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Find video protocols related to scientific articles indexed in Pubmed.
The role of whole-brain radiation therapy after stereotactic radiation surgery for brain metastases.
Pract Radiat Oncol
PUBLISHED: 09-07-2014
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The benefit of whole-brain radiation therapy (WBRT) following stereotactic radiation surgery (SRS) for brain metastases is controversial. We conducted a systematic analysis of published literature to explore the outcome of brain metastases treated with SRS and WBRT versus SRS alone using PubMed and MEDLINE. Outcomes including survival, control, salvage therapy, and other quality of life measures were reported. Three randomized controlled trials involving 389 patients with 1 to 4 brain metastases were selected. In 2 of these trials (n = 190), the mean 1-year survival was 33.2% for SRS + WBRT and 38.7% for SRS alone (P = .5233); 1-year local control was 89% for SRS + WBRT and 71% for SRS alone (P < .001). Mean crude distant recurrence rate for SRS + WBRT was 36.6% and 54% for SRS alone (P < .001). Patients without WBRT were over 3 times more likely to require salvage therapy (P < .001). The addition of WBRT was associated with a decreased health-related quality of life assessment, mini mental status exam, and Hopkins Verbal Learning Test (P < .05). Five retrospective studies (n = 1122) were also included in a separate analysis and yielded findings that supported results from the randomized trials. Our systematic analysis demonstrates that adjuvant WBRT following SRS for the treatment of oligometastases in the brain is more effective at controlling local and distant recurrence than SRS alone, but there is no apparent benefit for survival or symptomology. The proven cognitive decline and neurotoxicity present with WBRT should be weighed against the benefit of local control. Prognosis of brain metastasis is poor regardless of current treatment and further exploration for alternative adjuvant treatment for SRS is warranted.
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Rate of percutaneous coronary intervention for the management of acute coronary syndromes and stable coronary artery disease in the United States (2007 to 2011).
Am. J. Cardiol.
PUBLISHED: 07-18-2014
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Although the benefit of percutaneous coronary interventions (PCIs) for patients presenting with acute coronary syndromes (ACS) has been established in numerous studies, the role of PCI in stable coronary artery disease (CAD) remains controversial. With the publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluations trial and the appropriate use criteria for coronary artery revascularization, we sought to examine the impact of these treatment strategies and guidelines on the current practice of PCI in United States. We conducted a serial cross-sectional study with time trends of patients undergoing PCI for ACS and stable CAD from 2007 to 2011. The annual rate of all PCI decreased by 27.7% from 10,785 procedures per million adults per year in 2007 to 2008 to 7,801 procedures per million adults per year in 2010 to 2011 (p=0.03). Although there was no statistically significant decrease in the PCI utilization for ACS from 2007 to 2011, PCI utilization for stable CAD decreased by 51.7% (from 2,056 procedures per million adults per year in 2008 to 992 procedures per million adults per year in 2011, p=0.02). Hospitals with a higher volume of PCI experienced a more significant decrease. Decrease in PCI utilization for stable CAD was statistically significant for patients with Medicare and private insurance/health maintenance organization (44.5%, p=0.03 and 59.5%, p=0.007, respectively). In conclusion, the rate of PCI decreased substantially starting from 2009 in the United States. Most of the decrease was attributed to the reduction in PCI utilization for stable CAD.
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Length of red cell unit storage and risk for delirium after cardiac surgery.
Anesth. Analg.
PUBLISHED: 05-27-2014
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The time that red cell units are stored before transfusion may be associated with postoperative complications, although the evidence is conflicting. However, the association between the length of red cell unit storage and postoperative delirium has not been explored. We hypothesized that the length of storage of transfused red cell units would be associated with delirium after cardiac surgery.
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Radiation Dose During Coronary Angiogram: Relation to Body Mass Index.
Heart Lung Circ
PUBLISHED: 05-02-2014
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Ionising radiation based diagnostic and therapeutic cardiology and radiology procedures are very common in present day medical practice and are one of the largest medical sources of radiation to humans. The risk to health from radiation has been extensively documented. Obesity is becoming epidemic not only in the western world, but also in developing countries. In the present study we investigated if a patient's Body Mass Index (BMI) has an effect on the radiation dose received by the patient and operator during diagnostic coronary angiography (CAG).
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Recognizing and correcting failures in glioblastoma treatment.
Cancer Invest.
PUBLISHED: 04-25-2014
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While current treatment remains universal for glioblastoma, recent evidence has demonstrated marked heterogeneity in their molecular profiles. Due to the near universal rate of recurrence, attention has focused on individualized treatment and subgroup population differences that may influence the efficacy of adjuvant therapy. Recent studies have implicated chemo-radioresistant GBM stem cells (GSCs) in the propagation of heterogeneous tumor profiles. As a result, there has been a shift to classify and target GSCs in order to increase survival and delay relapse. The overall objective of our editorial is to highlight current failures in GBM treatment and to propose novel personalized methods to correct our shortcomings in GBM treatment.
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Considering iatrogenic psychosis after malignant glioma resection.
