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GST Primary GST Primary Best Strategies for Health Care Quality Im... Best Strategies for Health Care Quality Improvement - Diabetes Quality Improvement Strategies for Antibio... Kathryn McDonald, Stanford-UCSF Evidence-b... Systematic review assessing the effect of ... Quality Improvement Strategies for Antibiotics Management Kathryn McDonald, Stanford-UCSF Evidence-based Practice Center, 117 Encina Commons, Stanford, CA 94305-6019, Kathy.mcdonald@stanford.edu Systematic review assessing the effect of quality improvement strategies on appropriate prescribing of antibiotics and appropriate choice of antibiotics. Adherence Adherence Assistive Devices Assistive Devices Childhood Burn Hanson MacMillan Childhood Burn Hanson MacMillan CLSA_9 CLSA_9 Cyberabuse Cyberabuse Cognitive Behavioural Therapy for Violent ... This review included randomized trials abo... Cognitive Behavioural Therapy for Violent Men who Batter Their Partners This review included randomized trials about the effects of cognitive behavioral therapy on domestic violence. The intervention included programs based on the Duluth Model. The violence had to be committed by a male toward his female partner. The violence also had to be physical. The primary outcomes were new arrests and convictions, and new reports of violence. CABG vs PCI CABG vs PCI Quality Improvement Strategies for Prevent... Quality Improvement Strategies for Preventing Nosocomial Infections (Created 17-Feb-06) Quality Improvement Strategies for Asthma ... Quality Improvement Strategies for Asthma Control Erectile Dysfunction (Created 30-Jan-06) Erectile Dysfunction (Created 30-Jan-06) Inequality - Smoking Cessation to Reduce S... This review was the first part of a projec... Inequality - Smoking Cessation to Reduce Socio-Economic Differences This review was the first part of a project about inequality. It included randomized trials about the effect of smoking cessation interventions on reducing socio-economic differences. The studies had to report data either on persons with low socio-economic groups status or, preferably, on both low and high socio-economic groups. Diet and Physical Activity to Reduce Socio... This review was the second part in a proje... Diet and Physical Activity to Reduce Socio-Economic Differences This review was the second part in a project about inequality. It included randomized trials about the effect of interventions on reducing socio-economic differences in diet and physical activity. The studies had to report data either on persons with low socio-economic groups status or, preferably, on both low and high socio-economic groups. Workfare The data in SRS are not identical to the d... Workfare The data in SRS are not identical to the data in the published report. We used SRS only for an updated search. The review included randomized trials about the effect of welfare-to-work programs. Participants were welfare recipients. There were basically two types of programs. The educational type tried to build knowledge and skills in order to help the welfare recipients acquire jobs that could support them economically. The "work first" approach was more aimed at getting the participants quickly into a job. Exercise interventions for the management ... The objective of this systematic review wa... Exercise interventions for the management of frailty The objective of this systematic review was to examine the effectiveness of current exercise interventions on the management of frailty. A comprehensive search of Medline, Embase, Psycinfo, Cinahl, Scopus, Ageline, Eric, and SportDiscus databases was conducted and produced 1808 citations. So far we have completed 2 levels of “title and abstract” screening and we ended up with 262 articles. We have just started the full text screening. Eligibility criteria included original studies whose participants were identified as frail or prefrail with specific criteria and in which structured physical activity was included as at least one component of the intervention. Create a free account, build a dictionary with saved terms to re-use later! Public Domestic Violence - Using Cognitive Behavior Therapy Smoking Cessation to Reduce Socio-Economic Differences Diet and Physical Activity to Reduce Socio-Economic Differences Workfare Exercise Interventions for the Management of Frailty Search     Simple Advanced Refine (3 coded questions)  Any of these:   Exact Phrase: All of these: None of these: Author: Periodical: Projects: No restrictions   Libraries: Public   Select SRS Projects Show Saved Terms Select Library Show articles that do not have abstracts  Type of Article Clinical Trial Editorial Letter Meta-Analysis Practice Guideline Randomized Controlled Trial Review Addresses Bibliography Biography Case Reports Classical Article Clinical Conference Clinical Trial, Phase I Clinical Trial, Phase II Clinical Trial, Phase III Clinical Trial, Phase IV Comment Comparative Study Consensus Development Conference Consensus Development Conference, NIH Controlled Clinical Trial Corrected and Republished Article Dictionary Directory Duplicate Publication English Abstract Evaluation Studies Festschrift Government Publications Guideline Historical Article Interview In Vitro Journal Article Lectures Legal Cases Legislation Multicenter Study News Newspaper Article Overall Patient Education Handout Periodical Index Published Erratum Retracted Publication Research Support, N.I.H., Extramural Research Support, N.I.H., Intramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. 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Retraction of Publication Scientific Integrity Review Support of Research Technical Report Twin Study Validation Studies Not a Primary Study or Review Unknown Primary Study Case Series Case Control Cohort Study Observational Study Qualitative Research CBA or ITS Registry Double Blind Controlled before after study Quasi-randomized trial Simple before after study Cluster-RCT Non-Randomized Study Report Book Book chapter Dissertation Conference procedings Secondary Research Not RCT Humans or Animals Humans Animals Ages All Infant: birth-23 months All Child: 0-18 years All Adult: 19+ years Newborn: birth-1 month Infant: 1-23 months Preschool Child: 2-5 years Child: 6-12 years Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Middle Aged + Aged: 45+ years Aged: 65+ years 80 and over: 80+ years Undetermined Results(1-25 of 272) Sort By: Publication Date Relevance Took: 1.391 seconds to search 17,750,454  Action: Copy Results to new Clipboard Build Search Link Page 1 of 11 1 2 3 4 > Last >> (272 articles found) Initial experience with bioactive cerecyte detachable coils: impact on reducing recurrence rates. Apr 2008 Erol Veznedaroglu,Christopher J Koebbe,Adnan Siddiqui,Robert H Rosenwasser OBJECTIVE: Despite proven safety of endovascular coil embolization of intracranial aneurysms, the potential need for retreatment remains