26 results on '"Clifford J. Eskey"'
Search Results
2. Quantifying Tumor and Vasculature Deformations during Laryngoscopy
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Xiaotian Wu, David A. Pastel, Rihan Khan, Clifford J. Eskey, Yuan Shi, Michael Sramek, Joseph A. Paydarfar, and Ryan J. Halter
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Microsurgery ,Laryngoscopy ,Neoplasms ,Biomedical Engineering ,Humans ,Pharynx ,Larynx ,Article - Abstract
Retractors and scopes used in head and neck surgery to provide adequate surgical exposure also deform critical structures in the region. Surgeons typically use preoperative imaging to plan and guide their tumor resections, however the large tissue deformation resulting from placement of retractors and scopes reduces the utility of preoperative imaging as a reliable roadmap. We quantify the extent of tumor and vasculature deformation in patients with tumors of the larynx and pharynx undergoing diagnostic laryngoscopy. A mean tumor displacement of 1.02 cm was observed between the patients’ pre- and intra-operative states. Mean vasculature displacement at key bifurcation points was 0.99 cm. Registration to the hyoid bone can reduce tumor displacement to 0.67 cm and improve carotid stem angle deviations but increase overall vasculature displacement. The large deformation results suggest limitations in reliance on preoperative imaging and that using specific landmarks intraoperatively or having more intraoperative information could help to compensate for these deviations and ultimately improve surgical success.
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- 2022
3. Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic
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Ajit S. Puri, Allan Taylor, Huynh Le Vu, Tatemi Todaka, Teddy Y. Wu, Octavio M. Pontes-Neto, Eytan Raz, Pedro Lylyk, Jasmine Johann, Roberta Novakovic, Hormuzdiyar H. Dasenbrock, Francisco Mont’Alverne, Nobuyuki Sakai, Melanie Walker, Hugh Stephen Winters, Ossama Mansour, Yohei Takenobu, Gregory Walker, Miki Fujimura, Saif Bushnaq, Odysseas Kargiotis, Nabeel Herial, Markus A Möhlenbruch, Malveeka Sharma, Hiroshi Tokimura, Maxim Mokin, Jean Raymond, Michael D. Hill, Amal Abou-Hamden, Leonardo Renieri, Serdar Geyik, Yuri Sugiura, Luisa Fonseca, Roberto Crosa, Fabricio O Lima, Ameer E Hassan, Viet Quy Nguyen, Jane G. Morris, Steven W. Hetts, Jawad F. Kirmani, Matthew S. Tenser, Muhammad M. Qureshi, Gianmarco Bernava, Mahmoud H Mohammaden, Verónica V. Olavarría, Jun Deguchi, André Beer-Furlan, Steve M. Cordina, Hiroshi Yamagami, Mohamad Abdalkader, Toshiyuki Fujinaka, Clifford J. Eskey, Rotem Sivan-Hoffmann, Hao Zhang, Anirudh Kulkarni, Brendan Steinfort, Özlem Aykaç, Barbara Voetsch, Alex Brehm, Italo Linfante, Wenguo Huang, Omer Eker, M. Luis Silva, Pascal Jabbour, Lissa Peeling, Mollie McDermott, Pascale Lavoie, Kazutaka Sonoda, Thomas Devlin, Alicia C. Castonguay, Jin Soo Lee, Diogo C Haussen, Dileep R. Yavagal, Thanh N. Nguyen, Umair Rashid, Vasu Saini, Raghid Kikano, Hiroyuki Hashimoto, Masaaki Uno, Saima Ahmad, Artem Kaliaev, Eiji Hagashi, Ajay K. Wakhloo, Romain Bourcier, Ryoo Yamamoto, Jesse M. Thon, Georgios Tsivgoulis, Dorothea Altschul, Achmad Fidaus Sani, Satoshi Yamada, Varsha Singh, David S Liebeskind, Tatsuo Amano, Anchalee Churojana, Juan F. Arenillas, Junichi Iida, Charles C. Matouk, Nobuyuki Ohara, Osama O. Zaidat, Mario Martínez-Galdámez, Chandril Chugh, Don Frei, Vanessa Chalumeau, Brijesh P Mehta, Marios Psychogios, Anna Luisa Kühn, Leticia C Rebello, Xianjin Shang, Hosam Al-Jehani, Hiroki Fukuda, Hong Gee Roh, Gisele Sampaio Silva, Rakesh Khatri, Kenichi Todo, Amal Al Hashmi, Alex Bou Chebl, Sunil A Sheth, Zhongming