguay, Jin Soo Lee, Diogo C Haussen, Dileep R. Yavagal, Thanh N. Nguyen, Umair Rashid, Vasu Saini, Raghid Kikano, Hiroyuki Hashimoto, Masaaki Uno, Saima Ahmad, Artem Kaliaev, Eiji Hagashi, Ajay K. Wakhloo, Romain Bourcier, Ryoo Yamamoto, Jesse M. Thon, Georgios Tsivgoulis, Dorothea Altschul, Achmad Fidaus Sani, Satoshi Yamada, Varsha Singh, David S Liebeskind, Tatsuo Amano, Anchalee Churojana, Juan F. Arenillas, Junichi Iida, Charles C. Matouk, Nobuyuki Ohara, Osama O. Zaidat, Mario Martínez-Galdámez, Chandril Chugh, Don Frei, Vanessa Chalumeau, Brijesh P Mehta, Marios Psychogios, Anna Luisa Kühn, Leticia C Rebello, Xianjin Shang, Hosam Al-Jehani, Hiroki Fukuda, Hong Gee Roh, Gisele Sampaio Silva, Rakesh Khatri, Kenichi Todo, Amal Al Hashmi, Alex Bou Chebl, Sunil A Sheth, Zhongming Qiu, Oriana Cornett, Zhengzhou Yuan, Wazim Izzath, Hesham Masoud, Rodrigo Rivera, Michel Piotin, Vikram Huded, Mamoru Murakami, Mohamed Teleb, Viktor Szeder, Ruchir Shah, Dheeraj Gandhi, John Thornton, Michael Chen, Vitor Mendes Pereira, Nadia Hammami, Alice Ma, Anna M. Cervantes-Arslanian, James E. Siegler, Seby John, Carlos Ynigo Lopez, Mudassir Farooqui, David Ozretić, Takuya Kanamaru, Romain Guile, Daisuke Watanabe, Kosuke Miyake, Alejandro Rodriguez Vasquez, Patrick Nicholson, Yuki Yamamoto, William J. Mack, Naoto Kimura, Simon Mathew John, Robert Fahed, Yuji Matsumaru, David Y. Chung, Rishi Gupta, Ryuhei Kono, Michael Frankel, Victor S. Lopez Rivera, Johanna T. Fifi, Raul G Nogueira, Paolo Machi, Tudor G. Jovin, Jordi Blasco, Emma Griffin, Salvatore Mangiafico, Masafumi Morimoto, Jun Luo, Santiago Ortega-Gutierrez, Monika Killer-Oberpfalzer, Daniel Giansante Abud, Syed I. Hussain, Fawaz Al-Mufti, Yusuke Sugimura, Atilla Özcan Özdemir, Stephan A. Mayer, Sumeet Multani, Adel Alhazzani, Alhamza R Al-Bayati, Michael Kelly, Lee A Birnbaum, Shadi Yaghi, Jeyaraj D Pandian, Ji Man Hong, Junsuke Shimbo, Johnny Ho-Yin Wong, Elena A. Cora, Laura Mechtouff, Pedro S.C. Magalhães, Pablo M. Lavados, Yuichi Murayama, Dong Hun Shin, Simon Nagel, Ken Wong, Jose Antonio Fiorot, Jeremy Payne, Randall C. Edgell, Adrienne Weeks, CarMeN, laboratoire, Department of Neurology [Boston], Harvard Medical School [Boston] (HMS)-Massachusetts General Hospital [Boston], Emory University School of Medicine, Emory University [Atlanta, GA], Boston University School of Medicine (BUSM), Boston University [Boston] (BU), National Hospital Organization Osaka National Hospital [Japon] (NHO Osaka National Hospital), Alexandria University [Alexandrie], Boston Medical Center [Boston, MA, USA] (BMC), Xinqiao Hospital [Chongqing, China] (XH), University of Cape Town, La Sagrada Familia Clinic/Clínica La Sagrada Familia [Buenos Aires, Argentina] (LSFC), Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Hospital General de Fortaleza [Fortaleza, Brazil] (HGF), Nottingham University Hospitals NHS Trust [UK], Kobe City Medical Center General Hospital [Kobe, Hyogo, Japan] (KCMCGH), Azienda Ospedaliero-Universitaria Careggi [Firenze, Toscana, Italy] (AOUC), University Hospital Centre Zagreb, Partenaires INRAE, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de Neuroradiologie [CHU de Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Cleveland Clinic Abu Dhabi [Abou Dabi, Émirats arabes unis], Hôpital de Beaumont [Dublin, Ireland] (HB), Hospital-Estadual Central [Vitoria, Brazil] (HEC), Instituto de NeuroCirugía Asenjo, Institut national de neurologie Mongi-Ben Hamida [Tunis], Hue Central Hospital [Thua Thien Hue, Vietnam] (HCH), University of California [San Francisco] (UC San Francisco), University of California (UC), Centre hospitalier universitaire de Nantes (CHU Nantes), Washington University School of Medicine (WUSM), University of Washington [Seattle], Englewood Hospital and Medical Center [Englewood], Jefferson (Philadelphia University + Thomas Jefferson University), Westchester Medical Center [Valhalla, New York, USA] (WMC), Eskisehir Osmangazi University, University of Maryland School of Medicine, University of Maryland System, MAX Superspecialty Hospital [Saket, New Delhi, India] (MSH), Yale School of Medicine [New Haven, Connecticut] (YSM), Université Laval [Québec] (ULaval), Washington University School of Medicine in St. Louis, Washington University in Saint Louis (WUSTL), Rush University Medical Center [Chicago], Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), University of Toronto, NH Mazumdar Shah Medical Center [Bangalore, India] (NHMSMC), IMS Tokyo-Katsushika General Hospital [Tokyo, Japan], Gachon University [Seongnam, Korea] (GU), Hospital Municipal Sao Jose [Joinville, Santa Catarina, Brazil] (HMSJ), Lau Medical Center [Beirut, Lebanon] (LMC), University of Iowa [Iowa City], Royal Adelaide Hospital [Adelaide Australia], Kyorin University [Tokyo, Japan], Yokohama Brain and Spine Center [Yokohama, Japan] (YBSC), Dalhousie University [Halifax], Rambam Health Care Campus [Haifa, Israel], Centro Endovascular Neurologico Medica Uruguaya [Montevideo, Uruguay] (CENMU), Heidelberg University Hospital [Heidelberg], Imam Abdulrahman bin Faisal University [Alkhobar, Saudi Arabia] (IAFU), McGovern Medical School [Houston, TX, USA] (McGMS), The University of Texas Health Science Center at Houston (UTHealth), Cooper Medical School of Rowan University [Camden] (CMSRU), Airlangga University [Jawa Timur, Indonesia] (AU), University of Massachusetts Medical School [Worcester] (UMASS), University of Massachusetts System (UMASS), Geneva University Hospitals and Geneva University, Universidade de São Paulo = University of São Paulo (USP), Beth Israel Lahey Health [Burlington, MA, USA] (BILH), New York University School of Medicine (NYU Grossman School of Medicine), Memorial Neuroscience Institute [Pembroke Pines, FL, USA] (MNI), Iwate Prefectural Central Hospital [Morioka, Iwate, Japan] (IPCH), Japanese Red Cross Musashino Hospital [Tokyo], Ajou University, University of Ottawa [Ottawa], Saga-ken Medical Centre Koseikan [Saga, Japan] (SMCK), University of South Alabama, Konkuk University [Seoul], Royal Free Hospital [London, UK], Hospital Clinico Universitario de Valladolid [Castilla y León, Spain] (HCUV), Universidad de Valladolid [Valladolid] (UVa), Instituto de Ciencia de Materiales de Aragón [Saragoza, España] (ICMA-CSIC), University of Zaragoza - Universidad de Zaragoza [Zaragoza], Hospital Clínic de Barcelona [Catalonia, Spain], Centro Hospitalar Universitário de São João [Porto], Christchurch Hospital [Christchurch, New Zealand] (CH), University Hospital Basel [Basel], University of Southern California (USC), Kohnan Hospital - Sendai [Miyagi, Japan], University of Texas Southwestern Medical Center [Dallas], Nara City Hospital [Nara, Japan] (NCH), Toyonaka Municipal Hospital [Osaka, Japan] (TMH), Kagoshima City Hospita [Kagoshima, Japan] (KCH), Texas Tech University System [Lubbock, TX, USA] (TTUS), University of Saskatchewan [Saskatoon] (U of S), National Institute of Information and Communications Technology [Tokyo, Japan] (NICT), Royal Prince Alfred Hospital [Camperdown, Australia] (RPAH), Banner Desert Medical Center [Mesa, AZ, USA] (BDMC), Japanese Red Cross Matsue Hospital [Shimane, Japan] (JRCMH), Shiroyama Hospital [Osaka, Japan] (SH), Niigata City General Hospital [Niigata, Japan] (NCGH), Sugimura Hospital [Kumamoto, Japan] (SH), Kawasaki Medical School [Kurashiki, Japan] (KMS), Osaka Red Cross Hospital [Osaka, Japan] (ORCH), Université de Tsukuba = University of Tsukuba, Saiseikai Central Hospital [Tokyo, Japan] (SCH), Kinikyo Chuo Hospital - Sapporo [Hokkaido, Japan] (KCHS), NTT Medical Center Tokyo [Tokyo, Japan] (NTTMCT), Yokohama Shintoshi Neurosurgical Hospital [Yokohama, Japan]. (YSNH), Osaka General Medical Center [Osaka, Japan] (OGMC), University of Miami Leonard M. Miller School of Medicine (UMMSM), Bon Secours Mercy Health System [Toledo, OH, USA] (BSMHS), Maoming City Hospital [Guandong, China] (MCH), Miami Cardiac & Vascular Institute [Miami, FL, USA] (MC&VI), Hackensack University Medical Center [Hackensack], David Geffen School of Medicine [Los Angeles], University of California [Los Angeles] (UCLA), University of California (UC)-University of California (UC), University of Tennessee [Chattanooga] (UTC), The University of Texas at San Antonio (UTSA), Mianyang 404 Hospital [Sichuan, China] (M404H), Siriraj Hosital - Mahidol University [Bangkok, Thailand] (SHMU), SUNY Upstate Medical University, State University of New York (SUNY), Royal North Shore Hospital (RNSH), The University of Texas Rio Grande Valley [Harlingen, TX, USA] (UTRGV), Khoula Hospital [Muscat, Oman] (Ministry of Health - KH), University of Michigan [Ann Arbor], University of Michigan System, University of South Florida [Tampa] (USF), Henry Ford Health System [Detroit, MI, USA] (HFHS), Metropolitan Hospital [Piraeus, Greece] (MH), National and Kapodistrian University of Athens (NKUA), Maine Medical Center, Dartmouth Hitchcock Medical Center [Lebanon, NH, USA] (DHMC), Centro Universitário Feevale (BRAZIL), The Valley Hospital [Ridgewood, NJ, USA] (TVH), St Joseph's University Medical Center [Paterson, NJ, USA] (StJUMC), Christian Medical College and Hospital Ludhiana [Punjab, India] (CMCHL), Universidad del Desarrollo, University Graduate School of Medicine [Osaka, Japan], Tokushima University, Universidade Federal de São Paulo, Istanbul Aydin University [İstanbul, Turkey] (IAU), Swedish Medical Center [Englewood, CO, USA] (SMC), Bayhealth Medical Center [Dover, DE, USA] (BMC), Saiseikai Fukuoka General Hospital [Fukuoka, Japan] (SFGH), Osaka Rosai Hospital - Sakai [Osaka, Japan] (ORHS), King Saud University [Riyadh] (KSU), Mount Sinai Health System, University of Calgary, Huzhou University [Zhejiang], The Affiliated Hospital of Southwest Medical University - Luzhou [Sichuan, China] (TAHSMUL), Yijishan Hospital of Wannan Medical College [Wuhu, Anhui, China] (YHWMC), University of Toledo, WellStar Health System [Marietta, GA, USA] (WHS), Institut National de la Recherche Scientifique [Québec] (INRS), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CR CHUM), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM)-Université de Montréal (UdeM), SVIN COVID-19 Registry, the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO), Japanese Society of Vascular and Interventional Neurology Society (JVIN), University of California [San Francisco] (UCSF), University of California, Yale University School of Medicine, University of São Paulo (USP), and University of California-University of California
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[SDV]Life Sciences [q-bio] ,COVID-19 ,Subarachnoid Hemorrhage* / diagnostic imaging ,030204 cardiovascular system & hematology ,Intracranial Aneurysm* / therapy ,lcsh:RC346-429 ,0302 clinical medicine ,Pandemic ,Myocardial infarction ,Prospective Studies ,Stroke ,Original Research ,3. Good health ,[SDV] Life Sciences [q-bio] ,Treatment Outcome ,Intracranial Aneurysm* / diagnostic imaging ,Cardiology ,Subarachnoid haemorrhage ,haemorrhage ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Subgroup analysis ,subarachnoid ,Intracranial Aneurysm* / epidemiology ,03 medical and health sciences ,Aneurysm ,Internal medicine ,medicine ,Humans ,coil ,cardiovascular diseases ,Pandemics ,lcsh:Neurology. Diseases of the nervous system ,Retrospective Studies ,business.industry ,SARS-CoV-2 ,Intracranial Aneurysm ,Subarachnoid Hemorrhage ,medicine.disease ,infection ,nervous system diseases ,Mechanical thrombectomy ,Cross-Sectional Studies ,aneurysm ,Neurology (clinical) ,Subarachnoid Hemorrhage* / epidemiology ,business ,030217 neurology & neurosurgery - Abstract
BackgroundDuring the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.MethodsWe conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation.FindingsThere was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, pInterpretationThere was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.