criticized. The goal of this prospective study was to assess the safety, durability, and effect on recanalization rates of the Cerecyte (Micrus Corp., Sunnyvale, ... ( view more )CA) bioactive coil. METHODS: Two hundred twelve ruptured and unruptured aneurysms in 176 patients were prospectively enrolled in a database registry during a 12-month period. Adverse clinical outcomes directly attributed to the use of the Cerecyte coil were documented. Angiographic outcomes were determined immediately after coil embolization and during follow-up studies. All patients who received stent assistance or a non-Cerecyte coil were excluded. Two independent endovascular surgeons reviewed follow-up films. Any discrepancy was deemed a recurrence. RESULTS: After exclusion criteria, 81 patients with 89 aneurysms were available for a minimum of 6 months of follow-up. Of those 89 aneurysms, 65% were ruptured aneurysms and were treated in the acute setting. The mean size of the aneurysm was 7 mm. The mean angiographic follow-up period was 11.2 months. Recurrences requiring retreatment as a result of dome filling were identified in six aneurysms (6.7%). Four aneurysms (4%) developed compaction of more than 20%, which was defined as interstitial filling of the fundus. There was one thromboembolic event leading to permanent neurological deficit. No cases of chemical meningitis or delayed hydrocephalus occurred. CONCLUSION: The Cerecyte bioactive coil seems to be safe and effective for use in both ruptured and unruptured aneurysms. The bioactive polymer within the coils allows similar handling characteristics of a bare platinum coil. Studies to assess long-term outcomes with direct comparison to platinum coils and alternative bioactive coils are warranted. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Cigarette smoking as a risk factor for recurrence of aneurysms treated by endosaccular occlusion. Apr 2008 Rafael Ortiz,Michael Stefanski,Robert Rosenwasser,Erol Veznedaroglu OBJECT: Aneurysms treated by endovascular coil embolization have been associated with coil compaction, and the rate of recanalization has been reported to be as high as 40%. The authors report the first published evidence of a correlation between aneurysm recanalization correlated with a history of... ( view more ) cigarette smoking. METHODS: The authors conducted a retrospective chart review of all cases involving patients admitted to their institution from January 1, 2003, to December 31, 2003, for treatment of a cerebral aneurysm. Cases in which patients were treated with coil embolization were reviewed for inclusion. Coil compaction was defined as change in the shape of the coil mass. Aneurysm recanalization was defined as an increase in inflow to the aneurysm in comparison with baseline. The incidence of coil compaction and the relationship with cigarette smoking history were compared in patients with and without recurrence. RESULTS: A total of 110 patients qualified for inclusion. The odds ratio (OR) for aneurysm recanalization after endosaccular occlusion with respect to history of cigarette smoking was significant for the entire cohort (OR 4.53, 95% confidence interval [CI] 1.95-10.52) and especially for the female cohort (OR 3.72, 95% CI 1.45-9.54). The male cohort demonstrated a trend toward a direct correlation, but the sample size was not large enough for statistical significance (OR 7.50, 95% CI 1.02-55.00). CONCLUSIONS: There was an increased risk of recanalization especially in patients with low-grade subarachnoid hemorrhage who had a history of cigarette smoking. These data suggest a correlation between cigarette smoking and aneurysm recurrence. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Treatment of patients with the hypereosinophilic syndrome with mepolizumab. Mar 20, 2008 Marc E Rothenberg,Amy D Klion,Florence E Roufosse,Jean Emmanuel Kahn,Peter F Weller,Hans-Uwe Simon,Lawrence B Schwartz,Lanny J Rosenwasser,Johannes Ring,Elaine F Griffin,Ann E Haig,Paul I H Frewer,Jacqueline M Parkin,Gerald J Gleich,Mepolizumab HES Study Group BACKGROUND: The hypereosinophilic syndrome is a group of diseases characterized by persistent blood eosinophilia, defined as more than 1500 cells per microliter with end-organ involvement and no recognized secondary cause. Although most patients have a response to corticosteroids, side effects are ... ( view more )common and can lead to considerable morbidity. METHODS: We conducted an international, randomized, double-blind, placebo-controlled trial evaluating the safety and efficacy of an anti-interleukin-5 monoclonal antibody, mepolizumab, in patients with the hypereosinophilic syndrome. Patients were negative for the FIP1L1-PDGFRA fusion gene and required prednisone monotherapy, 20 to 60 mg per day, to maintain a stable clinical status and a blood eosinophil count of less than 1000 per microliter. Patients received either intravenous mepolizumab or placebo while the prednisone dose was tapered. The primary end point was the reduction of the prednisone dose to 10 mg or less per day for 8 or more consecutive weeks. RESULTS: The primary end point was reached in 84% of patients in the mepolizumab group, as compared with 43% of patients in the placebo group (hazard ratio, 2.90; 95% confidence interval [CI], 1.59 to 5.26; P<0.001) with no increase in clinical activity of the hypereosinophilic syndrome. A blood eosinophil count of less than 600 per microliter for 8 or more consecutive weeks was achieved in 95% of patients receiving mepolizumab, as compared with 45% of patients receiving placebo (hazard ratio, 3.53; 95% CI, 1.94 to 6.45; P<0.001). Serious adverse events occurred in seven patients receiving mepolizumab (14 events, including one death; mean [+/-SD] duration of exposure, 6.7+/-1.9 months) and in five patients receiving placebo (7 events; mean duration of exposure, 4.3+/-2.6 months). CONCLUSIONS: Our study shows that treatment with mepolizumab, an agent designed to target eosinophils, can result in corticosteroid-sparing for patients negative for FIP1L1-PDGFRA who have the hypereosinophilic syndrome. (ClinicalTrials.gov number, NCT00086658 [ClinicalTrials.gov].). ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Practical allergy (PRACTALL) report: risk assessment in anaphylaxis. Jan 2008 F E R Simons,A J Frew,I J Ansotegui,B S Bochner,D B K Golden,F D Finkelman,D Y M Leung,J Lotvall,G Marone,D D Metcalfe,U Müller,L J Rosenwasser,H A Sampson,L B Schwartz,M van Hage,A F Walls Effector mechanisms in anaphylaxis were reviewed. Current approaches to confirmation of the clinical diagnosis were discussed. Improved methods for distinguishing between allergen sensitization (which is common in the general population) and clinical risk of anaphylaxis (which is uncommon) were del... ( view more )iberated. Innovative techniques that will improve risk assessment in anaphylaxis in the future were described. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Hylan versus corticosteroid versus placebo for treatment of basal joint arthritis: a prospective, randomized, double-blinded clinical trial. Jan 2008 Benton E Heyworth,Jonathan H Lee,Paul D Kim,Carter B Lipton,Robert J Strauch,Melvin P Rosenwasser PURPOSE: Conservative, nonsurgical therapies for basal joint osteoarthritis, such as thumb spica splinting and intra-articular corticosteroid injections, remain the mainstays for symptomatic treatment. This study compares intra-articular hylan, corticosteroid, and placebo injections with regard to ... ( view more )pain relief, strength, symptom improvement, and metrics of manual function in a randomized, controlled, double-blinded study. METHODS: Sixty patients with basal joint arthritis were randomized to receive 2 intra-articular hylan injections 1 week apart, 1 placebo injection followed by 1 corticosteroid injection 1 week later, or 2 placebo injections 1 week apart. Patients were evaluated at 2, 4, 12, and 26 weeks and assessed with Visual Analog Scale pain scores, strength measures, difference scores, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and range of motion measurements. RESULTS: All groups reported pain relief at 2 weeks. The steroid and placebo groups had significantly less pain at week 4 compared with baseline, but this effect disappeared by week 12. Only hylan injections continued to provide pain relief at 12 and 26 weeks compared with baseline. There were no significant differences in pain between groups at any time. At 12 and 26 weeks, the hylan group had improved grip strength compared with baseline, whereas the steroid and placebo groups were weaker. At 4 weeks, the steroid group reported in the difference score a greater improvement in symptoms (68%) compared with the hylan (44%) and placebo (50%) groups. Whereas at 26 weeks the hylan group reported the largest improvement in symptoms (68%), this was not statistically different from the placebo (47%) and steroid (58%) groups. There were no significant differences in Disabilities of the Arm, Shoulder, and Hand scores or range of motion among the groups. There were no complications from any injection. CONCLUSIONS: There were no statistically significant differences among hylan, steroid, and placebo injections for most of the outcome measures at any of the follow-up time points. However, based on the durable relief of pain, improved grip strength, and the long-term improvement in symptoms compared with preinjection values, hylan injections should be considered in the management of basal joint arthritis of the thumb. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Internal fixation of distal radius fractures. Dec 2007 Richard Y Kim,Melvin P Rosenwasser When adequate fracture reduction cannot be achieved with closed techniques, internal fixation can restore anatomy and improve functional outcomes. Volar plating, dorsal plating, and radial plating are well-described techniques that are useful in isolation or in combination, depending on the specifi... ( view more )c fracture pattern. In this article, we review each of these techniques and provide case examples to illustrate their applicability. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles FCER2: a pharmacogenetic basis for severe exacerbations in children with asthma. Dec 2007 Kelan G Tantisira,Eric S Silverman,Thomas J Mariani,Jingsong Xu,Brent G Richter,Barbara J Klanderman,Augusto A Litonjua,Ross Lazarus,Lanny J Rosenwasser,Anne L Fuhlbrigge,Scott T Weiss BACKGROUND: Although inhaled corticosteroids (ICSs) generally protect against severe exacerbations in asthma, they may result in elevated IgE levels, which are associated with exacerbations. OBJECTIVE: To determine whether variation in the low-affinity IgE receptor gene, FCER2, is associated with s... ( view more )evere exacerbations defined as emergency department visits and/or hospitalizations in patients with asthma on ICSs. METHODS: We resequenced, then genotyped 10 FCER2 single nucleotide polymorphisms (SNPs) in 311 children randomized to inhaled budesonide as part of the Childhood Asthma Management Program. We evaluated the association of FCER2 variants with IgE levels and presence or absence of severe exacerbations over the 4-year clinical trial. We also evaluated differences in cellular expression of the novel FCER2 SNP, T2206C. RESULTS: In white subjects, 3 FCER2 SNPs were significantly associated (P < .05) with elevated 4-year IgE level; each was also associated with increased severe exacerbations. Final multivariable models demonstrated associations between T2206C and severe exacerbations in both white and African American children (hazard ratio, 3.95; 95% CI, 1.64-9.51; and hazard ratio, 3.08; 95% CI, 1.00-9.47), despite ICS use. Interaction models supported a true gene-environment effect in white subjects (interaction P = .004). T2206C was also associated with decreased FCER2 expression (P = .02). CONCLUSION: FCER2 predicts the likelihood of treatment protocol success in asthma. The associations of T2206C with IgE level, severe exacerbations, and FCER2 expression may provide a mechanistic basis for the observed findings. CLINICAL IMPLICATIONS: Genetic variation in FCER2 may help form a prognostic model for ICS response in asthma. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Management of distal anterior cerebral artery aneurysms: a single institution retrospective analysis (1997-2005). Nov 2007 Aditya Pandey,Robert H Rosenwasser,Erol Veznedaroglu OBJECTIVE: Our goal was to assess the clinical and angiographic outcomes among patients undergoing treatment for distal anterior cerebral artery aneurysms at the Jefferson Hospital for Neuroscience (1997-2005). METHODS: Forty-one patients (1.5% of all aneurysms treated) with distal anterior cerebra... ( view more )l artery aneurysms had undergone treatment. The clinical and angiographic outcomes of these patients were studied retrospectively using chart reviews, operative reports, and angiographic reports. The mean clinical and angiographic follow-up periods were 16 months (range, 3-74 mo) and 16.5 months (range, 6-81 mo), respectively. RESULTS: Twenty-eight (68%) patients had undergone endovascular embolization (22 women, six men; mean age, 58.2 yr), whereas 13 (32%) had undergone microsurgery for clip ligation (six men, seven women; mean age, 47.4 yr). Within the coiled group, 50% of the patients belonged in the Hunt and Hess (HH) III and IV groups, whereas 46.2% of the patients in the clipped group were elective patients (HH Grade 0). The mean aneurysmal sizes among the clipped and coiled groups were 4.9 and 5.5 mm, respectively. Among the clipped patient population, 100% of the patients had successful clip ligation as evidenced by intraoperative cerebral angiography, there was a 0% recurrence rate among the two patients who have had long-term follow-up, 0% recurrent subarachnoid hemorrhage, and 92% patients achieved a modified Glasgow Outcome Scale score of I to II. Among the coiled patient population, there was an 89% rate of successful embolization, 18% recurrence rate, 0% recurrent subarachnoid hemorrhage, and 64% achieved a modified Glasgow Outcome Scale score of I to II. None of the patients had clinically symptomatic vasospasm. A strong correlation existed between having a ventriculostomy and requiring a shunt in patients with HH Grade IV compared with patients in HH Grades I through III. CONCLUSION: In our analysis, clinical outcomes were better in the clipped group; however, the differences are not statistically significant (P = 0.3675) and are explained by the selection bias. Statistically significant predictors of outcomes were age (<60 yr), size of the aneurysm (>5 mm), absence of ventriculostomy, and presenting HH grade. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Repeated light-dark phase shifts modulate voluntary ethanol intake in male and female high alcohol-drinking (HAD1) rats. Oct 2007 James W Clark,Michael C Fixaris,Gabriel V Belanger,Alan M Rosenwasser BACKGROUND: Chronic disruption of sleep and other circadian biological rhythms, such as occurs in shift work or in frequent transmeridian travel, appears to represent a significant source of allostatic load, leading to the emergence of stress-related physical and psychological illness. Recent anima... ( view more )l experiments have shown that these negative health effects may be effectively modeled by exposure to repeated phase shifts of the daily light-dark (LD) cycle. As chronobiological disturbances are thought to promote relapse in abstinent alcoholics, and may also be associated with increased risk of subsequent alcohol abuse in nonalcoholic populations, the present experiment was designed to examine the effects of repeated LD phase shifts on voluntary ethanol intake in rats. A selectively bred, high alcohol-drinking (HAD1) rat line was utilized to increase the likelihood of excessive alcoholic-like drinking. METHODS: Male and female rats of the selectively bred HAD1 rat line were maintained individually under a LD 12:12 cycle with both ethanol (10% v/v) and water available continuously. Animals in the experimental group were subjected to repeated 6-hour LD phase advances at 3 to 4 week intervals, while control rats were maintained under a stable LD cycle throughout the study. Contact-sensing drinkometers were used to monitor circadian lick patterns, and ethanol and water intakes were recorded weekly. RESULTS: Control males showed progressively increasing ethanol intake and ethanol preference over the course of the study, but males exposed to chronic LD phase shifts exhibited gradual decreases in ethanol drinking. In contrast, control females displayed decreasing ethanol intake and ethanol preference over the course of the experiment, while females exposed to experimental LD phase shifts exhibited a slight increase in ethanol drinking. CONCLUSIONS: Chronic circadian desynchrony induced by repeated LD phase shifts resulted in sex-specific modulation of voluntary ethanol intake, reducing ethanol intake in males while slightly increasing intake in females. While partially contrary to initial predictions, these results are consistent with extensive prior research showing that chronic stress may either increase or decrease ethanol intake, depending on strain, sex, stressor type, and experimental history. Thus, repeated LD phase shifts may provide a novel chronobiological model for the analysis of stress effects on alcohol intake. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Risk assessment in anaphylaxis: current and future approaches. Jul 2007 F Estelle R Simons,Anthony J Frew,Ignacio J Ansotegui,Bruce S Bochner,David B K Golden,Fred D Finkelman,Donald Y M Leung,Jan Lotvall,Gianni Marone,Dean D Metcalfe,Ulrich Müller,Lanny J Rosenwasser,Hugh A Sampson,Lawrence B Schwartz,Marianne van Hage,Andrew F Walls Risk assessment of individuals with anaphylaxis is currently hampered by lack of (1) an optimal and readily available laboratory test to confirm the clinical diagnosis of an anaphylaxis episode and (2) an optimal method of distinguishing allergen-sensitized individuals who are clinically tolerant f... ( view more )rom those at risk for anaphylaxis episodes after exposure to the relevant allergen. Our objectives were to review the effector mechanisms involved in the pathophysiology of anaphylaxis; to explore the possibility of developing an optimal laboratory test to confirm the diagnosis of an anaphylaxis episode, and the possibility of improving methods to distinguish allergen sensitization from clinical reactivity; and to develop a research agenda for risk assessment in anaphylaxis. Researchers from the American Academy of Allergy, Asthma & Immunology and the European Academy of Allergology and Clinical Immunology held a PRACTALL (Practical Allergy) meeting to discuss these objectives. New approaches being investigated to support the clinical diagnosis of anaphylaxis include serial measurements of total tryptase in serum during an anaphylaxis episode, and measurement of baseline total tryptase levels after the episode. Greater availability of the test for mature beta-tryptase, a more specific mast cell activation marker for anaphylaxis than total tryptase, is needed. Measurement of chymase, mast cell carboxypeptidase A3, platelet-activating factor, and other mast cell products may prove to be useful. Consideration should be given to measuring a panel of mediators from mast cells and basophils. New approaches being investigated to help distinguish sensitized individuals at minimum or no risk from those at increased risk of developing anaphylaxis include measurement of the ratio of allergen-specific IgE to total IgE, determination of IgE directed at specific allergenic epitopes, measurement of basophil activation markers by using flow cytometry, and assessment of allergen-specific cytokine responses. Algorithms have been developed for risk assessment of individuals with anaphylaxis, along with a research agenda for studies that could lead to an improved ability to confirm the clinical diagnosis of anaphylaxis and to identify allergen-sensitized individuals who are at increased risk of anaphylaxis. ( view less ) View Full Abstract View Article Details   Related Articles Placebo response in asthma: a robust and objective phenomenon. Jun 2007 Margaret E Kemeny,Lanny J Rosenwasser,Reynold A Panettieri,Robert M Rose,Steve M Berg-Smith,Joel N Kline BACKGROUND: Placebos are hypothesized to exert positive effects on medical conditions by enhancing patient expectancies. Recent reviews suggest that placebo benefits are restricted to subjective responses, like pain, but might be ineffective for objective physiologic outcomes. Nevertheless, mind-bo... ( view more )dy links and placebo responsivity in asthma are widely believed to exist. OBJECTIVE: We carried out a randomized, double-blind investigation to (1) determine whether placebo can suppress