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Barbera SC, Do TM, Yu AC, Gupta JD, Gupta ND, Palacios E. Orbital Sarcoidosis With Invasion of the Lacrimal Gland. Ear Nose Throat J 2023:1455613231200767. [PMID: 37715695 DOI: 10.1177/01455613231200767] [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: 09/18/2023] Open
Affiliation(s)
- Spencer C Barbera
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Triet M Do
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amy C Yu
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jagan D Gupta
- Department of Radiology, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
| | - Neel D Gupta
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Enrique Palacios
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
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Ta MN, Do TM, Yu AC, Gupta JD, Gupta ND, Palacios E. Mucoepidermoid Carcinoma of the Hard Palate in a Middle-Aged Man. Ear Nose Throat J 2022:1455613221121042. [PMID: 35953442 DOI: 10.1177/01455613221121042] [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: 11/16/2022] Open
Affiliation(s)
- Mitchell N Ta
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Triet M Do
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Amy C Yu
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jagan D Gupta
- Department of Radiology, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
| | - Neel D Gupta
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Enrique Palacios
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
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Bergeron JM, Parsel SM, Do TM, Unis GD, McCoul ED. Association of a standardized measure of nasopharyngeal inflammation with Eustachian tube dysfunction questionnaire score. Int Forum Allergy Rhinol 2021; 11:1177-1186. [PMID: 33502803 DOI: 10.1002/alr.22771] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Standardized diagnostic criteria for Eustachian tube (ET) dysfunction (ETD) have not been established. The purpose of this study was to characterize the relationship between ET inflammation and ETD symptoms and to determine the diagnostic performance of a quantitative score. METHODS Patients were enrolled in a rhinology clinic between October 2018 and June 2019. Patients underwent nasal endoscopy and completed the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Nasopharyngeal inflammation identified on endoscopy was quantified using the Endoscopic Evaluation of the Eustachian Tube (3ET) score. Tympanometry was performed as indicated. Comorbid conditions were assigned during the patient encounter. RESULTS A total of 414 patients were included in the study. Patients with clinically significant ETD symptoms (ETDQ-7 ≥2.1) had higher 3ET scores than those without symptoms. A 1-point increase in 3ET score was associated with a 1.7-fold increase in odds of clinically significant ETD symptoms (adjusted OR [aOR], 1.72; 95% CI, 1.46 to 2.05). The 3ET scores were correlated with ETDQ-7 scores (ρ = 0.54) and 22-item Sino-Nasal Outcome Test (SNOT-22) scores (ρ = 0.52). 3ET scores were not associated with tympanometric peak pressures. Patients with ETD symptoms were more likely to have laryngopharyngeal reflux (aOR, 2.71; 95% CI, 1.24 to 6.18). A 3ET score of 4 predicted symptomatic state in 80% of cases with a specificity of 97.8% and positive predictive value of 96.6%. CONCLUSION Inflammatory findings at the nasopharyngeal ET orifice are associated with clinically significant ETD symptoms. The 3ET score is specific for a symptomatic state and has potential clinical utility in the evaluation of suspected ETD. ©2021 ARSAAOA, LLC.
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Affiliation(s)
- Jeffrey M Bergeron
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Sean M Parsel
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Triet M Do
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Graham D Unis
- Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA.,Department of Otorhinolaryngology, Ochsner Health System, New Orleans, LA
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Do TM, Unis GD, Kattar N, Ananth A, McCoul ED. Neuromodulators for Atypical Facial Pain and Neuralgias: A Systematic Review and Meta-Analysis. Laryngoscope 2020; 131:1235-1253. [PMID: 33037835 DOI: 10.1002/lary.29162] [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] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/31/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of neuromodulating agents for the management of atypical facial pain and primary facial neuralgias. METHODS We searched MEDLINE, Embase, CINAHL, and ClinicalTrials.gov databases for original research articles that examine the effectiveness and adverse reactions of pharmacologic therapy for the treatment of trigeminal neuralgia and atypical facial pain. Studies that included surgical interventions for atypical facial pain or facial pain secondary to other causes were excluded. Meta-analysis was conducted for reductions in symptom scores and adverse effects. RESULTS Of 3,409 articles screened, 73 full-text articles were included, consisting of 45 observational studies and 29 randomized controlled trials. Twenty-four different pharmacological agents were assessed; carbamazepine was the most frequently studied while botulinum toxin A demonstrated the highest consistency in reduction of symptom scores. Pooled estimate of three randomized controlled trials revealed that patients with trigeminal neuralgia who received botulinum toxin A had higher odds (odds ratio 7.46; 95% CI 3.53-15.78) of achieving a ≥50% reduction in visual analogue scale scores compared to controls. Pooled estimate of 15 observational studies showed that three-fourths of patients with trigeminal neuralgia who received carbamazepine experienced clinically significant pain reduction (prevalence proportion 0.75; 95% CI 0.66-0.83). CONCLUSIONS Patients receiving botulinum toxin A for trigeminal neuralgia had higher odds of achieving ≥50% reduction in pain scores. A significant proportion of patients with trigeminal neuralgia experienced positive response to carbamazepine. There was moderate evidence for amitriptyline in patients with atypical facial pain. Standardization of outcome reporting would facilitate future quantitative comparisons of therapeutic effectiveness. Laryngoscope, 131:1235-1253, 2021.
