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Lin E, Gandhi D, Volk M. Preventing Readmissions of Hepatic Encephalopathy: Strategies in the Acute Inpatient, Immediate Postdischarge, and Longitudinal Outpatient Setting. Clin Liver Dis 2024; 28:359-367. [PMID: 38548445 DOI: 10.1016/j.cld.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Hepatic encephalopathy (HE) is a strong predictor of early hospital readmission in patients with cirrhosis. Early hospital readmission increases health care costs and is associated with worse survival. Herein we provide an overview of strategies to prevent hospital readmissions in patients with HE, divided into 3 contexts: (a) acute inpatient, (b) immediate postdischarge, and (c) longitudinal outpatient setting.
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Affiliation(s)
- Emily Lin
- Department of Gastroenterology, Loma Linda University, Loma Linda, CA, USA
| | - Devika Gandhi
- Department of Gastroenterology, Loma Linda University, Loma Linda, CA, USA.
| | - Michael Volk
- Department of Medicine, Baylor Scott and White, Central Texas Region, Temple, TX, USA
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Thiruvengadam NR, Gupta S, Buller S, Awad I, Gandhi D, Ibarra A, Latorre G, Riquelme A, Kochman ML, Cote G, Shah SC, Saumoy M. The Clinical Impact and Cost-Effectiveness of Surveillance of Incidentally Detected Gastric Intestinal Metaplasia: A Microsimulation Analysis. Clin Gastroenterol Hepatol 2024; 22:51-61. [PMID: 37302442 DOI: 10.1016/j.cgh.2023.05.028] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND & AIMS Gastric intestinal metaplasia (GIM) is associated with a higher risk of noncardia intestinal gastric adenocarcinoma (GA). The aim of this study was to estimate lifetime benefits, complications, and cost-effectiveness of GIM surveillance using esophagogastroduodenoscopy (EGD). METHODS We developed a semi-Markov microsimulation model of patients with incidentally detected GIM, to compare the effectiveness of EGD surveillance with no surveillance at 10-year, 5-year, 3-year, 2-year, and 1-year intervals. We modeled a simulated cohort of 1,000,000 US individuals aged 50 with incidental GIM. Outcome measures were lifetime GA incidence, mortality, number of EGDs, complications, undiscounted life-years gained, and incremental cost-effectiveness ratio with a willingness-to-pay threshold of $100,000/quality-adjusted life-year (QALY). RESULTS In the absence of surveillance, the model simulated 32.0 lifetime GA cases and 23.0 lifetime GA deaths per 1000 individuals with GIM, respectively. Among surveilled individuals, simulated lifetime GA incidence (per 1000) decreased with shorter surveillance intervals (10-year to 1-year, 11.2-6.1) as did GA mortality (7.4-3.6). Compared with no surveillance, all modeled surveillance intervals yielded greater life expectancy (87-190 undiscounted life-years gained per 1000); 5-year surveillance provided the greatest number of life-years gained per EGD performed and was the cost-effective strategy ($40,706/QALY). In individuals with risk factors of family history of GA or anatomically extensive, incomplete-type GIM intensified 3-year surveillance was cost-effective (incremental cost-effectiveness ratio $28,156/QALY and $87,020/QALY, respectively). CONCLUSIONS Using microsimulation modeling, surveillance of incidentally detected GIM every 5 years is associated with reduced GA incidence/mortality and is cost-effective from a health care sector perspective. Real-world studies evaluating the impact of GIM surveillance on GA incidence and mortality in the United States are needed.
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Affiliation(s)
- Nikhil R Thiruvengadam
- Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, California.
| | - Shashank Gupta
- Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Seth Buller
- Loma Linda University School of Medicine, Loma Linda, California
| | - Imad Awad
- Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Devika Gandhi
- Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, California
| | - Allison Ibarra
- Division of Gastroenterology, University of California San Diego, San Diego, California
| | - Gonzalo Latorre
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arnoldo Riquelme
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro para la Prevención y el Control del Cáncer (CECAN), Santiago, Chile
| | - Michael L Kochman
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Gregory Cote
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon
| | - Shailja C Shah
- Division of Gastroenterology, University of California San Diego, San Diego, California; Gastroenterology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Monica Saumoy
- Center for Digestive Health, Penn Medicine Princeton Medical Center, Plainsboro, New Jersey
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Saumoy M, Gandhi D, Buller S, Patel S, Schneider Y, Cote G, Kochman ML, Thiruvengadam NR, Sharaiha RZ. Cost-effectiveness of endoscopic, surgical and pharmacological obesity therapies: a microsimulation and threshold analyses. Gut 2023; 72:2250-2259. [PMID: 37524445 DOI: 10.1136/gutjnl-2023-330437] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Weight loss interventions to treat obesity include sleeve gastrectomy (SG), lifestyle intervention (LI), endoscopic sleeve gastroplasty (ESG) and semaglutide. We aimed to identify which treatments are cost-effective and identify requirements for semaglutide to be cost-effective. DESIGN We developed a semi-Markov microsimulation model to compare the effectiveness of SG, ESG, semaglutide and LI for weight loss in 40 years old with class I/II/III obesity. Extensive one-way sensitivity and threshold analysis were performed to vary cost of treatment strategies and semaglutide adherence rate. Outcome measures were incremental cost-effectiveness ratios (ICERs), with a willingness-to-pay threshold of US$100 000/quality-adjusted life-year (QALY). RESULTS When strategies were compared with each other, ESG was cost-effective in class I obesity (US$4105/QALY). SG was cost-effective in class II obesity (US$5883/QALY) and class III obesity (US$7821/QALY). In class I/II/III, obesity, SG and ESG were cost-effective compared with LI. However, semaglutide was not cost-effective compared with LI for class I/II/III obesity (ICER US$508 414/QALY, US$420 483/QALY and US$350 637/QALY). For semaglutide to be cost-effective compared with LI, it would have to cost less than US$7462 (class III), US$5847 (class II) or US$5149 (class I) annually. For semaglutide to be cost-effective when compared with ESG, it would have to cost less than US$1879 (class III), US$1204 (class II) or US$297 (class I) annually. CONCLUSIONS Cost-effective strategies were: ESG for class I obesity and SG for class II/III obesity. Semaglutide may be cost-effective with substantial cost reduction. Given potentially higher utilisation rates with pharmacotherapy, semaglutide may provide the largest reduction in obesity-related mortality.
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Affiliation(s)
- Monica Saumoy
- Center for Digestive Health, Penn Medicine Princeton Medical Center, Plainsboro, New Jersey, USA
| | - Devika Gandhi
- Department of Gastroenterology and Hepatology, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Seth Buller
- Department of Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - Shae Patel
- Department of Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - Yecheskel Schneider
- Department of Gastroenterology, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Gregory Cote
- Department of Gastroenterology, Oregon Health Sciences University, Portland, Oregon, USA
| | - Michael L Kochman
- Department of Gastroenterology, Perelman School of Medicine the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nikhil R Thiruvengadam
- Department of Gastroenterology and Hepatology, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Reem Z Sharaiha
- Department of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, New York, USA
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Prajapati P, Wu X, Bajaj S, Gandhi D, Wintermark M, Malhotra A. Trends of Diversity in Neuroradiology Trainees in United States 2015-2022. AJNR Am J Neuroradiol 2023; 44:1009-1011. [PMID: 37500285 PMCID: PMC10494957 DOI: 10.3174/ajnr.a7947] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023]
Abstract
Radiology has historically not been a very diverse field. Many steps have been taken in the past decade to increase diversity in the field and make it more inclusive. This study shows the relative trends specifically in neuroradiology trainees, and the need for reassessment and further steps to increase diversity.