airway hyperreactivity in asthmatic subjects, (2) quantify the placebo effect, (3) identify predictors of the placebo response, and (4) determine whether physician interventions modify the placebo response. METHODS: In a double-blind, crossover design investigation, 55 subjects with mild intermittent and persistent asthma with stable airway hyperreactivity were randomized to placebo or salmeterol before serial methacholine challenges. Subjects were additionally randomized to physician interactions that communicated either positive or neutral expectancies regarding drug effect. RESULTS: Placebo bronchodilator administration significantly reduced bronchial hyperreactivity compared with baseline (the calculated concentration of methacholine required to induce a 20% decrease in FEV(1) nearly doubled); 18% of subjects were placebo responders by using conservative definitions. Experimental manipulation of physician behavior altered perceptions of the physician but not the magnitude or frequency of the placebo response. CONCLUSIONS: Objective placebo effects exist in asthma. These responses are of significant magnitude and likely to be meaningful clinically. The placebo response was not modulated by alterations in physician behavior in this study. CLINICAL IMPLICATIONS: The placebo response in patients with asthma is important in understanding the limitations of clinical research studies and in maximizing safe and effective therapies. This article confirms the existence of a strong placebo response in an objective and clinically relevant measure of disease activity. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Efficacy and comfort of olopatadine 0.2% versus epinastine 0.05% ophthalmic solution for treating itching and redness induced by conjunctival allergen challenge. Jun 2007 Francis S Mah,Lanny J Rosenwasser,William D Townsend,Jack V Greiner,George Bensch BACKGROUND: Olopatadine 0.2% (Pataday, Alcon Laboratories Inc., Fort Worth, Texas, USA) and epinastine 0.05% (Elestat, Inspire Pharmaceuticals, Inc., Durham, NC, USA) are topical ocular anti-allergic agents. Both are H(1) antihistamine/mast cell stabilizers indicated for the treatment of ocular itc... ( view more )hing associated with allergic conjunctivitis. OBJECTIVE: To compare the efficacy and comfort of olopatadine 0.2% with epinastine 0.05%, in the prevention of ocular itching associated with allergic conjunctivitis following conjunctival allergen challenge (CAC). RESEARCH DESIGN AND METHODS: This was a 7 week, four visit, double-masked, randomized, placebo-controlled CAC study. Visit 1 screened subjects for positive ocular allergic responses and Visit 2 confirmed those responses. At Visit 3, 92 subjects were randomized into one of four treatment groups to receive one drop of study medication in each eye: (1) olopatadine 0.2%/placebo, (2) epinastine 0.05%/placebo, (3) olopatadine 0.2%/epinastine 0.05%, (4) placebo/placebo. Subjects were challenged 12 h after drop instillation to evaluate duration of action. At Visit 4, subjects were challenged 5 min after drop instillation to evaluate onset of action. Drop comfort was assessed at Visit 4. MAIN OUTCOME MEASURES; RESULTS: This article focuses on the results of the onset-of-action challenge (Visit 4). At Visit 4, ocular itching was assessed at 3, 5, and 7 min and redness was assessed at 7, 15, and 20 min post-challenge. Drop comfort was assessed upon instillation, at 30s, and at 1, 2, and 5 min post-instillation. Olopatadine 0.2%-treated eyes exhibited significantly lower mean ocular itching scores versus epinastine 0.05%-treated eyes at 5 (p = 0.024) and 7 min (p = 0.003) post-challenge. Olopatadine 0.2%-treated eyes exhibited significantly lower mean redness scores versus epinastine 0.05%-treated eyes at all time points post-challenge (ciliary: p < or = 0.013, conjunctival: p < or = 0.015, episcleral: p < or = 0.006). Olopatadine 0.2% was rated as significantly more comfortable than epinastine 0.05% at 1 min post-drop instillation (p = 0.003). All adverse events were non-serious and unrelated to study medication. Although the CAC model reproduces allergic responses that are not environmentally-induced, patients experience varying severities of responses as are seen in real-world situations. CONCLUSION: Olopatadine 0.2% was superior to epinastine 0.05% in preventing ocular itching and redness at onset when induced by the CAC model. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. May 22, 2007 Harold P Adams,Gregory del Zoppo,Mark J Alberts,Deepak L Bhatt,Lawrence Brass,Anthony Furlan,Robert L Grubb,Randall T Higashida,Edward C Jauch,Chelsea Kidwell,Patrick D Lyden,Lewis B Morgenstern,Adnan I Qureshi,Robert H Rosenwasser,Phillip A Scott,Eelco F M Wijdicks,American Heart Association/American Stroke Association Stroke Council ,American Heart Association/American Stroke Association Clinical Cardiology Council ,American Heart Association/American Stroke Association Cardiovascular Radiology and Intervention Council ,Atherosclerotic Peripheral Vascular Disease Working Group ,Quality of Care Outcomes in Research Interdisciplinary Working Group PURPOSE: Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addit... ( view more )ion, information for healthcare policy makers is included. METHODS: Members of the panel were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and represented different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 2003 and used the American Heart Association Stroke Council's Levels of Evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. It is intended that this guideline be fully updated in 3 years. RESULTS: Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials. This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital. Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency treatment of stroke. Several interventions, including intra-arterial administration of thrombolytic agents and mechanical interventions, show promise. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke is needed. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. May 2007 Harold P Adams,Gregory del Zoppo,Mark J Alberts,Deepak L Bhatt,Lawrence Brass,Anthony Furlan,Robert L Grubb,Randall T Higashida,Edward C Jauch,Chelsea Kidwell,Patrick D Lyden,Lewis B Morgenstern,Adnan I Qureshi,Robert H Rosenwasser,Phillip A Scott,Eelco F M Wijdicks,American Heart Association ,American Stroke Association Stroke Council ,Clinical Cardiology Council ,Cardiovascular Radiology and Intervention Council ,Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups PURPOSE: Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addit... ( view more )ion, information for healthcare policy makers is included. METHODS: Members of the panel were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and represented different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 2003 and used the American Heart Association Stroke Council's Levels of Evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. It is intended that this guideline be fully updated in 3 years. RESULTS: Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials. This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital. Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency treatment of stroke. Several interventions, including intra-arterial administration of thrombolytic agents and mechanical interventions, show promise. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke is needed. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Polymorphism R62W results in resistance of CD23 to enzymatic cleavage in cultured cells. Apr 2007 J-F Meng,C McFall,L J Rosenwasser A nonsynonymous single nucleotide polymorphism (SNP) of the low-affinity IgE receptor (FcvarepsilonRII/CD23) gene resulting in an arginine to tryptophan exchange at amino-acid position 62 (R62W) has been associated with enhanced T-cell responses to antigen in allergic subjects. To explore the mecha... ( view more )nism, a CD23(a) cDNA was cloned into the plasmid pCMVScript-CD23a-C with a C allele (R62). The pCMVScript-CD23a-T with T (W62) was produced using a site-directed mutagenesis approach. The pCMVScript-CD23a-C only (CC), mixture of pCMVScript-CD23a-T and pCMVSCript-CD23a-C (CT) and pCMVScript-CD23a-T only (TT) plasmids were transfected in Cos-7 cells at equivalence in transfection efficiency. No soluble CD23 was released from TT transfectants whereas a higher level of soluble CD23 was detected in CC than in CT transfectants. Human leukocyte elastase (HLE), cathepsin G, the dust mite allergen Der p I and ADAM 33 (A disintegrin and metalloproteinase) were found to cleave membrane CD23 in CC but not in TT transfectants, implying the resistance of CD23 to enzymatic cleavage associated with T mutant. Addition of tunicamycin resulted in the resistance of CD23 to Der p I mediated cleavage in CC but no change in TT transfectants. These results indicate that R62W influences the stability of membrane CD23 molecules due to possibly diminished N-glycosylation. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience. Apr 2007 Aditya S Pandey,Christopher Koebbe,Robert H Rosenwasser,Erol Veznedaroglu OBJECTIVE: Treatment of posterior circulation aneurysms poses a great technical challenge for the practicing neurosurgeon. The advent of endovascular techniques has made such treatment more feasible. We report our experience with the endovascular management of ruptured and unruptured posterior circ... ( view more )ulation aneurysms during the past 10 years. METHODS: A retrospective analysis was performed on all patients with posterior circulation aneurysms undergoing endovascular treatment at Jefferson Hospital for Neuroscience between July 1995 and December 2005. This yielded 275 patients (67 men and 208 women). The degree of aneurysm occlusion was determined by the operating endovascular neurosurgeon at the time of the procedure. Successful embolization was defined as greater than 95% occlusion of the dome without any coil prolapsing into the parent vessel. Clinical outcome was evaluated using the modified Glasgow Outcome Scale. Clinical follow-up data was obtained for 262 patients (95.3%); the follow-up period ranged from 1 to 94 months (mean, 31.8 mo for procedures performed before 2004 and 13.3 mo for procedures performed during 2004 and 2005). Angiographic follow-up data was obtained for 224 patients (84.8%) for periods ranging from 6 to 94 months (mean, 31.3 mo for procedures performed before 2004 and 13.7 mo for procedures performed during 2004 and 2005). RESULTS: Based on the Hunt and Hess grading scale, the patient population included 106 patients (38.5%) with unruptured aneurysms, 43 patients (15.6%) with Grade I aneurysms, 16 patients (5.8%) with Grade II aneurysms, 56 patients (20.5%) with Grade III aneurysms, and 54 patients (19.6%) with Grade IV aneurysms. The locations of the posterior circulation aneurysms included 189 (68.7%) in the basilar apex or posterior cerebral artery, 23 (8.4%) in the basilar trunk/anterior inferior cerebellar artery, 22 (8%) in the superior cerebellar artery, and 41 (14.9%) in the vertebral artery or posterior inferior cerebellar artery. Of the 275 patients, 208 (76%) were women and 67 (24%) were men. The mean age at the time of treatment was 53.9 years (range, 7-90 yr). Of all patients treated, 237 patients (87.8%) had successful embolization (>95% occlusion of the dome). On angiographic follow-up, 55 patients (24.5%) developed recanalization of at least 5%. Retreatment was required in 11 patients (4.9%; 0.01%/patient yr) and rehemorrhage occurred in three patients (1.1%; 0.003%/patient yr). Clinical follow-up was graded using the modified Glasgow Outcome Scale (mGOS) and revealed 229 patients (87.4%) in the mGOS I category, 12 patients (4.6%) in the mGOS II category, eight patients (3%) in the mGOS III category, two patients (0.8%) in the mGOS IV category, and 11 patients (4.2%) were deceased (mGOS V). Clinically significant vasospasm requiring angioplasty occurred in 11 patients (6.5%) with subarachnoid hemorrhage, and 120 patients (71%) with subarachnoid hemorrhage required ventricular shunts. Complications causing clinical morbidity occurred in 14 patients (5.1%) and ranged from postoperative ischemia to recurrent subarachnoid hemorrhage. Of all clinical factors evaluated, Hunt and Hess grade was the strongest predictor of good clinical outcome (P < 0.0001). CONCLUSION: Endovascular coil embolization of posterior circulation aneurysms is an effective treatment in the short term but is associated with recurrence, which requires close surveillance, possible retreatment, and can, albeit very rarely, lead to rehemorrhage. Future technological advancements such as the development of biologically active coils will be essential in the permanent obliteration of aneurysms. ( view less ) View Full Abstract View Article Details   Related Articles Biomechanics and histology of intact and repaired digital nerves: an in vitro study. Apr 2007 Steven H Goldberg,Charles M Jobin,Austin G Hayes,Tom Gardner,Melvin P Rosenwasser,Robert J Strauch PURPOSE: To investigate the biomechanical properties of intact and repaired cadaver digital nerves. METHODS: Ultimate tensile failure strength and stiffness were determined in 67 human cadaver digital nerves. Total nerve area, fascicular area, and nonfascicular (connective tissue) area were determi... ( view more )ned from the metacarpophalangeal to the distal interphalangeal joint in another 35 axial nerve sections to determine regional anatomic variation. Thirty-eight additional digital nerves were transected, and epineural repairs were performed using simple, interrupted sutures. Suture number (2 vs 4), gauge (8-0 vs 9-0), and purchase length (1 mm vs 2 mm) were used in various combinations, and then the repaired nerves were pulled to failure. The mechanism of repair-site failure was determined for each suture. In situ tension