Qiu, Oriana Cornett, Zhengzhou Yuan, Wazim Izzath, Hesham Masoud, Rodrigo Rivera, Michel Piotin, Vikram Huded, Mamoru Murakami, Mohamed Teleb, Viktor Szeder, Ruchir Shah, Dheeraj Gandhi, John Thornton, Michael Chen, Vitor Mendes Pereira, Nadia Hammami, Alice Ma, Anna M. Cervantes-Arslanian, James E. Siegler, Seby John, Carlos Ynigo Lopez, Mudassir Farooqui, David Ozretić, Takuya Kanamaru, Romain Guile, Daisuke Watanabe, Kosuke Miyake, Alejandro Rodriguez Vasquez, Patrick Nicholson, Yuki Yamamoto, William J. Mack, Naoto Kimura, Simon Mathew John, Robert Fahed, Yuji Matsumaru, David Y. Chung, Rishi Gupta, Ryuhei Kono, Michael Frankel, Victor S. Lopez Rivera, Johanna T. Fifi, Raul G Nogueira, Paolo Machi, Tudor G. Jovin, Jordi Blasco, Emma Griffin, Salvatore Mangiafico, Masafumi Morimoto, Jun Luo, Santiago Ortega-Gutierrez, Monika Killer-Oberpfalzer, Daniel Giansante Abud, Syed I. Hussain, Fawaz Al-Mufti, Yusuke Sugimura, Atilla Özcan Özdemir, Stephan A. Mayer, Sumeet Multani, Adel Alhazzani, Alhamza R Al-Bayati, Michael Kelly, Lee A Birnbaum, Shadi Yaghi, Jeyaraj D Pandian, Ji Man Hong, Junsuke Shimbo, Johnny Ho-Yin Wong, Elena A. Cora, Laura Mechtouff, Pedro S.C. Magalhães, Pablo M. Lavados, Yuichi Murayama, Dong Hun Shin, Simon Nagel, Ken Wong, Jose Antonio Fiorot, Jeremy Payne, Randall C. Edgell, Adrienne Weeks, CarMeN, laboratoire, Department of Neurology [Boston], Harvard Medical School [Boston] (HMS)-Massachusetts General Hospital [Boston], Emory University School of Medicine, Emory University [Atlanta, GA], Boston University School of Medicine (BUSM), Boston University [Boston] (BU), National Hospital Organization Osaka National Hospital [Japon] (NHO Osaka National Hospital), Alexandria University [Alexandrie], Boston Medical Center [Boston, MA, USA] (BMC), Xinqiao Hospital [Chongqing, China] (XH), University of Cape Town, La Sagrada Familia Clinic/Clínica La Sagrada Familia [Buenos Aires, Argentina] (LSFC), Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Hospital General de Fortaleza [Fortaleza, Brazil] (HGF), Nottingham University Hospitals NHS Trust [UK], Kobe City Medical Center General Hospital [Kobe, Hyogo, Japan] (KCMCGH), Azienda Ospedaliero-Universitaria Careggi [Firenze, Toscana, Italy] (AOUC), University Hospital Centre Zagreb, Partenaires INRAE, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de Neuroradiologie [CHU de Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Cleveland Clinic Abu Dhabi [Abou Dabi, Émirats arabes unis], Hôpital de Beaumont [Dublin, Ireland] (HB), Hospital-Estadual Central [Vitoria, Brazil] (HEC), Instituto de NeuroCirugía Asenjo, Institut national de neurologie Mongi-Ben Hamida [Tunis], Hue Central Hospital [Thua Thien Hue, Vietnam] (HCH), University of California [San Francisco] (UC San Francisco), University of California (UC), Centre hospitalier universitaire de Nantes (CHU Nantes), Washington University School of Medicine (WUSM), University of Washington [Seattle], Englewood Hospital and Medical Center [Englewood], Jefferson (Philadelphia University + Thomas Jefferson University), Westchester Medical Center [Valhalla, New York, USA] (WMC), Eskisehir Osmangazi University, University of Maryland School of Medicine, University of Maryland System, MAX Superspecialty Hospital [Saket, New Delhi, India] (MSH), Yale School of Medicine [New Haven, Connecticut] (YSM), Université Laval [Québec] (ULaval), Washington University School of Medicine in St. Louis, Washington University in Saint Louis (WUSTL), Rush University Medical Center [Chicago], Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), University of Toronto, NH Mazumdar Shah Medical Center [Bangalore, India] (NHMSMC), IMS Tokyo-Katsushika