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Siegel BI, Nelson D, Peragallo JH, MacDonald TJ, Wolf DS. Visual outcomes after bevacizumab-based therapy for optic pathway glioma. Pediatr Blood Cancer 2023; 70:e30668. [PMID: 37707323 DOI: 10.1002/pbc.30668] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023]
Abstract
In optic pathway glioma (OPG), bevacizumab-based therapy (BBT) has promising effects on radiographic tumor burden, but the impact on vision is less clear. This single-institution study characterized visual acuity (VA) and visual field (VF) outcomes in 17 pediatric OPG patients treated with BBT. VA was stable or improved in 14 patients. Nine patients had evaluable VF data, six of whom experienced stability or improvement. Among six patients with vision deterioration as a treatment indication, stable or improved was observed for both VA and VF in five patients. In summary, BBT was associated with favorable visual outcomes in this cohort of patients with OPG.
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Affiliation(s)
| | - Daniel Nelson
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - Jason H Peragallo
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - Tobey J MacDonald
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - David S Wolf
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Kheder A, Elkins K, Wolf DS, Al-Ramadhani R, Bhalla S, Chern J, Gedela S. Possible underlying mechanism of epileptic nystagmus as studied by stereoelectroencephalography. Seizure 2023; 107:1-3. [PMID: 36905793 DOI: 10.1016/j.seizure.2023.02.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/01/2023] Open
Affiliation(s)
- Ammar Kheder
- Department of Neurology, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA, 30322, USA; Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA; Emory and Children's Pediatric Institute, 2015 Uppergate Drive, Atlanta, GA, 30322, USA.
| | - Kathryn Elkins
- Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA; Emory and Children's Pediatric Institute, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - David S Wolf
- Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA; Emory and Children's Pediatric Institute, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - Ruba Al-Ramadhani
- University of Pittsburgh Medical Center Children's Hospital, 4401 Penn Ave, Pittsburgh, PA, 15224, USA
| | - Sonam Bhalla
- Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA; Emory and Children's Pediatric Institute, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - Joshua Chern
- Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
| | - Satyanarayana Gedela
- Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA; Emory and Children's Pediatric Institute, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
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Marshall CS, Deng S, Jackson HS, Horn PS, Wolf DS, Thompson-Stone R, Gilbert DL. Adult Neurology Rotations for Child Neurology Residents: A Survey of Program Directors. Neurology 2022; 99:e858-e864. [PMID: 35618436 DOI: 10.1212/wnl.0000000000200759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 04/06/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to identify how child neurology and neurodevelopmental disabilities residency program directors (PDs) implemented revised Accreditation Council for Graduate Medical Education requirements for adult neurology training for child neurology residents. Prior to 2014, American Board of Psychiatry and Neurology certification for child neurology required an "adult year," with no specified rotation requirements. At that point, programs scheduled a median of 10 months of adult neurology rotations during the third postgraduate year (PGY-3). In 2014, the adult neurology requirements were modified to include 6 months of hospital-based, 3 months of outpatient, and 3 months of other elective (may include neurophysiology, neuropathology, and/or neuroradiology) rotations. However, the effects of these changes on child neurology residency training nationally have not been characterized. METHODS A 16-item online survey was emailed to 79 PDs in the United States in September 2020. Survey responses were collected from September to October 2020. Descriptive statistics were calculated, and associations with departmental affiliation (pediatrics/neurology), graduate medical education (GME) funding source, and program size were compared using non-parametric tests. RESULTS Response rate was 72% (53 pediatric neurology, 3 neurodevelopmental disabilities). Programs' median adult months per year were: 9 PGY-3, 2 PGY-4, and 1 PGY-5. Nearly all had both hospital inpatient and consult rotations with night and/or weekend shifts. 57% included neurocritical care and 36% epilepsy monitoring units. 48% of programs scheduled night and weekend shifts (including 25% that scheduled 24-hour call) for residents on outpatient and elective rotations. Few programs required adult neurophysiology (20%), neuropathology (32%), or neuroradiology (25%). Programs with children's hospital GME funding (for either 2 or 3 years) tended to be larger (p = 0.008). Otherwise, departmental affiliation, funding source, and program size were not associated with rotation timing. DISCUSSION Most child neurology residency programs still consolidate adult training in the PGY-3 year, and often schedule additional hospital shifts during outpatient and elective months. However, there is a small shift toward adult neurology rotations occurring in the PGY-4 and PGY-5 years. Departmental affiliation, funding source, and program size do not consistently affect training practices. Few programs mandate adult neurophysiology, neuropathology, or neuroradiology rotations.