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- 2021
5. Vertebroplasty and Kyphoplasty
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David A. Pastel, Clifford J. Eskey, and Joshua A. Hirsch
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- 2020
6. Symptomatic Lumbar Facet Synovial Cysts: Clinical Outcomes Following Percutaneous CT–Guided Cyst Rupture with Intra-articular Steroid Injection
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Mike Bao, David A. Pastel, Natalie Y. Ring, Clifford J. Eskey, Steffen J Haider, Nu R. Na, and Jessica G. Fried
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Adult ,Male ,musculoskeletal diseases ,Facet (geometry) ,medicine.medical_specialty ,Percutaneous ,Radiography ,Punctures ,Lumbar vertebrae ,Radiography, Interventional ,Zygapophyseal Joint ,Injections, Intra-Articular ,Disability Evaluation ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Surveys and Questionnaires ,Clinical endpoint ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cyst ,030212 general & internal medicine ,Aged ,Pain Measurement ,Aged, 80 and over ,Lumbar Vertebrae ,business.industry ,Middle Aged ,medicine.disease ,humanities ,Oswestry Disability Index ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Synovial Cyst ,Female ,Steroids ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
To evaluate clinical outcomes following percutaneous rupture of symptomatic lumbar facet synovial cysts (LFSCs) with intra-articular steroid injection.In this retrospective review, 44 consecutive patients with symptomatic LFSCs received primary treatment with CT-guided synovial cyst rupture with intra-articular steroid injection. Outcomes questionnaires were obtained before and 1, 4, 26, and 52 weeks after LFSC rupture. Assessment included pain medication use and numeric rating scale (NRS), Oswestry Disability Index (ODI), and 12-item short form health survey (SF-12) physical and mental composite scores (PCS and MCS). Clinical endpoint was 52-week survey response or surgery.LFSC rupture was technically successful in 84% (37/44) of cases. Clinical endpoint was reached in 68% (30/44) of patients with 82% overall 1-year follow-up. Lumbar spine surgery was performed in 25% (11/44) of patients within 1 year after procedure. Mean NRS, ODI, and SF-12 PCS demonstrated significant improvement at all follow-up time points (P.001). At 52-week follow-up, NRS decreased from 8.1 to 3.7 (P.001), ODI improved from 35 to 24 (P = .006), and SF-12 PCS improved from 31 to 42 (P.001). Daily pain medication decreased from 71% (31/44) of patients before procedure to 29% (9/26) at 52-week follow-up (P = .012). History of prior lumbar intervention was associated with poorer LFSC rupture success (P = .025) and ODI (P = .047).NRS, ODI, and SF-12 PCS indices improved and pain medication use decreased significantly at all time points over 1-year follow-up after percutaneous rupture of symptomatic LFSCs with intra-articular steroid injection.
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- 2017
7. Dynamic EPR Oximetry of Changes in Intracerebral Oxygen Tension During Induced Thromboembolism
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Kirk J. Maurer, Sangeeta Gohain, Clifford J. Eskey, Periannan Kuppusamy, Karen L Moodie, Harold M. Swartz, Nadeem Khan, and Huagang Hou
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inorganic chemicals ,Biophysics ,Hyperoxia ,Biochemistry ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Carbogen ,Thromboembolism ,medicine ,Animals ,Oximetry ,Hypoxia ,Stroke ,medicine.diagnostic_test ,business.industry ,Angiography ,Electron Spin Resonance Spectroscopy ,Brain ,Cell Biology ,General Medicine ,Oxygenation ,respiratory system ,Hypoxia (medical) ,medicine.disease ,Oxygen tension ,Oxygen ,Carotid Arteries ,Anesthesia ,cardiovascular system ,Breathing ,Female ,Rabbits ,medicine.symptom ,business ,030217 neurology & neurosurgery ,circulatory and respiratory physiology - Abstract
Cerebral tissue oxygenation (oxygen tension, pO2) is a critical parameter that is closely linked to brain metabolism, function, and pathophysiology. In this work, we have used electron paramagnetic resonance oximetry with a deep-tissue multi-site oxygen-sensing probe, called implantable resonator, to monitor temporal changes in cerebral pO2 simultaneously at four sites in a rabbit model of ischemic stroke induced by embolic clot. The pO2 values in healthy brain were not significantly different among the four sites measured over a period of 4 weeks. During exposure to 15% O2 (hypoxia), a sudden and significant decrease in pO2 was observed in all four sites. On the other hand, brief exposure to breathing carbogen gas (95% O2 + 5% CO2) showed a significant increase in the cerebral pO2 from baseline value. During ischemic stroke, induced by embolic clot in the left brain, a significant decline in the pO2 of the left cortex (ischemic core) was observed without any change in the contralateral sites. While the pO2 in the non-infarct regions returned to baseline at 24-h post-stroke, pO2 in the infarct core was consistently lower compared to the baseline and other regions of the brain. The results demonstrated that electron paramagnetic resonance oximetry with the implantable resonator can repeatedly and simultaneously report temporal changes in cerebral pO2 at multiple sites. This oximetry approach can be used to develop interventions to rescue hypoxic/ischemic tissue by modulating cerebral pO2 during hypoxic and stroke injury.
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- 2017
8. P-004 Thrombus classification with targeted magnetic nanoparticles
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W Wells, C Jackson, D Schartz, Clifford J. Eskey, and J Weaver
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Relaxometry ,biology ,business.industry ,medicine.medical_treatment ,Cerebral arteries ,Nanoparticle ,Thrombolysis ,medicine.disease ,Fibrin ,Thrombin ,medicine ,biology.protein ,Magnetic nanoparticles ,Thrombus ,business ,circulatory and respiratory physiology ,Biomedical engineering ,medicine.drug - Abstract
Purpose and introduction Thromboembolic material producing large vessel occlusion of the cerebral arteries varies substantially in composition and these differences affect the ability of both intravenous thrombolysis and mechanical thrombectomy to achieve rapid arterial recanalization. The binding of targeted magnetic nanoparticles may offer a means of noninvasively determining clot composition. We hypothesize that binding of targeted magnetic nanoparticles to thrombus is measurable and varies with clot composition. Materials and methods Thromboembolic material was extracted from 10 patients during emergent mechanical thrombectomy for large vessel occlusion in ICA, MCA, or basilar arteries. The nominal source of the thromboembolic material and time from onset to clot retrieval were recorded. Each sample was divided and sent both for standard histopathologic evaluation and for in vitro assessment by magnetic spectroscopy of nanoparticle Brownian rotation (MSB). The thromboembolic material was incubated in a solution of magnetic nanoparticles that had been coated with antibodies directed toward thrombin. Nanoparticle binding was measured using magnetic relaxometry. Results All clots bound measurable quantities of the thrombin-directed magnetic nanoparticles. 2/10 of the samples were composed of >90% fibrin material. These two samples demonstrated much higher than expected nanoparticle binding. The other samples had proportions of thrombus that ranged from 50 to 60%. Among these samples there was a significant correlation between nanoparticle weight and RBC content (R2 = 0.70, p Discussion Thrombin-directed nanoparticles bound thrombin-rich thromboembolic material roughly in proportion to the RBC content, as expected, confirming an affinity of these particles for this component of the clot. However, samples consisting almost exclusively of fibrin bound even higher levels of the nanoparticles suggesting the presence of an additional binding mechanism. Disclosures C. Eskey: None. W. Wells: None. D. Schartz: None. C. Jackson: None. J. Weaver: None.