BMJ Case Rep
PUBLISHED: 04-25-2014
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It is generally well known that medial temporal lobe resections have been associated with a variety of postoperative neuropsychiatric disturbances. Most of the neurosurgical literature on psychiatric disturbances after a temporal lobectomy concern patients with a strong history of epilepsy; however, relatively few articles have been reported due to a mesial temporal lobectomy following tumour removal. We report the case of a patient who underwent a gross total resection of a malignant astrocytoma in the temporal lobe who developed transient psychosis. Difficulties in diagnosing and predicting this condition are discussed as along with management considerations.
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An easily calculable and highly predictive risk index for postoperative renal failure after heart transplantation.
J. Thorac. Cardiovasc. Surg.
PUBLISHED: 04-06-2014
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This study derived and validated a risk index for postoperative renal failure after orthotopic heart transplantation.
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Does recipient age impact functional outcomes of orthotopic heart transplantation?
Ann. Thorac. Surg.
PUBLISHED: 03-20-2014
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This study evaluated changes in physical functional performance after orthotopic heart transplantation (OHT) with particular attention to the impact of recipient age on functional outcomes.
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Intractable ventricular fibrillation - post ascending aortic dissection repair.
Cardiovasc Revasc Med
PUBLISHED: 03-11-2014
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Ascending aortic dissection is a life threatening surgical emergency and carries high peri-operative mortality. Various biological adhesive materials are commonly used in such a surgery to enhance strengthening of separated layers of aortic wall. Despite of extensive use, embolization of the glue material remains a feared complication. Here we are describing a case, where BioGlue embolized down the left main stem and resulted in refractory ventricular arrhythmia and hemodynamic instability.
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Autologous mesenchymal stem cells produce concordant improvements in regional function, tissue perfusion, and fibrotic burden when administered to patients undergoing coronary artery bypass grafting: The Prospective Randomized Study of Mesenchymal Stem Cell Therapy in P
Circ. Res.
PUBLISHED: 02-24-2014
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Although accumulating data support the efficacy of intramyocardial cell-based therapy to improve left ventricular (LV) function in patients with chronic ischemic cardiomyopathy undergoing CABG, the underlying mechanism and impact of cell injection site remain controversial. Mesenchymal stem cells (MSCs) improve LV structure and function through several effects including reducing fibrosis, neoangiogenesis, and neomyogenesis.
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Increased rates of duodenal obstruction in pancreatic cancer patients receiving modern medical management.
Dig. Dis. Sci.
PUBLISHED: 02-06-2014
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Duodenal obstruction from pancreatic cancer historically occurs in 2-25 % of patients without surgery, but with new advances in chemotherapy and radiation therapy, the life expectancy of pancreatic cancer has increased.
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Prognostic value of the pre-transplant diastolic pulmonary artery pressure-to-pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension.
J. Heart Lung Transplant.
PUBLISHED: 01-28-2014
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Although the transpulmonary gradient (TPG) and pulmonary vascular resistance (PVR) are commonly used to differentiate heart failure patients with pulmonary vascular disease from those with passive pulmonary hypertension (PH), elevations in TPG and PVR may not always reflect pre-capillary PH. Recently, it has been suggested an elevated diastolic pulmonary artery pressure-to-pulmonary capillary wedge pressure gradient (DPG) may be a better indicator of pulmonary vascular remodeling, and therefore, may be of added prognostic value in patients with PH being considered for cardiac transplantation.
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Concomitant tricuspid valve surgery during implantation of continuous-flow left ventricular assist devices: a Society of Thoracic Surgeons database analysis.
J. Heart Lung Transplant.
PUBLISHED: 01-17-2014
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Performing concomitant tricuspid valve procedures (TVPs) in left ventricular assist device (LVAD) patients with significant pre-operative tricuspid regurgitation (TR) is controversial, and no studies have been large enough to definitively guide therapy.
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Extracranial glioblastoma in transplant recipients.
J. Cancer Res. Clin. Oncol.
PUBLISHED: 01-17-2014
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Traditionally, gliomas are considered to be confined to the central nervous system. The shortage of solid donor organs resulted in consideration of organs from patients with primary malignancy such as glioblastoma multiforme (GBM) for transplantation into patients suffering from end-stage organ disease.
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The role of intra-arterial chemotherapy as an adjuvant treatment for glioblastoma.
Br J Neurosurg
PUBLISHED: 01-16-2014
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Glioblastoma multiforme (GBM) is an aggressive tumor with poor survival outcomes and limited treatment options. We conducted a literature review to compare the survival outcomes of intra-arterial (IA) and intravenous (IV) chemotherapy delivery for GBM. Nine studies of IA chemotherapy infusion with 301 total patients met our criteria for inclusion and three studies contained IV treatment groups for comparison (n = 230 for IA, n = 71 for IV). The studies were grouped by either using newly diagnosed or recurrent GBM patients. In the newly diagnosed group, IV chemotherapy produced a statistically higher median overall survival (MOS; 16.3 months) compared with IA treatment (14.02 months). However, the total number of adverse events in IA chemotherapy was 1.08 per patient whereas for IV it was higher at 1.54 events per patient. Our recurrent GBM group includes only patients treated with IA chemotherapy which resulted in an average MOS of 10.84 months. This group had 2.7 adverse events per patient but no IV group is available for comparison. Historically, the survival of patients with recurrent GBM ranges from 3 to 9 months (Gil-Gil et al. Bevacizumab for the treatment of glioblastoma. Clin Med Insights Oncol 2013;7:123-35). For this reason, we believe IA chemotherapy to be a viable methodology in recurrent GBM patients to prolong survival at the risk of procedure-related complications and in newly diagnosed patients with the benefit of decreased complications.
