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MacGibbon J, Bavinton BR, Broady TR, Ellard J, Murphy D, Calabrese SK, Kalwicz DA, Heath-Paynter D, Molyneux A, Power C, Heslop A, de Wit J, Holt M. Corrigendum to: Familiarity with, perceived accuracy of, and willingness to rely on Undetectable=Untransmittable (U=U) among gay and bisexual men in Australia: results of a national cross-sectional survey. Sex Health 2023; 20:373. [PMID: 37603535 DOI: 10.1071/sh23050_co] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND The Undetectable=Untransmittable (U=U) message has been promoted since it was demonstrated that viral suppression through HIV treatment prevents sexual transmission between serodiscordant partners (HIV treatment as prevention). Our study assessed familiarity with, perceived accuracy of, and willingness to rely on U=U in a national sample of gay and bisexual men in Australia. METHODS We conducted a national, online cross-sectional survey in April-June 2021. Eligible participants were gay, bisexual and queer men and non-binary people who lived in Australia. Logistic regression was used to identify factors associated with familiarity, perceived accuracy and willingness to rely on U=U (by having condomless sex with a partner with HIV who has an undetectable viral load). RESULTS Of 1280 participants, most were familiar with U=U (1006/1280; 78.6%), the majority of whom believed U=U was accurate (677/1006; 67.3%). Both familiarity and perceived accuracy were higher among participants living with HIV, followed by pre-exposure prophylaxis (PrEP) users, HIV-negative participants not taking PrEP, and untested/unknown status participants. Knowing at least one person living with HIV, among other factors, was associated with familiarity and perceived accuracy of U=U; and familiarity was associated with perceived accuracy. Among participants familiar with U=U, less than half were willing to rely on U=U (473/1006; 47.0%). Familiarity with U=U and knowing at least one person living with HIV were associated with willingness to rely on U=U, among other factors. CONCLUSIONS We found familiarity with U=U was associated with perceived accuracy and willingness to rely upon it. There is an ongoing need to educate gay and bisexual men (particularly HIV-negative men) about U=U and its benefits.
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MacGibbon J, Bavinton BR, Broady TR, Ellard J, Murphy D, Calabrese SK, Kalwicz DA, Heath-Paynter D, Molyneux A, Power C, Heslop A, de Wit J, Holt M. Familiarity with, perceived accuracy of, and willingness to rely on Undetectable=Untransmittable (U=U) among gay and bisexual men in Australia: results of a national cross-sectional survey. Sex Health 2023:SH23050. [PMID: 37380171 DOI: 10.1071/sh23050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/01/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND The Undetectable=Untransmittable (U=U) message has been promoted since it was demonstrated that viral suppression through HIV treatment prevents sexual transmission between serodiscordant partners (HIV treatment as prevention). Our study assessed familiarity with, perceived accuracy of, and willingness to rely on U=U in a national sample of gay and bisexual men in Australia. METHODS We conducted a national, online cross-sectional survey in April-June 2021. Eligible participants were gay, bisexual and queer men and non-binary people who lived in Australia. Logistic regression was used to identify factors associated with familiarity, perceived accuracy and willingness to rely on U=U (by having condomless sex with a partner with HIV who has an undetectable viral load). RESULTS Of 1280 participants, most were familiar with U=U (1006/1280; 78.6%), the majority of whom believed U=U was accurate (677/1006; 67.3%). Both familiarity and perceived accuracy were higher among participants living with HIV, followed by pre-exposure prophylaxis (PrEP) users, HIV-negative participants not taking PrEP, and untested/unknown status participants. Knowing at least one person living with HIV, among other factors, was associated with familiarity and perceived accuracy of U=U; and familiarity was associated with perceived accuracy. Among participants familiar with U=U, less than half were willing to rely on U=U (473/1006; 47.0%). Familiarity with U=U and knowing at least one person living with HIV were associated with willingness to rely on U=U, among other factors. CONCLUSIONS We found familiarity with U=U was associated with perceived accuracy and willingness to rely upon it. There is an ongoing need to educate gay and bisexual men (particularly HIV-negative men) about U=U and its benefits.
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MacGibbon J, Bavinton BR, Drysdale K, Murphy D, Broady TR, Kolstee J, Molyneux A, Power C, Paynter H, de Wit J, Holt M. Explicit Relationship Agreements and HIV Pre-exposure Prophylaxis Use by Gay and Bisexual Men in Relationships. Arch Sex Behav 2023; 52:761-771. [PMID: 35939159 PMCID: PMC9360633 DOI: 10.1007/s10508-022-02382-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Relationship agreements are important for HIV prevention among gay and bisexual men (GBM) in relationships, with research earlier in the HIV epidemic often finding that agreements specified monogamy or condom use with casual partners. There is evidence that HIV pre-exposure prophylaxis (PrEP) has shifted sexual practices among some men in relationships, such as allowing condomless sex with casual partners, but there has been little attention paid to relationship agreements among GBM who use PrEP. In this paper, we analyzed national, Australian, cross-sectional data from an online survey completed by non-HIV-positive GBM in 2021 (N = 1,185). Using logistic regression, we identified demographic characteristics, sexual practices and the types of relationship agreement that were associated with PrEP use among GBM in relationships. Using Pearson's chi-squared tests, we explored whether PrEP users in relationships reported similar sexual practices to PrEP users not in relationships. PrEP use among GBM in relationships was independently associated with older age, identifying as gay, being in a non-monogamous relationship, having a spoken (explicit) relationship agreement, having a primary HIV-negative partner taking PrEP or a primary partner living with HIV, reporting recent condomless casual sex, reporting an STI diagnosis in the past year, and knowing at least one other PrEP user. We found that PrEP users in relationships had similar sexual practices to PrEP users not in relationships. GBM in relationships who have casual sex and who meet PrEP suitability criteria may be good candidates for PrEP. Our findings suggest that explicit relationship agreements remain important for HIV prevention, and they support PrEP use among GBM in relationships.
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Affiliation(s)
- James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, 2052, Australia.
| | | | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, 2052, Australia
| | - Dean Murphy
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, 2052, Australia
| | | | | | - Cherie Power
- New South Wales Ministry of Health, Sydney, Australia
| | - Heath Paynter
- Australian Federation of AIDS Organisations, Sydney, Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW Sydney, Sydney, 2052, Australia
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, 2052, Australia
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Holt M, MacGibbon J, Bavinton B, Broady T, Clackett S, Ellard J, Kolstee J, Molyneux A, Murphy D, Power C, de Wit J. COVID-19 Vaccination Uptake and Hesitancy in a National Sample of Australian Gay and Bisexual Men. AIDS Behav 2022; 26:2531-2538. [PMID: 35102499 PMCID: PMC8803280 DOI: 10.1007/s10461-022-03603-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/25/2022]
Abstract
Minority groups may face additional barriers to vaccination. In April-June 2021, we assessed the level of COVID-19 vaccination and willingness to be vaccinated in a national, online survey of 1280 gay and bisexual men in Australia. Over a quarter of the sample (28.0%) had been partially or fully vaccinated, and 80.0% of the unvaccinated were willing to be vaccinated. Vaccination was independently associated with older age, being university educated, and HIV status (with HIV-positive participants being more likely and untested participants less likely to be vaccinated). Willingness to be vaccinated was independently associated with living in a capital city and being university educated. Those who had lost income or their job due to COVID-19 were less willing to be vaccinated. Our results suggest encouraging COVID-19 vaccination among those with lower levels of health literacy and supporting those who have experienced financial stress because of the pandemic.