of the intact digital nerves was measured during passive metacarpophalangeal and proximal interphalangeal joint motion in another 19 intact digital nerves. RESULTS: There were no significant differences in failure load or stiffness with respect to the radial or ulnar nerves within a finger or between fingers. The primary tactile side of the finger tended to have a larger diameter digital nerve. Digital nerve failure was more common proximally than distally. Intact digital nerves failed at 6 N with a stiffness of 1 N/mm. Histologic analysis showed that fascicular area and total area decreased from proximal to distal, whereas the nonfascicular-to-fascicular area ratio increased. Four epineural sutures were statistically stronger than 2 sutures. Suture purchase length and gauge did not affect repair strength. The 8-0 nylon sutures failed primarily by cut-out, whereas the 9-0 sutures failed by cut-out or breakage. Repaired nerves failed at 1 to 2 N. Maximal metacarpophalangeal joint hyperextension resulted in 4 N of digital nerve tension. When the metacarpophalangeal joint was not hyperextended, proximal interphalangeal joint motion did not generate tension. CONCLUSIONS: Similar to flexor tendons, the number of suture strands crossing the repair site was the most important variable affecting digital nerve repair strength in this cadaveric model. ( view less ) View Full Abstract View Article Details   Related Articles Mucormycosis of the upper extremity in a patient with alcoholic encephalopathy. Mar 2007 Noah M Raizman,May Parisien,Michael W Grafe,Rachel J Gordon,Melvin P Rosenwasser Cutaneous mucormycosis is a rare opportunistic infection caused by fungi of the class Zygomycetes that can be rapidly fatal if unrecognized. The diagnosis of this infection is often made by infectious disease, dermatologic, or intensive care specialists. Lesions that affect the upper limb may requi... ( view more )re a hand surgeon to diagnose the infection. The diagnosis may be difficult to make, because these infectious lesions can be confused with ischemic pathology. We report on a rare case of cutaneous mucormycosis caused by Rhizopus arrhizus in a patient with cirrhosis and renal failure who presented with an ischemic hand. Type of study/level of evidence: Diagnostic V. ( view less ) View Full Abstract View Article Details   Related Articles Endovascular management of intracranial aneurysms: current experience and future advances. Nov 2006 Christopher J Koebbe,Erol Veznedaroglu,Pascal Jabbour,Robert H Rosenwasser OBJECTIVE: The past 15 years have seen a revolution in the treatment of intracranial aneurysms. Endovascular technology has evolved rapidly since the Food and Drug Administration approval of Guglielmi detachable coils in 1995, which now allows successful treatment of most aneurysms. The authors pro... ( view more )vide a review of their 11-year experience at Jefferson Hospital for Neuroscience with endovascular embolization of intracranial aneurysms and discuss clinical trial outcomes and future directions of this treatment method. METHODS: The authors reviewed the clinical and angiographic outcomes for 1307 patients undergoing endovascular treatment of intracranial aneurysms. Their analysis focuses on posterior circulation and middle cerebral artery aneurysms, as well as cases of stent-assisted coil embolization. They review their procedural protocol and patient selection criteria for endovascular management. RESULTS: Several large clinical trials have demonstrated the safety and efficacy of endovascular treatment of intracranial aneurysms. The International Subarachnoid Aneurysm Trial provides Level I evidence demonstrating a significant reduction in disability or death with endovascular treatment compared with surgical clipping. The most common procedural complications include intraprocedural rupture and thromboembolic events; avoidance strategies are also discussed. Vasospasm after subarachnoid hemorrhage causes neurological morbidity and mortality and can be successfully managed by early recognition and interventional treatment with angioplasty, pharmacologic agents, or both. CONCLUSION: Long-term studies evaluating experience with aneurysm coil embolization during the past decade indicate that this is a safe and durable treatment method. The introduction of stent-assist techniques has improved the management of wide-neck aneurysms. Future technology developments will likely improve the durability of endovascular treatment further by delivering bioactive agents that promote aneurysm thrombosis beyond the coil mass alone. It is clear that endovascular therapy of both ruptured and unruptured aneurysms is becoming a mainstay of practice in this patient population. Although not replacing open surgery, the continued improvements have allowed aneurysms that previously were amenable only to open clip ligation to be treated safely with durable long-term outcomes. ( view less ) View Full Abstract View Article Details   Related Articles Endovascular treatment of spinal cord arteriovenous malformations. Nov 2006 Erol Veznedaroglu,Peter K Nelson,Pascal M Jabbour,Robert H Rosenwasser Spinal cord arteriovenous malformations are rare lesions that represent one-tenth of the brain arteriovenous malformations. Depending on their location and relationship to the dura, these lesions are divided into four categories. Their clinical manifestations may vary from mild symptoms to severe m... ( view more )otor deficits. Spinal angiography remains the "gold standard" for diagnosing spinal cord vascular lesions. Although the type of shunting remains difficult to determine by the magnetic resonance imaging, it is well analyzed by spinal angiography. The cure of the shunting is not by itself a therapeutic goal, but the objective is the creation of a new hemodynamic equilibrium between the lesion and the spinal cord to decrease the risk of hemorrhage and prevent the progression of the spinal cord ischemia. The endovascular tools seem to be a reasonable therapeutic option for the treatment of the majority of the spinal cord arteriovenous malformations. ( view less ) View Full Abstract View Article Details   Related Articles Basicervical versus intertrochanteric fractures: an analysis of radiographic and functional outcomes. Oct 2006 Brian W Su,Benton E Heyworth,Themistocles S Protopsaltis,Carter B Lipton,Stephano M Sinicropi,Cary B Chapman,Marshall A Kuremsky,Melvin P Rosenwasser This retrospective study compared the long-term stability and functional outcomes of basicervical versus intertrochanteric fractures, and evaluated the use of an additional derotational screw in the treatment of basicervical fractures. Sixty-six patients (28 with basicervical fractures and 38 treat... ( view more )ed for stable and unstable intertrochanteric fractures) were identified. All intertrochanteric fractures were treated with a sliding hip screw. Basicervical fractures were treated with a sliding hip screw with