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Hybrid procedure as treatment for large obstructive left ventricular rhabdomyoma.
Ann. Thorac. Surg.
PUBLISHED: 01-15-2014
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We present one of the first reported cases of a neonate with a prenatal diagnosis of large left ventricular rhabdomyoma obstructing the outflow tract that underwent a hybrid procedure with stenting of the patent duct arteriosus and bilateral pulmonary artery banding.
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The role of Gliadel wafers in the treatment of high-grade gliomas.
Expert Rev Anticancer Ther
PUBLISHED: 11-19-2013
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Glioblastoma multiforme (GBM) is the most aggressive brain tumor. Standard treatment includes surgery, radiation and chemotherapy. Prognosis is dismal with an average survival of approximately 1 year. Gliadel wafers are one treatment option, working as a source for local chemotherapy delivery. Their use is controversial with questionable survival benefit and potential side effects. We reviewed the literature in an effort to clarify their role in the treatment of high-grade gliomas. A systematic PubMed search was performed using the keywords Gliadel, carmustine or BCNU wafers in newly diagnosed high-grade glioma patients. Treatment regimen, and median survival were analyzed. Adverse event ratio was calculated by computing the number of adverse events in a study per patient receiving carmustine wafers. Nineteen studies with 795 patients were included in our review. Survival was 8.7-22.6 months with a mean overall survival (OS) of 16.2 months (control survival is approximately 14 months with surgery and adjuvant chemoradiotherapy). Adverse event ratio using Gliadel wafersin control group. Complication rate was 42.7%. Gliadel wafers may marginally increase survival and local control in newly diagnosed GBM patients but are associated with a high complication rate; therefore, we do not recommend using Gliadel wafers in patients with GBM. Further research may be warranted once a safer alternative to Gliadel wafers has been introduced.
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Delayed ischemic stroke following spontaneous thrombosis of an arteriovenous malformation.
J Neurointerv Surg
PUBLISHED: 09-23-2013
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Spontaneous obliteration of an arteriovenous malformation (SOAVM) is a rare event that is not completely understood. Less than 100 cases of SOAVMs have been reported in the literature. We present a unique case of a middle-aged patient with spontaneous obliteration of a cerebral arteriovenous malformation (AVM) who developed an ischemic stroke due to thrombosis of the stagnant proximal segment of the inferior branch of the middle cerebral artery feeder. Although the pathophysiology is not well understood, the arterial feeder hemodynamic changes post SOAVM may behave similarly to what occurs in rare cases after surgical resection of AVMs. Our case raises the hypothesis that stagnation of flow in spontaneous AVM obliteration may lead to delayed ischemic stroke in the territory of the feeding artery.
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Delayed ischemic stroke following spontaneous thrombosis of an arteriovenous malformation.
BMJ Case Rep
PUBLISHED: 09-20-2013
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Spontaneous obliteration of an arteriovenous malformation (SOAVM) is a rare event that is not completely understood. Less than 100 cases of SOAVMs have been reported in the literature. We present a unique case of a middle-aged patient with spontaneous obliteration of a cerebral arteriovenous malformation (AVM) who developed an ischemic stroke due to thrombosis of the stagnant proximal segment of the inferior branch of the middle cerebral artery feeder. Although the pathophysiology is not well understood, the arterial feeder hemodynamic changes post SOAVM may behave similarly to what occurs in rare cases after surgical resection of AVMs. Our case raises the hypothesis that stagnation of flow in spontaneous AVM obliteration may lead to delayed ischemic stroke in the territory of the feeding artery.
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Obtaining specimens with slowed, accelerated and reversed aging in the honey bee model.
J Vis Exp
PUBLISHED: 09-12-2013
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Societies of highly social animals feature vast lifespan differences between closely related individuals. Among social insects, the honey bee is the best established model to study how plasticity in lifespan and aging is explained by social factors. The worker caste of honey bees includes nurse bees, which tend the brood, and forager bees, which collect nectar and pollen. Previous work has shown that brain functions and flight performance senesce more rapidly in foragers than in nurses. However, brain functions can recover, when foragers revert back to nursing tasks. Such patterns of accelerated and reversed functional senescence are linked to changed metabolic resource levels, to alterations in protein abundance and to immune function. Vitellogenin, a yolk protein with adapted functions in hormonal control and cellular defense, may serve as a major regulatory element in a network that controls the different aging dynamics in workers. Here we describe how the emergence of nurses and foragers can be monitored, and manipulated, including the reversal from typically short-lived foragers into longer-lived nurses. Our representative results show how individuals with similar chronological age differentiate into foragers and nurse bees under experimental conditions. We exemplify how behavioral reversal from foragers back to nurses can be validated. Last, we show how different cellular senescence can be assessed by measuring the accumulation of lipofuscin, a universal biomarker of senescence. For studying mechanisms that may link social influences and aging plasticity, this protocol provides a standardized tool set to acquire relevant sample material, and to improve data comparability among future studies.
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The role of radiosurgery to the tumor bed after resection of brain metastases.
Neurosurgery
PUBLISHED: 08-03-2013
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Optimal postoperative management paradigm for brain metastases remains controversial.