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Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia.
| | - James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | | | | | - Dean Murphy
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Cherie Power
- New South Wales Ministry of Health, Sydney, Australia
| | - John de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
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Pierot L, Gubucz I, Buhk JH, Holtmannspötter M, Herbreteau D, Stockx L, Spelle L, Berkefeld J, Januel AC, Molyneux A, Byrne JV, Fiehler J, Szikora I, Barreau X. Safety and Efficacy of Aneurysm Treatment with the WEB: Results of the WEBCAST 2 Study. AJNR Am J Neuroradiol 2017; 38:1151-1155. [PMID: 28450432 DOI: 10.3174/ajnr.a5178] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/07/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow disruption with the Woven EndoBridge (WEB) device is an innovative technique for the endovascular treatment of wide-neck bifurcation aneurysms. The initial version of the device (WEB Double-Layer) was evaluated in the WEB Clinical Assessment of IntraSaccular Aneurysm Therapy (WEBCAST) study, whereas the French Observatory study evaluated both WEB Double-Layer and Single-Layer versions of the device. WEBCAST 2 was designed to evaluate the WEB Single-Layer with Enhanced Visualization. MATERIALS AND METHODS Patients with wide-neck bifurcation aneurysms for which WEB treatment was possible were included. Clinical data including adverse events and clinical status at 1 month and 1 year were collected and analyzed. A core laboratory evaluated anatomic results at 1 year following the procedure. RESULTS Ten European neurointerventional centers included 55 patients (38 women; 27-77 years of age; mean, 54.4 ± 10.0 years) with 55 aneurysms. Aneurysm locations were the middle cerebral artery in 25 aneurysms (45.5%), the anterior communicating artery in 16 (29.1%), the basilar artery in 9 (16.4%), and the internal carotid artery terminus in 5 (9.1%). Procedural morbidity and mortality at 1 month were, respectively, 1.8% (1/55 patients) and 0.0% (0/55 patients). Morbidity and mortality at 1 year were, respectively, 3.9% (2/51 patients) and 2.0% (1/51 patients). At 1 year, complete occlusion was observed in 27/50 aneurysms (54.0%); neck remnant, in 13/50 (26.0%); and aneurysm remnant, in 10/50 (20.0%) (adequate occlusion in 40/50, 80.0%). CONCLUSIONS WEBCAST 2 confirms the high safety and efficacy of WEB aneurysm treatment demonstrated in the WEBCAST and French Observatory studies.
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Affiliation(s)
- L Pierot
- From the Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - I Gubucz
- National Institute of Clinical Neurosciences (I.G., I.S.), Budapest, Hungary
| | - J H Buhk
- Department of Neuroradiology (J.H.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - D Herbreteau
- Centre Hospitalier Universitaire Tours (D.H.), Tours, France
| | - L Stockx
- Ziekenhuis Oost-Limburg Genk (L. Stockx), Genk, Belgium
| | - L Spelle
- Hôpital Bicêtre (L. Spelle), Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - J Berkefeld
- Institut für Neuroradiologie (J.B.), Klinikum der Johann Wolfgang Goethe-Universitaet, Frankfurt, Germany
| | - A-C Januel
- Centre Hospitalier Universitaire Toulouse (A.-C.J.), Toulouse, France
| | - A Molyneux
- Oxford Neurovascular and Neuroradiology Research Unit (J.V.B., A.M.), John Radcliffe Hospital, Oxford, UK
| | - J V Byrne
- Oxford Neurovascular and Neuroradiology Research Unit (J.V.B., A.M.), John Radcliffe Hospital, Oxford, UK
| | - J Fiehler
- Department of Neuroradiology (J.H.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Szikora
- National Institute of Clinical Neurosciences (I.G., I.S.), Budapest, Hungary
| | - X Barreau
- Centre Hospitalier Universitaire Bordeaux (X.B.), Bordeaux, France
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Fiorella D, Arthur A, Molyneux A, Byrne J. O-026 The US WEB Intrasaccular Therapy Study (WEB-IT): 30 Day Results. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pierot L, Molyneux A, Byrne J. O-020 WEB® Aneurysm Treatment: Preliminary Results of WEBCAST 2 Study. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pierot L, Molyneux A, Byrne J. P-028 Safety and Efficacy of WEB® Aneurysm Treatment: Combined Analysis of WEBCAST, French Observatory, and WEBCAST2 Studies – Preliminary Results. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pierot L, Moret J, Turjman F, Herbreteau D, Raoult H, Barreau X, Velasco S, Desal H, Januel AC, Courtheoux P, Gauvrit JY, Cognard C, Molyneux A, Byrne J, Spelle L. WEB Treatment of Intracranial Aneurysms: Clinical and Anatomic Results in the French Observatory. AJNR Am J Neuroradiol 2016. [PMID: 26514608 DOI: 10.3760/cma.j.issn.1000-6702.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE Flow disruption with the WEB device is a new technique for the endovascular treatment of wide-neck bifurcation aneurysms. To obtain precise data regarding the safety and efficacy of this treatment with high-quality methodology, the prospective French Observatory study was conducted. Analysis of these data is presented, including 1-year follow-up. MATERIALS AND METHODS Patients with bifurcation aneurysms for which WEB treatment was indicated were included in this prospective, multicenter Good Clinical Practice study. Clinical data, including adverse events and clinical status at 1 month and 1 year, were collected and independently analyzed by a medical monitor. An independent core laboratory evaluated the anatomic results at 1 year following the procedure. RESULTS Ten French neurointerventional centers included 62 patients (39 women), 33-74 years of age (mean, 56.6 ± 9.80 years) with 63 aneurysms. Aneurysm locations were the middle cerebral artery in 32 aneurysms (50.8%), anterior communicating artery in 16 (25.4%), basilar artery in 9 (14.3%), and internal carotid artery terminus in 6 (9.5%). Morbidity and mortality at 1 month were, respectively, 3.2% (2/62 patients) and 0.0% (0/62). Morbidity and mortality (unrelated to the treatment) at 1 year were, respectively, 0.0% (0/59) and 3.4% (2/59 patients). At 1 year, complete occlusion was observed in 30/58 aneurysms (51.7%); neck remnant, in 16/58 aneurysms (27.6%); and aneurysm remnant, in 12/58 aneurysms (20.7%). CONCLUSIONS This prospective French Observatory study showed very good safety of aneurysm treatment with the WEB, with a high rate of adequate aneurysm occlusion at 1 year (79.3%).