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Affiliation(s)
- Cullen S Marshall
- Division of Child Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Stella Deng
- Division of Child Neurology, Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Hannah S Jackson
- Division of Child Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Paul S Horn
- Division of Child Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - David S Wolf
- Division of Pediatric Neurology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Robert Thompson-Stone
- Division of Child Neurology, Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Donald L Gilbert
- Division of Child Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
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Gadde JA, Wolf DS, Keller S, Gombolay GY. Rate of Leptomeningeal Enhancement in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody-Associated Encephalomyelitis. J Child Neurol 2021; 36:1042-1046. [PMID: 34547933 PMCID: PMC9054459 DOI: 10.1177/08830738211025867] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Myelin oligodendrocyte glycoprotein antibodies (MOG-abs) are associated with demyelinating diseases. Leptomeningeal enhancement occurs in 6% of adult MOG-abs patients but rates in pediatric MOG-abs patients are unknown. METHODS Retrospective review of pediatric MOG-abs patients was performed. RESULTS Twenty-one patients (7 boys, 14 girls) were included with an average age of 8.6 years (range 2-15 years). Seven of 21 (33%) pediatric MOG-abs patients had leptomeningeal enhancement. Two patients' relapses were manifested by leptomeningeal enhancement alone and another patient presented with seizures, encephalopathy, and aseptic meningitis without demyelinating lesions. Cerebrospinal fluid pleocytosis was seen in both leptomeningeal (4/7 patients) and nonleptomeningeal enhancement (10/14 patients). Interestingly, 3 patients with leptomeningeal enhancement had normal cerebrospinal fluid white blood cell count. Cortical edema was more likely in patients with leptomeningeal enhancement (P = .0263). CONCLUSION We expand the clinical spectrum of anti-MOG antibody-associated disorder. Patients with recurrent leptomeningeal enhancement without demyelinating lesions should be tested for MOG antibodies.
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Affiliation(s)
- Judith A. Gadde
- Department of Radiology and Imaging Sciences & Pediatrics, Emory University School of Medicine, GA, USA,Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Division of Pediatric Radiology and Neuroradiology, IL, USA
| | - David S. Wolf
- Division of Pediatric Neurology, Children’s Healthcare of Atlanta: Pediatrics Institute, Emory University, GA, USA
| | - Stephanie Keller
- Division of Pediatric Neurology, Children’s Healthcare of Atlanta: Pediatrics Institute, Emory University, GA, USA
| | - Grace Y. Gombolay
- Division of Pediatric Neurology, Children’s Healthcare of Atlanta: Pediatrics Institute, Emory University, GA, USA
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Siegel BI, Johnson M, Dawson TE, Kurzen E, Holt PJ, Wolf DS, Orenstein EW. Reducing Prescribing Errors in Hospitalized Children on the Ketogenic Diet. Pediatr Neurol 2021; 115:42-47. [PMID: 33333459 DOI: 10.1016/j.pediatrneurol.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Children on the ketogenic diet must limit carbohydrate intake to maintain ketosis and reduce seizure burden. Patients on ketogenic diet are vulnerable to harm in the hospital setting where carbohydrate-containing medications are commonly prescribed. We developed clinical decision support to reduce inappropriate prescription of carbohydrate-containing medications in hospitalized children on ketogenic diet. METHODS A clinical decision support alert was developed through formative and summative usability testing. The alert warned prescribers when they entered an order for a carbohydrate-containing medication in patients on ketogenic diet. The alert was implemented using a quasi-experimental design with sequential crossover from control to intervention at two tertiary care pediatric hospitals within a single health system. The primary outcome was carbohydrate-containing medication orders per patient-day. RESULTS During the study period, there were 280 ketogenic diet patient admissions totaling 1219 patient-days. The carbohydrate-containing medication order rate declined from 0.69 to 0.35 orders per patient-day (absolute rate reduction 0.34, 95% confidence interval 0.25-0.43), corresponding to 256 inappropriate orders prevented. The alert fired 398 times and was accepted (i.e., the order was removed) 227 times for an overall acceptance rate of 57%. CONCLUSIONS Implementation of a clinical decision support alert at order-entry resulted in a sustained reduction in carbohydrate-containing medication orders for hospitalized patients on ketogenic diet without an increase in alert burden. Clinical decision support developed with user-centered design principles can improve patient safety for children on ketogenic diet by influencing prescriber behavior.