General Hospital [Tokyo, Japan], Gachon University [Seongnam, Korea] (GU), Hospital Municipal Sao Jose [Joinville, Santa Catarina, Brazil] (HMSJ), Lau Medical Center [Beirut, Lebanon] (LMC), University of Iowa [Iowa City], Royal Adelaide Hospital [Adelaide Australia], Kyorin University [Tokyo, Japan], Yokohama Brain and Spine Center [Yokohama, Japan] (YBSC), Dalhousie University [Halifax], Rambam Health Care Campus [Haifa, Israel], Centro Endovascular Neurologico Medica Uruguaya [Montevideo, Uruguay] (CENMU), Heidelberg University Hospital [Heidelberg], Imam Abdulrahman bin Faisal University [Alkhobar, Saudi Arabia] (IAFU), McGovern Medical School [Houston, TX, USA] (McGMS), The University of Texas Health Science Center at Houston (UTHealth), Cooper Medical School of Rowan University [Camden] (CMSRU), Airlangga University [Jawa Timur, Indonesia] (AU), University of Massachusetts Medical School [Worcester] (UMASS), University of Massachusetts System (UMASS), Geneva University Hospitals and Geneva University, Universidade de São Paulo = University of São Paulo (USP), Beth Israel Lahey Health [Burlington, MA, USA] (BILH), New York University School of Medicine (NYU Grossman School of Medicine), Memorial Neuroscience Institute [Pembroke Pines, FL, USA] (MNI), Iwate Prefectural Central Hospital [Morioka, Iwate, Japan] (IPCH), Japanese Red Cross Musashino Hospital [Tokyo], Ajou University, University of Ottawa [Ottawa], Saga-ken Medical Centre Koseikan [Saga, Japan] (SMCK), University of South Alabama, Konkuk University [Seoul], Royal Free Hospital [London, UK], Hospital Clinico Universitario de Valladolid [Castilla y León, Spain] (HCUV), Universidad de Valladolid [Valladolid] (UVa), Instituto de Ciencia de Materiales de Aragón [Saragoza, España] (ICMA-CSIC), University of Zaragoza - Universidad de Zaragoza [Zaragoza], Hospital Clínic de Barcelona [Catalonia, Spain], Centro Hospitalar Universitário de São João [Porto], Christchurch Hospital [Christchurch, New Zealand] (CH), University Hospital Basel [Basel], University of Southern California (USC), Kohnan Hospital - Sendai [Miyagi, Japan], University of Texas Southwestern Medical Center [Dallas], Nara City Hospital [Nara, Japan] (NCH), Toyonaka Municipal Hospital [Osaka, Japan] (TMH), Kagoshima City Hospita [Kagoshima, Japan] (KCH), Texas Tech University System [Lubbock, TX, USA] (TTUS), University of Saskatchewan [Saskatoon] (U of S), National Institute of Information and Communications Technology [Tokyo, Japan] (NICT), Royal Prince Alfred Hospital [Camperdown, Australia] (RPAH), Banner Desert Medical Center [Mesa, AZ, USA] (BDMC), Japanese Red Cross Matsue Hospital [Shimane, Japan] (JRCMH), Shiroyama Hospital [Osaka, Japan] (SH), Niigata City General Hospital [Niigata, Japan] (NCGH), Sugimura Hospital [Kumamoto, Japan] (SH), Kawasaki Medical School [Kurashiki, Japan] (KMS), Osaka Red Cross Hospital [Osaka, Japan] (ORCH), Université de Tsukuba = University of Tsukuba, Saiseikai Central Hospital [Tokyo, Japan] (SCH), Kinikyo Chuo Hospital - Sapporo [Hokkaido, Japan] (KCHS), NTT Medical Center Tokyo [Tokyo, Japan] (NTTMCT), Yokohama Shintoshi Neurosurgical Hospital [Yokohama, Japan]. (YSNH), Osaka General Medical Center [Osaka, Japan] (OGMC), University of Miami Leonard M. Miller School of Medicine (UMMSM), Bon Secours Mercy Health System [Toledo, OH, USA] (BSMHS), Maoming City Hospital [Guandong, China] (MCH), Miami Cardiac & Vascular Institute [Miami, FL, USA] (MC&VI), Hackensack University Medical Center [Hackensack], David Geffen School of Medicine [Los Angeles], University of California [Los Angeles] (UCLA), University of California (UC)-University of California (UC), University of Tennessee [Chattanooga] (UTC), The