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Dendritic cell vaccine for recurrent high-grade gliomas in pediatric and adult subjects: clinical trial protocol.
Neurosurgery
PUBLISHED: 07-23-2013
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Although there have been significant advances in understanding the basic pathogenesis of glioblastoma multiforme, the median survival of patients has changed little in the past 25 years. Recent studies have suggested that immune modulation through dendritic cell (DC) vaccines may stimulate the immune system against tumor antigens and potentially increase survival.
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Epigenetic pathways and glioblastoma treatment.
Epigenetics
PUBLISHED: 06-27-2013
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Glioblastoma multiforme (GBM) is the most common malignant adult brain tumor. Standard GBM treatment includes maximal safe surgical resection with combination radiotherapy and adjuvant temozolomide (TMZ) chemotherapy. Alarmingly, patient survival at five-years is below 10%. This is in part due to the invasive behavior of the tumor and the resulting inability to resect greater than 98% of some tumors. In fact, recurrence after such treatment may be inevitable, even in cases where gross total resection is achieved. The Cancer Genome Atlas (TCGA) research network performed whole genome sequencing of GBM tumors and found that GBM recurrence is linked to epigenetic mechanisms and pathways. Central to these pathways are epigenetic enzymes, which have recently emerged as possible new drug targets for multiple cancers, including GBM. Here we review GBM treatment, and provide a systems approach to identifying epigenetic drivers of GBM tumor progression based on temporal modeling of putative GBM cells of origin. We also discuss advances in defining epigenetic mechanisms controlling GBM initiation and recurrence and the drug discovery considerations associated with targeting epigenetic enzymes for GBM treatment.
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Past history of skin infection and risk of surgical site infection after elective surgery.
Ann. Surg.
PUBLISHED: 05-25-2013
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To identify baseline patient characteristics associated with increased susceptibility to surgical site infection (SSI) after elective surgery.
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Active immunotherapy using dendritic cells in the treatment of glioblastoma multiforme.
Cancer Treat. Rev.
PUBLISHED: 05-20-2013
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Glioblastoma multiforme, the most common malignant brain tumor still has a dismal prognosis with conventional treatment. Therefore, it is necessary to explore new and/or adjuvant treatment options to improve patient outcomes. Active immunotherapy is a new area of research that may be a successful treatment option. The focus is on vaccines that consist of antigen presenting cells (APCs) loaded with tumor antigen. We have conducted a systematic review of prospective studies, case reports and clinical trials. The goal of this study was to examine the efficacy and safety in terms of complications, median overall survival (OS), progression free survival (PFS) and quality of life.
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Understanding variability in hospital-specific costs of coronary artery bypass grafting represents an opportunity for standardizing care and improving resource use.
J. Thorac. Cardiovasc. Surg.
PUBLISHED: 05-06-2013
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This study was undertaken to examine interhospital variability in inpatient costs of coronary artery bypass grafting (CABG).
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Adjuvant whole brain radiation following resection of brain metastases.
J Clin Neurosci
PUBLISHED: 04-28-2013
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Brain metastasis is a common complication of systemic cancer and significant cause of suffering in oncology patients. Despite a plethora of available treatment modalities, the prognosis is poor with a median survival time of approximately one year. For patients with controlled systemic disease, good performance status, and a limited number of metastases, treatment typically entails surgical resection or radiosurgery, followed by whole brain radiotherapy (WBRT) to control microscopic disease. WBRT is known to control the progression of cancer in the brain, but it can also have toxic effects, particularly with regard to neurocognition. There is no consensus as to whether the benefit of WBRT outweighs the potential harm. We review the evidence related to the question of whether patients undergoing surgical resection of brain metastases should receive adjuvant WBRT.
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Valve surgery for infective endocarditis is associated with high hospital charges.
J. Heart Valve Dis.
PUBLISHED: 04-25-2013
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Half of all patients with infective endocarditis (IE) will require early surgical intervention, and another 40% will eventually undergo surgical treatment for their disease. Although the surgical management of IE is effective, the financial impact of the disease has never been assessed.
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Predictors of long-term survival in patients with glioblastoma multiforme: advancements from the last quarter century.
Cancer Invest.
PUBLISHED: 04-24-2013
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Over the last quarter century there has been significant progress toward identifying certain characteristics and patterns in GBM patients to predict survival times and outcomes. We sought to identify clinical predictors of survival in GBM patients from the past 24 years. We examined patient survival related to tumor locations, surgical treatment, postoperative course, radiotherapy, chemotherapy, patient age, GBM recurrence, imaging characteristics, serum, and molecular markers. We present predictors that may increase, decrease, or play no significant role in determining a GBM patients long-term survival or affect the quality of life.
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Awake craniotomy for brain tumor resection: the rule rather than the exception?
J Neurosurg Anesthesiol
PUBLISHED: 04-23-2013
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Awake craniotomy (AC) has seen an expanded role in brain tumor surgery over the past few decades. AC allows intraoperative cortical mapping and the continuous assessment of neurophysiological parameters, which are otherwise unattainable under general anesthesia (GA). The ability of AC to analyze eloquent brain areas makes it a powerful method for reducing the risks associated with tumor resection, especially in motor and language cortex. We present a review of the literature to examine the benefits and limits of using AC over GA.