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Affiliation(s)
- Triet M Do
- Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Graham D Unis
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, U.S.A
| | - Nrusheel Kattar
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, U.S.A.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, U.S.A
| | - Ashwin Ananth
- Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Edward D McCoul
- Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, U.S.A.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, U.S.A
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Kattar N, Do TM, Unis GD, Migneron MR, Thomas AJ, McCoul ED. Olfactory Training for Postviral Olfactory Dysfunction: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 164:244-254. [PMID: 32660334 DOI: 10.1177/0194599820943550] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [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: 01/15/2023]
Abstract
OBJECTIVE Olfactory dysfunction is a common problem that is most frequently attributed to upper respiratory infection. Postviral olfactory dysfunction (PVOD) can be prolonged and clinically challenging to treat. Olfactory training (OT) has demonstrated potential benefit for patients with nonspecific olfactory dysfunction. We sought to evaluate the efficacy of OT specifically for PVOD by pooled analysis of the existing evidence. DATA SOURCES PubMed, Embase, and Web of Science. REVIEW METHODS Following PRISMA guidelines, PubMed, Embase, and Web of Science databases were queried and abstracts screened independently by 2 investigators. We included studies evaluating the efficacy of OT for PVOD and excluded studies evaluating pharmacologic interventions or olfactory loss from other causes. RESULTS Of the initial 1981 abstracts reviewed, 16 full-text articles were included. Sniffin' Sticks olfactory testing results were reported in 15 (93%) studies as threshold (T), discrimination (D), and identification (I) subscores and TDI total scores. All studies reported clinically significant results after OT, defined as a score improvement of TDI >5.5. Four studies were included in the meta-analysis, in which pooled estimates revealed that patients with PVOD who received OT had a 2.77 (95% confidence interval, 1.67-4.58) higher odds of achieving a clinically important difference in TDI scores compared to controls. CONCLUSION Meta-analysis of existing data demonstrates clinically significant improvements in PVOD associated with OT. Variability exists among OT protocols and may benefit from further optimization. Existing data supports the use of OT for the treatment of existing and newly emerging cases of PVOD.
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Affiliation(s)
- Nrusheel Kattar
- Ochsner Clinical School, University of Queensland School of Medicine, Queensland, USA
| | - Triet M Do
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Graham D Unis
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Matthew R Migneron
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Andrew J Thomas
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Edward D McCoul
- Ochsner Clinical School, University of Queensland School of Medicine, Queensland, USA.,Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
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Goukasian N, Hwang KS, Romero T, Grotts J, Do TM, Groh JR, Bateman DR, Apostolova LG. Association of brain amyloidosis with the incidence and frequency of neuropsychiatric symptoms in ADNI: a multisite observational cohort study. BMJ Open 2019; 9:e031947. [PMID: 31857304 PMCID: PMC6937083 DOI: 10.1136/bmjopen-2019-031947] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To investigate the relationship between amyloid burden and frequency of existing and incidence of new neuropsychiatric symptoms (NPS) in elderly with and without cognitive decline. METHODS 275 cognitively normal controls (NC), 100 subjective memory complaint (SMC), 559 mild cognitive impairment (MCI) and 143 Alzheimer's disease dementia subjects from the Alzheimer's Disease Neuroimaging Initiative received (18F)-florbetapir positron emission tomography (PET) scans. Yearly neuropsychiatric inventory (Neuropsychiatric Inventory (NPI)/NPI-Questionnaire) data were collected from the study partners at each visit. Mean standard uptake volume ratios (SUVR) normalised to whole cerebellum were obtained. Positive amyloid PET scan was defined as mean SUVR ≥1.17. Fisher's exact test was used to compare frequency and incidence between amyloid positive and amyloid negative subjects. Survival analyses were used to estimate of neuropsychiatric symptoms (NPS) between amyloid positive and amyloid negative subjects. Survival analyses were used to estimate hazard ratios for developing the most common NPS by amyloid status. RESULTS No differences in NPS frequency were seen between amyloid positive and amyloid negative NC, SMC, MCI or dementia groups. MCI subjects with amyloid pathology however tended to have greater frequency x severity (FxS) of anxiety, hallucinations, delusions, apathy, disinhibition, irritability, aberrant motor behavior, and appetite, but not agitation, depression, night-time disturbances, or elation. MCI subjects with amyloid pathology were at greater risk for developing apathy, anxiety and agitation over time. Baseline presence of agitation and apathy and new onset agitation, irritability and apathy predicted faster conversion to dementia among MCI subjects. CONCLUSIONS Amyloid pathology is associated with greater rate of development of new NPS in MCI. Anxiety and delusions are significant predictors of amyloid pathology. Agitation, irritability and apathy are significant predictors for conversion from MCI to dementia.