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Affiliation(s)
- Benjamin I Siegel
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
| | | | | | - Emily Kurzen
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Philip J Holt
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - David S Wolf
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Evan W Orenstein
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
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Fisher MJ, Liu GT, Ferner RE, Gutmann DH, Listernick R, de Blank P, Zeid J, Ullrich NJ, Heidary G, Bornhorst M, Stasheff SF, Rosser T, Borchert M, Ardern-Holmes S, Flaherty M, Hummel TR, Motley WW, Bielamowicz K, Phillips PH, Bouffet E, Reginald A, Wolf DS, Peragallo J, Van Mater D, El-Dairi M, Sato A, Tarczy-Hornoch K, Klesse L, Hogan N, Foreman N, McCourt E, Allen J, Ranka M, Campen C, Beres S, Moertel C, Areaux R, Stearns D, Orge F, Crawford J, O’Halloran H, Brodsky M, Esbenshade AJ, Donahue S, Cutter G, Avery RA. NFB-09. ENROLLMENT AND CLINICAL CHARACTERISTICS OF NEWLY DIAGNOSED, NEUROFIBROMATOSIS TYPE 1 ASSOCIATED OPTIC PATHWAY GLIOMA (NF1-OPG): PRELIMINARY RESULTS FROM AN INTERNATIONAL MULTI-CENTER NATURAL HISTORY STUDY. Neuro Oncol 2020. [PMCID: PMC7715986 DOI: 10.1093/neuonc/noaa222.613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Because treatment and clinical management decisions for children with NF1-OPG remain challenging, we sought to establish evidence-based guidelines. We prospectively enrolled children with newly-diagnosed NF1-OPGs, and gathered standardized clinical neuro-oncology and ophthalmology assessments. METHODS Only children with NF1 and newly diagnosed OPGs, confirmed by central review, were eligible. Indications for obtaining the initial MRI, as well as factors associated with the decision to treat with chemotherapy or observe without treatment, were obtained. Quantitative visual acuity (VA), other ophthalmic features, and imaging were captured at standard time points. Goal enrollment is 250 subjects. RESULTS One-hundred thirty-three children (52% female) from 20 institutions met inclusion criteria, and were included in this preliminary analysis. Eighty-six percent of subjects were able to perform quantitative VA testing at enrollment. The most common reasons for the diagnostic MRI included screening related to NF1 diagnosis (36.8%), ophthalmologic concerns (29.3%), and non-ophthalmologic concerns (24.8%), such as headache. To date, twenty subjects have initiated treatment with chemotherapy, twelve (9%) at the time of the initial OPG diagnosis. Median age at OPG diagnosis was 3.1 years. Age and sex distribution were similar in subjects immediately entering the observation and treatment arms (median age 3.0 versus 3.5 years, respectively). CONCLUSION Most children with NF1-OPGs are observed at time of their initial OPG diagnosis, rather than treated. Importantly, a large proportion of children are able to complete quantitative VA testing at enrollment. Once enrollment is complete, these data will help to establish evidence-based guidelines for clinical management of NF1-OPGs.
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Affiliation(s)
| | - Grant T Liu
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rosalie E Ferner
- Guy’s and St, Thomas’ Hospitals NHS Foundation Trust, London, England, United Kingdom
| | - David H Gutmann
- Washington University School of Medicine, St. Louis, MO, USA
| | - Robert Listernick
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Peter de Blank
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Janice Zeid
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | | | | | | | | | - Tena Rosser
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Mark Borchert
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Maree Flaherty
- The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Trent R Hummel
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - W Walker Motley
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Eric Bouffet
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - David S Wolf
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | | | | | | | | | | | - Laura Klesse
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nick Hogan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Jeffrey Allen
- New York University Langone Health, New York, NY, USA
| | - Milan Ranka
- New York University Langone Health, New York, NY, USA
| | | | | | | | - Ray Areaux
- University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA
| | - Duncan Stearns
- University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Faruk Orge
- University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - John Crawford
- Rady Children’s Hospital, University of California San Diego, San Diego, CA, USA
| | - Henry O’Halloran
- Rady Children’s Hospital, University of California San Diego, San Diego, CA, USA
| | | | | | - Sean Donahue
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gary Cutter
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Avery
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Patel R, Gombolay GY, Peljovich AE, Conklin J, Blackwell LS, Howarth R, Wolf DS, Upadhyayula SR, Verma S. Acute Flaccid Myelitis: A Single Pediatric Center Experience From 2014 to 2019. J Child Neurol 2020; 35:912-917. [PMID: 32677590 DOI: 10.1177/0883073820939392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Acute flaccid myelitis has emerged as the leading cause of acute flaccid paralysis in children. Acute flaccid myelitis leads to significant physical disability; hence, objective outcome measures to study disease severity and progression are desirable. In addition, nerve transfer to improve motor function in affected children needs further study. METHODS Retrospective study of acute flaccid myelitis subjects managed at Children's Healthcare of Atlanta from August 2014 to December 2019. Clinical, electromyography and nerve conduction study, neuropsychological functional independence (WeeFIM), and nerve transfer data were reviewed. RESULTS Fifteen children (11 boys and 4 girls) mean age 5.1±3.2 years (range 14 months to 12 years) were included. All subjects (n = 15) presented with severe asymmetric motor weakness and absent tendon reflexes. Motor nerve conduction study of the affected limbs in 93% (n = 14) showed absent or markedly reduced amplitude. Ten patients received comprehensive inpatient rehabilitation and neuropsychological evaluation. Admission and discharge WeeFIM scores showed deficits most consistent and pronounced in the domains of self-care and mobility. Multiple nerve transfer surgery was performed on 13 limbs (9 upper and 4 lower extremities) in 6 children. Postsurgery (mean duration of 10.4 ± 5.7 months) follow-up demonstrated improvement on active movement scale (AMS) in 4 subjects. CONCLUSION Acute flaccid myelitis affects school-age children with asymmetric motor weakness, absent tendon reflexes, and reduced or absent motor amplitude on nerve conduction study. Comprehensive rehabilitation and nerve transfer led to improvement in motor function on neuropsychology WeeFIM and AMS scores.