or without a derotational screw. Radiographically measured fracture collapse and tip-apex distance were measured at least 6 weeks after surgery; SF-36 score and Functional Recovery Score data was collected at least 1 year after surgery. The proportion of fractures with > 10% collapse was significantly greater in the basicervical group than the subset of stable intertrochanteric fractures (P = .009), but not than the subset of unstable intertrochanteric fractures. The mean SF-36 bodily pain section domain was greater (less pain) in the basicervical group than the unstable intertrochanteric group (P = .02). No other significant differences in SF-36 scores were noted between the basicervical and either intertrochanteric group. Basicervical fractures collapse more than stable intertrochanteric fractures, suggesting that they may have greater biomechanical instability. This instability, however, does not translate into clinically significant decreases in functional outcome. Using a derotational screw with a sliding hip screw does not affect fracture stability or clinical outcome. ( view less ) View Full Abstract View Article Details   Related Articles Gross and histological analysis of healing after dog flexor tendon repair with the Teno Fix device. Oct 2006 B W Su,F J Raia,H M Quitkin,M Parisien,R J Strauch,M P Rosenwasser The purpose of this study was to examine the in vivo characteristics of the stainless-steel Teno Fix device used for flexor tendon repair. The common flexor digitorum superficialis tendon was transected in 16 dogs and repaired with the device. The animals were euthanized at 3, 6, or 12 weeks postop... ( view more )eratively. Difficulties with cast immobilization led nine of 16 animals to be full weight bearing too early, leading to rupture of their repairs. The seven tendons with successful primary repairs (gap <2mm) underwent histological examination. This in vivo study demonstrates that use of the Teno Fix in "suture" of dog flexor tendons did not lead to scarring at the tendon surface, does not cause an inflammatory reaction within the tendon and does not interfere with tendon healing. ( view less ) View Full Abstract View Article Details   Related Articles Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. Aug 2006 C A Akdis,M Akdis,T Bieber,C Bindslev-Jensen,M Boguniewicz,P Eigenmann,Q Hamid,A Kapp,D Y M Leung,J Lipozencic,T A Luger,A Muraro,N Novak,T A E Platts-Mills,L Rosenwasser,A Scheynius,F E R Simons,J Spergel,K Turjanmaa,U Wahn,S Weidinger,T Werfel,T Zuberbier,European Academy of Allergology ,Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Group There are remarkable differences in the diagnostic and therapeutic management of atopic dermatitis practiced by dermatologists and pediatricians in different countries. Therefore, the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology nomi... ( view more )nated expert teams who were given the task of finding a consensus to serve as a guideline for clinical practice in Europe as well as in North America. The consensus report is part of the PRACTALL initiative, which is endorsed by both academies. ( view less ) View Full Abstract View Article Details   Related Articles Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. Jul 2006 Cezmi A Akdis,Mübeccel Akdis,Thomas Bieber,Carsten Bindslev-Jensen,Mark Boguniewicz,Philippe Eigenmann,Qutayba Hamid,Alexander Kapp,Donald Y M Leung,Jasna Lipozencic,Thomas A Luger,Antonella Muraro,Natalija Novak,Thomas A E Platts-Mills,Lanny Rosenwasser,Annika Scheynius,F Estelle R Simons,Jonathan Spergel,Kristiina Turjanmaa,Ulrich Wahn,Stefan Weidinger,Thomas Werfel,Torsten Zuberbier,European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology There are remarkable differences in the diagnostic and therapeutic management of atopic dermatitis practiced by dermatologists and pediatricians in different countries. Therefore, the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology nomi... ( view more )nated expert teams who were given the task of finding a consensus to serve as a guideline for clinical practice in Europe as well as in North America. The consensus report is part of the PRACTALL initiative, which is endorsed by both academies. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Feasibility and limitations of endovascular coil embolization of anterior communicating artery aneurysms: morphological considerations. Jul 2006 John K Birknes,Sung-Kyun Hwang,Aditya S Pandey,Kevin Cockroft,Anne-Marie Dyer,Ronald P Benitez,Erol Veznedaroglu,Robert H Rosenwasser OBJECTIVE: The purpose of this study is to analyze anterior communicating artery (AComA) aneurysm morphology and its relationship to the limitations and feasibility of endovascular coil embolization. METHODS: One hundred twenty-three patients were treated with endovascular coil embolization for ACo... ( view more )mA aneurysms. Aneurysm morphology was classified into six categories according to the projection of the aneurysm (anterior, posterior/superior, or inferior) and neck size (< 4 mm or >or= 4 mm). The following categories were used: Class A1, anterior projection and neck of aneurysm less than 4 mm; Class A2, anterior projection and neck of aneurysm 4 mm or more; Class B1, posterior (superior) projection and neck of aneurysm less than 4 mm; Class B2, posterior (superior) projection and neck of aneurysm 4 mm or more; Class C1, inferior projection and neck of aneurysm less than 4 mm; and Class C2, inferior projection and neck of aneurysm 4 mm or more. Endovascular procedures were categorized as either successful or unsuccessful according to specific criteria. In addition, patients were followed for recanalization. Clinical follow-up data was obtained at discharge and after 6 months and was classified according to the Glasgow Outcome Scale. RESULTS: Complete or near complete aneurysm occlusion was observed in 108 (88%) patients, partial embolization was performed in three (2.4%) patients, and embolization was attempted in 12 (9.7%) patients. Successful embolization for AComA aneurysms was performed in 86 out of 123 (70%) patients or 77.5% (86 out of 111 patients) of those patients in whom embolization was possible. Statistical analysis demonstrated that anterior projecting aneurysms were more likely to be successfully coiled than either inferior or posterior/superior directed AComA aneurysms. In addition, inferiorly projecting AComA aneurysms and wide-neck aneurysms had a significantly higher rate of recanalization. CONCLUSION: Endovascular coil embolization of AComA aneurysms shows good outcome in our study. Despite advanced modern techniques, there are limitations in the endovascular approach to AComA aneurysms. Consideration of aneurysm morphology may be used to guide approaches in the treatment of AComA aneurysms. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Page 1 of 11 1 2 3 4 > Last >> (272 articles found)

      
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