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- 2019
9. Penetrating Midface Trauma: A Case Report, Review of the Literature, and a Diagnostic and Management Protocol
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Nithya Puttige Ramesh, Eric P. Holmgren, Clifford J. Eskey, Derrek Schartz, and Kimutai Sylvester
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Adult ,Male ,Facial trauma ,Firearms ,medicine.medical_specialty ,Maxillary sinus ,Radiography ,Wounds, Penetrating ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Canthus ,Facial Injuries ,Sinus (anatomy) ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,030206 dentistry ,medicine.disease ,medicine.anatomical_structure ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Angiography ,Wounds, Gunshot ,Surgery ,Radiology ,Eyelid ,Oral Surgery ,Tomography, X-Ray Computed ,business - Abstract
Purpose Penetrating facial trauma is an uncommon injury, but patients who present with these dramatic situations require special consideration. We describe the case of a young man who had been shot with an arrow that deeply penetrated his midface as well as report the results of a literature review of penetrating midface injuries. The information gathered was used to create a diagnostic protocol for patients who sustain such injuries. Methods A PubMed search up to October 2019 using several key phrases was performed, and 623 unique articles were evaluated. Excluding firearm injuries to the midface, there were 57 unique cases that involved penetrating midface injuries. Clinical and imaging data were compiled and evaluated with descriptive statistical analysis. Results The average patient age was 27 years, with a male predilection. The most common reported etiology was accidental trauma (54%), and a knife was the most common weapon of injury (30%). The most common (32%) specific location of trauma was within the orbital region, including the canthus or the eyelid. In all cases where the patient had not died immediately, surgery was used to remove the penetrating object. We found that computed tomography was the most commonly obtained imaging study (39% of cases). Radiographs were the sole imaging in 28% of the cases, with angiography (16%) and magnetic resonance imaging (10%) used less frequently in management. In 28% of the cases, deep structures, such as the carotid artery, sphenoid sinus, or skull base, were involved in the injury. In 25% of the cases, there was injury to the central nervous system. Death occurred in 8.8% of the cases. Postoperative complications occurred in at least 21% of the cases. Statistical analysis also revealed a significant correlation between antibiotic use and full recovery. Penetration of the object posterior to the maxillary sinus was correlated with incomplete recovery or death. Conclusions Based on all case reports collected, a Dartmouth Penetrating Midface Protocol was developed to aid the practitioner who may happen to be responsible for these dramatic life-threatening injuries. The Dartmouth Penetrating Midface Protocol is based on the type of imaging available at the treating facility, the neurologic and hemodynamic stability of the patient, and the depth of penetration beyond the posterior wall of the maxillary sinus.
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- 2021
10. Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association
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Constantino Peña, Mahesh V Jayaraman, Thanh N. Nguyen, Hermann Christian Schumacher, William A. Gray, Clifford J. Eskey, David C. Hess, Dilip K. Pandey, Randall T. Higashida, Sameer A. Ansari, Cameron G. McDougall, Philip M. Meyers, and J. Kevin DeMarco
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Vessel occlusion ,Embolectomy ,030204 cardiovascular system & hematology ,Radiosurgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Fibrinolytic Agents ,Dural arteriovenous fistulas ,law ,Physiology (medical) ,Medicine ,Humans ,cardiovascular diseases ,Intensive care medicine ,Stroke ,Central Nervous System Vascular Malformations ,Interventional treatment ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,medicine.disease ,Embolization, Therapeutic ,Venous thrombosis ,Cerebrovascular Disorders ,Intracranial Arteriovenous Malformations ,Intracranial Thrombosis ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Intracranial endovascular interventions provide effective and minimally invasive treatment of a broad spectrum of diseases. This area of expertise has continued to gain both wider application and greater depth as new and better techniques are developed and as landmark clinical studies are performed to guide their use. Some of the greatest advances since the last American Heart Association scientific statement on this topic have been made in the treatment of ischemic stroke from large intracranial vessel occlusion, with more effective devices and large randomized clinical trials showing striking therapeutic benefit. The treatment of cerebral aneurysms has also seen substantial evolution, increasing the number of aneurysms that can be treated successfully with minimally invasive therapy. Endovascular therapies for such other diseases as arteriovenous malformations, dural arteriovenous fistulas, idiopathic intracranial hypertension, venous thrombosis, and neoplasms continue to improve. The purpose of the present document is to review current information on the efficacy and safety of procedures used for intracranial endovascular interventional treatment of cerebrovascular diseases and to summarize key aspects of best practice.
- Published
- 2018
11. Platelet function inhibitors and platelet function testing in neurointerventional procedures: Table 1
- Author
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Ryan A. Grant, Josser E Delgado Almandoz, Seon Kyu Lee, Joey English, Chirag D. Gandhi, Philip M. Meyers, Huy M. Do, Sameer A. Ansari, William J. Mack, Steven W. Hetts, G. Lee Pride, Ciaran J. Powers, M. Shazam Hussain, Charles J. Prestigiacomo, Michael Kelly, Barbara Albani, Mahesh V Jayaraman, Clifford J. Eskey, Johanna T. Fifi, Tareq Kass-Hout, Peter A. Rasmussen, Joshua A Hirsch, Michael J. Alexander, Athos Patsalides, Ketan R. Bulsara, and Todd Abruzzo
- Subjects
Aspirin ,Prasugrel ,business.industry ,medicine.medical_treatment ,Stent ,General Medicine ,Clopidogrel ,P2Y12 ,Anesthesia ,medicine ,Surgery ,Platelet ,Neurology (clinical) ,Platelet activation ,business ,Ticagrelor ,medicine.drug - Abstract
Over the past decade there has been a growing use of intracranial stents for the treatment of both ischemic and hemorrhagic cerebrovascular disease, including stents to assist in the remodeling of the neck of aneurysms as well as the use of flow diverting devices for aneurysm treatment. With this increase in stent usage has come a growing need for the neurointerventional (NI) community to understand the pharmacology of medications used for modifying platelet function, as well as the testing methodologies available. Platelet function testing in NI procedures remains controversial. While pre-procedural antiplatelet assays might lead to a reduced rate of thromboembolic complications, little evidence exists to support this as a standard of care practice. Despite the routine use of dual antiplatelet therapy (DAT) with aspirin and a P2Y12 receptor antagonist (such as clopidogrel, prasugrel, or ticagrelor) in most neuroembolization procedures necessitating intraluminal reconstruction devices, thromboembolic complications are still encountered.1–3 Moreover, DAT carries the risk of hemorrhagic complications, with intracerebral hemorrhage (ICH) being the most potentially devastating.4 ,5 Light transmission aggregometry (LTA) is the gold standard to test for platelet reactivity, but it is usually expensive and may not be easily obtainable at many centers. This has led to the development of point-of-care assays, such as the VerifyNow (Accumetrics, San Diego, California, USA), which correlates strongly with LTA and can reliably measure the degree of P2Y12 receptor inhibition.6–9 VerifyNow results are reported in P2Y12 reaction units (PRUs), with a lower PRU value corresponding to a higher level of P2Y12 receptor inhibition and, presumably, a lower probability of platelet aggregation, and a higher PRU value corresponding to a lower level of P2Y12 receptor inhibition and, hence, a higher chance of platelet activation and aggregation. While aspirin resistance is perhaps less common, clopidogrel resistance may be more challenging as …
- Published
- 2014
12. (P10) Proof-of-Principle Study of Hyperbaric Oxygen (HBO) as a Radiosensitizer Prior to Stereotactic Radiosurgery (SRS) for Brain Metastases (NCT01850563)
- Author
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Zhongze Li, Jay C. Buckey, David W. Roberts, Clifford J. Eskey, Divya Ravi, and Alan C. Hartford
- Subjects
Cancer Research ,Radiosensitizer ,Radiation ,business.industry ,medicine.medical_treatment ,Radiosurgery ,03 medical and health sciences ,0302 clinical medicine ,Hyperbaric oxygen ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Radiology, Nuclear Medicine and imaging ,Nuclear medicine ,business ,030217 neurology & neurosurgery - Published
- 2018
13. Hyperbaric Oxygen (HBO) as Radiosensitizer Prior to Stereotactic Radiosurgery (SRS) for Brain Metastases: Primary Outcomes and Quality of Life (QOL)
- Author
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Zhongze Li, Alan C. Hartford, Benjamin B. Williams, Jay C. Buckey, David J. Gladstone, Clifford J. Eskey, G.A. Russo, D. Ravi, and L.A. Jarvis
- Subjects
Cancer Research ,medicine.medical_specialty ,Radiosensitizer ,Radiation ,business.industry ,medicine.medical_treatment ,Radiosurgery ,Hyperbaric oxygen ,Oncology ,Quality of life ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business - Published
- 2019
14. Vertebral augmentation: report of the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery
- Author
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Joshua A Hirsch, M. Shazam Hussain, Ronil V. Chandra, Charles J. Prestigiacomo, Chirag D. Gandhi, Mahesh V Jayaraman, Huy M. Do, Seon Kyu Lee, William J. Mack, Michael Kelly, Clifford J. Eskey, G. Lee Pride, Todd Abruzzo, Donald Frei, Felipe C. Albuquerque, Philip M. Meyers, Ketan R. Bulsara, and Sandra Narayanan
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Osteoporosis ,Balloon ,Bed rest ,Asymptomatic ,medicine ,Back pain ,Animals ,Humans ,Multicenter Studies as Topic ,Kyphoplasty ,Prospective Studies ,Societies, Medical ,Randomized Controlled Trials as Topic ,Vertebroplasty ,business.industry ,General Medicine ,medicine.disease ,Orthotic device ,Surgery ,Vertebra ,medicine.anatomical_structure ,Practice Guidelines as Topic ,Spinal Fractures ,Vascular tumor ,Neurology (clinical) ,Radiology ,medicine.symptom ,business - Abstract
Vertebroplasty and kyphoplasty are minimally invasive image-guided procedures that involve the injection of cement (typically polymethylmethacrylate (PMMA)) into a vertebral body. Kyphoplasty involves inflation of a balloon tamp to create a cavity within the vertebral body into which cement is subsequently injected. The majority of these vertebral augmentation procedures are performed to relieve back pain from osteoporotic or cancer-related vertebral compression fractures and to reinforce the vertebral body with neoplasm or vascular tumor. The primary goal of vertebroplasty and kyphoplasty is to reduce back pain and to improve patient's functional status, and the secondary goal is stabilization of a vertebra weakened by fracture or neoplasia. ### Osteoporotic vertebral fractures Osteoporosis is a common disease that causes significant morbidity and incurs a significant healthcare cost to the community. The major osteoporotic fractures involve the hip, vertebra, proximal humerus and distal forearm; the lifetime osteoporotic fracture risk at age 50 is approximately one in two women and one in five men.1 The lifetime incidence of symptomatic osteoporotic vertebral fractures in women at age 50 is estimated at 10–15%1; once a vertebral fracture occurs, there is a 20% risk of another vertebral fracture within 12 months.2 Most osteoporotic vertebral compression fractures are asymptomatic or result in minimal pain; only a third of vertebral fractures result in medical attention.3 Conservative medical therapy is therefore appropriate for the vast majority of vertebral compression fractures since most acute back pain symptoms are mild and subside over a period of 6–8 weeks as the fracture heals. The goals of conservative therapy are pain reduction (with analgesics and/or bed rest), improvement in functional status (with orthotic devices and physical therapy) and prevention of future fractures (with vitamin D, calcium supplementation and antiresorptive agents). However, conservative treatment for those with severe pain or limitation of function is not benign. It …
- Published
- 2013
15. Tumor Bed Dynamics After Surgical Resection of Brain Metastases: Implications for Postoperative Radiosurgery
- Author
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Eugen B. Hug, Marc R. Bellerive, David W. Roberts, Kadir Erkmen, Clifford J. Eskey, David J. Gladstone, Nathan E. Simmons, L.A. Jarvis, and Alan C. Hartford
- Subjects
Adult ,Male ,Surgical resection ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Radiosurgery ,Young Adult ,parasitic diseases ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Tumor bed ,Postoperative Period ,Aged ,Retrospective Studies ,Radiation ,medicine.diagnostic_test ,Brain Neoplasms ,business.industry ,Magnetic resonance imaging ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Tumor Burden ,Surgery ,Radiation therapy ,Oncology ,Tumor progression ,Disease Progression ,Female ,Radiology ,business ,Brain metastasis - Abstract
Purpose To analyze 2 factors that influence timing of radiosurgery after surgical resection of brain metastases: target volume dynamics and intracranial tumor progression in the interval between surgery and cavity stereotactic radiosurgery (SRS). Methods and Materials Three diagnostic magnetic resonance imaging (MRI) scans were retrospectively analyzed for 41 patients with a total of 43 resected brain metastases: preoperative MRI scan (MRI-1), MRI scan within 24 hours after surgery (MRI-2), and MRI scan for radiosurgery planning, which is generally performed ≤1 week before SRS (MRI-3). Tumors were contoured on MRI-1 scans, and resection cavities were contoured on MRI-2 and MRI-3 scans. Results The mean tumor volume before surgery was 14.23 cm 3 , and the mean cavity volume was 8.53 cm 3 immediately after surgery and 8.77 cm 3 before SRS. In the interval between surgery and SRS, 20 cavities (46.5%) were stable in size, defined as a change of ≤2 cm 3 ; 10 cavities (23.3%) collapsed by >2 cm 3 ; and 13 cavities (30.2%) increased by >2 cm 3 . The unexpected increase in cavity size was a result of local progression (2 cavities), accumulation of cyst-like fluid or blood (9 cavities), and nonspecific postsurgical changes (2 cavities). Finally, in the interval between surgery and SRS, 5 cavities showed definite local tumor progression, 4 patients had progression elsewhere in the brain, 1 patient had both local progression and progression elsewhere, and 33 patients had stable intracranial disease. Conclusions In the interval between surgical resection and delivery of SRS, surgical cavities are dynamic in size; however, most cavities do not collapse, and nearly one-third are larger at the time of SRS. These observations support obtaining imaging for radiosurgery planning as close to SRS delivery as possible and suggest that delaying SRS after surgery does not offer the benefit of cavity collapse in most patients. A prospective, multi-institutional trial will provide more guidance to the optimal timing of cavity SRS.