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The role of preoperative embolization for intracranial meningiomas.
J. Neurosurg.
PUBLISHED: 04-12-2013
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As endovascular techniques have become more advanced, preoperative embolization has become an increasingly used intervention in the management of meningiomas. To date, however, no consensus has been reached on the use of this technique. To clarify the role of preoperative embolization in the management of meningiomas, the authors conducted a systematic review of case reports, case series, and prospective studies to increase the current understanding of the management options for these common lesions and complications associated with preoperative embolization.
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Screening pre-bariatric surgery patients for esophageal disease with esophageal capsule endoscopy.
World J. Gastroenterol.
PUBLISHED: 04-08-2013
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To determine if esophageal capsule endoscopy (ECE) is an adequate diagnostic alternative to esophagogastroduodenoscopy (EGD) in pre-bariatric surgery patients.
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Unilateral humoral rejection after reoperative single-lung transplant.
Ann. Thorac. Surg.
PUBLISHED: 03-26-2013
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The role of antibody-mediated rejection in acute and chronic rejection after lung transplantation is poorly understood. We report the case of a prior single-lung transplant recipient undergoing an acute antibody-mediated rejection isolated to her new, contralateral single-lung transplant. A 44-year-old woman 6 years after undergoing a single-lung transplant for idiopathic pulmonary fibrosis underwent a second single-lung transplant for bronchiolitis obliterans syndrome. Despite a negative crossmatch, she subsequently exhibited severe antibody-mediated rejection to her new allograft within 6 days of transplantation. The process of allograft sensitization is dynamic, and further study is warranted to better understand this process.
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Associations between valve repair and reduced operative mortality in 21,056 mitral/tricuspid double valve procedures.
Eur J Cardiothorac Surg
PUBLISHED: 03-20-2013
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Repair of either the mitral (M) or tricuspid (T) valve in single valve surgery is associated with reduced operative mortality. It is unclear, however, how valve repair influences mortality in combined MT procedures. This topic was evaluated in the Society of Thoracic Surgeons database.
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Outcomes of cholecystectomy in US heart transplant recipients.
Ann. Surg.
PUBLISHED: 03-13-2013
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The aim of this study was to evaluate outcomes and predictors of in-hospital mortality after cholecystectomy in heart transplant (HTx) recipients.
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Septuagenarians bridged to heart transplantation with a ventricular assist device have outcomes similar to younger patients.
Ann. Thorac. Surg.
PUBLISHED: 02-22-2013
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Although orthotopic heart transplantation (OHT) is increasingly being offered to older patients, few studies have evaluated outcomes in patients older than 70 years of age. We undertook this study to characterize the outcomes of septuagenarians bridged to transplantation (BTT) in the modern era.
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Trends in repair of intact and ruptured descending thoracic aortic aneurysms in the United States: A population-based analysis.
J. Thorac. Cardiovasc. Surg.
PUBLISHED: 02-11-2013
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To evaluate trends and outcomes of descending thoracic aortic aneurysm (DTAA) repair in the United States.
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Ventricular assist device implantation in the elderly: nationwide outcomes in the United States.
J Card Surg
PUBLISHED: 02-06-2013
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The aim of this study was to evaluate nationwide outcomes of ventricular assist device (VAD) implantation in elderly patients in the United States.
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Functional status is highly predictive of outcomes after redo lung transplantation: an analysis of 390 cases in the modern era.
Ann. Thorac. Surg.
PUBLISHED: 01-30-2013
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The aim of this study was to evaluate whether functional status is a predictor of outcomes after redo lung transplantation (LTx).
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Lung injury and acute respiratory distress syndrome after cardiac surgery.
Ann. Thorac. Surg.
PUBLISHED: 01-23-2013
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As many as 20% of patients undergoing cardiac surgery will have acute respiratory distress syndrome during the perioperative period, with a mortality as high as 80%. If patients at risk can be identified, preventative measures can be taken and may improve outcomes. Care for patients with acute respiratory distress syndrome is supportive, with low tidal volume ventilation being the mainstay of therapy. Careful fluid management, minimization of blood product transfusion, appropriate nutrition, and early physical rehabilitation may improve outcomes. In cases of refractory hypoxemia, rescue therapies such as recruitment maneuvers, high-frequency oscillatory ventilation, and extracorporeal membrane oxygenation may preserve life.
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Lung size mismatch and survival after single and bilateral lung transplantation.
Ann. Thorac. Surg.
PUBLISHED: 01-21-2013
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A higher predicted total lung capacity (pTLC)-ratio (=pTLC donor/pTLC recipient), suggestive of oversized allografts, is associated with improved survival after lung transplantation. It is unknown whether the pTLC-ratio has a different association with survival in bilateral (BLT) versus single lung transplantation (SLT).
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Discriminating radiation necrosis from tumor progression in gliomas: a systematic review what is the best imaging modality?