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Affiliation(s)
- P Prajapati
- From the Department of Radiology and Biomedical Imaging (P.P., S.B., A.M.), Yale School of Medicine, New Haven, Connecticut
| | - X Wu
- Department of Radiology (X.W.), University of California at San Francisco, San Francisco, California
| | - S Bajaj
- From the Department of Radiology and Biomedical Imaging (P.P., S.B., A.M.), Yale School of Medicine, New Haven, Connecticut
| | - D Gandhi
- University of Maryland School of Medicine (D.G.), Baltimore, Maryland
| | - M Wintermark
- Department of Neuroradiology (M.W.), MD Anderson Cancer Center, Houston, Texas
| | - A Malhotra
- From the Department of Radiology and Biomedical Imaging (P.P., S.B., A.M.), Yale School of Medicine, New Haven, Connecticut
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Gandhi D, Leonor P, Skef W. Novel use of an endoscopic morcellator to assist in removal of a fully embedded esophageal stent. VideoGIE 2023; 8:337-339. [PMID: 37719950 PMCID: PMC10500174 DOI: 10.1016/j.vgie.2023.03.010] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Video 1Use of endoscopic morcellator to assist in removal of stent.
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Affiliation(s)
- Devika Gandhi
- Division of Gastroenterology & Hepatology, Loma Linda University Medical Center, Loma Linda, California
| | - Paul Leonor
- Division of Gastroenterology & Hepatology, Loma Linda University Medical Center, Loma Linda, California
| | - Wasseem Skef
- Division of Gastroenterology & Hepatology, Loma Linda University Medical Center, Loma Linda, California
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6
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Desai AP, Gandhi D, Xu C, Ghabril M, Nephew L, Patidar KR, Campbell NL, Chalasani N, Boustani M, Orman ES. Confusion assessment method accurately screens for hepatic encephalopathy and predicts short-term mortality in hospitalized patients with cirrhosis. Metab Brain Dis 2023; 38:1749-1758. [PMID: 36529762 PMCID: PMC10935593 DOI: 10.1007/s11011-022-01149-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Hepatic encephalopathy (HE), a subtype of delirium, is common in cirrhosis and associated with poor outcomes. Yet, objective bedside screening tools for HE are lacking. We examined the relationship between an established screening tool for delirium, Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and short-term outcomes while comparing its performance with previously established measures of cognitive function such as West Haven criteria (WHC). Prospectively enrolled adults with cirrhosis who completed the CAM-ICU from 6/2014-6/2018 were followed for 90 days. Blinded provider-assigned West Haven Criteria (WHC) and other measures of cognitive function were collected. Logistic regression was used to test associations between CAM-ICU status and outcomes. Mortality prediction by CAM-ICU status was assessed using Area under the Receiver Operating Characteristics curves (AUROC). Of 469 participants, 11% were CAM-ICU( +), 55% were male and 94% were White. Most patients were Childs-Pugh class C (59%). CAM-ICU had excellent agreement with WHC (Kappa = 0.79). CAM-ICU( +) participants had similar demographic features to those CAM-ICU(-), but had higher MELD (25 vs. 19, p < 0.0001), were more often admitted to the ICU (28% vs. 7%, p < 0.0001), and were more likely to be admitted for HE and infection. CAM-ICU( +) participants had higher mortality (inpatient:37% vs. 3%, 30-day:51% vs. 11%, 90-day:63% vs. 23%, p < 0.001). CAM-ICU status predicted mortality with AUROC of 0.85, 0.82 and 0.77 for inpatient, 30-day and 90-day mortality, respectively. CAM-ICU easily screens for delirium/HE, has excellent agreement with WHC, and identifies a hospitalized cirrhosis cohort with high short-term mortality.
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Affiliation(s)
- Archita P Desai
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA.
- Center for Health Innovation and Implementation Science, Indiana University, Indianapolis, IN, USA.
| | - Devika Gandhi
- Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, CA, USA
| | - Chenjia Xu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Marwan Ghabril
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA
| | - Lauren Nephew
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA
| | - Kavish R Patidar
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA
| | - Noll L Campbell
- Center for Health Innovation and Implementation Science, Indiana University, Indianapolis, IN, USA
- Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN, USA
- Indiana University Center for Aging Research at the Regenstrief Institute, Indianapolis, IN, USA
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA
| | - Malaz Boustani
- Center for Health Innovation and Implementation Science, Indiana University, Indianapolis, IN, USA
- Indiana University Center for Aging Research at the Regenstrief Institute, Indianapolis, IN, USA
- Division of Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eric S Orman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA
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Khan A, Khunte M, Wu X, Bajaj S, Payabvash S, Wintermark M, Matouk C, Seidenwurm DJ, Gandhi D, Parizel P, Mezrich J, Malhotra A. Malpractice Litigation Related to Diagnosis and Treatment of Intracranial Aneurysms. AJNR Am J Neuroradiol 2023; 44:460-466. [PMID: 36997286 PMCID: PMC10084911 DOI: 10.3174/ajnr.a7828] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/23/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND AND PURPOSE Approaches to management of intracranial aneurysms are inconsistent, in part due to apprehension relating to potential malpractice claims. The purpose of this article was to review the causes of action underlying medical malpractice lawsuits related to the diagnosis and management of intracranial aneurysms and to identify the factors associated and their outcomes. MATERIALS AND METHODS We consulted 2 large legal databases in the United States to search for cases in which there were jury awards and settlements related to the diagnosis and management of patients with intracranial aneurysms in the United States. Files were screened to include only those cases in which the cause of action involved negligence in the diagnosis and management of a patient with an intracranial aneurysm. RESULTS Between 2000 and 2020, two hundred eighty-seven published case summaries were identified, of which 133 were eligible for inclusion in the analysis. Radiologists constituted 16% of 159 physicians sued in these lawsuits. Failure to diagnose was the most common medical malpractice claim referenced (100/133 cases), with the most common subgroups being "failure to include cerebral aneurysm as a differential and thus perform adequate work-up" (30 cases), and "failure to correctly interpret aneurysm evidence on CT or MR imaging" (16 cases). Only 6 of these 16 cases were adjudicated at trial, with 2 decided in favor of the plaintiff (awarded $4,000,000 and $43,000,000, respectively). CONCLUSIONS Incorrect interpretation of imaging is relatively infrequent as a cause of malpractice litigation compared with failure to diagnose aneurysms in the clinical setting by neurosurgeons, emergency physicians, and primary care providers.