- Published
- 2012
16. Invasive interventional management of post-hemorrhagic cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage
- Author
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Philip M. Meyers, Christopher J. Moran, Charles J. Prestigiacomo, Clifford J. Eskey, Kristine A Blackham, Raisa Lev, Sandra Narayanan, and Todd Abruzzo
- Subjects
medicine.medical_specialty ,Subarachnoid hemorrhage ,Vasodilator Agents ,medicine.medical_treatment ,Ischemia ,Neurosurgical Procedures ,Cerebral circulation ,Cerebral vasospasm ,Infusion therapy ,Angioplasty ,medicine ,Humans ,Infusions, Intra-Arterial ,Vasospasm, Intracranial ,Intensive care medicine ,Stroke ,business.industry ,General Medicine ,Evidence-based medicine ,Reference Standards ,Subarachnoid Hemorrhage ,medicine.disease ,Surgery ,Neurology (clinical) ,business ,Angioplasty, Balloon - Abstract
Current clinical practice standards are addressed for the invasive interventional management of post-hemorrhagic cerebral vasospasm (PHCV) in patients with aneurysmal subarachnoid hemorrhage. The conclusions, based on an assessment by the Standards Committee of the Society of Neurointerventional Surgery, included a critical review of the literature using guidelines for evidence based medicine proposed by the Stroke Council of the American Heart Association and the University of Oxford, Centre for Evidence Based Medicine. Specifically examined were the safety and efficacy of established invasive interventional therapies, including transluminal balloon angioplasty (TBA) and intra-arterial vasodilator infusion therapy (IAVT). The assessment shows that these invasive interventional therapies may be beneficial and may be considered for PHCV-that is, symptomatic with cerebral ischemia and refractory to maximal medical management. As outlined in this document, IAVT may be beneficial for the management of PHCV involving the proximal and/or distal intradural cerebral circulation. TBA may be beneficial for the management of PHCV that involves the proximal intradural cerebral circulation. The assessment shows that for the indications described above, TBA and IAVT are classified as Class IIb, Level B interventions according to the American Heart Association guidelines, and Level 4, Grade C interventions according to the University of Oxford Centre for Evidence Based Medicine guidelines.
- Published
- 2012
17. Reporting standards for angiographic evaluation and endovascular treatment of cerebral arteriovenous malformations: Table 1
- Author
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Joshua A Hirsch, M. Shazam Hussain, Mahesh V Jayaraman, Christopher J. Moran, Charles J. Prestigiacomo, Colin P. Derdeyn, Clifford J. Eskey, Mary E. Jensen, Cameron G. McDougall, Peter A. Rasmussen, Justin F. Fraser, Philip M. Meyers, and Kristine A Blackham
- Subjects
medicine.medical_specialty ,business.industry ,Treatment outcome ,MEDLINE ,General Medicine ,Endovascular therapy ,Surgery ,Cerebral arteriovenous malformations ,medicine ,Neurology (clinical) ,Endovascular treatment ,Intensive care medicine ,business - Abstract
These guidelines were developed by consensus of a multidisciplinary panel of specialists interested in the evaluation and treatment of patients with arteriovenous malformations (AVMs) of the CNS. The reporting criteria described will serve as a template for trial design and for clinical investigators who wish to report on endovascular therapy of cerebral AVMs. Direct comparison of various treatment paradigms is important to standardization of care, maximization of good treatment outcomes, assessment of new methods and technologies.
- Published
- 2011
18. Hemorrhagic Stroke
- Author
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Scott D, Smith and Clifford J, Eskey
- Subjects
Central Nervous System Vascular Malformations ,Intracranial Arteriovenous Malformations ,Brain Neoplasms ,Intracranial Aneurysm ,General Medicine ,Subarachnoid Hemorrhage ,Magnetic Resonance Imaging ,Cerebral Angiography ,Stroke ,Cerebral Amyloid Angiopathy ,Sinus Thrombosis, Intracranial ,Humans ,Radiology, Nuclear Medicine and imaging ,Tomography, X-Ray Computed ,Intracranial Hemorrhages ,Magnetic Resonance Angiography - Abstract
When patients present to the emergency room with sudden onset of focal neurologic symptoms or altered consciousness, hemorrhagic stroke is a major focus of emergency diagnostic evaluation. The entities that compose hemorrhagic stroke, intracerebral and subarachnoid hemorrhage, are readily diagnosed with advanced imaging. This article reviews current imaging options for the detection of acute hemorrhage, along with the expected imaging findings for each modality. Common and unusual causes and their distinguishing imaging features are discussed. Imaging strategies and recent work in specific imaging findings that may guide patient management in the future are also addressed.
- Published
- 2011
19. Value of Immediate Preprocedure Magnetic Resonance Imaging in Patients Scheduled to Undergo Vertebroplasty or Kyphoplasty
- Author
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Becky K. Benz, John M. Gemery, Clifford J. Eskey, and John J. McIntyre
- Subjects
medicine.medical_specialty ,Time Factors ,Radiography ,Central nervous system disease ,Fractures, Compression ,Preoperative Care ,Back pain ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,Fracture Healing ,Vertebroplasty ,medicine.diagnostic_test ,business.industry ,Vertebral compression fracture ,Incidence (epidemiology) ,Magnetic resonance imaging ,Retrospective cohort study ,medicine.disease ,Magnetic Resonance Imaging ,Occult ,Surgery ,Back Pain ,Spinal Fractures ,Neurology (clinical) ,Radiology ,medicine.symptom ,business - Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE To determine the incidence of additional vertebral compression fractures diagnosed with repeat MRI immediately before vertebroplasty or kyphoplasty. SUMMARY OF BACKGROUND DATA Vertebral compression fractures, which occur frequently in the elderly, are more likely in patients with prior vertebral compression fracture. When patients are evaluated for vertebroplasty, it is important to identify all unhealed fractures for effective treatment planning. METHODS In a retrospective study, we reviewed the records of all patients (n = 194) treated with vertebroplasty or kyphoplasty over a 6-year period at our institution, and identified all patients who had undergone a repeat MRI within 7 days of vertebroplasty or kyphoplasty. These studies were obtained as part of a clinical protocol prescribing a repeat MRI for any patient whose MRI had been obtained more than 3 months before the evaluation, or who had a change in their pain between referral and evaluation. RESULTS Twenty patients met inclusion criteria for the immediate preprocedure MRI protocol. A total of 14 new fractures in 11 patients were discovered on the immediate preprocedure MRI. Of these 14, 6 had less than 15% loss of height, making them potentially occult on radiographs; 3 fractures developed in 2 patients who had no change in back pain. CONCLUSION In select candidates for vertebroplasty or kyphoplasty, a repeat preprocedure MRI obtained within 1 week can help ensure that all painful fractures are treated. There is demonstrable value in this protocol for patients with an imaging evaluation over 3 months old or who have had any change in symptoms since the initial imaging workup.
- Published
- 2009
20. Quick-brain magnetic resonance imaging for nonhydrocephalus indications
- Author
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Ann-Christine Duhaime, Joseph S. Pekala, Patricia B. Quebada, Susan R. Durham, Clifford J. Eskey, Jorge A. Forero, and Symeon Missios
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Lumbar puncture ,business.industry ,Macrocephaly ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Surgery ,Hydrocephalus ,Central nervous system disease ,medicine ,Brain magnetic resonance imaging ,Radiology ,medicine.symptom ,business ,Intracranial cyst ,Chiari malformation - Abstract
Object In 2002, “quick-brain” (QB) MR imaging (ultrafast spin echo T2-weighted imaging) was introduced as an alternative technique to CT scanning for assessing children with hydrocephalus. The authors have observed high patient and physician satisfaction with this technique at their institution, which has led to an increasing frequency of its use for nonhydrocephalic indications. The goal in this study was to characterize, quantitate, and assess the use of QB MR imaging for these additional indications. Methods Between February 2003 and December 2007, 1146 consecutive QB MR imaging studies were performed, and the findings were entered prospectively into a radiology database. All available clinical records were retrospectively reviewed to assign ≥ 1 of the following indications to each study: hydrocephalus, macrocephaly, Chiari malformation, intracranial cyst, screening prior to lumbar puncture, screening for congenital anomalies, trauma, and other. Changes in the distribution of indications over time and clinical experience for each indication were reviewed. Results The total number of QB imaging studies performed increased each year. The proportion of studies performed for nonhydrocephalic indications also increased (from 23 to 50%). The most common indication was screening for macrocephaly, and all other indications were nearly evenly distributed. Quick-brain MR imaging was used extensively for the initial evaluation and follow-up in patients with little need for additional studies. Its false-negative rate, however, remains unknown. Conclusions The role of QB MR imaging for nonhydrocephalic indications is expanding, and it appears promising for a number of screening and surveillance paradigms. “Quick-brain plus” protocols for specific indications may add sensitivity and are under development.