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Affiliation(s)
| | - Kristy S Hwang
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tamineh Romero
- Medicine Statistics Core, University of California Los Angeles, Los Angeles, California, USA
| | - Jonathan Grotts
- Medicine Statistics Core, University of California Los Angeles, Los Angeles, California, USA
| | - Triet M Do
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jenna R Groh
- Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel R Bateman
- Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Liana G Apostolova
- Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Apostolova LG, Risacher SL, Duran T, Stage EC, Goukasian N, West JD, Do TM, Grotts J, Wilhalme H, Nho K, Phillips M, Elashoff D, Saykin AJ. Associations of the Top 20 Alzheimer Disease Risk Variants With Brain Amyloidosis. JAMA Neurol 2018; 75:328-341. [PMID: 29340569 PMCID: PMC5885860 DOI: 10.1001/jamaneurol.2017.4198] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [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] [Received: 02/01/2017] [Accepted: 10/19/2017] [Indexed: 01/28/2023]
Abstract
Importance Late-onset Alzheimer disease (AD) is highly heritable. Genome-wide association studies have identified more than 20 AD risk genes. The precise mechanism through which many of these genes are associated with AD remains unknown. Objective To investigate the association of the top 20 AD risk variants with brain amyloidosis. Design, Setting, and Participants This study analyzed the genetic and florbetapir F 18 data from 322 cognitively normal control individuals, 496 individuals with mild cognitive impairment, and 159 individuals with AD dementia who had genome-wide association studies and 18F-florbetapir positron emission tomographic data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), a prospective, observational, multisite tertiary center clinical and biomarker study. This ongoing study began in 2005. Main Outcomes and Measures The study tested the association of AD risk allele carrier status (exposure) with florbetapir mean standard uptake value ratio (outcome) using stepwise multivariable linear regression while controlling for age, sex, and apolipoprotein E ε4 genotype. The study also reports on an exploratory 3-dimensional stepwise regression model using an unbiased voxelwise approach in Statistical Parametric Mapping 8 with cluster and significance thresholds at 50 voxels and uncorrected P < .01. Results This study included 977 participants (mean [SD] age, 74 [7.5] years; 535 [54.8%] male and 442 [45.2%] female) from the ADNI-1, ADNI-2, and ADNI-Grand Opportunity. The adenosine triphosphate-binding cassette subfamily A member 7 (ABCA7) gene had the strongest association with amyloid deposition (χ2 = 8.38, false discovery rate-corrected P < .001), after apolioprotein E ε4. Significant associations were found between ABCA7 in the asymptomatic and early symptomatic disease stages, suggesting an association with rapid amyloid accumulation. The fermitin family homolog 2 (FERMT2) gene had a stage-dependent association with brain amyloidosis (FERMT2 × diagnosis χ2 = 3.53, false discovery rate-corrected P = .05), which was most pronounced in the mild cognitive impairment stage. Conclusions and Relevance This study found an association of several AD risk variants with brain amyloidosis. The data also suggest that AD genes might differentially regulate AD pathologic findings across the disease stages.