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Affiliation(s)
- L Pierot
- From the Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - J Moret
- Hôpital Beaujon, (J.M., L.S.), Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - F Turjman
- Centre Hospitalier Universitaire de Lyon (F.T.), Lyon, France
| | - D Herbreteau
- Centre Hospitalier Universitaire de Tours (D.H.), Tours, France
| | - H Raoult
- Centre Hospitalier Universitaire de Rennes (H.R., J.-Y.G.), Rennes, France
| | - X Barreau
- Centre Hospitalier Universitaire de Bordeaux (X.B.), Bordeaux, France
| | - S Velasco
- Centre Hospitalier Universitaire de Poitiers (S.V.), Poitiers, France
| | - H Desal
- Centre Hospitalier Universitaire de Nantes (H.D.), Nantes, France
| | - A-C Januel
- Centre Hospitalier Universitaire de Toulouse (A.-C.J., C.C.), Toulouse, France
| | - P Courtheoux
- Centre Hospitalier Universitaire de Caen (P.C.), Caen, France
| | - J-Y Gauvrit
- Centre Hospitalier Universitaire de Rennes (H.R., J.-Y.G.), Rennes, France
| | - C Cognard
- Centre Hospitalier Universitaire de Toulouse (A.-C.J., C.C.), Toulouse, France
| | - A Molyneux
- Oxford Neurovascular and Neuroradiology Research Unit (A.M., J.B.), Oxford Radcliffe Hospital, Oxford, UK
| | - J Byrne
- From the Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - L Spelle
- Hôpital Beaujon, (J.M., L.S.), Assistance Publique-Hôpitaux de Paris, Clichy, France
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Abdelwareth A, Molyneux A, Madhotra R, Ishaq S, Rostami K. Small bowel pigmentation. Gastroenterol Hepatol Bed Bench 2016; 9:343-344. [PMID: 27895863 PMCID: PMC5118862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Alaa Abdelwareth
- Department of Gastroenterology, Milton Keynes University Hospital, United Kingdom
| | - Angus Molyneux
- Department of Pathology, Milton Keynes University Hospital, United Kingdom
| | - Ravi Madhotra
- Department of Gastroenterology, Milton Keynes University Hospital, United Kingdom
| | - Sauid Ishaq
- Dudley Group of Hospitals NHS Foundation Trust, United Kingdom,Birmingham City University, Birmingham, United Kingdom
| | - Kamran Rostami
- Department of Gastroenterology, Milton Keynes University Hospital, United Kingdom
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Cheung VTF, Singanayagam J, Molyneux A, Rajoriya N. Dysphagia to liver failure. BMJ Case Rep 2015; 2015:bcr-2015-212522. [PMID: 26611487 DOI: 10.1136/bcr-2015-212522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Jey Singanayagam
- Department of Radiology, Milton Keynes University Hospital, Milton Keynes, UK
| | - Angus Molyneux
- Department of Histopathology, Milton Keynes University Hospital, Milton Keynes, UK
| | - Neil Rajoriya
- Department of Gastroenterology, Milton Keynes University Hospital, Milton Keynes, UK
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Pierot L, Moret J, Turjman F, Herbreteau D, Raoult H, Barreau X, Velasco S, Desal H, Januel AC, Courtheoux P, Gauvrit JY, Cognard C, Molyneux A, Byrne J, Spelle L. WEB Treatment of Intracranial Aneurysms: Clinical and Anatomic Results in the French Observatory. AJNR Am J Neuroradiol 2015; 37:655-9. [PMID: 26514608 DOI: 10.3174/ajnr.a4578] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/30/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow disruption with the WEB device is a new technique for the endovascular treatment of wide-neck bifurcation aneurysms. To obtain precise data regarding the safety and efficacy of this treatment with high-quality methodology, the prospective French Observatory study was conducted. Analysis of these data is presented, including 1-year follow-up. MATERIALS AND METHODS Patients with bifurcation aneurysms for which WEB treatment was indicated were included in this prospective, multicenter Good Clinical Practice study. Clinical data, including adverse events and clinical status at 1 month and 1 year, were collected and independently analyzed by a medical monitor. An independent core laboratory evaluated the anatomic results at 1 year following the procedure. RESULTS Ten French neurointerventional centers included 62 patients (39 women), 33-74 years of age (mean, 56.6 ± 9.80 years) with 63 aneurysms. Aneurysm locations were the middle cerebral artery in 32 aneurysms (50.8%), anterior communicating artery in 16 (25.4%), basilar artery in 9 (14.3%), and internal carotid artery terminus in 6 (9.5%). Morbidity and mortality at 1 month were, respectively, 3.2% (2/62 patients) and 0.0% (0/62). Morbidity and mortality (unrelated to the treatment) at 1 year were, respectively, 0.0% (0/59) and 3.4% (2/59 patients). At 1 year, complete occlusion was observed in 30/58 aneurysms (51.7%); neck remnant, in 16/58 aneurysms (27.6%); and aneurysm remnant, in 12/58 aneurysms (20.7%). CONCLUSIONS This prospective French Observatory study showed very good safety of aneurysm treatment with the WEB, with a high rate of adequate aneurysm occlusion at 1 year (79.3%).
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Affiliation(s)
- L Pierot
- From the Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - J Moret
- Hôpital Beaujon, (J.M., L.S.), Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - F Turjman
- Centre Hospitalier Universitaire de Lyon (F.T.), Lyon, France
| | - D Herbreteau
- Centre Hospitalier Universitaire de Tours (D.H.), Tours, France
| | - H Raoult
- Centre Hospitalier Universitaire de Rennes (H.R., J.-Y.G.), Rennes, France
| | - X Barreau
- Centre Hospitalier Universitaire de Bordeaux (X.B.), Bordeaux, France
| | - S Velasco
- Centre Hospitalier Universitaire de Poitiers (S.V.), Poitiers, France
| | - H Desal
- Centre Hospitalier Universitaire de Nantes (H.D.), Nantes, France
| | - A-C Januel
- Centre Hospitalier Universitaire de Toulouse (A.-C.J., C.C.), Toulouse, France
| | - P Courtheoux
- Centre Hospitalier Universitaire de Caen (P.C.), Caen, France
| | - J-Y Gauvrit
- Centre Hospitalier Universitaire de Rennes (H.R., J.-Y.G.), Rennes, France
| | - C Cognard
- Centre Hospitalier Universitaire de Toulouse (A.-C.J., C.C.), Toulouse, France
| | - A Molyneux
- Oxford Neurovascular and Neuroradiology Research Unit (A.M., J.B.), Oxford Radcliffe Hospital, Oxford, UK
| | - J Byrne
- From the Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - L Spelle
- Hôpital Beaujon, (J.M., L.S.), Assistance Publique-Hôpitaux de Paris, Clichy, France
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Pierot L, Molyneux A, Byrne J, Investigators W. E-044 web-sl/sls ®aneurysm treatment: one-month safety results in webcast2 study. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pierot L, Molyneux A, Byrne J. O-021 safety and efficacy of web ®aneurysm treatment: combined analysis of webcast and french observatory studies. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pierot L, Moret J, Turjman F, Herbreteau D, Raoult H, Barreau X, Velasco S, Desal H, Januel AC, Courtheoux P, Gauvrit JY, Cognard C, Soize S, Molyneux A, Spelle L. WEB Treatment of Intracranial Aneurysms: Feasibility, Complications, and 1-Month Safety Results with the WEB DL and WEB SL/SLS in the French Observatory. AJNR Am J Neuroradiol 2015; 36:922-7. [PMID: 25655876 DOI: 10.3174/ajnr.a4230] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/24/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Safety analyses in the French Observatory have shown that treatment of intracranial aneurysms by using flow disruption with the Woven EndoBridge Device (WEB) is safe, with low morbidity and no mortality. The objective of this study was to analyze treatment feasibility, complications, and safety results in patients treated with the Woven EndoBridge Device Dual-Layer (WEB DL) and Woven EndoBridge Device Single-Layer/Single-Layer Sphere (WEB SL/SLS) in the French Observatory. MATERIALS AND METHODS Patients with bifurcation aneurysms were included in this prospective, multicenter good clinical practices study. A medical monitor independently analyzed procedural and clinical data. The study started with the WEB DL, and secondarily, the WEB SL/SLS was authorized in the study. RESULTS Between November 2012 and January 2014, 10 French centers included 62 patients with 63 aneurysms. Thirty patients with 31 aneurysms were treated with the WEB DL, and 32 patients with 32 aneurysms, with the WEB SL/SLS. The percentage of anterior communicating artery aneurysms treated with WEB SL/SLS was significantly higher (37.5%) compared with WEB DL (12.9%) (P = .04). The WEB SL/SLS was more frequently used in aneurysms of <10 mm than the WEB DL (respectively, 96.9% and 67.7%; P = .002). Morbidity was similar in both groups (WEB DL, 3.3%; WEB SL/SLS, 3.1%), and mortality was 0.0% in both groups. CONCLUSIONS This comparative study shows increased use of WEB treatment in ruptured, small, and anterior communicating artery aneurysms when using WEB SL/SLS. There was a trend toward fewer thromboembolic complications with the WEB SL/SLS. With both the WEB DL and WEB SL/SLS, the treatment was safe, with low morbidity and no mortality.