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Affiliation(s)
- Rifali Patel
- Pediatric Neurology, MercyOne, Des Moines, IA, USA
| | - Grace Y Gombolay
- Division of Pediatric Neurology, Department of Pediatrics and Neurology, 1371Emory University School of Medicine, Atlanta, GA, USA
| | - Allan E Peljovich
- The Hand and Upper Extremity Center of Georgia, Department of Orthopaedic Surgery, 1367Children's Healthcare of Atlanta, Atlanta Medical Center Orthopaedic Residency Program, Atlanta, GA, USA
| | - Jessica Conklin
- Division of Neuropsychology, 1367Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Laura S Blackwell
- Division of Neuropsychology, 1367Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Robyn Howarth
- Division of Neuropsychology, 1367Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - David S Wolf
- Division of Pediatric Neurology, Department of Pediatrics and Neurology, 1371Emory University School of Medicine, Atlanta, GA, USA
| | - Saila R Upadhyayula
- Division of Pediatric Neurology, Department of Pediatrics and Neurology, 1371Emory University School of Medicine, Atlanta, GA, USA
| | - Sumit Verma
- Division of Pediatric Neurology, Department of Pediatrics and Neurology, 1371Emory University School of Medicine, Atlanta, GA, USA
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Wolf DS, Wu CQ, Smith EA. AUTHOR REPLY. Urology 2020; 139:167. [DOI: 10.1016/j.urology.2019.12.051] [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: 11/27/2022]
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Utay NS, Vigil KJ, Somasunderam A, Aulicino PC, Smulevitz B, Chiadika S, Wolf DS, Kimata JT, Arduino RC. Timing of Antiretroviral Therapy Initiation Determines Rectal Natural Killer Cell Populations. AIDS Res Hum Retroviruses 2020; 36:314-323. [PMID: 31838858 DOI: 10.1089/aid.2019.0225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Despite antiretroviral therapy (ART), innate and adaptive immunologic damage persists in the periphery and gut. T memory stem cells (Tscm) and natural killer (NK) cells are pivotal for host defense. Tscm are memory cells capable of antigen response and self-renewal, and circulating and gut NK cell populations may facilitate HIV control. The impact of early ART on circulating and gut Tscm and NK cells is unknown. We enrolled participants who initiated ART during acute versus chronic HIV-1 infection versus no ART in chronic infection. We performed flow cytometry to identify NK and Tscm cells in the blood and rectum and polymerase chain reaction to quantify the HIV-1 reservoir in both sites. We used the Mann-Whitney U-test and Spearman correlation coefficients for analysis. Participants who started ART in acute infection had lower rectal CD56brightCD16dim cell frequencies than participants who started ART in chronic HIV-1 infection and lower CD56bright and CD56brightCD16- cell frequencies than participants with chronic infection without ART. Higher circulating NK cell, CD56-CD16bright, CD56dim, and CD56dimCD16bright frequencies correlated with higher HIV-1 DNA levels in rectal CD4+ T cells, whereas higher circulating CD4+ T cell counts correlated with higher rectal NK, CD56brightCD16dim, and CD56dimCD16bright frequencies. Peripheral CD56brightCD16- cells were inversely associated with rectal CD56-CD16bright cells. Rectal CD8+ Tscm frequencies were higher in participants without ART than participants with chronic infection on ART. Timing of ART initiation determines rectal NK cell populations, and ART may influence rectal Tscm populations. Whether the gut reservoir contributes to NK cell activation requires further study.