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Affiliation(s)
- A Khan
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - M Khunte
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - X Wu
- Department of Radiology (X.W.), University of California at San Francisco, San Francisco, California
| | - S Bajaj
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - S Payabvash
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - M Wintermark
- Department of Radiology (M.W.), MD Anderson Cancer Center, Houston, Texas
| | - C Matouk
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
- Neurosurgery (C.M.), Yale School of Medicine, New Haven, Connecticut
| | - D J Seidenwurm
- Department of Neuroradiology (D.J.S.), Sutter Health, Sacramento, California
| | - D Gandhi
- Departments of Interventional Neuroradiology, Radiology, and Nuclear Medicine (D.G.)
- Neurology (D.G.)
- Neurosurgery (D.G.), University of Maryland School of Medicine, Baltimore, Maryland
| | - P Parizel
- Department of Radiology (P.P.), University of Western Australia, Perth, Australia
| | - J Mezrich
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - A Malhotra
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
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Wessell AP, Carvalho HDP, Le E, Cannarsa G, Kole MJ, Stokum JA, Chryssikos T, Miller TR, Chaturvedi S, Gandhi D, Yarbrough K, Satti SR, Jindal G. A Critical Assessment of the Golden Hour and the Impact of Procedural Timing in Stroke Thrombectomy. AJNR Am J Neuroradiol 2020; 41:822-827. [PMID: 32414902 DOI: 10.3174/ajnr.a6556] [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] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/04/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies in acute ischemic stroke have demonstrated the importance of minimizing delays to endovascular treatment and keeping thrombectomy procedural times at <30-60 minutes. The purpose of this study was to investigate the impact of thrombectomy procedural times on clinical outcomes. MATERIALS AND METHODS We retrospectively compared 319 patients having undergone thrombectomy according to procedural time (<30 minutes, 30-60 minutes, and >60 minutes) and time from stroke onset to endovascular therapy (≤6 or >6 hours). Clinical characteristics of patients with postprocedural intracranial hemorrhage were also assessed. Logistic regression was used to determine independent predictors of poor outcome at 90 days (mRS ≥3). RESULTS Greater age (OR, 1.03; 95% CI, 1.01-1.06; P = .016), higher admission NIHSS score (OR, 1.10; 95% CI, 1.04-1.16; P = .001), history of diabetes mellitus (OR, 1.96; 95% CI, 1.05-3.65; P = .034), and postprocedural intracranial hemorrhage were independently associated with greater odds of poor outcome. Modified TICI scale scores of 2c (OR, 0.11; 95% CI, 0.04-0.28; P < .001) and 3 (OR, 0.15; 95% CI, 0.06-0.38; P < .001) were associated with reduced odds of poor outcome. Although not statistically significant on univariate analysis, onset to endovascular therapy of >6 hours was independently associated with increased odds of poor outcome (OR, 2.20; 95% CI, 1.11-4.36; P = .024) in the final multivariate model (area under the curve = 0.820). Procedural time was not independently associated with clinical outcome in the final multivariate model (P > .05). CONCLUSIONS Thrombectomy procedural times beyond 60 minutes are associated with lower revascularization rates and worse 90-day outcomes. Procedural time itself was not an independent predictor of outcome. While stroke thrombectomy procedures should be performed rapidly, our study emphasizes the significance of achieving revascularization despite the requisite procedural time. However, the potential for revascularization must be weighed against the risks associated with multiple thrombectomy attempts.
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Affiliation(s)
- A P Wessell
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - H D P Carvalho
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
| | - E Le
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
| | - G Cannarsa
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - M J Kole
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - J A Stokum
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - T Chryssikos
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - T R Miller
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
| | - S Chaturvedi
- Neurology (S.C., K.Y.), University of Maryland Medical Center, Baltimore, Maryland
| | - D Gandhi
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
| | - K Yarbrough
- Neurology (S.C., K.Y.), University of Maryland Medical Center, Baltimore, Maryland
| | - S R Satti
- Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, Delaware
| | - G Jindal
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
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Su P, Guo S, Roys S, Maier F, Bhat H, Melhem ER, Gandhi D, Gullapalli RP, Zhuo J. Transcranial MR Imaging-Guided Focused Ultrasound Interventions Using Deep Learning Synthesized CT. AJNR Am J Neuroradiol 2020; 41:1841-1848. [PMID: 32883668 DOI: 10.3174/ajnr.a6758] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/05/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Transcranial MR imaging-guided focused ultrasound is a promising novel technique to treat multiple disorders and diseases. Planning for transcranial MR imaging-guided focused ultrasound requires both a CT scan for skull density estimation and treatment-planning simulation and an MR imaging for target identification. It is desirable to simplify the clinical workflow of transcranial MR imaging-guided focused ultrasound treatment planning. The purpose of this study was to examine the feasibility of deep learning techniques to convert MR imaging ultrashort TE images directly to synthetic CT of the skull images for use in transcranial MR imaging-guided focused ultrasound treatment planning. MATERIALS AND METHODS The U-Net neural network was trained and tested on data obtained from 41 subjects (mean age, 66.4 ± 11.0 years; 15 women). The derived neural network model was evaluated using a k-fold cross-validation method. Derived acoustic properties were verified by comparing the whole skull-density ratio from deep learning synthesized CT of the skull with the reference CT of the skull. In addition, acoustic and temperature simulations were performed using the deep learning CT to predict the target temperature rise during transcranial MR imaging-guided focused ultrasound. RESULTS The derived deep learning model generates synthetic CT of the skull images that are highly comparable with the true CT of the skull images. Their intensities in Hounsfield units have a spatial correlation coefficient of 0.80 ± 0.08, a mean absolute error of 104.57 ± 21.33 HU, and a subject-wise correlation coefficient of 0.91. Furthermore, deep learning CT of the skull is reliable in the skull-density ratio estimation (r = 0.96). A simulation study showed that both the peak target temperatures and temperature distribution from deep learning CT are comparable with those of the reference CT. CONCLUSIONS The deep learning method can be used to simplify workflow associated with transcranial MR imaging-guided focused ultrasound.