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Affiliation(s)
- L Pierot
- From the Department of Neuroradiology (L.P., S.S.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - J Moret
- Department of Neuroradiology (J.M., L.S.), Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - F Turjman
- Department of Neuroradiology (F.T.), Centre Hospitalier Universitaire Lyon, Lyon, France
| | - D Herbreteau
- Department of Neuroradiology (D.H.), Centre Hospitalier Universitaire Tour, Tours, France
| | - H Raoult
- Department of Neuroradiology (H.R., J.-Y.G.), Centre Hospitalier Universitaire Rennes, Rennes, France
| | - X Barreau
- Department of Neuroradiology (X.B.), Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - S Velasco
- Department of Neuroradiology (S.V.), Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - H Desal
- Department of Neuroradiology (H.D.), Centre Hospitalier Universitaire Nantes, Nantes, France
| | - A-C Januel
- Department of Neuroradiology (A.-C.J., C.C.), Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - P Courtheoux
- Department of Neuroradiology (P.C.), Centre Hospitalier Universitaire Caen, Caen, France
| | - J-Y Gauvrit
- Department of Neuroradiology (H.R., J.-Y.G.), Centre Hospitalier Universitaire Rennes, Rennes, France
| | - C Cognard
- Department of Neuroradiology (A.-C.J., C.C.), Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - S Soize
- From the Department of Neuroradiology (L.P., S.S.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - A Molyneux
- Department of Neuroradiology (A.M.), Oxford Neurovascular and Neuroradiology Research Unit, Oxford Radcliffe Hospital, Oxford, United Kingdom
| | - L Spelle
- Department of Neuroradiology (J.M., L.S.), Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
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Pierot L, Spelle L, Costalat V, Szikora I, Klisch J, Herbreteau D, Holtmannspoetter M, Weber W, Liebig T, Cognard C, Bonafé A, Moret J, Byrne J, Molyneux A. E-029 WEB Flow Disruption: Preliminary Results from WEBCAST trial. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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White P, Molyneux A. O-011 UK National Prospective Flow Diverter Registry of Aneurysm Treatment: First 200 patients - Safety and efficacy findings. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Main S, Somani V, Molyneux A, Bhattacharya M, Randhawa R, Kavidasan A. Unsuspected pulmonary alveolar proteinosis in a patient with a slow resolving pneumonia: A case report. Respir Med Case Rep 2013; 10:1-3. [PMID: 26029499 PMCID: PMC3920425 DOI: 10.1016/j.rmcr.2013.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/26/2013] [Accepted: 06/03/2013] [Indexed: 01/15/2023] Open
Abstract
Pulmonary Alveolar Proteinosis (PAP) is a rare condition with an incidence of one in two million and is classified as primary or secondary. This is the first reported case presenting as a slow resolving pneumonia.
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Affiliation(s)
- Stephanie Main
- Department of Chest Medicine and Lung Physiology, Milton Keynes Hospital NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes, Buckinghamshire MK6 5LD, UK
| | - Vikas Somani
- Department of Chest Medicine and Lung Physiology, Milton Keynes Hospital NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes, Buckinghamshire MK6 5LD, UK
| | - Angus Molyneux
- Department of Cellular Pathology, Milton Keynes Hospital NHS Foundation Trust, Buckinghamshire, UK
| | - Milan Bhattacharya
- Department of Chest Medicine and Lung Physiology, Milton Keynes Hospital NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes, Buckinghamshire MK6 5LD, UK
| | - Rabinder Randhawa
- Department of Chest Medicine and Lung Physiology, Milton Keynes Hospital NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes, Buckinghamshire MK6 5LD, UK
| | - Ajikumar Kavidasan
- Department of Chest Medicine and Lung Physiology, Milton Keynes Hospital NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes, Buckinghamshire MK6 5LD, UK
- Corresponding author. Tel.: +44 1908 660033.
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Coley S, Sneade M, Clarke A, Mehta Z, Kallmes D, Cekirge S, Saatci I, Roy D, Molyneux A. Cerecyte coil trial: procedural safety and clinical outcomes in patients with ruptured and unruptured intracranial aneurysms. AJNR Am J Neuroradiol 2011; 33:474-80. [PMID: 22207299 DOI: 10.3174/ajnr.a2836] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE This study arose from a need to systematically evaluate the clinical and angiographic outcomes of intracranial aneurysms treated with modified coils. We report the procedural safety and clinical outcomes in a prospective randomized controlled trial of endovascular coiling for ruptured and unruptured intracranial aneurysms, comparing polymer-loaded Cerecyte coils with bare platinum coils in 23 centers worldwide. MATERIALS AND METHODS Five hundred patients between 18 and 70 years of age with a ruptured or unruptured target aneurysm planning to undergo endovascular coiling were randomized to receive Cerecyte or bare platinum coils. Analysis was by intention to treat. RESULTS Two hundred forty-nine patients were allocated to Cerecyte coils and 251 to bare platinum coils. Baseline characteristics were balanced. For ruptured aneurysms, in-hospital mortality was 2/114 (1.8%) with Cerecyte versus 0/119 (0%) bare platinum coils. There were 8 (3.4%) adverse procedural events resulting in neurological deterioration: 5/114 (4.4%) with Cerecyte versus 3/119 (2.5%) with bare platinum coils (P = .22). The 6-month mRS score of ≤2 was not significantly different in 103/109 (94.5%) patients with Cerecyte and 110/112 (98.2%) patients with bare platinum coils. Poor outcome (mRS score of ≥3 or death) was 6/109 (5.5%) with Cerecyte versus 2/112 (1.8%) with bare platinum coils (P = .070). For UIAs, there was no in-hospital mortality. There were 7 (2.7%) adverse procedural events with neurological deterioration, 5/133 (3.8%) with Cerecyte versus 2/131 (1.5%) with bare platinum coils (P = .13). There was a 6-month mRS score of ≤2 in 114/119 (95.8%) patients with Cerecyte versus 123/123 (100%) patients with bare platinum coils. There was poor outcome (mRS ≥3 and 1 death) in 5/119 (4.2%) patients with Cerecyte versus 0/123 (0%) patients with bare platinum coils (P = .011). CONCLUSIONS There was a statistical excess of poor outcomes in the Cerecyte arm at discharge in the ruptured aneurysm group and at 6-month follow-up in the unruptured group. Overall adverse clinical outcomes and in-hospital mortality were exceptionally low in both groups.