J. Neurooncol.
PUBLISHED: 01-11-2013
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Differentiating post radiation necrosis from progression of glioma and pseudoprogression poses a diagnostic conundrum for many clinicians. As radiation therapy and temozolomide chemotherapy have become the mainstay of treatment for higher-grade gliomas, radiation necrosis and post treatment changes such as pseudoprogression have become a more relevant clinical problem for neurosurgeons and neurooncologists. Due to their radiological similarity to tumor progression, accurate recognition of these findings remains paramount given their vastly different treatment regimens and prognoses. However, no consensus has been reached on the optimal technique to discriminate between these two lesions. In order to clarify the types of imaging modalities for recurrent enhancing lesions, we conducted a systematic review of case reports, case series, and prospective studies to increase our current understanding of the imaging options for these common lesions and their efficacy. In particular, we were interested in distinguishing radiation necrosis from true tumor progression. A PubMed search was performed to include all relevant studies where the imaging was used to differentiate between radiation necrosis and recurrent gliomas with post-radiation enhancing lesions. After screening for certain parameters in our study, seventeen articles with 435 patients were included in our analysis including 10 retrospective and 7 prospective studies. The average time from the end of radiation therapy to the onset of a recurrent enhancing lesion was 13.2 months. The most sensitive and specific imaging modality was SPECT with a sensitivity of 87.6 % and specificity of 97.8 %. Based on our review, we conclude that certain imaging modalities may be preferred over other less sensitive/specific techniques. Overall, tests such as SPECT may be preferable in differentiating TP (tumor progression) from RN (radiation necrosis) due to its high specificity, while nonspecific imaging such as conventional MRI is not ideal.
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Clinical risk factors for primary graft dysfunction after lung transplantation.
Am. J. Respir. Crit. Care Med.
PUBLISHED: 01-10-2013
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Rationale: Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors. Objectives: We sought to identify donor, recipient, and perioperative risk factors for PGD. Methods: We performed a 10-center prospective cohort study enrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours post-transplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression. Measurements and Main Results: A total of 1,255 patients from 10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6; P = 0.002); FiO2 during allograft reperfusion (OR, 1.1 per 10% increase in FiO2; 95% CI, 1.0-1.2; P = 0.01); single lung transplant (OR, 2; 95% CI, 1.2-3.3; P = 0.008); use of cardiopulmonary bypass (OR, 3.4; 95% CI, 2.2-5.3; P < 0.001); overweight (OR, 1.8; 95% CI, 1.2-2.7; P = 0.01) and obese (OR, 2.3; 95% CI, 1.3-3.9; P = 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1-5.6; P = 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6-7.7; P = 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95% CI, 1.1-1.5; P < 0.001). PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P < 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P < 0.001) mortality. Conclusions: We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies. Clinical trial registered with www.clinicaltrials.gov (NCT 00552357).
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The management of incidental low-grade gliomas using magnetic resonance imaging: systematic review and optimal treatment paradigm.
Neurosurg Focus
PUBLISHED: 12-03-2011
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The discovery of incidental low-grade gliomas (LGGs) on MR imaging is rare, and currently there is no existing protocol for management of these lesions. Various studies have approached the dilemma of managing patients with incidental LGGs. While some advocate surgery and radiotherapy, others reserve surgery until there is radiological evidence of growth. For neurosurgeons and radiologists, determining the course of action after routine brain imaging poses not only a medical but also an ethical dilemma. The authors conducted a systematic review of case reports and case series in hopes of enhancing the current understanding of the management options for these rare lesions.
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Lung transplant in idiopathic pulmonary fibrosis.
Arch Surg
PUBLISHED: 10-19-2011
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To review the present status of lung transplant (LTx) in patients with idiopathic pulmonary fibrosis (IPF).
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A novel method of measuring cardiac preservation injury demonstrates University of Wisconsin solution is associated with less ischemic necrosis than Celsior in early cardiac allograft biopsy specimens.
J. Heart Lung Transplant.
PUBLISHED: 09-30-2011
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No consensus exists on the optimal heart preservative solution (HPS) for cardiac allograft preservation. The significance of varying degrees of acute ischemic necrosis (AIN) in early transplant biopsy specimens is unknown. We investigated the effects of HPS on early cardiac histopathology by developing a novel grading system of AIN.
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Development of a quantitative donor risk index to predict short-term mortality in orthotopic heart transplantation.
J. Heart Lung Transplant.
PUBLISHED: 09-26-2011
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No standard index based on donor factors exists for predicting mortality after orthotopic heart transplantation (OHT). We utilized United Network for Organ Sharing (UNOS) data to develop a quantitative donor risk score for OHT.
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Surgical treatment of advanced heart failure: alternatives to heart transplantation and mechanical circulatory assist devices.
Prog Cardiovasc Dis
PUBLISHED: 08-31-2011
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Although orthotopic heart transplantation is the gold standard for definitive surgical treatment of end-stage heart failure, other operative therapies exist for dealing with severe systolic left ventricular dysfunction. The choice of surgical intervention depends on the etiology and functional characteristics of the patients ventricular dysfunction. In patients with ischemic cardiomyopathy, surgical revascularization improves survival. Patients with mitral regurgitation experience significant functional improvement from mitral valve repair and replacement. In patients with aortic valve dysfunction, aortic valve replacement results in improved survival and functional status. Although surgical ventricular reconstruction is controversial, significant data exist suggesting that it is an effective therapy in a subset of patients with left ventricular dysfunction. Finally, passive restraint devices are effective at halting further ventricular dilation. Although cardiac surgery in patients with severe ventricular dysfunction can be complicated by significant morbidity and mortality, experienced centers have demonstrated acceptable outcomes in carefully selected patients.