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Affiliation(s)
- P Su
- From the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland.,Siemens Medical Solutions USA (P.S., H.B.), Malvern, Pennsylvania
| | - S Guo
- From the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland.,Center for Metabolic Imaging and Therapeutics (S.G., S.R., R.G., J.Z.), University of Maryland Medical Center, Baltimore, Maryland
| | - S Roys
- From the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland.,Center for Metabolic Imaging and Therapeutics (S.G., S.R., R.G., J.Z.), University of Maryland Medical Center, Baltimore, Maryland
| | - F Maier
- Siemens Healthcare GmbH (F.M.), Erlangen, Germany
| | - H Bhat
- Siemens Medical Solutions USA (P.S., H.B.), Malvern, Pennsylvania
| | - E R Melhem
- From the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland
| | - D Gandhi
- From the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland
| | - R P Gullapalli
- From the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland.,Center for Metabolic Imaging and Therapeutics (S.G., S.R., R.G., J.Z.), University of Maryland Medical Center, Baltimore, Maryland
| | - J Zhuo
- From the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland .,Center for Metabolic Imaging and Therapeutics (S.G., S.R., R.G., J.Z.), University of Maryland Medical Center, Baltimore, Maryland
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Choksi A, Tsymbalyuk S, Tolaymat B, Li G, Gandhi D, Miller T, Jindal G, Chao C. Abstract No. 463 First Independent review of the vascade vascular closure device: the only device marketed as “proven” safer than manual compression. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.544] [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: 11/25/2022] Open
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11
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Miller TR, Kole MJ, Le EJ, Cannarsa G, Jones S, Wessell AP, Jindal G, Aldrich EF, Simard JM, Gandhi D. Pipeline Diameter Significantly Impacts the Long-Term Fate of Jailed Side Branches during Treatment of Intracranial Aneurysms. AJNR Am J Neuroradiol 2018; 39:2270-2277. [PMID: 30385475 DOI: 10.3174/ajnr.a5863] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/28/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although covered side branches typically remain patent acutely following Pipeline Embolization Device embolization of intracranial aneurysms, the long-term fate of these vessels remains uncertain. We therefore elected to investigate factors that may influence the long-term patency of these covered side branches. MATERIALS AND METHODS We retrospectively evaluated the long-term patency of side branches covered by the Pipeline Embolization Device at our institution during treatment of intracranial aneurysms with at least 6 months of conventional angiography follow-up. Procedural and anatomic factors that might influence the fate of covered side branches were explored. RESULTS One hundred forty-eight Pipeline Embolization Device treatments in 137 patients met the inclusion criteria. In 217 covered side branches, 29 (13.4%) were occluded on follow-up, and 40 (18.4%) were stenotic. All stenoses and occlusions were asymptomatic. In the entire cohort and in the largest subset of ophthalmic arteries, a smaller Pipeline Embolization Device diameter was associated with branch vessel occlusion (P = .001, P = .013). When we considered stenotic and occluded side branches together, smaller Pipeline Embolization Device size (P = .029) and administration of intraprocedural abciximab (P = .03) predicted side branch stenosis/occlusion, while anterior choroidal branch type (P = .003) was a predictor of gross side branch patency. CONCLUSIONS A smaller Pipeline Embolization Device diameter is associated with delayed side branch stenosis/occlusion following Pipeline Embolization Device treatment, likely due to the higher metal density of smaller caliber devices. Although hemodynamic factors, including the potential for collateral flow, are still paramount in determining the fate of covered side branches, the amount of metal coverage at the side branch orifice also plays an important role.
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Affiliation(s)
- T R Miller
- From the Departments of Diagnostic Radiology (T.R.M., G.J., D.G.)
| | - M J Kole
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - E J Le
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - G Cannarsa
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - S Jones
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - A P Wessell
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - G Jindal
- From the Departments of Diagnostic Radiology (T.R.M., G.J., D.G.).,Neuroradiology (G.J., D.G.).,Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - E F Aldrich
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - J M Simard
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - D Gandhi
- From the Departments of Diagnostic Radiology (T.R.M., G.J., D.G.).,Neuroradiology (G.J., D.G.).,Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
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12
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Malhotra A, Wu X, Geng B, Hersey D, Gandhi D, Sanelli P. Management of Small Unruptured Intracranial Aneurysms: A Survey of Neuroradiologists. AJNR Am J Neuroradiol 2018; 39:875-880. [PMID: 29650787 DOI: 10.3174/ajnr.a5631] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE The long-term history and management of unruptured intracranial aneurysms is not well understood. Our aim was to determine current practice patterns in the management of unruptured intracranial aneurysms, especially regarding imaging surveillance for conservatively managed aneurysms of this type. MATERIALS AND METHODS An on-line survey was designed to examine physician practice and preference regarding the management of small unruptured intracranial aneurysms (≤7 mm in diameter). The survey was circulated to members of the American Society of Neuroradiology. Participation was voluntary, and all responses were anonymous. RESULTS A total of 227 individual survey responses were obtained and included in the analysis with 54.6% (124/227) from diagnostic neuroradiologists (practicing >50% neuroradiology) and one-third (29%) from neurointerventional radiologists. One hundred seventy-three of 227 responded that routine, periodic imaging surveillance would be appropriate for conservatively managed unruptured intracranial aneurysms, and 84% of respondents recommended surveillance frequency of at least once a year. Fifty-nine percent favored indefinite, life-long follow-up for small unruptured intracranial aneurysms, and a similar number of respondents favored noncontrast MR angiography for aneurysm follow-up. Significant heterogeneity was found in size measurements used to assess aneurysms and criteria used to define growth on surveillance imaging. CONCLUSIONS The natural history of intracranial aneurysms is not well-understood. A large proportion of incidentally detected, unruptured aneurysms are small (<7 mm). The survey results show significant heterogeneity in practice even among neuroradiologists and underlies the need to standardize imaging practice. Further studies are needed to assess the optimal frequency and duration of surveillance imaging for unruptured intracranial aneurysms. The criteria used to measure aneurysms and define growth on imaging also need to be standardized.
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Affiliation(s)
- A Malhotra
- From the Department of Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, New Haven, Connecticut
| | - X Wu
- Yale School of Medicine (X.W., B.G.), New Haven, Connecticut
| | - B Geng
- Yale School of Medicine (X.W., B.G.), New Haven, Connecticut
| | - D Hersey
- Clinical Information Services (D.H.), Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - D Gandhi
- Department of Interventional Neuroradiology (D.G.), University of Maryland School of Medicine, Baltimore, Maryland
| | - P Sanelli
- Department of Radiology (P.S.), Northwell Health, New York, New York
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Gupta V, Jindal G, Serulle Y, Stoner J, Miller T, Gandhi D. Abstract No. 674 Recent technical advancements in endovascular stroke treatment are associated with a decrease in time to recanalization, contrast material volume, and incidence of contrast induced nephropahty. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.719] [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: 10/17/2022] Open
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14
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Ip J, Vigar M, Grimes D, Xie Y, Gandhi D. P2674Surveillance of AF Recurrence post Surgical AF Ablation using implantable cardiac monitor: 30 months follow up. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2674] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Sajedi PI, Gonzalez JN, Cronin CA, Kouo T, Steven A, Zhuo J, Thompson O, Castellani R, Kittner SJ, Gandhi D, Raghavan P. Carotid Bulb Webs as a Cause of "Cryptogenic" Ischemic Stroke. AJNR Am J Neuroradiol 2017; 38:1399-1404. [PMID: 28495950 DOI: 10.3174/ajnr.a5208] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/27/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Carotid webs are intraluminal shelf-like filling defects at the carotid bulb with recently recognized implications in patients with recurrent ischemic stroke. We sought to determine whether carotid webs are an under-recognized cause of "cryptogenic" ischemic stroke and to estimate their prevalence in the general population. MATERIALS AND METHODS A retrospective review of neck CTA studies in young patients with cryptogenic stroke over the past 6 years (n = 33) was performed to determine the prevalence of carotid webs compared with a control group of patients who received neck CTA studies for reasons other than ischemic stroke (n = 63). RESULTS The prevalence of carotid webs in the cryptogenic stroke population was 21.2% (95% CI, 8.9%-38.9%). Patients with symptomatic carotid webs had a mean age of 38.9 years (range, 30-48 years) and were mostly African American (86%) and women (86%). In contrast, only 1.6% (95% CI, 0%-8.5%) of patients in the control group demonstrated a web. Our findings demonstrate a statistically significant association between carotid webs and ischemic stroke (OR = 16.7; 95% CI, 2.78-320.3; P = .01). CONCLUSIONS Carotid webs exhibit a strong association with ischemic stroke, and their presence should be suspected in patients lacking other risk factors, particularly African American women.