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Affiliation(s)
- Netanya S. Utay
- Division of General Medicine, Department of Internal Medicine, McGovern Medical School, UT Health Science Center at Houston, Houston, Texas
| | - Karen J. Vigil
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, UT Health Science Center at Houston, Houston, Texas
| | - Anoma Somasunderam
- Division of General Medicine, Department of Internal Medicine, McGovern Medical School, UT Health Science Center at Houston, Houston, Texas
| | - Paula C. Aulicino
- Laboratorio de Biología Celular y Retrovirus, Hospital de Pediatría “Juan P. Garrahan”-CONICET, Buenos Aires, Argentina
| | - Beverly Smulevitz
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School, UT Health Science Center at Houston, Houston, Texas
| | - Simbo Chiadika
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School, UT Health Science Center at Houston, Houston, Texas
| | | | - Jason T. Kimata
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Roberto C. Arduino
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, UT Health Science Center at Houston, Houston, Texas
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Wu CQ, Wolf DS, Smith EA. Fate of Pediatric Renal Angiomyolipoma During mTOR Inhibitor Treatment in Tuberous Sclerosis Complex. Urology 2020; 139:161-167. [PMID: 32081671 DOI: 10.1016/j.urology.2019.12.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the clinical and radiographic follow-up of renal angiomyolipoma (AML) in pediatric patients with tuberous sclerosis complex (TSC) on mTOR inhibitors. METHODS We performed retrospective chart review of children who were diagnosed with TSC between 2000 and 2019 and prescribed everolimus at age ≤18 years. Treatment assessment was performed in patients who were medically-compliant by serum drug trough levels and who had at least a baseline and one subsequent renal imaging study. RESULTS Nineteen patients were analyzed. Average age of everolimus initiation was 9 years, and indication was neurologic in 17 (90%). Fourteen patients (73.6%) had AML with average size of 1.9 (0.4-5) cm. Medication was discontinued due to side effects in 3 (16%) patients. Treatment assessment was analyzed for 15 patients with median medication exposure 5.1 (0.8-8.5) years. Among 13 with AML, the dominant lesion decreased in size in 9 (69%) and stayed stable in 4 (31%). Greatest absolute size decrease was seen for lesions ≥2 cm. No new AML lesions formed during treatment. CONCLUSION Although not currently approved for this indication, everolimus appears to be well-tolerated with similar efficacy for pediatric AML as in adult AML. Use may be most warranted in children with AML ≥2 cm.
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Affiliation(s)
- Charlotte Q Wu
- Division of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
| | - David S Wolf
- Division of Pediatric Neurology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Edwin A Smith
- Division of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
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Vera CN, Linam WM, Gadde JA, Wolf DS, Walson K, Montoya JG, Rostad CA. Congenital Toxoplasmosis Presenting as Eosinophilic Encephalomyelitis With Spinal Cord Hemorrhage. Pediatrics 2020; 145:peds.2019-1425. [PMID: 31941759 DOI: 10.1542/peds.2019-1425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 11/24/2022] Open
Abstract
A 4-week-old male neonate with a history of intermittent hypothermia in the newborn nursery presented with an acute onset of bilateral lower extremity paralysis and areflexia. Extensive workup demonstrated eosinophilic encephalomyelitis and multifocal hemorrhages of the brain and spinal cord. Funduscopic examination revealed bilateral chorioretinitis with macular scarring. The laboratory values were notable for peripheral eosinophilia and cerebrospinal fluid eosinophilic pleocytosis (28 white blood cells/µL, 28% eosinophils), markedly elevated protein (1214 mg/dL), and hypoglycorrhachia (20 mg/dL). Toxoplasma gondii immunoglobulin M (IgM) test result was positive. Reference testing obtained at the Palo Alto Medical Foundation Toxoplasma Serology Laboratory confirmed the diagnosis of congenital toxoplasmosis in the infant with a positive immunoglobulin G (IgG) dye test result, immunoglobulin A enzyme-linked immunosorbent assay, and IgM immunosorbent agglutination assay. The diagnosis of an infection acquired during gestation in the mother was established by a positive maternal IgG dye test result, IgM enzyme-linked immunosorbent assay, immunoglobulin A, immunoglobulin E, and low IgG avidity. At 6-month follow-up, the infant had marginal improvement in his retinal lesions and residual paraplegia with hyperreflexia and clonus of the lower extremities. A repeat MRI demonstrated interval development of encephalomalacia with suspected cortical laminar necrosis and spinal cord atrophy in the areas of previous hemorrhage. Clinicians should be aware of this severe spectrum of congenital toxoplasmosis disease and should remain vigilant for subtler signs that may prompt earlier testing, diagnosis, and treatment.