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Association of operative time of day with outcomes after thoracic organ transplant.
JAMA
PUBLISHED: 06-03-2011
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Recent emphasis on systems-based approaches to patient safety has led to several studies demonstrating worse outcomes associated with surgery at night.
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Infectious complications after pulsatile-flow and continuous-flow left ventricular assist device implantation.
J. Heart Lung Transplant.
PUBLISHED: 05-25-2011
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Infection is a significant source of morbidity and mortality after left ventricular assist device (LVAD) implantation. Newer generation continuous-flow (CF) LVADs are smaller, requiring smaller pump pockets and drive-line exit sites as compared with pulsatile-flow (PF) devices. With their recent adoption, CF device patients benefit from improved provider experience in the detection and treatment of infectious complications. Given these advances in design and experience, we examined the incidence of infectious complications in patients receiving CF and PF devices.
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Complex regional pain syndrome.
Foot Ankle Clin
PUBLISHED: 05-24-2011
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Complex regional pain syndrome (CRPS) is a challenging pain condition for doctors and patients, with a natural history characterized by chronicity and relapses that can result in significant disability. CRPS is difficult to diagnose and treat, and requires close follow-up to ensure that progress is being made. Early diagnosis and treatment are required to prevent a long-standing or permanent disability. Clinical features such as spontaneous pain, edema, hyperalgesia, temperature or sudomotor changes, motor function abnormality, and autonomic changes are the hallmark of this disease. The treatment of CRPS remains controversial, and includes medications, physical therapy, regional anesthesia, and neuromodulation.
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Effect of sensitization in US heart transplant recipients bridged with a ventricular assist device: update in a modern cohort.
J. Thorac. Cardiovasc. Surg.
PUBLISHED: 05-02-2011
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Preformed anti-human leukocyte antigen antibodies have been associated with prolonged wait times and increased mortality in orthotopic heart transplantation. We used United Network for Organ Sharing data to examine panel reactive antibody titers in patients bridged to transplant with left ventricular assist devices.
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Platelet nitric oxide signalling in heart failure: role of oxidative stress.
Cardiovasc. Res.
PUBLISHED: 04-18-2011
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Heart failure is associated with deficient endothelial nitric oxide (NO) production as well as increased oxidative stress and accelerated NO degradation. The aim of this study was to evaluate platelet NO biosynthesis and superoxide anion (O(2)(-)) production in patients with heart failure.
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Marital status improves survival after orthotopic heart transplantation.
J. Heart Lung Transplant.
PUBLISHED: 04-16-2011
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Large national registries lack information on social support, which is increasingly recognized as an important factor associated with improved outcomes after solid-organ transplantation. We examined our institutional database to identify social factors associated with improved outcomes after orthotopic heart transplantation (OHT).
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Insurance and education predict long-term survival after orthotopic heart transplantation in the United States.
J. Heart Lung Transplant.
PUBLISHED: 04-14-2011
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Insurance status and education are known to affect health outcomes. However, their importance in orthotopic heart transplantation (OHT) is unknown. The United Network for Organ Sharing (UNOS) database provides a large cohort of OHT recipients in which to evaluate the effect of insurance and education on survival.
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Insurance status is an independent predictor of long-term survival after lung transplantation in the United States.
J. Heart Lung Transplant.
PUBLISHED: 04-01-2011
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Socioeconomic factors such as education, health insurance, and race are known to affect health outcomes. The United Network for Organ Sharing (UNOS) database provides a large cohort of lung transplant (LTx) recipients in which to evaluate the effect of insurance on survival.
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Organ storage with University of Wisconsin solution is associated with improved outcomes after orthotopic heart transplantation.
J. Heart Lung Transplant.
PUBLISHED: 03-26-2011
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Despite significant advances in cardiac allograft preservation, the optimal preservative solution is unknown. We evaluated the impact of the most commonly used solutions in the USA, the University of Wisconsin solution (UW) and Celsior solution (CS), on outcomes after orthotopic heart transplantation (OHT).
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Graft reconstruction of inferior vena cava for renal cell carcinoma stage pT3b or greater.
Urology
PUBLISHED: 03-11-2011
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To review the methods and outcomes for simultaneous radical nephrectomy and inferior vena cava (IVC) graft reconstruction at our institution. Renal cell carcinoma has the potential to propagate and invade the IVC, requiring resection and/or reconstruction of the IVC concurrently with radical nephrectomy.
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Severe acute kidney injury according to the RIFLE (risk, injury, failure, loss, end stage) criteria affects mortality in lung transplantation.
J. Heart Lung Transplant.
PUBLISHED: 03-09-2011
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The RIFLE criteria (risk, injury, failure, loss, end stage) are new consensus definitions for acute kidney injury (AKI) associated with increased mortality; however, they have not been applied in lung transplantation (LTx). Using the RIFLE criteria, we examined the effect of AKI on outcomes and cost in LTx.
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Emergency cardiac surgery in patients with acute coronary syndromes: a review of the evidence and perioperative implications of medical and mechanical therapeutics.
Anesth. Analg.