- Published
- 2008
21. Vertebral augmentation in osteoporotic fractures
- Author
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Alex M. Barrocas, Clifford J. Eskey, and Joshua A Hirsch
- Subjects
Male ,medicine.medical_specialty ,Osteoporosis ,Fracture Fixation, Internal ,Fractures, Compression ,medicine ,Humans ,Polymethyl Methacrylate ,Orthopedic Procedures ,Kyphosis ,Rachis ,Aged ,General Environmental Science ,Aged, 80 and over ,Bone Density Conservation Agents ,business.industry ,Vertebral compression fracture ,Bone Cements ,Treatment options ,Middle Aged ,medicine.disease ,Biomechanical Phenomena ,Surgery ,Vertebra ,Fractures, Spontaneous ,Treatment Outcome ,medicine.anatomical_structure ,Disease Progression ,General Earth and Planetary Sciences ,Female ,business - Abstract
Osteoporotic vertebral compression fractures result in an enormous medical, social and economic burden to society. Here, we review osteoporotic vertebral compression fractures, focusing on both their diagnosis and the treatment options, particularly vertebral augmentation.
- Published
- 2007
22. Deep-Tissue Oxygen Monitoring in the Brain of Rabbits for Stroke Research
- Author
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Periannan Kuppusamy, Karen L Moodie, Harold M. Swartz, Nadeem Khan, Clifford J. Eskey, Huagang Hou, Sangeeta Gohain, William C. Culp, Gaixin Du, and Sassan Hodge
- Subjects
medicine.medical_specialty ,Ischemia ,Infarction ,Hyperoxia ,Article ,Brain Ischemia ,Brain ischemia ,Carbogen ,Internal medicine ,medicine ,Animals ,Oximetry ,Stroke ,Monitoring, Physiologic ,Advanced and Specialized Nursing ,business.industry ,Penumbra ,Electron Spin Resonance Spectroscopy ,Brain ,Reproducibility of Results ,Blood flow ,medicine.disease ,Electrodes, Implanted ,Surgery ,Oxygen ,Disease Models, Animal ,Calibration ,Cardiology ,Rabbits ,Neurology (clinical) ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The primary event in the ischemic stroke is a rapid decline in the oxygen levels after the loss of blood flow in specific areas of the brain. Subsequent pathological processes results in a central core area of severely ischemic tissue surrounded by a region of moderate ischemic tissue (penumbra) with a preserved cellular metabolism. The outcome of an ischemic stroke depends on the size of the infarct core and the potential to salvage the cells in the penumbra, which is hypoperfused, and therefore, at risk of infarction but still viable. Such viable penumbral tissue can be rescued by quick interventions that can increase oxygen levels or slow metabolism in the ischemic area to minimize oxidative injury on reperfusion. Several strategies have been investigated to rescue ischemic tissue using experimental models, especially rodents, but largely failed in subsequent clinical trials. The rabbit model of ischemic stroke using embolic clot is a promising model for developing effective strategies. This model first led to the prediction of the clinical response of recombinant tissue-type plasminogen activator to restore blood flow in patients.1 The drug is currently recommended for administration within 3 hours for best outcomes and has also shown modest benefit when administered within 4.5 to 6 hours of clinical onset.2 The rabbit model of embolic clot is now considered as a pertinent model for translational research by the Stroke Therapy Academic Industry Roundtable recommendations.3 To rationally develop effectual therapies, it is important to understand the effect of ischemic stroke on oxygen levels (partial pressure of oxygen [pO2]) in the regions directly affected by the pathology, as well as contralateral regions of the rabbit brain. The potential changes in tissue po2 of contralateral regions may provide crucial information on adaptive response, if any, of the brain …
- Published
- 2015
23. 'SKyphoplasty': A Single Institution's Initial Experience
- Author
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Joshua A Hirsch, Stuart R. Pomerantz, Samuel C. Tong, and Clifford J. Eskey
- Subjects
Aged, 80 and over ,Male ,medicine.medical_specialty ,business.industry ,Bone Cements ,Balloon ,SKyphoplasty ,Surgery ,Treatment Outcome ,Fluoroscopy ,Fractures, Compression ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Osteoporosis ,Spinal Fractures ,Female ,Radiology, Nuclear Medicine and imaging ,New device ,Single institution ,Cardiology and Cardiovascular Medicine ,business ,Aged - Abstract
PURPOSE The treatment of painful compression fractures has been revolutionized by vertebroplasty and kyphoplasty, two recently developed techniques that continue to evolve. This article describes a new device for the performance of kyphoplasty that uses a polymer device rather than a balloon to create a void in the bone. MATERIALS AND METHODS In nine consecutive patients, kyphoplasty was performed at 12 vertebral levels with osteoporotic compression with use of the new SKy bone expander polymer device. RESULTS The device was successful in creating a void in the bone at all levels. The procedure was also effective in alleviating pain from compression fractures. There were no technical failures or complications. CONCLUSION The SKy bone expander polymer device is effective and safe for the performance of kyphoplasty to alleviate pain from vertebral compression fractures.
- Published
- 2006
24. Functional magnetic resonance imaging of the primary somatosensory cortex in piglets
- Author
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Carter P. Dodge, Terrance M. Darcey, Andrew J. Saykin, Brenna C. McDonald, Ann-Christine Duhaime, Paul Tomashosky, Loretta L. Grate, and Clifford J. Eskey
- Subjects
Swine ,Traumatic brain injury ,Somatosensory system ,Evoked Potentials, Somatosensory ,Head Injuries, Closed ,Sensation ,Image Processing, Computer-Assisted ,Animals ,Humans ,Medicine ,Child ,Dominance, Cerebral ,Brain Mapping ,medicine.diagnostic_test ,Echo-Planar Imaging ,business.industry ,Age Factors ,Magnetic resonance imaging ,Recovery of Function ,Somatosensory Cortex ,General Medicine ,Human brain ,Image Enhancement ,medicine.disease ,Magnetic Resonance Imaging ,Functional imaging ,Disease Models, Animal ,medicine.anatomical_structure ,Somatosensory evoked potential ,business ,Functional magnetic resonance imaging ,Neuroscience - Abstract
Object The piglet is an excellent model for the developing human brain, and has been used increasingly in various centers for studies of traumatic brain injury and other insults. Unlike rodent or primate models, however, there are few behavioral scales for the piglet, and the available ones are used to test general responsiveness rather than specific functional outcome. The differing behavioral repertoires of animals of different ages provide an additional challenge when age-dependent injury responses are compared. To overcome these experimental limitations of piglets in brain injury research, the authors developed a functional magnetic resonance (fMR) imaging paradigm that can be used to track recovery in the somatosensory cortex over time in anesthetized animals of different ages. Methods Fifteen fMR imaging studies in eight piglets were performed before and after scaled cortical impact injury to the primary somatosensory cortex subserving snout sensation. Specific anesthetic and imaging protocols enabled visualization of cortical activation, and comparison with somatosensory evoked potentials obtained before and after injury was obtained. A piglet brain template for group-level analysis of these data was constructed, similar to the fMR imaging techniques used in humans, to allow for group comparisons and longitudinal change analysis over time. Conclusions Loss of function in a specifically traumatized cortical region and its subsequent recovery over time can now be demonstrated visually by fMR imaging in the piglet. Besides its value in understanding intrinsic recovery mechanisms and plasticity at different ages, this functional outcome measure will enable the use of the piglet model in treatment trials specifically designed for the immature brain.
- Published
- 2006
25. Focal paraneoplastic limbic encephalitis presenting as orgasmic epilepsy
- Author
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Clifford J. Eskey, Camilo E. Fadul, Konstantin H. Dragnev, E. W. Stommel, and Josep Dalmau
- Subjects
Cancer Research ,Pathology ,medicine.medical_specialty ,Lung Neoplasms ,Neurology ,Fluid-attenuated inversion recovery ,Electroencephalography ,Temporal lobe ,Central nervous system disease ,Epilepsy ,Limbic Encephalitis ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Carcinoma, Small Cell ,Orgasm ,Lung cancer ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Treatment Outcome ,Epilepsy, Temporal Lobe ,Oncology ,Female ,Neurology (clinical) ,business ,Encephalitis ,Paraneoplastic Syndromes, Nervous System - Abstract
Purpose: To report orgasmic epilepsy as a manifestation of paraneoplastic limbic encephalitis in a patient with small cell lung cancer. Case report: A 57 years-old woman presented with 2 month history of daily spells that consisted of a sudden pleasure provoking feeling described ‘like an orgasm’ lasting for 30 s to 1 min. She was a heavy smoker and had noted recent weight loss. Bronchial biopsy, following the finding of a right lung mass, confirmed the diagnosis of small cell lung cancer (SCLC). Spells subsided after starting carbamazepine. The lung cancer was treated with chemotherapy and chest radiation therapy resulting in a complete radiologic response. Results: Brain magnetic resonance imaging (MRI) revealed left temporal lobe area of increased signal on T2 and FLAIR sequence. T1-weighted images after contrast administration demonstrated a circumscribed area of enhancement in the left anterior medial temporal lobe. Electroencephalogram (EEG) showed focal left mid-temporal sharp waves and intermittent slowing. Anti-Hu antibodies were detected in her serum supporting a diagnosis of paraneoplastic limbic encephalitis as the cause of her orgasmic epilepsy. The patient has been followed for 2 years after treatment without tumor recurrence or neurological deterioration. Conclusion: Orgasmic epilepsy is another mode of presentation of paraneoplastic limbic encephalitis leading to the diagnosis of an occult SCLC. EEG and MRI findings suggest that in this case the seizures originated from the left hemisphere. It is possible that early recognition and treatment of the SCLC will improve the prognosis of this neurologic entity.
- Published
- 2005
26. Neurologic Injury Associated with CABG Surgery: Outcomes, Mechanisms, and Opportunities for Improvement
- Author
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Andrew J. Saykin, Clifford J. Eskey, Gerald T. O'Connor, Donald S. Likosky, Robert M. Roth, and Cathy S. Ross
- Subjects
Clinical Trials as Topic ,medicine.medical_specialty ,business.industry ,General Medicine ,Cabg surgery ,Prognosis ,Surgery ,Neurologic injury ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,Practice Guidelines as Topic ,medicine ,Humans ,Coronary Artery Bypass ,Nervous System Diseases ,Practice Patterns, Physicians' ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Artery - Abstract
Neurologic injuries, whether subtle or overt, are a major source of morbidity secondary to coronary artery bypass graft (CABG) surgery. A comprehensive review of research in the area of neurologic injury is provided. We conclude this article by providing insight regarding areas requiring further investigation in order to reduce sustainably the risk of these iatrogenic events among patient undergoing CABG surgery.