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Affiliation(s)
- Casey N Vera
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - W Matthew Linam
- Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Judith A Gadde
- Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - David S Wolf
- Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Karen Walson
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jose G Montoya
- Toxoplasma Serology Laboratory, Palo Alto Medical Foundation, Palo Alto, California; and.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Christina A Rostad
- Children's Healthcare of Atlanta, Atlanta, Georgia; .,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
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Kadom N, Castellino RC, Wolf DS. Reply. AJNR Am J Neuroradiol 2019; 40:E32. [PMID: 31072977 DOI: 10.3174/ajnr.a6062] [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: 11/07/2022]
Affiliation(s)
- N Kadom
- Departments of Radiology and Pediatrics
| | - R C Castellino
- Department of Pediatrics and Aflac Cancer & Blood Disorders Center Children's Healthcare of Atlanta Atlanta, Georgia
| | - D S Wolf
- Department of Pediatrics, Division of Child Neurology Emory University School of Medicine Atlanta, Georgia
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Wolf DS, Golden WC, Hoover-Fong J, Applegate C, Cohen BA, Germain-Lee EL, Goldberg MF, Crawford TO, Gauda EB. High-dose glucocorticoid therapy in the management of seizures in neonatal incontinentia pigmenti: a case report. J Child Neurol 2015; 30:100-6. [PMID: 24682289 DOI: 10.1177/0883073813517509] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Incontinentia pigmenti is an X-linked dominant disorder resulting from a mutation of IKBKG. This disorder has a classic dermatologic presentation, but neurologic involvement, with seizures and cortical infarction, can arise shortly after birth. There are no specific therapies available for the manifestations of incontinentia pigmenti. Here, we describe the clinical, electrographic, and neuroradiologic effect of systemic glucocorticoid therapy in a neonate with incontinentia pigmenti manifesting an epileptic encephalopathy. Treatment with dexamethasone led to a dramatic reduction in seizure activity and improvement in bullous lesions. A novel mutation in IKBKG is also reported.
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Affiliation(s)
- David S Wolf
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA Division of Pediatric Neurology, Emory University/Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - W Christopher Golden
- Department of Pediatrics, Eudowood Neonatal Pulmonary Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie Hoover-Fong
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolyn Applegate
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernard A Cohen
- Division of Pediatric Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily L Germain-Lee
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Kennedy Krieger Institute, Baltimore, MD, USA Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Morton F Goldberg
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas O Crawford
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Estelle B Gauda
- Department of Pediatrics, Eudowood Neonatal Pulmonary Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Machicado JD, Younes M, Wolf DS. An unusual cause of odynophagia in a patient with eosinophilic esophagitis. Gastroenterology 2014; 147:37-8. [PMID: 24877872 DOI: 10.1053/j.gastro.2014.02.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 02/12/2014] [Indexed: 01/07/2023]
Affiliation(s)
- Jorge D Machicado
- Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas
| | - Mamoun Younes
- Department of Pathology and Laboratory Medicine, University of Texas Medical School at Houston, Houston, Texas
| | - David S Wolf
- Division of Gastroenterology, University of Texas Medical School at Houston, Houston, Texas
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Machicado JD, Younes M, Wolf DS. A rare cause of gastrointestinal bleeding in the intensive care unit. Healthcare-associated mucormycosis. Gastroenterology 2014; 146:911, 1136-7. [PMID: 24560854 DOI: 10.1053/j.gastro.2013.11.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/15/2013] [Indexed: 12/02/2022]
Affiliation(s)
- Jorge D Machicado
- Department of Internal Medicine, University of Texas Medical School at Houston, Texas
| | - Mamoun Younes
- Department of Pathology and Laboratory Medicine, University of Texas Medical School at Houston, Texas
| | - David S Wolf
- Division of Gastroenterology, Department of Internal Medicine, University of Texas Medical School at Houston, Texas
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Rubin MIN, Thosani NC, Tanikella R, Wolf DS, Fallon MB, Lukens FJ. Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: testing the current guidelines. Dig Liver Dis 2013; 45:744-9. [PMID: 23540659 PMCID: PMC10963047 DOI: 10.1016/j.dld.2013.02.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/30/2013] [Accepted: 02/05/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Current guidelines include an algorithm for predicting choledocholithiasis. Presence of any very strong predictor or both strong predictors confers a high (>50%) probability of choledocholithiasis. Absence of predictors confers low risk (<10%) of choledocholithiasis. Other combinations have an intermediate risk of choledocholithiasis. AIM Determine accuracy of the proposed algorithm in predicting choledocholithiasis. METHODS Retrospective analysis of all endoscopic retrograde cholangiopancreatographies performed for suspected choledocholithiasis in 3 years in a Tertiary care hospital and a community hospital serviced by The University of Texas Health Science Center at Houston Division of Gastroenterology. Application of the guidelines, and comparing results to endoscopic retrograde cholangiopancreatography findings. RESULTS A total of 1080 endoscopic retrograde cholangiopancreatographies were performed; 521 for choledocholithiasis. Most patients were Hispanic and female. Univariate analysis: presence of any very strong predictor and both strong predictors had an OR for choledocholithiasis of 3.30 and 2.36 respectively. Multivariate analysis: odds of choledocholithiasis with any very strong predictor was 2.87, and both strong predictors 3.24. Choledocholithiasis was present in 71.5%, and 41% of patients with high, and intermediate risk respectively. CONCLUSION This study confirms the utility of clinical predictors for the diagnosis of choledocholithiasis. All of the very strong predictors and one of the strong predictors increased the odds of choledocholithiasis. Patients with high risk for choledocholithiasis had a probability of 79% of choledocholithiasis. Sensitivity and specificity of current predictors are too low to obviate the possible need of non-invasive tests to confirm or exclude choledocholithiasis in all risk groups.