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Affiliation(s)
- S Coley
- Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, UK
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Molyneux A, Coley S, Sneade M, Mehta Z. O-013 Cerecyte coil trial: the clinical outcome of endovascular coiling in patients with ruptured and unruptured intracranial aneurysms treated with Cerecyte coils compared with bare platinum coils. Results of a prospective randomized trial. J Neurointerv Surg 2010. [DOI: 10.1136/jnis.2010.003244.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Molyneux A, Fox A, Sneade M, Mehta Z. O-014 Cerecyte coil trial: the angiographic outcome of endovascular coiling in patients with ruptured and unruptured intracranial aneurysms treated with cerecyte coils compared with bare platinum coils. Results of a prospective randomized trial. J Neurointerv Surg 2010. [DOI: 10.1136/jnis.2010.003244.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Goirigolzarri I, Pitt M, Molyneux A, De Pablos C, Garcia A. P25-13 Spinal cord injury at birth as a consequence of a postulated prenatal anterior spinal artery ischemic infarct: The value of electromyographic studies. Clin Neurophysiol 2010. [DOI: 10.1016/s1388-2457(10)61035-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sellar R, Molyneux A. ISAT: The International Subarachnoid Aneurysm Trail. Lessons and Update. Interv Neuroradiol 2008; 14 Suppl 1:50-1. [PMID: 20557774 DOI: 10.1177/15910199080140s109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 08/10/2008] [Indexed: 11/16/2022] Open
Affiliation(s)
- R Sellar
- Western General Hospital; Edinburgh, Scotland, UK - -
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Henderson S, Pitman M, McCarthy J, Molyneux A, Old J. Molecular prenatal diagnosis of Hb H Hydrops Fetalis caused by haemoglobin Adana and the implications to antenatal screening for α-thalassaemia. Prenat Diagn 2008; 28:859-61. [DOI: 10.1002/pd.2045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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van der Schaaf I, Algra A, Wermer M, Molyneux A, Clarke M, van Gijn J, Rinkel G. Endovascular coiling versus neurosurgical clipping for patients with aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2005:CD003085. [PMID: 16235314 DOI: 10.1002/14651858.cd003085.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients who have had an aneurysmal subarachnoid haemorrhage (SAH) are at very high risk of rebleeding if the aneurysm is not treated. The standard treatment for several decades has been surgical clipping of the neck of the aneurysm. In recent years, an alternative, the introduction of detachable coils to occlude the aneurysm, has become more common. OBJECTIVES To compare the effects of endovascular coiling versus neurosurgical clipping in patients with aneurysmal subarachnoid haemorrhage. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched in February 2005). In addition we searched MEDLINE (1966 to January 2004) and EMBASE (1980 to January 2004), and contacted trialists. SELECTION CRITERIA We included randomised trials in which endovascular coiling of aneurysms was compared with neurosurgical clipping in patients with SAH who have proven aneurysm. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data and assessed trial quality. Trialists were contacted to obtain missing information. MAIN RESULTS We identified three randomised trials: two published and one unpublished. The trials included a total of 2272 patients (range per trial: 20 to 2143 patients). Most of the patients were in good clinical condition and had an aneurysm on the anterior circulation. After one year of follow up, the relative risk (RR) of poor outcome for coiling versus clipping was 0.76 (95% confidence interval (CI) 0.67 to 0.88). The absolute risk reduction was 7% (95% CI 4% to 11%). In the worst-case scenario analysis for poor outcome overall, the relative risk for coiling versus clipping was 0.81 (95% CI 0.70 to 0.92) and the absolute risk reduction was 6% (95% CI 2% to 10%). For patients with anterior circulation aneurysm the relative risk of poor outcome was 0.78 (95% CI 0.68 to 0.90) and the absolute risk decrease was 7% (95% CI 3% to 10%). For those with a posterior circulation aneurysm the relative risk was 0.41 (95% CI 0.19 to 0.92) and the absolute decrease in risk 27% (95% CI 6% to 48%). AUTHORS' CONCLUSIONS The evidence comes mainly from one large trial. For patients in good clinical condition with ruptured aneurysms of either the anterior or posterior circulation we have firm evidence that, if the aneurysm is considered suitable for both surgical clipping and endovascular treatment, coiling is associated with a better outcome.
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Affiliation(s)
- I van der Schaaf
- University Hospital Utrecht, Department of Neurology, PO Box 85500, Utrecht, Netherlands 3508 GA.
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Molyneux A, Králíková E, Himmerová V. [ABC of smoking cessation. Nicotine replacement therapy]. Cas Lek Cesk 2004; 143:781-3. [PMID: 15628577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Nicotine replacement therapy doubles the success rate in smoking cessation during all intervention levels - so its effectiveness is higher with the most intensive support. The patient can choose the NRT form since the effectiveness does not differ substantially. Nicotine replacement therapy should be offered to each nicotine dependent smoker willing to stop. In the case of abstinence the treatment should be taken at least 6 to 8 weeks.
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Affiliation(s)
- A Molyneux
- Odborný lékar respiracních chorob v City Hospital, Nottingham
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Schulz UGR, Briley D, Meagher T, Molyneux A, Rothwell PM. Abnormalities on diffusion weighted magnetic resonance imaging performed several weeks after a minor stroke or transient ischaemic attack. J Neurol Neurosurg Psychiatry 2003; 74:734-8. [PMID: 12754341 PMCID: PMC1738485 DOI: 10.1136/jnnp.74.6.734] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Diffusion weighted brain imaging (DWI) is used in acute stroke, and also shows an acute ischaemic lesion in most transient ischamic attack (TIA) patients scanned acutely. However, it may also be useful in identifying subacute ischaemic lesions in patients with minor stroke or TIA who present several weeks after symptom onset. This study investigated the sensitivity and the observer reproducibility of DWI in cerebral TIA and minor ischaemic stroke patients scanned more than two weeks after the last symptomatic event. METHODS Consecutive patients underwent magnetic resonance imaging (T2, DWI, ADC). The presence of clinically appropriate lesions was assessed by two independent observers, and related to the type of presenting event, the NIH score, persistence of symptoms and signs, and the time since the presenting event. RESULTS 101 patients (53 men) were scanned at a median time of 21 days (IQR=17-28) after symptom onset. Reproducibility of the assessment of DWI abnormalities was high: interobserver agreement =97% (kappa=0.94, p<0.0001); intraobserver agreement =94% (kappa=0.88, p<0.0001). DWI showed a clinically appropriate ischaemic lesion in 29 of 51 (57%) minor stroke patients, and in 7 of 50 (14%) TIA patients. The independent predictors of a positive DWI scan were presentation with minor stroke versus TIA (p=0.009) and increasing NIH score (p=0.009), but there was no difference between patients presenting 2-4 weeks compared with >4 weeks after symptom onset. In minor stroke patients, the presence of a clinically appropriate lesion was associated with persistent symptoms (63% versus 36%; p=0.12) and signs (64% versus 33%, p=0.06) at the time of scanning. CONCLUSIONS DWI shows a clinically appropriate ischaemic lesion in more than half of minor stroke patients presenting more than two weeks after the symptomatic event, but only in a small proportion of patients with TIA. The persistence of lesions on DWI is closely related to markers of severity of the ischaemic event. These results justify larger studies of the clinical usefulness of DWI in subacute minor stroke.