- Published
- 2004
27. Normal Variation of Vertebral Artery on CT Angiography and Its Implications for Diagnosis of Acquired Pathology
- Author
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Samuel Tong, R. Gilberto Gonzalez, Clifford J. Eskey, and Pina C. Sanelli
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pathology ,Vertebral artery ,Reference Values ,medicine.artery ,Image Processing, Computer-Assisted ,Vertebrobasilar Insufficiency ,medicine ,Foramen ,Humans ,Radiology, Nuclear Medicine and imaging ,Vertebral Artery ,Observer Variation ,Vertebral Artery Dissection ,medicine.diagnostic_test ,business.industry ,Cerebral Angiography ,Normal variation ,medicine.anatomical_structure ,Angiography ,Circulatory system ,Female ,Radiology ,Tomography ,Tomography, X-Ray Computed ,business ,Cerebral angiography ,Artery - Abstract
Purpose CT angiography (CTA) is rapidly becoming a popular tool for the evaluation of cerebrovascular diseases. Noninvasive diagnosis of vertebral artery pathology using CTA relies in part on diminished vertebral artery size or eccentric position relative to the transverse foramen. However, normal variation of the vertebral artery on CT has not been systematically described. Method Patients younger than 40 years who underwent CTA for reasons other than evaluation of vertebral artery disease were studied. Area measurements of the vertebral artery and the transverse foramen were performed by three radiologists. Variance component analysis was performed. Results There is marked variation in the size of the vertebral artery relative to the transverse foramen, with the vertebral artery occupying 8-85% of the foramen. In many patients, marked asymmetry in relative vertebral artery size and position was observed. This asymmetry would often vary markedly from level to level within the same patient. Conclusion Vertebral artery size and position in the transverse foramina vary markedly in normal young subjects. These normal variations must be considered when evaluating vertebral artery pathology on CT angiograms.
- Published
- 2002
28. Platelet function inhibitors and platelet function testing in neurointerventional procedures
- Author
-
Chirag D, Gandhi, Ketan R, Bulsara, Johanna, Fifi, Tareq, Kass-Hout, Ryan A, Grant, Josser E, Delgado Almandoz, Joey, English, Philip M, Meyers, Todd, Abruzzo, Charles J, Prestigiacomo, Ciaran James, Powers, Seon-Kyu, Lee, Barbara, Albani, Huy M, Do, Clifford J, Eskey, Athos, Patsalides, Steven, Hetts, M Shazam, Hussain, Sameer A, Ansari, Joshua A, Hirsch, Michael, Kelly, Peter, Rasmussen, William, Mack, G Lee, Pride, Michael J, Alexander, and Mahesh V, Jayaraman
- Subjects
Platelet Function Tests ,Practice Guidelines as Topic ,Humans ,Stents ,Neurosurgical Procedures ,Platelet Aggregation Inhibitors - Published
- 2014
29. IMAGING OF BENIGN AND MALIGNANT SOFT TISSUE TUMORS OF THE NECK
- Author
-
Caroline D. Robson, Clifford J. Eskey, and Alfred L. Weber
- Subjects
Diagnostic Imaging ,medicine.medical_specialty ,Pathology ,Neoplasms, Fibrous Tissue ,Adipose tissue ,Soft Tissue Neoplasms ,Radiology, Interventional ,Patient Care Planning ,Neoplasms, Muscle Tissue ,Biopsy ,Medical imaging ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Malignant soft tissue tumors ,Radiation treatment planning ,Neoplasms, Adipose Tissue ,medicine.diagnostic_test ,business.industry ,Soft tissue ,Magnetic resonance imaging ,General Medicine ,Magnetic Resonance Imaging ,Head and Neck Neoplasms ,Radiology ,Tomography ,Tomography, X-Ray Computed ,business - Abstract
Soft tissue tumors of the neck are a heterogeneous group of neoplasms arising from adipose, muscular, and fibrous tissue. With the exception of lymphomas, they account for only a small fraction of neck masses. Nevertheless, accurate diagnosis is important since the behavior of these neoplasms differs markedly from each other and from other head and neck masses. Noninvasive imaging, usually with CT and MR imaging, plays an important role in diagnostic evaluation and treatment planning for these tumors. In some cases, imaging features may be suggestive of a single entity. In most cases, imaging is needed to assess the location and extent of the tumor prior to biopsy or excision. This article discusses imaging techniques used for such assessment, the imaging features that help to separate these neoplasms from other head and neck tumors, and the behavior and imaging features of each of the more common benign and malignant soft tissue tumors that occur in the neck.
- Published
- 2000
30. Mass Effect in the Thoracic Spine from Remnant Bone Wax: An MR Imaging Pitfall
- Author
-
Joel M. Stein, Alexander C. Mamourian, and Clifford J. Eskey
- Subjects
Male ,Paraplegia ,medicine.medical_specialty ,Cord ,Thoracic spine ,business.industry ,Bone wax ,Palmitates ,Signal void ,medicine.disease ,Magnetic Resonance Imaging ,Mr imaging ,Thoracic Vertebrae ,Spine ,Waxes ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neurology (clinical) ,Radiology ,business ,False Negative Reactions ,Aged - Abstract
SUMMARY: Bone wax used in neurosurgical procedures is a rare cause of complications after surgery. We present a patient who developed paraplegia following thoracic spine surgery. A subsequent MR imaging study demonstrated a signal void that resembled postoperative air but appeared to cause cord compression and proved after a second surgery to represent bone wax. Recognizing the MR imaging and CT characteristics of bone wax is important to prevent mistaking it for residual air in postoperative imaging.
- Published
- 2009
31. Neuroradiology Cases
- Author
-
Clifford J. Eskey, Clifford J. Belden, David A. Pastel, Arastoo Vossough, Albert J. Yoo, Clifford J. Eskey, Clifford J. Belden, David A. Pastel, Arastoo Vossough, and Albert J. Yoo
- Subjects
- Nervous System Diseases--radiography--Case Rep, Diagnostic Techniques, Neurological--Case Report
- Abstract
Designed for both in-depth study as well as quick reference, Neuroradiology Cases covers the field of brain imaging through 192 concise and clinically relevant cases. Part of the Cases in Radiology series, this book follows the easy-to-learn case format of question and answer, complete with concise summaries and a generous amount of top-quality images. Following the format of the American Board of Radiology examinations, cases are grouped into three sections: Brain, Spine, and Ear, Nose, and Throat. Within each section, cases are randomly ordered and include challenging examples of common diseases as well as typical examples of less common ones. This collection of cases is ideal for the resident preparing for the boards, the fellow for the CAQ exam, or the radiologist in need of a quick review.
- Published
- 2012
32. Resident and Fellow Section
- Author
-
Clifford J Eskey, Joaquim Farinhas, Jeffrey Allen Cohen, Mehdi Kazmi, and Brian M. Grosberg
- Subjects
Central nervous system disease ,medicine.medical_specialty ,Text mining ,Neurology ,business.industry ,Anesthesia ,medicine ,Neurology (clinical) ,Neurological disorder ,Intensive care medicine ,medicine.disease ,business - Published
- 2007
33. A predictive model of outcomes during cerebral aneurysm coiling
- Author
-
Adina S. Fischer, Kimon Bekelis, Todd A. MacKenzie, Symeon Missios, Clifford J. Eskey, and Nicos Labropoulos
- Subjects
Adult ,Male ,medicine.medical_specialty ,Subarachnoid hemorrhage ,Databases, Factual ,Deep vein ,Context (language use) ,Aneurysm ,Predictive Value of Tests ,Risk Factors ,medicine ,Humans ,Hospital Mortality ,Stroke ,Aged ,Retrospective Studies ,Heart Failure ,Venous Thrombosis ,Models, Statistical ,business.industry ,Incidence ,Retrospective cohort study ,Intracranial Aneurysm ,General Medicine ,Acute Kidney Injury ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,Thrombosis ,Embolization, Therapeutic ,Pulmonary embolism ,Surgery ,medicine.anatomical_structure ,Logistic Models ,Outcome and Process Assessment, Health Care ,Multivariate Analysis ,Critical Pathways ,Female ,Neurology (clinical) ,business ,Pulmonary Embolism - Abstract
Background Benchmarking of complications is necessary in the context of the developing path to accountable care. We attempted to create a predictive model of negative outcomes in patients undergoing cerebral aneurysm coiling (CACo). Methods We performed a retrospective cohort study involving patients who underwent CACo from 2005 to 2009 and who were registered in the Nationwide Inpatient Sample database. A model for outcome prediction based on individual patient characteristics was developed. Results Of the 10 607 patients undergoing CACo, 6056 presented with unruptured aneurysms (57.1%) and 4551 with subarachnoid hemorrhage (42.9%). The respective inpatient postoperative risks were 0.3%, 5.7%, 1.8%, 0.8%, 0.5%, 0.2%, 1.9%, and 0.1% for unruptured aneurysms, and 13.8%, 52.8%, 4.9%, 36.7%, 1%, 2.9%, 2.3%, and 0.8% for ruptured aneurysms for death, unfavorable discharge, stroke, treated hydrocephalus, cardiac complications, deep vein thrombosis, pulmonary embolism, and acute renal failure. Multivariate analysis identified risk factors independently associated with the above outcomes. A validated model for outcome prediction based on individual patient characteristics was developed. The accuracy of the model was estimated by the area under the receiver operating characteristic curve, and it was found to have good discrimination. Conclusions The presented model can aid in the prediction of the incidence of postoperative complications, and can be used as an adjunct in tailoring the treatment of cerebral aneurysms.