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Affiliation(s)
- Moises Ilan Nevah Rubin
- The University of Texas Health Science Center at Houston, Division of Gastroenterology, Hepatology and Nutrition, Houston, TX, United States
| | - Nirav C. Thosani
- The University of Texas Health Science Center at Houston, Division of Gastroenterology, Hepatology and Nutrition, Houston, TX, United States
| | - Rajasekhar Tanikella
- The University of Texas Health Science Center at Houston, Division of Gastroenterology, Hepatology and Nutrition, Houston, TX, United States
| | - David S. Wolf
- The University of Texas Health Science Center at Houston, Division of Gastroenterology, Hepatology and Nutrition, Houston, TX, United States
| | - Michael B. Fallon
- The University of Texas Health Science Center at Houston, Division of Gastroenterology, Hepatology and Nutrition, Houston, TX, United States
| | - Frank J. Lukens
- The Mayo Clinic Jacksonville, Division of Gastroenterology and Hepatology, Jacksonville, FL, United States
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Thosani N, Quesada A, Kulkarni D, Wolf DS. The many faces of gastrointestinal T-cell lymphoma manifest simultaneously in the same patient. Endoscopy 2013; 45 Suppl 2 UCTN:E31-2. [PMID: 23526503 DOI: 10.1055/s-0032-1325856] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- N Thosani
- Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Medical School at Houston, Houston, Texas, USA.
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Wolf DS, Cohen KJ. Is low and slow the way to go? Metronomic therapy in the treatment of pediatric brain tumors. CNS Oncol 2013; 2:211-3. [DOI: 10.2217/cns.13.14] [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: 11/21/2022] Open
Affiliation(s)
- David S Wolf
- Department of Neurology, The Johns Hopkins Hospital, 1800 Orleans Street, Bloomberg 11379, Baltimore, MD 21287, USA
| | - Kenneth J Cohen
- The Sidney Kidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, 1800 Orleans Street, Bloomberg 11379, Baltimore, MD 21287, USA
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Yohay K, Wolf DS, Aronson LJ, Duus M, Melhem ER, Cohen KJ. Vascular distribution of glioblastoma multiforme at diagnosis. Interv Neuroradiol 2013; 19:127-31. [PMID: 23472735 DOI: 10.1177/159101991301900119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 11/25/2012] [Indexed: 11/17/2022] Open
Abstract
Treatment of high-grade gliomas with selective intra-arterial (IA) administration of chemotherapies has been proposed, and utilized as a therapeutic modality. This approach offers the conceptual benefit of providing maximal delivery of the agent to the tumor bed, while potentially reducing systemic exposure to the agent. This retrospective study was designed to determine the vascular distribution of glioblastoma multiforme (GBM) at the time of diagnosis in an effort to determine what proportion of patients would likely be candidates for this approach. The preoperative MRI scans of 50 patients with GBM were analyzed and compared to published normative data of intracranial vascular distribution. Vascular distribution was determined by analyzing post-gadolinium axial and coronal T1 images, axial T2 images, and axial T2 images with an additional 1 cm margin (T2 + 1 cm) added in all dimensions. T1 analysis demonstrated 60% of tumors in a single vascular distribution. T2 analysis of these tumors reduced that number to 34%. When the T2 + 1 cm margin was utilized, only 6% of tumors were in a single vascular distribution. 66% of tumors were limited to the anterior circulation on T1 imaging but only 34% on T2 + 1 cm imaging. 30% of tumors were also within the distribution of the anterior choroidal artery. These findings suggest that the use of selective IA administration of agents is necessarily limited to a fraction of presenting patients or will require administration via multiple cerebral arteries.