University of Texas at San Antonio (UTSA), Mianyang 404 Hospital [Sichuan, China] (M404H), Siriraj Hosital - Mahidol University [Bangkok, Thailand] (SHMU), SUNY Upstate Medical University, State University of New York (SUNY), Royal North Shore Hospital (RNSH), The University of Texas Rio Grande Valley [Harlingen, TX, USA] (UTRGV), Khoula Hospital [Muscat, Oman] (Ministry of Health - KH), University of Michigan [Ann Arbor], University of Michigan System, University of South Florida [Tampa] (USF), Henry Ford Health System [Detroit, MI, USA] (HFHS), Metropolitan Hospital [Piraeus, Greece] (MH), National and Kapodistrian University of Athens (NKUA), Maine Medical Center, Dartmouth Hitchcock Medical Center [Lebanon, NH, USA] (DHMC), Centro Universitário Feevale (BRAZIL), The Valley Hospital [Ridgewood, NJ, USA] (TVH), St Joseph's University Medical Center [Paterson, NJ, USA] (StJUMC), Christian Medical College and Hospital Ludhiana [Punjab, India] (CMCHL), Universidad del Desarrollo, University Graduate School of Medicine [Osaka, Japan], Tokushima University, Universidade Federal de São Paulo, Istanbul Aydin University [İstanbul, Turkey] (IAU), Swedish Medical Center [Englewood, CO, USA] (SMC), Bayhealth Medical Center [Dover, DE, USA] (BMC), Saiseikai Fukuoka General Hospital [Fukuoka, Japan] (SFGH), Osaka Rosai Hospital - Sakai [Osaka, Japan] (ORHS), King Saud University [Riyadh] (KSU), Mount Sinai Health System, University of Calgary, Huzhou University [Zhejiang], The Affiliated Hospital of Southwest Medical University - Luzhou [Sichuan, China] (TAHSMUL), Yijishan Hospital of Wannan Medical College [Wuhu, Anhui, China] (YHWMC), University of Toledo, WellStar Health System [Marietta, GA, USA] (WHS), Institut National de la Recherche Scientifique [Québec] (INRS), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CR CHUM), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM)-Université de Montréal (UdeM), SVIN COVID-19 Registry, the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO), Japanese Society of Vascular and Interventional Neurology Society (JVIN), University of California [San Francisco] (UCSF), University of California, Yale University School of Medicine, University of São Paulo (USP), and University of California-University of California
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[SDV]Life Sciences [q-bio] ,COVID-19 ,Subarachnoid Hemorrhage* / diagnostic imaging ,030204 cardiovascular system & hematology ,Intracranial Aneurysm* / therapy ,lcsh:RC346-429 ,0302 clinical medicine ,Pandemic ,Myocardial infarction ,Prospective Studies ,Stroke ,Original Research ,3. Good health ,[SDV] Life Sciences [q-bio] ,Treatment Outcome ,Intracranial Aneurysm* / diagnostic imaging ,Cardiology ,Subarachnoid haemorrhage ,haemorrhage ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Subgroup analysis ,subarachnoid ,Intracranial Aneurysm* / epidemiology ,03 medical and health sciences ,Aneurysm ,Internal medicine ,medicine ,Humans ,coil ,cardiovascular diseases ,Pandemics ,lcsh:Neurology. Diseases of the nervous system ,Retrospective Studies ,business.industry ,SARS-CoV-2 ,Intracranial Aneurysm ,Subarachnoid Hemorrhage ,medicine.disease ,infection ,nervous system diseases ,Mechanical thrombectomy ,Cross-Sectional Studies ,aneurysm ,Neurology (clinical) ,Subarachnoid Hemorrhage* / epidemiology ,business ,030217 neurology & neurosurgery - Abstract
BackgroundDuring the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.MethodsWe conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation.FindingsThere was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, pInterpretationThere was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.