- Published
- 2013
34. Brain mechanical property measurement using MRE with intrinsic activation
- Author
-
John B. Weaver, Irina Perreard, Jessica G Swienckowski, Clifford J. Eskey, S. Scott Lollis, Adam J. Pattison, Keith D. Paulsen, and Matthew D. J. McGarry
- Subjects
medicine.medical_specialty ,Materials science ,Radiological and Ultrasound Technology ,Cardiac cycle ,Movement ,Linear elasticity ,Poromechanics ,Poison control ,Brain ,Magnetic Resonance Imaging ,Article ,Surgery ,Magnetic resonance elastography ,Biomechanical Phenomena ,Shear modulus ,Vibration ,Elasticity Imaging Techniques ,Imaging, Three-Dimensional ,medicine ,Blood Vessels ,Radiology, Nuclear Medicine and imaging ,Biomedical engineering ,Mechanical Phenomena - Abstract
Many pathologies alter the mechanical properties of tissue. Magnetic resonance elastography (MRE) has been developed to noninvasively characterize these quantities in vivo. Typically, small vibrations are induced in the tissue of interest with an external mechanical actuator. The resulting displacements are measured with phase contrast sequences and are then used to estimate the underlying mechanical property distribution. Several MRE studies have quantified brain tissue properties. However, the cranium and meninges, especially the dura, are very effective at damping externally applied vibrations from penetrating deeply into the brain. Here, we report a method, termed 'intrinsic activation', that eliminates the requirement for external vibrations by measuring the motion generated by natural blood vessel pulsation. A retrospectively gated phase contrast MR angiography sequence was used to record the tissue velocity at eight phases of the cardiac cycle. The velocities were numerically integrated via the Fourier transform to produce the harmonic displacements at each position within the brain. The displacements were then reconstructed into images of the shear modulus based on both linear elastic and poroelastic models. The mechanical properties produced fall within the range of brain tissue estimates reported in the literature and, equally important, the technique yielded highly reproducible results. The mean shear modulus was 8.1 kPa for linear elastic reconstructions and 2.4 kPa for poroelastic reconstructions where fluid pressure carries a portion of the stress. Gross structures of the brain were visualized, particularly in the poroelastic reconstructions. Intra-subject variability was significantly less than the inter-subject variability in a study of six asymptomatic individuals. Further, larger changes in mechanical properties were observed in individuals when examined over time than when the MRE procedures were repeated on the same day. Cardiac pulsation, termed intrinsic activation, produces sufficient motion to allow mechanical properties to be recovered. The poroelastic model is more consistent with the measured data from brain at low frequencies than the linear elastic model. Intrinsic activation allows MRE to be performed without a device shaking the head so the patient notices no differences between it and the other sequences in an MR examination.
- Published
- 2012
35. Case 35
- Author
-
Clifford J. Eskey, Clifford J. Belden, David A. Pastel, Arastoo Vossough, and Albert J. Yoo
- Published
- 2012
36. Case 52
- Author
-
Clifford J. Eskey, Clifford J. Belden, David A. Pastel, Arastoo Vossough, and Albert J. Yoo
- Published
- 2012
37. Case 62
- Author
-
Clifford J. Eskey, Clifford J. Belden, David A. Pastel, Arastoo Vossough, and Albert J. Yoo
- Published
- 2012
38. Case 130
- Author
-
Clifford J. Eskey, Clifford J. Belden, David A. Pastel, Arastoo Vossough, and Albert J. Yoo
- Published
- 2012
39. Case 28
- Author
-
Clifford J. Eskey, Clifford J. Belden, David A. Pastel, Arastoo Vossough, and Albert J. Yoo
- Published
- 2012
40. Case 85
- Author
-
Clifford J. Eskey, Clifford J. Belden, David A. Pastel, Arastoo Vossough, and Albert J. Yoo
- Published
- 2012
41. Case 95
- Author
-
Clifford J. Eskey, Clifford J. Belden, David A. Pastel, Arastoo Vossough, and Albert J. Yoo
- Published
- 2012
42. Case 7
- Author
-
Clifford J. Eskey, Clifford J. Belden, David A. Pastel, Arastoo Vossough, and Albert J. Yoo
- Published
- 2012
43. Neuroradiology Cases
- Author
-
Clifford J. Eskey, Clifford J. Belden, David A. Pastel, Arastoo Vossough, and Albert J. Yoo
- Published
- 2012
44. Case 49
- Author
-
Clifford J. Eskey, Clifford J. Belden, David A. Pastel, Arastoo Vossough, and Albert J. Yoo
- Published
- 2012
45. Absence of abnormal vessels in the subarachnoid space on conventional magnetic resonance imaging in patients with spinal dural arteriovenous fistulas
- Author
-
Clifford J. Eskey, Alexander C. Mamourian, and Timothy R. Miller
- Subjects
Male ,medicine.medical_specialty ,Cord ,Arteriovenous fistula ,Contrast Media ,Gadolinium ,Magnetic resonance angiography ,Subarachnoid Space ,Dural arteriovenous fistulas ,Edema ,medicine ,Humans ,In patient ,Aged ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Spinal Cord ,Arteriovenous Fistula ,Surgery ,Female ,Neurology (clinical) ,Radiology ,Dura Mater ,Subarachnoid space ,medicine.symptom ,business - Abstract
Spinal dural arteriovenous fistula (DAVF) is an uncommon condition that can be difficult to diagnose. This often results in misdiagnosis and treatment delay. Although conventional MRI plays an important role in the initial screening for the disease, the typical MRI findings may be absent. In this article, the authors present a series of 4 cases involving patients with angiographically proven spinal DAVFs who demonstrated cord T2 prolongation on conventional MRI but without abnormal subarachnoid flow voids or enhancement. These cases suggest that spinal DAVF cannot be excluded in symptomatic patients with cord edema based on conventional MRI findings alone. Dynamic Gd-enhanced MR angiography (MRA) was successful in demonstrating abnormal spinal vasculature in all 4 cases. This limited experience provides support for the role of spinal MRA in patients with abnormal cord signal and symptoms suggestive of DAVF even when typical MRI findings of a DAVF are absent.
- Published
- 2012
46. Contributors
- Author
-
Frank L. Acosta, P. David Adelson, John R. Adler, ., Kamran V. Aghayev, Manish K. Aghi, Basheal M. Agrawal, Manmeet S. Ahluwalia, Faiz Ahmad, Ellen Air, Pablo Ajler, Felipe C. Albuquerque, Arun P. Amar, Luca Amendola, Christopher Ames, Beejal Y. Amin, Sepideh Amin-Hanjani, Joshua M. Ammerman, William S. Anderson, Ronald I. Apfelbaum, Michael L.J. Apuzzo, Rocco Armonda, Paul M. Arnold, Harel Arzi, Ashok R. Asthagiri, Kurtis Auguste, Tariq E. Awad, Khaled M. Aziz, Tipu Aziz, Joachim M. Baehring, Mirza N. Baig, Roy Bakay, Perry A. Ball, Stefano Bandiera, Nicholas M. Barbaro, Frederick G. Barker, Daniel L. Barrow, Sachin Batra, Joshua Bederson, Kimon Bekelis, Carlo Bellabarba, Lorenzo Bello, Allan J. Belzberg, Bernard R. Bendok, Ludwig Benes, Edward C. Benzel, Helmut Bertalanffy, Chetan Bettegowda, Ravi Bhatia, Sanjay Bhatia, Allen T. Bishop, Keith L. Black, Lewis S. Blevins, George T. Blike, Ari Blitz, Göran C. Blomstedt, Benjamin Blondel, Kofi Boahene, Bernardo Boleaga, Markus Bookland, Stefano Boriani, Christopher M. Boxell, Henry Brem, Albino Bricolo, Jason A. Brodkey, Jacques Brotchi, Jeffrey N. Bruce, Michael Bruneau, Bradley R. Buchbinder, Kim J. Burchiel, Timothy G. Burke, Ali Bydon, Francesco Cacciola, Kevin Cahill, Paolo Cappabianca, Anthony J. Caputy, Francesco Cardinale, Ricardo L. Carrau, Benjamin S. Carson, Bob S. Carter, Giuseppe Casaceli, Laura Castana, Gabriel Castillo, Luigi M. Cavallo, C. Michael Cawley, Aabir Chakraborty, Edward F. Chang, Eric C. Chang, Steven D. Chang, Jens R. Chapman, E. Thomas Chappell, Neeraj Chaudhary, Douglas Chen, James Chen, Linda C. Chen, Boyle C. Cheng, Joshua J. Chern, John H. Chi, Wade W. Chien, E. Antonio Chiocca, Rohan Chitale, Bhupal Chitnavis, Lana D. Christiano, Ray M. Chu, Elisa F. Ciceri, Michelle J. Clarke, Alan Cohen, Annamaria Colao, Geoffrey P. Colby, Massimo Collice, Daniel Condit, Alexander L. Coon, Cassius Vinícius Corrêa Dos Reis, G. Rees Cosgrove, Massimo Cossu, William T. Couldwell, William T. Curry, Guilherme Dabus, Teodoro Forcht Dagi, Giuseppe D'Aliberti, Moise Danielpour, Mark J. Dannenbaum, Ronan M. Dardis, Hormuzdiyar H. Dasenbrock, Reza Dashti, Arthur L. Day, John Diaz Day, Vedran Deletis, Ramiro Del-Valle, Franco DeMonte, Francesco Dimeco, Robert Dodd, Francesco Doglietto, Lutz Dörner, Michael J. Dorsi, Gaby D. Doumit, James M. Drake, Doniel Drazin, Rose Du, Thomas B. Ducker, Hugues Duffau, Bradley S. Duhon, Paula Eboli, Mohamed Samy Elhammady, Pamela Ely, Nancy E. Epstein, Kadir Erkmen, Thomas Errico, Emad N. Eskandar, Clifford J. Eskey, Felice Esposito, Camilo E. Fadul, Gilbert J. Fanciullo, Kyle M. Fargen, Gidon Felsen, Dong Xia Feng, Richard G. Fessler, Aaron G. Filler, John C. Flickinger, John R. Floyd, Kevin T. Foley, Kostas N. Fountas, Howard Francis, James L. Frazier, Kai Frerichs, David M. Frim, Sebastien Froelich, Takanori Fukushima, Philippe Gailloud, Sergio Maria Gaini, Chirag D. Gandhi, Dheeraj Gandhi, Gale Gardner, Paul Gardner, Mark Garrett, Tomás Garzón-Muvdi, Alessandro Gasbarrini, Fred H. Geisler, Joseph J. Gemmete, Massimo Gerosa, Atul Goel, Ziya L. Gokaslan, L. Fernando Gonzalez, C. Rory Goodwin, Takeo Goto, Grahame C. Gould, M. Sean Grady, Andrew W. Grande, Ramesh Grandhi, Alexander L. Green, Jeffrey P. Greenfield, Bradley A. Gross, Rachel Grossman, Mari Groves, Gerardo Guinto, Richard Gullan, Gaurav