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Affiliation(s)
- P I Sajedi
- From the Departments of Diagnostic Radiology and Nuclear Medicine (P.R., P.I.S., T.K., J.Z.)
| | | | - C A Cronin
- Neurology (J.N.G., C.A.C., O.T., S.J.K.)
| | - T Kouo
- From the Departments of Diagnostic Radiology and Nuclear Medicine (P.R., P.I.S., T.K., J.Z.)
| | - A Steven
- Department of Diagnostic Radiology and Nuclear Medicine (A.S.), Ochsner Medical Center, New Orleans, Louisiana
| | - J Zhuo
- From the Departments of Diagnostic Radiology and Nuclear Medicine (P.R., P.I.S., T.K., J.Z.)
| | - O Thompson
- Neurology (J.N.G., C.A.C., O.T., S.J.K.)
| | - R Castellani
- Department of Pathology (R.C.), University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | | | - D Gandhi
- Interventional Neuroradiology (D.G.), University of Maryland School of Medicine, Baltimore, Maryland
| | - P Raghavan
- From the Departments of Diagnostic Radiology and Nuclear Medicine (P.R., P.I.S., T.K., J.Z.)
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16
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Ip J, Vigar M, Grimes D, Xie Y, Gandhi D, Cheng J. 1360Surveillance of AF recurrence post AF ablation using implantable cardiac monitor: 3 year follow up. Europace 2017. [DOI: 10.1093/ehjci/eux157] [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: 11/14/2022] Open
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17
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Miller TR, Zhuo J, Jindal G, Shivashankar R, Beaty N, Gandhi D. The Efficacy of Shielding Systems for Reducing Operator Exposure during Neurointerventional Procedures: A Real-World Prospective Study. AJNR Am J Neuroradiol 2017; 38:450-454. [PMID: 28007766 DOI: 10.3174/ajnr.a5038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neurointerventional surgery may expose patients and physician operators to substantial amounts of ionizing radiation. Although strategies for reducing patient exposure have been explored in the medical literature, there has been relatively little published in regards to decreasing operator exposure. The purpose of this study was to evaluate the efficacy of shielding systems in reducing physician exposure in a modern neurointerventional practice. MATERIALS AND METHODS Informed consent was obtained from operators for this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved study. Operator radiation exposure was prospectively measured during 60 consecutive neurointerventional procedures from October to November 2013 using a 3-part lead shielding system. Exposure was then evaluated without lead shielding in a second 60-procedure block from April to May 2014. A radiation protection drape was randomly selected for use in half of the cases in each block. Two-way analysis of covariance was performed to test the effect of shielding systems on operator exposure while controlling for other covariates, including procedure dose-area product. RESULTS Mean operator procedure dose was 20.6 μSv for the entire cohort and 17.7 μSv when using some type of shielding. Operator exposure significantly correlated with procedure dose-area product, but not with other covariates. After we adjusted for procedure dose-area product, the use of lead shielding or a radiation protection drape significantly reduced operator exposure by 45% (F = 12.54, P < .0001) and 29% (F = 7.02, P = .009), respectively. The difference in protection afforded by these systems was not statistically significant (P = .46), and their adjunctive use did not provide additional protection. CONCLUSIONS Extensive lead shielding should be used as much as possible in neurointerventional surgery to reduce operator radiation exposure to acceptable levels. A radiation protection drape is a reasonable alternative when standard lead shielding is unavailable or impractical to use without neglecting strategies to minimize the dose.
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Affiliation(s)
- T R Miller
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
| | - J Zhuo
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
| | - G Jindal
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
| | - R Shivashankar
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
| | - N Beaty
- Neurosurgery (N.B.), University of Maryland Medical Center, Baltimore, Maryland
| | - D Gandhi
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
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18
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Suresh V, Sridhar K, Vijay S, Gandhi D, Kamath S, Raghavendra K. Checklist manifesto for craniosynostosis correction. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.254] [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: 10/19/2022]
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19
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Abstract
Initially used in the treatment of prostate cancer and uterine fibroids, the role of focused ultrasound has expanded as transcranial acoustic wave distortion and other limitations have been overcome. Its utility relies on focal energy deposition via acoustic wave propagation. The duty cycle and intensity of focused ultrasound influence the rate of energy deposition and result in unique physiologic and biomechanical effects. Thermal ablation via high-intensity continuous exposure generates coagulative necrosis of tissues. High-intensity, pulsed application reduces temporally averaged energy deposition, resulting in mechanical effects, including reversible, localized BBB disruption, which enhances neurotherapeutic agent delivery. While the precise mechanisms remain unclear, low-intensity, pulsed exposures can influence neuronal activity with preservation of cytoarchitecture. Its noninvasive nature, high-resolution, radiation-free features allow focused ultrasound to compare favorably with other modalities. We discuss the physical characteristics of focused ultrasound devices, the biophysical mechanisms at the tissue level, and current and emerging applications.
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Affiliation(s)
- N Khanna
- From the Department of Diagnostic Radiology and Nuclear Medicine (N.K., D.G., A.S., V.F., E.R.M.)
| | - D Gandhi
- From the Department of Diagnostic Radiology and Nuclear Medicine (N.K., D.G., A.S., V.F., E.R.M.)
| | - A Steven
- From the Department of Diagnostic Radiology and Nuclear Medicine (N.K., D.G., A.S., V.F., E.R.M.)
| | - V Frenkel
- From the Department of Diagnostic Radiology and Nuclear Medicine (N.K., D.G., A.S., V.F., E.R.M.) .,Greenebaum Cancer Center (V.F.), University of Maryland School of Medicine, Baltimore, Maryland
| | - E R Melhem
- From the Department of Diagnostic Radiology and Nuclear Medicine (N.K., D.G., A.S., V.F., E.R.M.)
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20
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Patel S, Gandhi D, Mehta V, Bhatia K, Epelbaum O. Plesiomonas shigelloides : an extremely rare cause of Spontaneous Bacterial Peritonitis. Acta Gastroenterol Belg 2016; 79:52-53. [PMID: 26852764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Plesiomonas shigelloides, a rare cause of gastroenteritis in humans, is a gram negative rod belonging to the Enterobacteriaceae family. In addition, it has also been implicated in extra-intestinal infection, but prevalence data on such infections have been limited to case reports. To date there has been only one published case of P. shigelloides causing spontaneous bacterial peritonitis (SBP). We describe another patient with P. shigelloides SBP and compare our findings with those from the original case.