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- 2021
4. Dynamic EPR Oximetry of Changes in Intracerebral Oxygen Tension During Induced Thromboembolism
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Kirk J. Maurer, Sangeeta Gohain, Clifford J. Eskey, Periannan Kuppusamy, Karen L Moodie, Harold M. Swartz, Nadeem Khan, and Huagang Hou
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inorganic chemicals ,Biophysics ,Hyperoxia ,Biochemistry ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Carbogen ,Thromboembolism ,medicine ,Animals ,Oximetry ,Hypoxia ,Stroke ,medicine.diagnostic_test ,business.industry ,Angiography ,Electron Spin Resonance Spectroscopy ,Brain ,Cell Biology ,General Medicine ,Oxygenation ,respiratory system ,Hypoxia (medical) ,medicine.disease ,Oxygen tension ,Oxygen ,Carotid Arteries ,Anesthesia ,cardiovascular system ,Breathing ,Female ,Rabbits ,medicine.symptom ,business ,030217 neurology & neurosurgery ,circulatory and respiratory physiology - Abstract
Cerebral tissue oxygenation (oxygen tension, pO2) is a critical parameter that is closely linked to brain metabolism, function, and pathophysiology. In this work, we have used electron paramagnetic resonance oximetry with a deep-tissue multi-site oxygen-sensing probe, called implantable resonator, to monitor temporal changes in cerebral pO2 simultaneously at four sites in a rabbit model of ischemic stroke induced by embolic clot. The pO2 values in healthy brain were not significantly different among the four sites measured over a period of 4 weeks. During exposure to 15% O2 (hypoxia), a sudden and significant decrease in pO2 was observed in all four sites. On the other hand, brief exposure to breathing carbogen gas (95% O2 + 5% CO2) showed a significant increase in the cerebral pO2 from baseline value. During ischemic stroke, induced by embolic clot in the left brain, a significant decline in the pO2 of the left cortex (ischemic core) was observed without any change in the contralateral sites. While the pO2 in the non-infarct regions returned to baseline at 24-h post-stroke, pO2 in the infarct core was consistently lower compared to the baseline and other regions of the brain. The results demonstrated that electron paramagnetic resonance oximetry with the implantable resonator can repeatedly and simultaneously report temporal changes in cerebral pO2 at multiple sites. This oximetry approach can be used to develop interventions to rescue hypoxic/ischemic tissue by modulating cerebral pO2 during hypoxic and stroke injury.
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- 2017
5. P-004 Thrombus classification with targeted magnetic nanoparticles
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W Wells, C Jackson, D Schartz, Clifford J. Eskey, and J Weaver
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Relaxometry ,biology ,business.industry ,medicine.medical_treatment ,Cerebral arteries ,Nanoparticle ,Thrombolysis ,medicine.disease ,Fibrin ,Thrombin ,medicine ,biology.protein ,Magnetic nanoparticles ,Thrombus ,business ,circulatory and respiratory physiology ,Biomedical engineering ,medicine.drug - Abstract
Purpose and introduction Thromboembolic material producing large vessel occlusion of the cerebral arteries varies substantially in composition and these differences affect the ability of both intravenous thrombolysis and mechanical thrombectomy to achieve rapid arterial recanalization. The binding of targeted magnetic nanoparticles may offer a means of noninvasively determining clot composition. We hypothesize that binding of targeted magnetic nanoparticles to thrombus is measurable and varies with clot composition. Materials and methods Thromboembolic material was extracted from 10 patients during emergent mechanical thrombectomy for large vessel occlusion in ICA, MCA, or basilar arteries. The nominal source of the thromboembolic material and time from onset to clot retrieval were recorded. Each sample was divided and sent both for standard histopathologic evaluation and for in vitro assessment by magnetic spectroscopy of nanoparticle Brownian rotation (MSB). The thromboembolic material was incubated in a solution of magnetic nanoparticles that had been coated with antibodies directed toward thrombin. Nanoparticle binding was measured using magnetic relaxometry. Results All clots bound measurable quantities of the thrombin-directed magnetic nanoparticles. 2/10 of the samples were composed of >90% fibrin material. These two samples demonstrated much higher than expected nanoparticle binding. The other samples had proportions of thrombus that ranged from 50 to 60%. Among these samples there was a significant correlation between nanoparticle weight and RBC content (R2 = 0.70, p Discussion Thrombin-directed nanoparticles bound thrombin-rich thromboembolic material roughly in proportion to the RBC content, as expected, confirming an affinity of these particles for this component of the clot. However, samples consisting almost exclusively of fibrin bound even higher levels of the nanoparticles suggesting the presence of an additional binding mechanism. Disclosures C. Eskey: None. W. Wells: None. D. Schartz: None. C. Jackson: None. J. Weaver: None.