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Affiliation(s)
- K Yohay
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
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Wolf DS, Dunkin BJ, Ertan A. Endoscopic radiofrequency ablation of Barrett's esophagus. Surg Technol Int 2012; 22:83-89. [PMID: 23292670] [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: 06/01/2023]
Abstract
Recently, extensive data have been published about the safety and efficacy of endoscopic radiofrequency ablation (RFA) of Barrett's esophagus (BE) with early cancer and dysplasia as well as without dysplasia. RFA has been shown to be effective and safe. Circumferential RFA is delivered using the HALO(360+) Ablation System (Covidien, Inc., Mansfield, MA), which consists ofa high-power energy generator, a sizing balloon catheter, and a number of balloon-based ablation catheters with varying outer diameters. Focal RF energy is delivered using the HALO(90) or HALO(60) Ablation Systems (Covidien, Inc., Mansfield, MA), consisting of a radiofrequency energy generator and an endoscope-mounted electrode. Both RFA systems have official approval to be used in the United States, Europe, and other countries for the treatment of BE as well as in patients with gastric antral vascular ectasia and radiation proctopathy. With increasing widespread use of these systems, a full mastery of the equipment and therapeutic technique is essential to maximize eradication rates of BE while maintaining patient safety. A cost-effective patient selection and eradication protocol for RFA is essential to success with this technique in patients with BE. This article will discuss our experience with RFA treatment of BE using the HALO system for effective eradication of Barrett's dysplasia and early Barrett's cancer and review available data especially from the U.S. National Registry.
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Affiliation(s)
- David S Wolf
- University of Texas Medical School, Houston, TX, USA
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Affiliation(s)
- Harvey S Singer
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Dugan JT, O'Shea CN, Wolf DS. Complete esophageal obstruction due to anterior cervical plate erosion diagnosed by retrograde endoscopy via a PEG tube tract. Gastrointest Endosc 2011; 73:1281-2. [PMID: 21354564 DOI: 10.1016/j.gie.2011.01.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 01/04/2011] [Indexed: 12/11/2022]
Affiliation(s)
- John T Dugan
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas Medical School at Houston, Houston, Texas, USA
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Wolf DS, Wasan SM, Merhav H, Adler DG. Hemobilia in a patient with protein S deficiency after laparoscopic cholecystectomy that caused acute pancreatitis: successful endoscopic management. Gastrointest Endosc 2005; 62:163-6. [PMID: 15990843 DOI: 10.1016/s0016-5107(05)00516-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- David S Wolf
- Department of Internal Medicine, The University of Texas-Houston Health Science Center, Texas 77030, USA
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Wolf DS, Gearing M, Snowdon DA, Mori H, Markesbery WR, Mirra SS. Progression of regional neuropathology in Alzheimer disease and normal elderly: findings from the Nun study. Alzheimer Dis Assoc Disord 1999; 13:226-31. [PMID: 10609672 DOI: 10.1097/00002093-199910000-00009] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although diffuse plaques in the neocortex may represent an early stage in the evolution of neuritic plaques, plaques in the striatum and cerebellum retain their predominantly diffuse nature in Alzheimer disease (AD), regardless of disease duration. We had the opportunity to explore the progression of these regional features by using autopsy brain specimens from 15 cognitively normal and five AD subjects, all Catholic sisters enrolled in the Nun Study, a longitudinal study on aging and AD. Neuropathologic changes were assessed in the temporal cortex, striatum, and cerebellum without knowledge of clinical status. We found diffuse plaques in the striatum in six (40%) and cerebellar plaques in none of the brains from the non-demented subjects. Striatal plaques were present in all five and cerebellar plaques in four of the five AD cases. In the 20 cases overall, the presence of striatal plaques generally paralleled the occurrence of neuritic plaques in neocortex and correlated with lower scores on several neuropsychologic tests assessing memory. Our findings suggest that striatal diffuse plaques occur relatively early in the progression of AD pathology and coincide with neocortical pathology and cognitive changes. Thus, it is unlikely that temporal factors alone account for regional differences in progression of AD neuropathology.
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Affiliation(s)
- D S Wolf
- Department of Pathology and Laboratory Medicine, VA Medical Center and Emory University School of Medicine, Atlanta, Georgia, USA
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Wolf DS, Raczka EK, Shevlin AM. Charcot's joint in a juvenile-onset diabetic: a case report. J Am Podiatry Assoc 1977; 67:200-3. [PMID: 845397 DOI: 10.7547/87507315-67-3-200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Wolf DS. Cavernous hemangioma. A case report. J Am Podiatry Assoc 1969; 59:446-7. [PMID: 5354013 DOI: 10.7547/87507315-59-11-446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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