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Affiliation(s)
- Liana G. Apostolova
- Department of Neurology, School of Medicine, Indiana University, Indianapolis
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, School of Medicine, Indiana University, Indianapolis
- Department of Medical and Molecular Genetics, School of Medicine, Indiana University, Indianapolis
| | - Shannon L. Risacher
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, School of Medicine, Indiana University, Indianapolis
| | - Tugce Duran
- Department of Neurology, School of Medicine, Indiana University, Indianapolis
| | - Eddie C. Stage
- Department of Neurology, School of Medicine, Indiana University, Indianapolis
| | - Naira Goukasian
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John D. West
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, School of Medicine, Indiana University, Indianapolis
| | - Triet M. Do
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jonathan Grotts
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Holly Wilhalme
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kwangsik Nho
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, School of Medicine, Indiana University, Indianapolis
| | - Meredith Phillips
- Department of Neurology, School of Medicine, Indiana University, Indianapolis
| | - David Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Andrew J. Saykin
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, School of Medicine, Indiana University, Indianapolis
- Department of Medical and Molecular Genetics, School of Medicine, Indiana University, Indianapolis
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Stage E, Duran T, Risacher SL, Goukasian N, Do TM, West JD, Wilhalme H, Nho K, Phillips M, Elashoff D, Saykin AJ, Apostolova LG. The effect of the top 20 Alzheimer disease risk genes on gray-matter density and FDG PET brain metabolism. Alzheimers Dement (Amst) 2016; 5:53-66. [PMID: 28054028 PMCID: PMC5198883 DOI: 10.1016/j.dadm.2016.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We analyzed the effects of the top 20 Alzheimer disease (AD) risk genes on gray-matter density (GMD) and metabolism. METHODS We ran stepwise linear regression analysis using posterior cingulate hypometabolism and medial temporal GMD as outcomes and all risk variants as predictors while controlling for age, gender, and APOE ε4 genotype. We explored the results in 3D using Statistical Parametric Mapping 8. RESULTS Significant predictors of brain GMD were SLC24A4/RIN3 in the pooled and mild cognitive impairment (MCI); ZCWPW1 in the MCI; and ABCA7, EPHA1, and INPP5D in the AD groups. Significant predictors of hypometabolism were EPHA1 in the pooled, and SLC24A4/RIN3, NME8, and CD2AP in the normal control group. DISCUSSION Multiple variants showed associations with GMD and brain metabolism. For most genes, the effects were limited to specific stages of the cognitive continuum, indicating that the genetic influences on brain metabolism and GMD in AD are complex and stage dependent.
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Affiliation(s)
- Eddie Stage
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tugce Duran
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shannon L Risacher
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Naira Goukasian
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Triet M Do
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John D West
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Holly Wilhalme
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kwangsik Nho
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Meredith Phillips
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Indiana University Network Science Institute, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Liana G Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
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Abstract
OBJECTIVES To determine the impact of either single or combined local therapeutic modalities for poorly differentiated (Gleason score 8 to 10) prostate cancer. METHODS Between 1987 and 1996, 156 patients were diagnosed with biopsy proven, poorly differentiated (Gleason score 8 to 10), clinically localized prostate cancer. Of these patients, 87 were treated with radical prostatectomy alone, 19 with radiotherapy, and 24 with both prostatectomy and postoperative radiotherapy. RESULTS The median follow-up time was 74.6 months. The 5-year biochemical progression-free survival (PFS) for patients with a Gleason score of 8 to 10 was 65%, 30%, and 20% for patients treated with surgery plus postoperative radiotherapy, radiotherapy alone, and surgery alone, respectively (P <0.0001 between postoperative radiotherapy and all other groups, P = 0.6131 between surgery and radiotherapy). The 5-year clinical PFS was 80%, 60%, and 35% for patients treated with surgery plus postoperative radiotherapy, radiotherapy alone, and surgery alone (P <0.0001 between postoperative radiotherapy and all others, P = 0.1975 between surgery and radiotherapy). The independent prognosticators for biochemical failure included serum prostate-specific antigen level greater than 20 ng/mL and seminal vesicle invasion; only seminal vesicle invasion was prognostic for clinical failure. CONCLUSIONS Patients with high-grade prostate cancer (Gleason score 8 to 10) have uniformly poor, but apparently similar, biochemical and clinical PFS rates when treated by either prostatectomy or radiotherapy alone. The addition of postoperative radiotherapy in the treatment of these patients may be associated with improved biochemical and clinical PFS compared with either modality alone.
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Affiliation(s)
- T M Do
- Department of Radiation Oncology, Kaiser Permanente Medical Center, Los Angeles, California 90027, USA
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Abstract
Pericarditis has not been well associated with exercise test induced ST-elevations. This case report of a pericarditis patient who underwent exercise stress testing and other similar cases found in the literature suggest that this is an unrecognized clinical manifestation of pericarditis.
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Affiliation(s)
- T M Do
- Cardiology Service and Department of Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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Affiliation(s)
- T M Do
- School of Pharmacy, University of California, San Francisco 94143
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