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- 2019
6. Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association
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Constantino Peña, Mahesh V Jayaraman, Thanh N. Nguyen, Hermann Christian Schumacher, William A. Gray, Clifford J. Eskey, David C. Hess, Dilip K. Pandey, Randall T. Higashida, Sameer A. Ansari, Cameron G. McDougall, Philip M. Meyers, and J. Kevin DeMarco
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medicine.medical_specialty ,medicine.medical_treatment ,Vessel occlusion ,Embolectomy ,030204 cardiovascular system & hematology ,Radiosurgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Fibrinolytic Agents ,Dural arteriovenous fistulas ,law ,Physiology (medical) ,Medicine ,Humans ,cardiovascular diseases ,Intensive care medicine ,Stroke ,Central Nervous System Vascular Malformations ,Interventional treatment ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,medicine.disease ,Embolization, Therapeutic ,Venous thrombosis ,Cerebrovascular Disorders ,Intracranial Arteriovenous Malformations ,Intracranial Thrombosis ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Intracranial endovascular interventions provide effective and minimally invasive treatment of a broad spectrum of diseases. This area of expertise has continued to gain both wider application and greater depth as new and better techniques are developed and as landmark clinical studies are performed to guide their use. Some of the greatest advances since the last American Heart Association scientific statement on this topic have been made in the treatment of ischemic stroke from large intracranial vessel occlusion, with more effective devices and large randomized clinical trials showing striking therapeutic benefit. The treatment of cerebral aneurysms has also seen substantial evolution, increasing the number of aneurysms that can be treated successfully with minimally invasive therapy. Endovascular therapies for such other diseases as arteriovenous malformations, dural arteriovenous fistulas, idiopathic intracranial hypertension, venous thrombosis, and neoplasms continue to improve. The purpose of the present document is to review current information on the efficacy and safety of procedures used for intracranial endovascular interventional treatment of cerebrovascular diseases and to summarize key aspects of best practice.
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- 2018
7. (P10) Proof-of-Principle Study of Hyperbaric Oxygen (HBO) as a Radiosensitizer Prior to Stereotactic Radiosurgery (SRS) for Brain Metastases (NCT01850563)
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Zhongze Li, Jay C. Buckey, David W. Roberts, Clifford J. Eskey, Divya Ravi, and Alan C. Hartford
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Cancer Research ,Radiosensitizer ,Radiation ,business.industry ,medicine.medical_treatment ,Radiosurgery ,03 medical and health sciences ,0302 clinical medicine ,Hyperbaric oxygen ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Radiology, Nuclear Medicine and imaging ,Nuclear medicine ,business ,030217 neurology & neurosurgery - Published
- 2018
8. Vertebral augmentation: report of the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery
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Joshua A Hirsch, M. Shazam Hussain, Ronil V. Chandra, Charles J. Prestigiacomo, Chirag D. Gandhi, Mahesh V Jayaraman, Huy M. Do, Seon Kyu Lee, William J. Mack, Michael Kelly, Clifford J. Eskey, G. Lee Pride, Todd Abruzzo, Donald Frei, Felipe C. Albuquerque, Philip M. Meyers, Ketan R. Bulsara, and Sandra Narayanan
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medicine.medical_specialty ,medicine.medical_treatment ,Osteoporosis ,Balloon ,Bed rest ,Asymptomatic ,medicine ,Back pain ,Animals ,Humans ,Multicenter Studies as Topic ,Kyphoplasty ,Prospective Studies ,Societies, Medical ,Randomized Controlled Trials as Topic ,Vertebroplasty ,business.industry ,General Medicine ,medicine.disease ,Orthotic device ,Surgery ,Vertebra ,medicine.anatomical_structure ,Practice Guidelines as Topic ,Spinal Fractures ,Vascular tumor ,Neurology (clinical) ,Radiology ,medicine.symptom ,business - Abstract
Vertebroplasty and kyphoplasty are minimally invasive image-guided procedures that involve the injection of cement (typically polymethylmethacrylate (PMMA)) into a vertebral body. Kyphoplasty involves inflation of a balloon tamp to create a cavity within the vertebral body into which cement is subsequently injected. The majority of these vertebral augmentation procedures are performed to relieve back pain from osteoporotic or cancer-related vertebral compression fractures and to reinforce the vertebral body with neoplasm or vascular tumor. The primary goal of vertebroplasty and kyphoplasty is to reduce back pain and to improve patient's functional status, and the secondary goal is stabilization of a vertebra weakened by fracture or neoplasia. ### Osteoporotic vertebral fractures Osteoporosis is a common disease that causes significant morbidity and incurs a significant healthcare cost to the community. The major