Gupta, Nalin Gupta, Todd C. Hankinson, Ake Hansasuta, James S. Harrop, Griffith R. Harsh, Alia Hdeib, Stefan Heinze, John Heiss, Dieter Hellwig, Juha Hernesniemi, Roberto C. Heros, Todd Hillman, Jose Hinojosa, Girish K. Hiremath, Brian L. Hoh, L. Nelson Hopkins, Wesley Hsu, Yin C. Hu, Jason H. Huang, Judy Huang, Peter J. Hutchinson, Jonathan A. Hyam, Adriana G. Ioachimescu, Pascal M. Jabbour, Juan Jackson, George I. Jallo, Ivo P. Janecka, Mohsen Javadpour, Andrew Jea, Sunil Jeswani, David H. Jho, Diana H. Jho, Hae-Dong Jho, Bowen Jiang, Tae-Young Jung, M. Yashar S. Kalani, Hideyuki Kano, Silloo B. Kapadia, Michael G. Kaplitt, Christoph Kappus, Eftychia Z. Kapsalaki, Yuval Karmon, Amin B. Kassam, Sudhir Kathuria, Takeshi Kawase, Alexander A. Khalessi, Kathleen Khu, Daniel H. Kim, Matthias Kirsch ., Riku Kivisaari, Angelos G. Kolias, Douglas Kondziolka, Marcus C Korinth, Dietmar Krex, Mark D. Krieger, Kartik G. Krishnan, Ajit A. Krishnaney, Maureen Lacy, Santosh D. Lad, Jose Alberto Landeiro, Frederick F. Lang, Shih-Shan Lang, Françoise LaPierre, Paul S. Larson, Michael T. Lawton, Marco Lee, Martin Lehecka, Allan Levi, Elad I. Levy, Robert E. Lieberson, Michael Lim, Ning Lin, Göran Lind, Bengt Linderoth, Timothy Lindley, Antoine Listrat, Charles Y. Liu, James K. Liu, John C. Liu, Giorgio Lo Russo, Christopher M. Loftus, Russell R. Lonser, Daniel C. Lu, Yi Lu, L. Dade Lunsford, M. Mason Macenski, Jaroslaw Maciaczyk, Joseph R. Madsen, Subu N. Magge, Giulio Maira, Martijn J.A. Malessy, David G. Malone, Allen Maniker, Geoffrey T. Manley, Jotham Manwaring, Mitchell Martineau, Robert L. Martuza, Marlon S. Mathews, Nestoras Mathioudakis, Paul McCormick, Michael W. McDermott, Cameron G. McDougall, H. Maximilian Mehdorn, Vivek A. Mehta, Arnold Menezes, Patrick Mertens, Frederic B. Meyer, Matthew K. Mian, Rajiv Midha, Diego San Millán Ruíz, Jonathan Miller, Neil R. Miller, Zaman Mirzadeh, Ganpati Prasad Mishra, Symeon Missios, James B. Mitchell, Alim Mitha, J. Mocco, Abhay Moghekar, Jacques J. Morcos, Chad J. Morgan, John F. Morrison, Henry Moyle, Carrie R. Muh, Debraj Mukherjee, Arya Nabavi, Michael J. Nanaszko, Dipankar Nandi, Raj Narayan, Sabareesh K. Natarajan, Edgar Nathal, Vikram V. Nayar, Audumbar Shantaram Netalkar, C. Benjamin Newman, Trang Nguyen, Laura B. Ngwenya, Antonio Nicolato, Mika Niemelä, Guido Nikkhah, Anitha Nimmagadda, John K. Niparko, Ajay Niranjan, Richard B. North, José María Núñez, W. Jerry Oakes, Christopher S. Ogilvy, Kenji Ohata, Jeffrey G. Ojemann, Steven Ojemann, David O. Okonkwo, Edward H. Oldfield, Brent O'Neill, Nelson M. Oyesiku, Roberto Pallini, Aditya S. Pandey, Dachling Pang, Kyriakos Papadimitriou, José María Pascual, Aman Patel, Anoop P. Patel, Toral R. Patel, Vincenzo Paterno, Rana Patir, Alexandra R. Paul, Sanjay J. Pawar, Richard Penn, Erlick A.C. Pereira, Mick J. Perez-Cruet, Eric C. Peterson, Mark A. Pichelmann, Joseph M. Piepmeier, Marcus O. Pinsker, Lawrence H. Pitts, Rick J. Placide, Willem Pondaag, Kalmon Post, Matthew B. Potts, Lars Poulsgaard, Gustavo Pradilla, Charles J. Prestigiacomo, Daniel M. Prevedello, Ruth Prieto, Alfredo Quiñones-Hinojosa, Leonidas M. Quintana, Scott Y. Rahimi, Rudy J. Rahme, Rodrigo Ramos-Zúñiga, Nathan J. Ranalli, Shaan M. Raza, Pablo F. Recinos, Violette Renard Recinos, Shrikant Rege, Thomas Reithmeier, Katherine Relyea, Daniel Resnick, Daniele Rigamonti, Philippe Rigoard, Jaakko Rinne, Jon H. Robertson, Shimon Rochkind, Jack P. Rock, Rossana Romani, Guy Rosenthal, Robert H. Rosenwasser, Nathan C. Rowland, James T. Rutka, Samuel Ryu, Francesco Sala, Roberto Salvatori, Kari Sammalkorpi, Nader Sanai, Thomas Santarius, Amar Saxena, Gabriele Schackert, Uta Schick, Thomas A. Schildhauer, Alexandra Schmidek, Henry H. Schmidek, Meic H. Schmidt, Paul Schmitt, Johannes Schramm, Joseph Schwab, Theodore H. Schwartz, Patrick Schweder, Daniel M. Sciubba, R. Michael Scott, Raymond F. Sekula, Patrick Senatus, Amjad Shad, Ali Shaibani, Manish S. Sharma, Rewati Raman Sharma, Sameer A. Sheth, Alexander Y. Shin, Ali Shirzadi, Adnan H. Siddiqui, Roberto Leal Silveira, Nathan E. Simmons, Marc Sindou, Marco Sinisi, Timothy Siu, Edward Smith, Joseph R. Smith, Patricia Smith, Matthew Smyth, Domenico Solari, David Solomon, Adam M. Sonabend, Mark M. Souweidane, Edgardo Spagnuolo, Robert F. Spetzler, Robert J. Spinner, Andreas M. Stark, Philip A. Starr, Ladislau Steiner, Michael P. Steinmetz, Shirley I. Stiver, Prem Subramanian, Michael E. Sughrue, Ian Suk, Daniel Q. Sun, Ulrich Sure, Oszkar Szentirmai, Alexander Taghva, Giuseppe Talamonti, Rafael J. Tamargo, Richard J. Teff, John M. Tew, Nicholas Theodore, Philip V. Theodosopoulos, B. Gregory Thompson, Wuttipong Tirakotai, Stavropoula I. Tjoumakaris, James H. Tonsgard, David Trejo, Michael Trippel, R. Shane Tubbs, Luis M. Tumialan, Andreas Unterberg, Michael S. Vaphiades, T. Brooks Vaughan, Anand Veeravagu, Ana Luisa Velasco, Francisco Velasco, Gregory J. Velat, Angela Verlicchi, Frank D. Vrionis, Michel Wager, M. Christopher Wallace, Gary S. Wand, Benjamin C. Warf, Michael F. Waters, Joseph Watson, Martin H. Weiss, Nirit Weiss, William Welch, J. Kent Werner, Louis A. Whitworth, Christopher Winfree, Timothy F. Witham, Jean-Paul Wolinsky, Judith M. Wong, Shaun Xavier, Bakhtiar Yamini, Claudio Yampolsky, Michael J. Yaremchuk, Reza Yassari, Chun-Po Yen, John Yianni, Alexander K. Yu, Eric L. Zager, Bruno Zanotti, Marco Zenteno, Mehmet Zileli, and Alexandros D. Zouzias
- Published
- 2012
47. Vertebroplasty and Kyphoplasty
- Author
-
Clifford J. Eskey
- Subjects
business.industry ,Medicine ,business - Published
- 2012
48. Reporting standards for angiographic evaluation and endovascular treatment of cerebral arteriovenous malformations
- Author
-
Mahesh V, Jayaraman, Philip M, Meyers, Colin P, Derdeyn, Justin F, Fraser, Joshua A, Hirsch, M Shazam, Hussain, Kristine A, Blackham, Clifford J, Eskey, Mary E, Jensen, Christopher J, Moran, Charles Joseph, Prestigiacomo, Peter A, Rasmussen, and Cameron G, McDougall
- Subjects
Intracranial Arteriovenous Malformations ,Research Report ,Treatment Outcome ,Endovascular Procedures ,Practice Guidelines as Topic ,Animals ,Humans ,Cerebral Angiography - Abstract
These guidelines were developed by consensus of a multidisciplinary panel of specialists interested in the evaluation and treatment of patients with arteriovenous malformations (AVMs) of the CNS. The reporting criteria described will serve as a template for trial design and for clinical investigators who wish to report on endovascular therapy of cerebral AVMs. Direct comparison of various treatment paradigms is important to standardization of care, maximization of good treatment outcomes, assessment of new methods and technologies.
- Published
- 2011
49. Role of oxygen vs. glucose in energy metabolism in a mammary carcinoma perfused ex vivo: direct measurement by 31P NMR
- Author
-
Rakesh K. Jain, Michael M. Domach, Clifford J. Eskey, and Alan P. Koretsky
- Subjects
Magnetic Resonance Spectroscopy ,Time Factors ,Cellular respiration ,Metabolite ,Adenocarcinoma ,Carbohydrate metabolism ,Biology ,Phosphates ,chemistry.chemical_compound ,Oxygen Consumption ,In vivo ,Respiration ,Animals ,Glycolysis ,Hypoxia ,Multidisciplinary ,Mammary Neoplasms, Experimental ,Phosphorus ,Hydrogen-Ion Concentration ,Rats, Inbred F344 ,Rats ,Oxygen ,Kinetics ,Glucose ,chemistry ,Biochemistry ,Lactates ,Female ,Energy Metabolism ,Perfusion ,Ex vivo ,Research Article - Abstract
The role of glycolysis vs. respiration in tumor energy metabolism has been studied, to date, primarily in vitro by using single cells, multicellular spheroids, or tissue slices. With the advent of in vivo NMR spectroscopy, several investigators have shown that tumor energy status depends on its blood flow. Since manipulation of blood flow alters both oxygen and glucose delivery to a solid tumor, these studies have not been able to separate the relative contribution of oxygen vs. glucose in energy metabolism in vivo. In the present study, we have overcome this problem by combining two methods: the tissue-isolated R3230AC mammary adenocarcinoma perfused ex vivo and 31P NMR spectroscopy. The isolated tumor permits one to control the perfusion pressure as well as the metabolite concentrations in the perfusate. NMR spectroscopy permits one to measure the ratio of nucleoside triphosphate to inorganic phosphate (NTP/Pi) and pH. Our results show that (i) the NTP/Pi ratio ex vivo is similar to that observed in vivo prior to surgery, (ii) the NTP/Pi ratio is insensitive to flow changes at high flow rates but is proportional to flow rate at flows comparable to those found in vivo, (iii) the NTP/Pi ratio of these tumors is resistant to hypoxia and is not maintained when glucose is removed or replaced with glutamine, and (iv) although both O2 and glucose are consumed by these tumors, the effect of perfusate flow rate appears to be mediated largely through glucose delivery. The current approach not only provides information about the role of glycolysis vs. respiration in a rodent tumor but also is general and versatile enough to provide similar data in human tumors perfused ex vivo.
- Published
- 1993
50. Pathology quiz case 1. Basal cell adenocarcinoma (BCAC) of a minor salivary gland
- Author
-
P Tate, Maddox, Joseph A, Paydarfar, Candice C, Black, and Clifford J, Eskey
- Subjects
Adult ,Male ,Humans ,Adenocarcinoma ,Deglutition Disorders ,Salivary Gland Neoplasms ,Salivary Glands, Minor - Published
- 2010
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