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21
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Monnier J, Georgin-Lavialle S, Canioni D, Soussan M, Lhermitte L, Bruneau J, Dubreuil P, Chandesris MO, Bodemer C, Gandhi D, Hermine O. Sarcomes mastocytaires : série de cas français et revue de la littérature. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.063] [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: 11/30/2022]
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22
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Raghavan P, Serulle Y, Gandhi D, Morales R, Quinn K, Angster K, Hertzano R, Eisenman D. Postoperative Imaging Findings following Sigmoid Sinus Wall Reconstruction for Pulse Synchronous Tinnitus. AJNR Am J Neuroradiol 2015; 37:136-42. [PMID: 26427834 DOI: 10.3174/ajnr.a4511] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 06/09/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Transmastoid sigmoid sinus wall reconstruction is a surgical technique increasingly used for the treatment of pulsatile tinnitus arising from sigmoid sinus wall anomalies. The imaging appearance of the temporal bone following this procedure has not been well-characterized. The purpose of this study was to evaluate the postoperative imaging appearance in a group of patients who underwent this procedure. MATERIALS AND METHODS The medical records of 40 consecutive patients who underwent transmastoid sigmoid sinus wall reconstruction were reviewed. Thirteen of 40 patients underwent postoperative imaging. Nineteen CT and 7 MR imaging examinations were assessed for the characteristics of the materials used for reconstruction, the impact of these on the adjacent sigmoid sinus, and complications. RESULTS Tinnitus resolved in 38 of 40 patients. Nine patients were imaged postoperatively for suspected complications, including dural sinus thrombosis, facial swelling, and wound drainage. Two patients underwent imaging for persistent tinnitus, and 2, for development of tinnitus on the side contralateral to the side of surgery. The materials used for reconstruction (NeuroAlloderm, HydroSet, bone pate) demonstrated characteristic imaging appearances and could be consistently identified. In 5 of 13 patients, there was extrinsic compression of the sigmoid sinus by graft material. Dural sinus thrombosis occurred in 2 patients. CONCLUSIONS The imaging findings following sigmoid sinus wall repair are characteristic. Graft materials may result in extrinsic compression of the sigmoid sinus, and this finding may be confused with dural venous thrombosis. Awareness of the imaging characteristics of the graft materials used enables this differentiation.
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Affiliation(s)
- P Raghavan
- From the Departments of Radiology (P.R., Y.S., D.G., R.M.)
| | - Y Serulle
- From the Departments of Radiology (P.R., Y.S., D.G., R.M.)
| | - D Gandhi
- From the Departments of Radiology (P.R., Y.S., D.G., R.M.)
| | - R Morales
- From the Departments of Radiology (P.R., Y.S., D.G., R.M.)
| | - K Quinn
- Otolaryngology (K.Q., K.A., R.H., D.E.), University of Maryland Medical Center, Baltimore, Maryland
| | - K Angster
- Otolaryngology (K.Q., K.A., R.H., D.E.), University of Maryland Medical Center, Baltimore, Maryland
| | - R Hertzano
- Otolaryngology (K.Q., K.A., R.H., D.E.), University of Maryland Medical Center, Baltimore, Maryland
| | - D Eisenman
- Otolaryngology (K.Q., K.A., R.H., D.E.), University of Maryland Medical Center, Baltimore, Maryland
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Rampini S, Kilinc D, Li P, Monteil C, Gandhi D, Lee GU. Micromagnet arrays for on-chip focusing, switching, and separation of superparamagnetic beads and single cells. Lab Chip 2015; 15:3370-3379. [PMID: 26160691 DOI: 10.1039/c5lc00581g] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Nonlinear magnetophoresis (NLM) is a novel approach for on-chip transport and separation of superparamagnetic (SPM) beads, based on a travelling magnetic field wave generated by the combination of a micromagnet array (MMA) and an applied rotating magnetic field. Here, we present two novel MMA designs that allow SPM beads to be focused, sorted, and separated on-chip. Converging MMAs were used to rapidly collect the SPM beads from a large region of the chip and focus them into synchronised lines. We characterise the collection efficiency of the devices and demonstrate that they can facilitate on-chip analysis of populations of SPM beads using a single-point optical detector. The diverging MMAs were used to control the transport of the beads and to separate them based on their size. The separation efficiency of these devices was determined by the orientation of the magnetisation of the micromagnets relative to the external magnetic field and the size of the beads and relative to that of micromagnets. By controlling these parameters and the rotation of the external magnetic field we demonstrated the controlled transport of SPM bead-labelled single MDA-MB-231 cells. The use of these novel MMAs promises to allow magnetically-labelled cells to be efficiently isolated and then manipulated on-chip for analysis with high-resolution chemical and physical techniques.
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Affiliation(s)
- S Rampini
- Bionanoscience Group, School of Chemistry and Chemical Biology, UCD, Dublin, Ireland.
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Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible Cerebral Vasoconstriction Syndrome, Part 2: Diagnostic Work-Up, Imaging Evaluation, and Differential Diagnosis. AJNR Am J Neuroradiol 2015; 36:1580-8. [PMID: 25614476 DOI: 10.3174/ajnr.a4215] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The diagnostic evaluation of a patient with reversible cerebral vasoconstriction syndrome integrates clinical, laboratory, and radiologic findings. Imaging plays an important role by confirming the presence of cerebral vasoconstriction; monitoring potential complications such as ischemic stroke; and suggesting alternative diagnoses, including CNS vasculitis and aneurysmal subarachnoid hemorrhage. Noninvasive vascular imaging, including transcranial Doppler sonography and MR angiography, has played an increasingly important role in this regard, though conventional angiography remains the criterion standard for the evaluation of cerebral artery vasoconstriction. Newer imaging techniques, including high-resolution vessel wall imaging, may help in the future to better discriminate reversible cerebral vasoconstriction syndrome from primary angiitis of the CNS, an important clinical distinction.
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Affiliation(s)
- T R Miller
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - R Shivashankar
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - M Mossa-Basha
- Department of Diagnostic Radiology (M.M.-B.), Section of Neuroradiology, University of Washington, Seattle, Washington
| | - D Gandhi
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
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Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible Cerebral Vasoconstriction Syndrome, Part 1: Epidemiology, Pathogenesis, and Clinical Course. AJNR Am J Neuroradiol 2015; 36:1392-9. [PMID: 25593203 DOI: 10.3174/ajnr.a4214] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Reversible cerebral vasoconstriction syndrome is a clinical and radiologic syndrome that represents a common presentation of a diverse group of disorders. The syndrome is characterized by thunderclap headache and reversible vasoconstriction of cerebral arteries, which can either be spontaneous or related to an exogenous trigger. The pathophysiology of reversible cerebral vasoconstriction syndrome is unknown, though alterations in cerebral vascular tone are thought to be a key underlying mechanism. The syndrome typically follows a benign course; however, reversible cerebral vasoconstriction syndrome may result in permanent disability or death in a small minority of patients secondary to complications such as ischemic stroke or intracranial hemorrhage.