osteoporotic fractures involve the hip, vertebra, proximal humerus and distal forearm; the lifetime osteoporotic fracture risk at age 50 is approximately one in two women and one in five men.1 The lifetime incidence of symptomatic osteoporotic vertebral fractures in women at age 50 is estimated at 10–15%1; once a vertebral fracture occurs, there is a 20% risk of another vertebral fracture within 12 months.2 Most osteoporotic vertebral compression fractures are asymptomatic or result in minimal pain; only a third of vertebral fractures result in medical attention.3 Conservative medical therapy is therefore appropriate for the vast majority of vertebral compression fractures since most acute back pain symptoms are mild and subside over a period of 6–8 weeks as the fracture heals. The goals of conservative therapy are pain reduction (with analgesics and/or bed rest), improvement in functional status (with orthotic devices and physical therapy) and prevention of future fractures (with vitamin D, calcium supplementation and antiresorptive agents). However, conservative treatment for those with severe pain or limitation of function is not benign. It …
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- 2013
9. Deep-Tissue Oxygen Monitoring in the Brain of Rabbits for Stroke Research
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Periannan Kuppusamy, Karen L Moodie, Harold M. Swartz, Nadeem Khan, Clifford J. Eskey, Huagang Hou, Sangeeta Gohain, William C. Culp, Gaixin Du, and Sassan Hodge
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medicine.medical_specialty ,Ischemia ,Infarction ,Hyperoxia ,Article ,Brain Ischemia ,Brain ischemia ,Carbogen ,Internal medicine ,medicine ,Animals ,Oximetry ,Stroke ,Monitoring, Physiologic ,Advanced and Specialized Nursing ,business.industry ,Penumbra ,Electron Spin Resonance Spectroscopy ,Brain ,Reproducibility of Results ,Blood flow ,medicine.disease ,Electrodes, Implanted ,Surgery ,Oxygen ,Disease Models, Animal ,Calibration ,Cardiology ,Rabbits ,Neurology (clinical) ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The primary event in the ischemic stroke is a rapid decline in the oxygen levels after the loss of blood flow in specific areas of the brain. Subsequent pathological processes results in a central core area of severely ischemic tissue surrounded by a region of moderate ischemic tissue (penumbra) with a preserved cellular metabolism. The outcome of an ischemic stroke depends on the size of the infarct core and the potential to salvage the cells in the penumbra, which is hypoperfused, and therefore, at risk of infarction but still viable. Such viable penumbral tissue can be rescued by quick interventions that can increase oxygen levels or slow metabolism in the ischemic area to minimize oxidative injury on reperfusion. Several strategies have been investigated to rescue ischemic tissue using experimental models, especially rodents, but largely failed in subsequent clinical trials. The rabbit model of ischemic stroke using embolic clot is a promising model for developing effective strategies. This model first led to the prediction of the clinical response of recombinant tissue-type plasminogen activator to restore blood flow in patients.1 The drug is currently recommended for administration within 3 hours for best outcomes and has also shown modest benefit when administered within 4.5 to 6 hours of clinical onset.2 The rabbit model of embolic clot is now considered as a pertinent model for translational research by the Stroke Therapy Academic Industry Roundtable recommendations.3 To rationally develop effectual therapies, it is important to understand the effect of ischemic stroke on oxygen levels (partial pressure of oxygen [pO2]) in the regions directly affected by the pathology, as well as contralateral regions of the rabbit brain. The potential changes in tissue po2 of contralateral regions may provide crucial information on adaptive response, if any, of the brain …
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- 2015
10. Mass Effect in the Thoracic Spine from Remnant Bone Wax: An MR Imaging Pitfall
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Joel M. Stein, Alexander C. Mamourian, and Clifford J. Eskey
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Male ,Paraplegia ,medicine.medical_specialty ,Cord ,Thoracic spine ,business.industry ,Bone wax ,Palmitates ,Signal void ,medicine.disease ,Magnetic Resonance Imaging ,Mr imaging ,Thoracic Vertebrae ,Spine ,Waxes ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neurology (clinical) ,Radiology ,business ,False Negative Reactions ,Aged - Abstract
SUMMARY: Bone wax used in neurosurgical procedures is a rare cause of complications after surgery. We present a patient who developed paraplegia following thoracic spine surgery. A subsequent MR imaging study demonstrated a signal void that resembled postoperative air but appeared to cause cord compression and proved after a second surgery to represent bone wax. Recognizing the MR imaging and CT characteristics of bone wax is important to prevent mistaking it for residual air in postoperative imaging.