PUBLISHED: 03-08-2011
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Patients with acute coronary syndromes who require emergency cardiac surgery present complex management challenges. The early administration of antiplatelet and antithrombotic drugs has improved overall survival for patients with acute myocardial infarction, but to achieve maximal benefit, these drugs are given before coronary anatomy is known and before the decision to perform percutaneous coronary interventions or surgical revascularization has been made. A major bleeding event secondary to these drugs is associated with a high rate of death in medically treated patients with acute coronary syndrome possibly because of subsequent withholding of antiplatelet and antithrombotic therapies that otherwise reduce the rate of death, stroke, or recurrent myocardial infarction. Whether the added risk of bleeding and blood transfusion in cardiac surgical patients receiving such potent antiplatelet or antithrombotic therapy before surgery specifically for acute coronary syndromes affects long-term mortality has not been clearly established. For patients who do proceed to surgery, strategies to minimize bleeding include stopping the anticoagulation therapy and considering platelet and/or coagulation factor transfusion and possibly recombinant-activated factor VIIa administration for refractory bleeding. Mechanical hemodynamic support has emerged as an important option for patients with acute coronary syndromes in cardiogenic shock. For these patients, perioperative considerations include maintaining appropriate anticoagulation, ensuring suitable device flow, and periodically verifying correct device placement. Data supporting the use of these devices are derived from small trials that did not address long-term postoperative outcomes. Future directions of research will seek to optimize the balance between reducing myocardial ischemic risk with antiplatelet and antithrombotics versus the higher rate perioperative bleeding by better risk stratifying surgical candidates and by assessing the effectiveness of newer reversible drugs. The effects of mechanical hemodynamic support on long-term patient outcomes need more stringent analysis.
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Bleeding complications and blood product utilization with left ventricular assist device implantation.
Ann. Thorac. Surg.
PUBLISHED: 03-01-2011
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Bleeding complications are a major source of morbidity and reoperation after left ventricular assist device (LVAD) implantation, yet remain poorly characterized in patients receiving LVADs. We assessed bleeding complications in an institutional cohort of LVAD patients.
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Parameters of donor-recipient size mismatch and survival after bilateral lung transplantation.
J. Heart Lung Transplant.
PUBLISHED: 02-11-2011
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The purpose of this study was to investigate the relationship between donor-recipient height, gender and predicted estimates of total lung capacity (pTLC) mismatches and post-transplant survival.
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Society of Thoracic Surgeons Risk Score predicts hospital charges and resource use after aortic valve replacement.
J. Thorac. Cardiovasc. Surg.
PUBLISHED: 02-03-2011
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The impact of Society of Thoracic Surgeons predicted mortality risk score on resource use has not been previously studied. We hypothesize that increasing Society of Thoracic Surgeons risk scores in patients undergoing aortic valve replacement are associated with greater hospital charges.
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Creation of a quantitative recipient risk index for mortality prediction after cardiac transplantation (IMPACT).
Ann. Thorac. Surg.
PUBLISHED: 02-01-2011
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No recipient risk index exists predicting short-term mortality after orthotopic heart transplantation (OHT). We utilized United Network for Organ Sharing (UNOS) data to develop a novel quantitative recipient risk score for use in OHT.
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Acute cholecystitis preceding mycotic aortic pseudoaneurysm in a heart transplant recipient.
J Card Surg
PUBLISHED: 10-11-2010
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Mycotic pseudoaneurysm is a rare complication after orthotopic heart transplantation (OHT). This case describes a middle-aged OHT recipient who developed a mycotic pseudoaneurysm after an episode of acute cholecystitis. The region of involved aorta was effectively repaired using a patch of bovine pericardium and a brief period of hypothermic circulatory arrest.
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Comparative analysis of hospital costs of open and endovascular thoracic aortic repair.
Vasc Endovascular Surg
PUBLISHED: 09-09-2010
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Endovascular technologies represent major advancements in treating descending thoracic aortic aneurysms (DTAA). We compared hospital charges of open thoracic aortic replacement (OTAR) with endovascular repair of thoracic aortic aneurysms (TEVAR).
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Impact of the lung allocation score on resource utilization after lung transplantation in the United States.
J. Heart Lung Transplant.
PUBLISHED: 05-18-2010
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The United States lung allocation score (LAS) allows rapid organ allocation to higher acuity patients. Although, wait-list time and wait-list mortality have improved, the costs of lung transplantation (LTx) in these higher acuity patients are largely unknown. We hypothesize that LTx in high LAS recipients is associated with increased charges and resource utilization.
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Unexpected sclerosing mediastinitis involving the ascending aorta in the setting of a multifocal fibrosclerotic disorder.
Pathol. Res. Pract.
PUBLISHED: 05-05-2010
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Sclerosing mediastinitis is an uncommon condition associated with infections, inflammatory diseases, autoimmune disorders, and malignancies. It predominantly affects the trachea, superior vena cava, pulmonary veins, and pulmonary arteries. We herein present the first case of sclerosing mediastinitis involving the ascending aorta as part of a multifocal fibrosclerotic disorder.
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Low potassium dextran is superior to University of Wisconsin solution in high-risk lung transplant recipients.
J. Heart Lung Transplant.
PUBLISHED: 04-19-2010
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The ideal solution for recovery of donor lungs remains unknown. Low potassium dextran (LPD) solution is most common, but University of Wisconsin (UW) solution is also used. The United Network for Organ Sharing (UNOS) database allows assessment of preservation solutions in a large cohort of lung transplant (LTx) patients.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.