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Affiliation(s)
- T R Miller
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - R Shivashankar
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - M Mossa-Basha
- Department of Diagnostic Radiology (M.M.-B.), Section of Neuroradiology, University of Washington, Seattle, Washington
| | - D Gandhi
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
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Gandhi D, Jindal G, Shivashankar R, Miller T, Beaty N. O-027 Micro Vascular Plug (MVP) Assisted Vessel Occlusion in Neurovascular Pathologies: Technical Results and Initial Clinical Experience. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Gandhi D, Miller T, Beaty N, Fortes M, Simard J, Aldrich E, Jindal G. E-063 Endovascular treatment of intracranial aneurysms using a new, low profile intracranial micro-catheter: Initial experience. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.121] [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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Prasad V, Jindal G, Gandhi D. E-016 Risk of Contrast-Induced Nephropathy Following High Dose of Contrast Media in Patients Undergoing Neuroendovascular Procedures. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.74] [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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Patel A, Gandhi D, Aldrich E, Simard M, Aarabi B, Jindal G. E-032 Multidisciplinary Treatment of Anterior Cerebral Artery Pseudoaneurysms: A Single Centre Experience. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.90] [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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Fortes M, Jindal G, Gomez J, Gandhi D. E-014 Endovascular occlusion of trigeminal artery-cavernous fistula following spontaneous rupture of a persistent trigeminal artery (PTA): technical considerations and case report: Abstract E-014 Figure 1. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Fortes M, Polifka A, Jindal G, Gandhi D. P-008 Use of the axera neurovascular access device as a tool to promote patient comfort, faster recovery and turnover times without an arterial implant. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455b.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: 11/03/2022]
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Fortes M, Gandhi D. E-015 The dilemma of posterior communicating infundibulum masquerading as aneurysm on 2D digital subtraction angiography (DSA): utility of “empty apex sign” as a diagnostic tool. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.15] [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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Jindal G, Gandhi D, Polifka A. P-038 Stenting of traumatic cervical internal carotid artery pseudoaneurysms, 10 year experiences at a level I trauma center. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455b.38] [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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Gandhi D, Chen J, Pearl M, Huang J, Gemmete JJ, Kathuria S. Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment. AJNR Am J Neuroradiol 2012; 33:1007-13. [PMID: 22241393 DOI: 10.3174/ajnr.a2798] [Citation(s) in RCA: 245] [Impact Index Per Article: 20.4] [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
Intracranial DAVFs are pathologic dural-based shunts and account for 10%-15% of all intracranial arteriovenous malformations. These malformations derive their arterial supply primarily from meningeal vessels, and the venous drainage is either via dural venous sinuses or through the cortical veins. DAVFs have a reported association with dural sinus thrombosis, venous hypertension, previous craniotomy, and trauma, though many lesions are idiopathic. The diagnosis is dependent on a high level of clinical suspicion and high-resolution imaging. Cross-sectional imaging techniques by using CT and MR imaging aid in the diagnosis, but conventional angiography remains the most accurate method for complete characterization and classification of DAVFs. The pattern of venous drainage observed on dynamic vascular imaging determines the type of DAVF and correlates with the severity of symptoms and the risk of hemorrhage.
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Affiliation(s)
- D Gandhi
- Division of Interventional Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21201, USA.
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Ansari SA, Rath TJ, Gandhi D. Reversible cerebral vasoconstriction syndromes presenting with subarachnoid hemorrhage: a case series. J Neurointerv Surg 2011; 3:272-8. [DOI: 10.1136/jnis.2010.004242] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [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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Seear M, Gandhi D, Carr R, Dayal A, Raghavan D, Sharma N. The need for better data about counterfeit drugs in developing countries: a proposed standard research methodology tested in Chennai, India. J Clin Pharm Ther 2010; 36:488-95. [PMID: 21729113 DOI: 10.1111/j.1365-2710.2010.01198.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE There is still surprisingly little basic research data to support widely repeated claims about the prevalence of drug counterfeiting. To meet the need for more reliable drug quality data, we designed a study framework that includes clear definitions of measured end points, sampling methods and assay technique. Our objective was to test this research design in Chennai (formerly Madras), India, using a joint Indian and Canadian team. METHODS The city was divided into ten areas along municipal lines. From each area, ten stores and pharmacies selling drugs were selected. At each of these 100 outlets, three study drugs (artesunate, ciprofloxacin and rifampicin) were purchased. The 300 samples were tested by Liquid Chromatography-Mass Spectrometry. Assay content was expressed as a percentage of stated tablet content. Based on assay results and their distribution, we developed drug quality definitions for normal manufacturing standards, counterfeiting, decomposition, poor quality control and adulteration. RESULTS The group mean for ciprofloxacin was close to normal manufacturing limits (99·2 ± 7·1%) but rifampicin (91·6 ± 5·7%), and artesunate (80·1 ± 9·1%), were both below normal pharmaceutical standards. Overall, 43% of all samples fell below the widely accepted manufacturing range of 90-110% of stated content. No tablet from any sample contained less than 50% of the stated dose. WHAT IS NEW AND CONCLUSION The quality of at least some anti-infective drugs in Chennai is below commonly accepted standards but we found no evidence of criminal counterfeiting. Poor drug quality was most likely due to decomposition during storage or poor manufacturing standards. Our research methodology worked well under practical conditions and should hopefully be of value to others working in this area.
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Affiliation(s)
- M Seear
- Centre for International Child Health Department of Pharmacy, Children's and Women's Hospital, Vancouver, BC, Canada.
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Khanna N, Arnold S, Sadaphal S, Joshi A, Stewart D, Gandhi D. Nicotine dependence and depression among women smokers on methadone maintenance. Eur J Gen Pract 2010; 16:222-8. [PMID: 20942738 DOI: 10.3109/13814788.2010.516359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Tobacco use and depression are highly prevalent among methadone maintenance (MM) treatment programme participants. Our aim was to study the relationship between nicotine dependence, depression, and readiness to change smoking behaviour among women smokers in MM compared to women smokers attending a primary care clinic (Control group). METHOD We conducted a cross-sectional survey of 117 MM women smokers and 50 controls attending a family medicine clinic. All participants completed a computerized self-administered questionnaire, including demographic information, medical history, and drug and tobacco use history. Participants also completed the Fagerström Test for Nicotine Dependence (FTND), the Center for Epidemiologic Studies Depression Scale (CES-D), and the University of Rhode Island Change Assessment (URICA) instrument. RESULTS In this study 83% African American women had an average age of 43 years. Of the women smokers in the MM group, 95% were daily smokers compared to 46% in the Control group (P <0.05). The MM women smokers had CES-D scores of 22.5 compared to 14.7 in women of the Control group (P <0.0001). Women smokers in MM were significantly more likely to be depressed, more dependent on nicotine, and more ready to change their smoking behaviour. CONCLUSIONS Our data show a higher level of nicotine dependence and depression, and greater readiness to change among women smokers in methadone maintenance programmes compared to women smokers attending primary care clinics. Methadone treatment programmes present a need and an opportunity to assess and intervene in nicotine dependence and depression and in addressing and eliminating health disparities.