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Affiliation(s)
- U G R Schulz
- Stroke Prevention Research Unit, Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK
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Molyneux A, Lewis S, Leivers U, Anderton A, Antoniak M, Brackenridge A, Nilsson F, McNeill A, West R, Moxham J, Britton J. Clinical trial comparing nicotine replacement therapy (NRT) plus brief counselling, brief counselling alone, and minimal intervention on smoking cessation in hospital inpatients. Thorax 2003; 58:484-8. [PMID: 12775857 PMCID: PMC1746718 DOI: 10.1136/thorax.58.6.484] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Guidelines recommend that smoking cessation interventions are offered in all clinical settings to all smokers willing to make a quit attempt. Since the effectiveness of routine provision of behavioural counselling and nicotine replacement therapy (NRT) to smokers admitted to hospital has not been established, a randomised controlled trial of these interventions given together compared with counselling alone or minimal intervention was performed in hospital inpatients. METHODS Medical and surgical inpatients who were current smokers at the time of admission were randomised to receive either usual care (no additional advice at admission), counselling alone (20 minute intervention with written materials), or NRT plus counselling (counselling intervention with a 6 week course of NRT). Continuous and point prevalence abstinence from smoking (validated by exhaled carbon monoxide <10 ppm) was measured at discharge from hospital and at 3 and 12 months, and self-reported reduction in cigarette consumption in smokers was assessed at 3 and 12 months. RESULTS 274 inpatient smokers were enrolled. Abstinence was higher in the NRT plus counselling group (n=91) than in the counselling alone (n=91) or usual care (n=92) groups. The difference between the groups was significant for validated point prevalence abstinence at discharge (55%, 43%, 37% respectively, p=0.045) and at 12 months (17%, 6%, 8%, p=0.03). The respective differences in continuous validated abstinence at 12 months were 11%, 4%, 8% (p=0.25). There was no significant difference between counselling alone and usual care, or in reduction in cigarette consumption between the treatment groups. CONCLUSIONS NRT given with brief counselling to hospital inpatients is an effective routine smoking cessation intervention.
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Affiliation(s)
- A Molyneux
- Division of Respiratory Medicine, University of Nottingham, City Hospital Nottingham, UK.
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Molyneux A, Lewis S, Antoniak M, Hubbard R, McNeill A, Godfrey C, Madeley R, Britton J. Is smoking a communicable disease? Effect of exposure to ever smokers in school tutor groups on the risk of incident smoking in the first year of secondary school. Tob Control 2002; 11:241-5. [PMID: 12198276 PMCID: PMC1759024 DOI: 10.1136/tc.11.3.241] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate the effect of joining a first year secondary school tutor group with a high prevalence of ever smoking on the risk of incident smoking in schoolchildren. DESIGN Cross-sectional questionnaire survey. SETTING 10 randomly selected secondary schools in Nottinghamshire, UK. PARTICIPANTS Pupils in years (grades) 7-11 (aged 11-16 years). MAIN OUTCOME MEASURE Incident smoking in the first year of secondary education, defined as pupils who reported smoking their first cigarette during year 7. RESULTS Of 6522 pupils (75% of those eligible) who completed the questionnaire, 17% were current smokers and 49% had ever smoked, of whom 23% had started smoking in year 7. Incident smoking in year 7 was more common in girls, in children with parents or siblings who smoke, and in more deprived children, and was independently increased in relation to the proportion of ever smokers in the year 7 tutor group joined by the child (adjusted odds ratio of incident smoking for a child joining a year 7 tutor group in the highest relative to the lowest quartile of ever smoking prevalence 1.45, 95% confidence interval (CI) 1.11 to 1.89). Exposure to ever smokers in year 7 tutor groups also accounted for most of the increased risk of incident smoking associated with socioeconomic deprivation. CONCLUSIONS The risk of incident smoking in children entering secondary education is independently increased by exposure to other ever smokers in school tutor groups. Incident smoking in adolescents is thus to some extent a communicable disorder, and may be partly preventable by policies that reduce exposure to smoking at school.
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Affiliation(s)
- A Molyneux
- University of Nottingham, Division of Respiratory Medicine, City Hospital, Nottingham, UK
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Clement K, Chamberlain P, Boyd P, Molyneux A. Prenatal diagnosis of an epignathus: a case report and review of the literature. Ultrasound Obstet Gynecol 2001; 18:178-181. [PMID: 11530004 DOI: 10.1046/j.1469-0705.2001.00456.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
An epignathus is an extremely rare form of teratoma that arises from the oral cavity, most commonly from the palate. We describe a case identified sonographically at 17 weeks' gestation after a raised maternal serum alpha-fetoprotein was recorded. This pregnancy was terminated but we review the literature over the last 10 years and describe the management options available in such cases.
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Affiliation(s)
- K Clement
- Ultrasound and Prenatal Diagnosis Unit, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
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Molyneux A, Gazis A, Packham C. Attachments in public health for physicians. J R Coll Physicians Lond 2000; 34:555-6. [PMID: 11191973 PMCID: PMC9665445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Hospital-based specialist registrars in Nottingham are offered six month secondments in public health medicine. These attachments give clinicians valuable skills in public health and an opportunity to influence the development of local health service provision. Other skills gained are an understanding of the balance between health promotion and disease treatment; the management of limited resources; an appreciation of the effects of social deprivation; the chairing and preparing of committee meetings; and contact tracing of communicable diseases. We strongly recommend the experience gained from working in a lively public health department.
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Affiliation(s)
- A Molyneux
- Department of Respiratory Medicine, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB.
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Clarke R, Joachim C, Esiri M, Morris J, Bungay H, Molyneux A, Budge M, Frost C, King E, Barnetson L, Smith AD. Leukoaraiosis at presentation and disease progression during follow-up in histologically confirmed cases of dementia. Ann N Y Acad Sci 2000; 903:497-500. [PMID: 10818544 DOI: 10.1111/j.1749-6632.2000.tb06405.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R Clarke
- Clinical Trial Service Unit, Radcliffe Infirmary, Oxford, United Kingdom.
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Molyneux A, Kerr R. Endovascular aneurysm treatment and the incidence of vasospasm. AJNR Am J Neuroradiol 1999; 20:944-5. [PMID: 10369372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Rowe J, Blamire AM, Domingo Z, Moody V, Molyneux A, Byrne J, Cadoux-Hudson T, Radda G. Discrepancies between cerebral perfusion and metabolism after subarachnoid haemorrhage: a magnetic resonance approach. J Neurol Neurosurg Psychiatry 1998; 64:98-103. [PMID: 9436736 PMCID: PMC2169903 DOI: 10.1136/jnnp.64.1.98] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION There is a variable relation between angiographic vasospasm and delayed ischaemic neurological deficit (DIND). Magnetic resonance (MR) techniques have the potential to investigate the haemodynamic, metabolic, and structural changes occurring with these complications. These techniques have been applied to study DIND in patients recovering from subarachnoid haemorrhage. METHODS Fifteen studies were performed on 11 patients, 10 with DIND. Vasospasm was diagnosed angiographically or with transcranial Doppler. The MR protocol consisted of T2 weighted imaging, contrast enhanced dynamic perfusion scanning, TI weighted imaging, and two dimensional localised proton spectroscopy. Relative cerebral blood volume maps were generated from perfusion scans. Metabolite ratios were calculated from proton spectra. RESULTS All patients had cortical oedema on T2 weighted images, significantly more pronounced in patients of poor clinical grade (p<0.01). Spectra were normal in good grade patients. Lactate was increased and N-acetyl aspartate decreased in the poor grades, significantly worse in grade 4 compared with grade 3 patients (p<0.05). Spectral changes also correlated with the severity of oedema (p<0.05). Relative blood volumes were significantly higher in oedematous regions of poor compared with good grade patients (p<0.05). Lactate was seen in regions of the brain with increased relative blood volume. CONCLUSIONS Despite the paramagnetic effects of haemorrhage, or of the coils and clips used to treat aneurysms, this study demonstrates that patients recovering from subarachnoid haemorrhage can undergo complex MR studies. Oedema, lactate, and increased relative blood volume correlate well with each other and with DIND and poor clinical grade.
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Affiliation(s)
- J Rowe
- MRC Magnetic Resonance Spectroscopy Unit, John Radcliffe Hospital, Oxford, UK
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Jobst K, Smith A, Hindley N, King E, Bametson L, Barton J, Shepstone B, Soper N, Nagy Z, Joachim C, Molyneux A. 451 SPET (99mTc-HMPAO) and X-ray CT in the diagnosis of Alzheimer's disease: Improved accuracy over clinical criteria in a cohort of 114 prospectively evaluated subjects with histopathological diagnoses. Neurobiol Aging 1996. [DOI: 10.1016/s0197-4580(96)80453-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Twenty patients with aneurysms were studied with transcranial Doppler before, during and after endovascular treatment with Guglielmi detachable coils. Catheterization of the anterior circulation decreased middle cerebral artery velocities by 15-20%. Inserting coils into the aneurysms increased pulsatility indices modestly, reflecting a stiffening of the cerebral circulation. Pre- and posttreatment velocities were not significantly different, and there was no evidence of coil embolization precipitating vasospasm. The haemodynamic stability, seen during and after therapy, suggests that coil embolization may prove a safe alternative way of treating acutely ruptured aneurysms.
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Affiliation(s)
- J G Rowe
- MRC Magnetic Resonance Spectroscopy Unit, John Radcliffe Hospital, Headington, Oxford, UK
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38
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Sharpe M, Hawton K, Seagroatt V, Bamford J, House A, Molyneux A, Sandercock P, Warlow C. Depressive disorders in long-term survivors of stroke. Associations with demographic and social factors, functional status, and brain lesion volume. Br J Psychiatry 1994; 164:380-6. [PMID: 8199792 DOI: 10.1192/bjp.164.3.380] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Sixty surviving patients from a community-based stroke register who had computerised tomography (CT) scan evidence of a single brain lesion were interviewed three to five years after their first ever stroke. Depression (DSM-III-R major depression, partially resolved major depression, and dysthymia) was present in 11 (18%) of the patients and was associated with impaired physical and cognitive functioning, greater age, residence in an institution, absence of a close personal relationship, and larger original brain lesion. Of these variables, only functional dependence (odds ratio 16.4; confidence interval 1.6-170), larger lesion volume (6.6; 1-50), and female sex (8; 1.1-56) remained significantly associated with depression after controlling for all other variables. We conclude that depression in long-term survivors of stroke has many of the same associations as depression in non-stroke elderly populations. Depression in long-term stroke survivors may also be associated with larger original brain lesions, although this requires confirmation in a prospective study.
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Affiliation(s)
- M Sharpe
- University Department of Psychiatry, Warneford Hospital, Oxford
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Jacobs IJ, Smith SA, Wiseman RW, Futreal PA, Harrington T, Osborne RJ, Leech V, Molyneux A, Berchuck A, Ponder BA. A deletion unit on chromosome 17q in epithelial ovarian tumors distal to the familial breast/ovarian cancer locus. Cancer Res 1993; 53:1218-21. [PMID: 8095178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Linkage analysis in familial breast and ovarian cancer and studies of allelic deletion in sporadic ovarian tumors have suggested that chromosome 17q may be the location of a gene of importance in ovarian carcinogenesis. We have examined tumor and normal DNA samples from 120 patients with ovarian tumors for allelic deletion at 12 loci on chromosome 17q. Allelic deletion was observed in 64 cases (53%) of which 56 showed loss of heterozygosity at all loci analyzed on 17q. The pattern of allele loss at metastatic sites was consistent with loss of heterozygosity having occurred prior to metastasis. A common region of deletion, defined by 6 cases of invasive epithelial ovarian cancer and a benign serous cystadenoma, spanned 16 cM and was delimited by nm23 and GH. This region is distal to the region on chromosome 17q to which the familial breast/ovarian cancer susceptibility gene has been mapped. The results suggest that a tumor suppressor gene involved in sporadic ovarian carcinogenesis is located on the distal portion of chromosome 17q and is distinct from the gene linked to familial cases.
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Affiliation(s)
- I J Jacobs
- Cancer Research Campaign Human Cancer Genetics Group, University of Cambridge, United Kingdom
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40
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Jobst KA, Smith AD, Szatmari M, Molyneux A, Esiri ME, King E, Smith A, Jaskowski A, McDonald B, Wald N. Detection in life of confirmed Alzheimer's disease using a simple measurement of medial temporal lobe atrophy by computed tomography. Lancet 1992; 340:1179-83. [PMID: 1359259 DOI: 10.1016/0140-6736(92)92890-r] [Citation(s) in RCA: 175] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The medial temporal lobe of the brain is important for normal cognitive function, notably for memory, and is the region with the most extensive pathological change in Alzheimer's disease (AD). We wanted to find out if atrophy of the medial temporal lobe could be detected in life in patients in whom a diagnosis of AD was subsequently established histopathologically. The minimum width of the medial temporal lobe, measured by temporal-lobe-oriented computed tomography (CT) about one year before death, in 44 patients with a histopathological diagnosis of AD (cases) was nearly half (0.56 of the median) that in 75 controls of the same age with no clinical evidence of dementia (95% confidence interval 0.51-0.61). There was little overlap between the distributions of measurements in cases and controls. A cut-off (< 0.79 MoM) selected to yield a 5% false-positive rate gave an expected detection rate of 92%. A cut-off selected to yield a false-positive rate of 1% (< 0.70 MoM) yielded a 79% detection rate. 20 of the 44 patients with histopathologically diagnosed AD had been scanned more than once before death, and the test (cut-off < 0.79 MoM) was positive in all 20 more than a year before and in 9/10 more than 2 years before death. In 10 subjects with dementia but with histopathology excluding AD, the mean minimum width of the medial temporal lobe was significantly greater than that in the cases with AD, but was not significantly different from that in controls. Medial temporal lobe CT is a non-invasive, rapid, simple and effective test for AD which could have immediate application firstly in improving the accuracy of prevalence and incidence studies and, secondly, for the identification of groups of high-risk patients in the evaluation of novel treatments for AD. In the future, it could be applied as a screening test.
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Affiliation(s)
- K A Jobst
- Oxford Project to Investigate Memory and Ageing (OPTIMA), University Department of Pharmacology, UK
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Affiliation(s)
- T F Massoud
- Department of Neuroradiology, Radcliffe Infirmary, Oxford, U.K
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Abstract
This case report concerns the spontaneous closure of a middle cerebral arteriovenous fistula, lesions which are normally treated by surgery or interventional therapy. We have been unable to find any previous report of spontaneous closure of a similar fistula.
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Affiliation(s)
- C Santosh
- Department of Neuroradiology, Southern General Hospital, Glasgow, UK
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Abstract
In a community-based study of patients with a first-ever stroke, intellectual impairment (as defined by scores on a common screening test for dementia, the Mini-Mental State Examination) was found in 26% at 1 month post-stroke, and in 21% at 6 and 12 month follow-up. Low scores on the screening test were associated with greater age, physical disability before the stroke, larger stroke lesion volumes as measured on CT scan, and non-stroke changes such as atrophy and white matter low attenuation on the CT scan. There was a negative correlation between scores on the Mini-Mental State Examination and symptom levels on two measures of mood disorder. However, there was no evidence of a specific relationship between major depression and low scores on the Mini-Mental State. We examined various aspects of the relationship between mood symptoms and low scores on the Mini-Mental State, but found no evidence to support the suggestion that this relationship represented an example of depressive pseudodementia. We discuss the significance of our findings for clinical psychiatry and neuropsychology.