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Affiliation(s)
- N Khanna
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore 21201, USA
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Abstract
Amyloidomas are benign tumorlike lesions consisting of localized deposits of amyloid and are the rarest form in the group of amyloidosis-related lesions. Diagnosis requires special stains; therefore, a high degree of suspicion for this disease is required. In this review, we describe the imaging features of amyloidomas involving the intracranial compartment, head and neck, and spine. We also discuss the differential diagnosis and briefly review the pertinent literature.
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Affiliation(s)
- Hemant Parmar
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan 48109-0302, USA.
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Gandhi D, Huang J, Choudhary A, Kathuria S. E-051 Upper cervical spinal dural arteriovenous fistulae: an under recognized entity? J Neurointerv Surg 2010. [DOI: 10.1136/jnis.2010.003251.51] [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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Gandhi D, Huang J, Gomez J, Kathuria S. E-038 Utility of Dyna CT in the evaluation and management of cranial and skull base arteriovenous fistulas. J Neurointerv Surg 2010. [DOI: 10.1136/jnis.2010.003251.38] [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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Kathuria S, Ehtiati T, Gandhi D. E-040 Utility of Syngo iGuide needle guidance system for intraoperative navigation in percutaneous spine interventions: a cadaveric study. J Neurointerv Surg 2010. [DOI: 10.1136/jnis.2010.003251.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Ansari S, Chaudhary N, Gandhi D, Thompson B, Gemmete J. P-015 Mid term and long term results with second generation Matrix2 detachable coils. J Neurointerv Surg 2010. [DOI: 10.1136/jnis.2010.003236.15] [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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Gandhi D, Kathuria S, Subramanian P, Miller N, Huang J. E-001 Utility of flexible guide catheter in assisting transvenous superior ophthalmic vein catheterization and embolization of difficult to treat carotid-cavernous/orbital fistulas. J Neurointerv Surg 2010. [DOI: 10.1136/jnis.2010.003251.1] [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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Gemmete JJ, Chaudhary N, Pandey A, Gandhi D, Sullivan SE, Marentette LJ, Chepeha DB, Ansari SA. Usefulness of percutaneously injected ethylene-vinyl alcohol copolymer in conjunction with standard endovascular embolization techniques for preoperative devascularization of hypervascular head and neck tumors: technique, initial experience, and correlation with surgical observations. AJNR Am J Neuroradiol 2009; 31:961-6. [PMID: 20037136 DOI: 10.3174/ajnr.a1936] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [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 Few reports have described the embolization of head and neck lesions by using direct percutaneous techniques. We report our preliminary experience in the direct percutaneous embolization of hypervascular head and neck tumors by using Onyx in conjunction with standard endovascular embolization techniques. We describe the technical aspects of the procedure and its efficacy in reducing intraoperative blood loss. MATERIALS AND METHODS We retrospectively studied 14 patients (3 females and 11 males; mean age, 33.4 years; range, 11-56 years) with 15 hypervascular tumors of the head and neck that underwent direct percutaneous embolization with Onyx in conjunction with particulate embolization. Nine paragangliomas and 6 JNAs underwent treatment. Documented blood loss was obtained from operative reports in these 15 patients with surgical resection performed 24-48 hours after the embolization. RESULTS Intratumoral penetration with progressive blood flow stasis was achieved during each injection. A mean of 3.1 needles (20-gauge, 3.5-inch spinal needle) were placed percutaneously into the lesion (range, 1-6). The mean intraoperative blood loss was 780 mL (range, <50-2200 mL). Near total angiographic devascularization was achieved in 13 of 15 tumors. There were no local complications or neurologic deficits from the percutaneous access or embolization of these hypervascular tumors. CONCLUSIONS In this study, the use of percutaneous injected Onyx in conjunction with standard endovascular embolization techniques in patients with hypervascular head and neck tumors seemed to enhance the ability to devascularize these tumors before operative removal.
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Affiliation(s)
- J J Gemmete
- Division of Interventional Neuroradiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan 48109-0030, USA.
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Gandhi D, Mitchell K, Miick R, Chang B. Clinicopathologic Analysis of Gross Tumor Size and Microscopic Extension in Liver Metastases from Colorectal Cancer (CRC): Implications for Stereotactic Body Radiotherapy (SBRT). Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.089] [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: 10/20/2022]
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Hackett S, Hill L, Patel J, Ratnaraja N, Ifeyinwa A, Farooqi M, Nusgen U, Debenham P, Gandhi D, Makwana N, Smit E, Welch S. Clinical characteristics of paediatric H1N1 admissions in Birmingham, UK. Lancet 2009; 374:605. [PMID: 19700001 DOI: 10.1016/s0140-6736(09)61511-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gandhi D, Ansari S, Razack N. 023 Temporary flow arrest for tracking and placing the compliant balloon catheter at the neck of a large or giant aneurysm: technique and initial results. J Neurointerv Surg 2009. [DOI: 10.1136/jnis.2009.000851w] [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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Gandhi D, Pandey A, Ansari SA, Gemmete JJ, Thompson BG, Mukherji SK. Multi-detector row CT angiography with direct intra-arterial contrast injection for the evaluation of neurovascular disease: technique, applications, and initial experience. AJNR Am J Neuroradiol 2009; 30:1054-8. [PMID: 19213819 DOI: 10.3174/ajnr.a1438] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 11/07/2022]
Abstract
The purpose of this study was to evaluate the usefulness of 64-section multi-detector row CT angiography (CTA) with direct intra-arterial contrast injection (IA-CTA) for the evaluation of neurovascular disease. This technique was used in 11 patients at our institution. All studies were technically successful, and there were no complications. Small vascular malformations were mapped easily on high-resolution IA-CTA images, enabling microsurgical resection or stereotactic radiosurgery. In a similar fashion, additional morphologic features were revealed on IA-CTA images not seen on standard 2D and 3D digital subtraction angiography. Of 11 patients undergoing IA-CTA, 7 patients had further anatomic clarity of the small arteriovenous fistula/malformation and 4 patients had changes in the treatment plan on the basis of the IA-CTA findings.
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Affiliation(s)
- D Gandhi
- Division of Interventional Neuroradiology, Russell H. Morgan Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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Miracle AC, Rezaei A, Gandhi D, Mukherji SK. CT perfusion of the neck: internal carotid artery versus external carotid artery as the reference artery. AJNR Am J Neuroradiol 2009; 30:1598-601. [PMID: 19369615 DOI: 10.3174/ajnr.a1531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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
Arterial selection for reference time-enhancement curve generation in deconvolution-based perfusion CT (PCT) studies of the head and neck is under-evaluated. This study of 11 patients with confirmed head and neck squamous cell carcinoma demonstrates significant correlation (range, r = 0.85-0.95) between perfusion parameter values derived with internal carotid artery (ICA) as compared to an external carotid artery reference, supporting the use of the ICA as arterial reference in PCT studies of the neck.
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Affiliation(s)
- A C Miracle
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI 48190, USA.
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