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Affiliation(s)
- A House
- University Department of Clinical Neurology, Oxford
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Sharpe M, Hawton K, House A, Molyneux A, Sandercock P, Bamford J, Warlow C. Mood disorders in long-term survivors of stroke: associations with brain lesion location and volume. Psychol Med 1990; 20:815-828. [PMID: 2284390 DOI: 10.1017/s0033291700036503] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sixty surviving patients from a community-based stroke register who had CT scan evidence of a single brain lesion and neurological signs appropriate to it were interviewed three to five years following their first-ever stroke. Mood disorder (anxiety and depression), physical disability, and intellectual impairment were assessed using standardized measures. The position and volume of the brain lesion was determined from CT scans performed soon after the stroke. The prevalence of depressive disorder was lower in this sample than that reported in previous studies (DSM-IIIR major depression 8.3%; all DSM-IIIR depressive disorders 18.3%). Reports by other workers for an association of depressive disorder either with left-sided brain lesions, or with anteriorly placed lesions in the left cerebral hemisphere, were not supported. Neither was there evidence of a correlation between symptom score and proximity of the lesion to the anterior pole of the left cerebral hemisphere. Psychiatric symptom scores were however greater with larger volume brain lesions. Anxiety disorders, especially agoraphobia, were relatively common (20% if diagnosed in the presence of depressive disorder), but were not related to lesion location or volume.
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Affiliation(s)
- M Sharpe
- University Department of Psychiatry and Neurology, Oxford
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House A, Dennis M, Warlow C, Hawton K, Molyneux A. Mood disorders after stroke and their relation to lesion location. A CT scan study. Brain 1990; 113 ( Pt 4):1113-29. [PMID: 2397385 DOI: 10.1093/brain/113.4.1113] [Citation(s) in RCA: 153] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In a community-based study of stroke survivors, we identified 73 consecutive patients with a stroke, the first ever in a lifetime, who had a CT scan which showed a neurologically appropriate single stroke lesion, and who did not have a psychiatric disorder in the year preceding the stroke. A detailed follow-up study of these patients using standardized psychiatric assessments failed to confirm a number of recent claims about poststroke depressive disorders. We found no evidence that left-sided lesions were associated with more severe or persistent depressive symptoms, or that right-sided lesions were associated with hypomania. The DSM III syndrome of major depression was much less common than has previously been reported, and was not specifically associated with lesions placed anteriorly in the left hemisphere. There was a weak correlation between mood symptom scores and the proximity of the stroke lesion to the frontal pole of the hemisphere, but no evidence of a difference between right and left hemisphere strokes in the nature of the relationship between lesion distribution and mood symptoms. We suggest that previous studies have different findings because of differences in the conventions applied to the definition and measurement of psychiatric disorders after stroke, and because other studies have concentrated on selected inpatient populations.
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Affiliation(s)
- A House
- Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK
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Dennis M, Bamford J, Sandercock P, Molyneux A, Warlow C. Computed tomography in patients with transient ischaemic attacks: when is a transient ischaemic attack not a transient ischaemic attack but a stroke? J Neurol 1990; 237:257-61. [PMID: 2391549 DOI: 10.1007/bf00314630] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In a prospective community-based study, 184 patients with transient ischaemic attacks (TIAs) were identified from a study population of about 105,000 between 1981 and 1986. Computed tomography (CT) was attempted in all those with cerebral ischaemic attacks (n = 152, 83%); patients with amaurosis fugax only (n = 32, 27%) were not scanned routinely. Scans were obtained in 120 (79%) of those with cerebral attacks and 12 (38%) of those with amaurosis fugax. The scans were reported by a neuroradiologist who was blinded to the patients' clinical features. Of 120 (27%:95% confidence interval 19-35) scans in patients with cerebral attacks, 32 showed a focal area of hypodensity or cortical loss, but in only 14 (12%:95% confidence interval 6-18) was this in an area of the brain appropriate to the patients' symptoms. There were no significant differences in the clinical features, the duration of attacks or the prognosis (i.e., risk of death, stroke or myocardial infarction) of patients with and without ischaemic lesions on CT. It is concluded that patients with clinically definite TIAs who have a presumed ischaemic and appropriately sited lesion on CT should not be re-classified as having had a stroke.
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Affiliation(s)
- M Dennis
- University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK
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Abstract
OBJECTIVE To estimate the prevalence of emotionalism after stroke, to assess its relation with other mood disorders, and to identify clinical variables with which it is associated. DESIGN Descriptive study of a cohort of patients consecutively entered on a community stroke register. SETTING Community based research project. PATIENTS A total of 128 patients who had suffered first ever stroke. INTERVENTIONS AND END POINTS: Patients were interviewed by a psychiatrist at 1, 6, and 12 months after stroke. Mood state was assessed by standardised semistructured interview (present state examination) and self report (Beck depression inventory). Intellectual impairment was assessed by mini mental state examination and Frenchay aphasia screening test. In addition, stroke lesions were localised by computed tomography. MAIN RESULTS Emotionalism was reported by 13 of 89 patients (15%) at one month, 25 of 119 (21%) at six months, and 12 of 112 (11%) at 12 months after stroke. Patients with emotionalism had higher scores on both measures of mood disorder (at 6 months: mean Beck score 10.5 v 6.4; present state examination score 7.2 v 5.1) and more diagnosable psychiatric disorder (at 6 months: 40% v 14%; odds ratio 4.2, 95% confidence interval 1.5 to 11.9). Almost all episodes were provoked by clearly identified and appropriate emotional experiences. Patients with emotionalism also had more intellectual impairment and larger lesions on computed tomography. Lesions in the left frontal and temporal regions were particularly associated with emotionalism: at 6 months 8 of 14 patients (57%) with such lesions had emotionalism compared with 10 of 52 (19%) of those with lesions elsewhere (odds ratio 5.6, 95% confidence interval 1.4 to 22). CONCLUSIONS Emotionalism is common after stroke. It is neither emotionally meaningless and inappropriate, nor is it found mostly in patients with bilateral brain damage. Emotionalism is associated with symptoms of a more general mood disturbance and is found especially in patients with left frontal and temporal lesions.
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Affiliation(s)
- A House
- Department of Clinical Neurology, Radcliffe Infirmary, Oxford
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Rowbotham L, Molyneux A, Morris B. Modified method of analysis for metadrenaline in urine. Clin Chem 1989. [DOI: 10.1093/clinchem/35.3.513a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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49
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Rowbotham L, Molyneux A, Morris B. Modified method of analysis for metadrenaline in urine. Clin Chem 1989; 35:513. [PMID: 2920435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Bamford J, Sandercock P, Dennis M, Warlow C, Jones L, McPherson K, Vessey M, Fowler G, Molyneux A, Hughes T. A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project 1981-86. 1. Methodology, demography and incident cases of first-ever stroke. J Neurol Neurosurg Psychiatry 1988; 51:1373-80. [PMID: 3266234 PMCID: PMC1032805 DOI: 10.1136/jnnp.51.11.1373] [Citation(s) in RCA: 333] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A prospective study of acute cerebrovascular disease in a community of about 105,000 people is reported. The study protocol combined rapid clinical assessment of patients with accurate diagnosis of the pathological type of stroke by CT or necropsy, whether or not they were admitted to hospital. The study population was defined as those people who were registered with one of 50 collaborating general practitioners (GPs). Referrals to the study were primarily from the GPs though, to ensure complete case ascertainment, hospital casualty and admission registers, death certificates and special data from the Oxford Record Linkage Study were also scrutinized. Six hundred and seventy five cases of clinically definite first-ever in a lifetime stroke were registered in four years yielding a crude annual incidence of 1.60/1,000 or 2.00/1,000 when adjusted to the 1981 population of England and Wales. The age and sex specific incidence rates for first stroke showed a steep rise with age for both sexes. The odds of a male sustaining a first stroke were 26% greater than those of a female. Ninety one per cent of patients were examined in a median time of four days after the event by a study neurologist and 88% had cerebral CT or necropsy.
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Affiliation(s)
- J Bamford
- Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK
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