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- 2009
11. A predictive model of outcomes during cerebral aneurysm coiling
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Adina S. Fischer, Kimon Bekelis, Todd A. MacKenzie, Symeon Missios, Clifford J. Eskey, and Nicos Labropoulos
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Adult ,Male ,medicine.medical_specialty ,Subarachnoid hemorrhage ,Databases, Factual ,Deep vein ,Context (language use) ,Aneurysm ,Predictive Value of Tests ,Risk Factors ,medicine ,Humans ,Hospital Mortality ,Stroke ,Aged ,Retrospective Studies ,Heart Failure ,Venous Thrombosis ,Models, Statistical ,business.industry ,Incidence ,Retrospective cohort study ,Intracranial Aneurysm ,General Medicine ,Acute Kidney Injury ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,Thrombosis ,Embolization, Therapeutic ,Pulmonary embolism ,Surgery ,medicine.anatomical_structure ,Logistic Models ,Outcome and Process Assessment, Health Care ,Multivariate Analysis ,Critical Pathways ,Female ,Neurology (clinical) ,business ,Pulmonary Embolism - Abstract
Background Benchmarking of complications is necessary in the context of the developing path to accountable care. We attempted to create a predictive model of negative outcomes in patients undergoing cerebral aneurysm coiling (CACo). Methods We performed a retrospective cohort study involving patients who underwent CACo from 2005 to 2009 and who were registered in the Nationwide Inpatient Sample database. A model for outcome prediction based on individual patient characteristics was developed. Results Of the 10 607 patients undergoing CACo, 6056 presented with unruptured aneurysms (57.1%) and 4551 with subarachnoid hemorrhage (42.9%). The respective inpatient postoperative risks were 0.3%, 5.7%, 1.8%, 0.8%, 0.5%, 0.2%, 1.9%, and 0.1% for unruptured aneurysms, and 13.8%, 52.8%, 4.9%, 36.7%, 1%, 2.9%, 2.3%, and 0.8% for ruptured aneurysms for death, unfavorable discharge, stroke, treated hydrocephalus, cardiac complications, deep vein thrombosis, pulmonary embolism, and acute renal failure. Multivariate analysis identified risk factors independently associated with the above outcomes. A validated model for outcome prediction based on individual patient characteristics was developed. The accuracy of the model was estimated by the area under the receiver operating characteristic curve, and it was found to have good discrimination. Conclusions The presented model can aid in the prediction of the incidence of postoperative complications, and can be used as an adjunct in tailoring the treatment of cerebral aneurysms.
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- 2013
12. Brain mechanical property measurement using MRE with intrinsic activation
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John B. Weaver, Irina Perreard, Jessica G Swienckowski, Clifford J. Eskey, S. Scott Lollis, Adam J. Pattison, Keith D. Paulsen, and Matthew D. J. McGarry
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medicine.medical_specialty ,Materials science ,Radiological and Ultrasound Technology ,Cardiac cycle ,Movement ,Linear elasticity ,Poromechanics ,Poison control ,Brain ,Magnetic Resonance Imaging ,Article ,Surgery ,Magnetic resonance elastography ,Biomechanical Phenomena ,Shear modulus ,Vibration ,Elasticity Imaging Techniques ,Imaging, Three-Dimensional ,medicine ,Blood Vessels ,Radiology, Nuclear Medicine and imaging ,Biomedical engineering ,Mechanical Phenomena - Abstract
Many pathologies alter the mechanical properties of tissue. Magnetic resonance elastography (MRE) has been developed to noninvasively characterize these quantities in vivo. Typically, small vibrations are induced in the tissue of interest with an external mechanical actuator. The resulting displacements are measured with phase contrast sequences and are then used to estimate the underlying mechanical property distribution. Several MRE studies have quantified brain tissue properties. However, the cranium and meninges, especially the dura, are very effective at damping externally applied vibrations from penetrating deeply into the brain. Here, we report a method, termed 'intrinsic activation', that eliminates the requirement for external vibrations by measuring the motion generated by natural blood vessel pulsation. A retrospectively gated phase contrast MR angiography sequence was used to record the tissue velocity at eight phases of the cardiac cycle. The velocities were numerically integrated via the Fourier transform to produce the harmonic displacements at each position within the brain. The displacements were then reconstructed into images of the shear modulus based on both linear elastic and poroelastic models. The mechanical properties produced fall within the range of brain tissue estimates reported in the literature and, equally important, the technique yielded highly reproducible results. The mean shear modulus was 8.1 kPa for linear elastic reconstructions and 2.4 kPa for poroelastic reconstructions where fluid pressure carries a portion of the stress. Gross structures of the brain were visualized, particularly in the poroelastic reconstructions. Intra-subject variability was significantly less than the inter-subject variability in a study of six asymptomatic individuals. Further, larger changes in mechanical properties were observed in individuals when examined over time than when the MRE procedures were repeated on the same day. Cardiac pulsation, termed intrinsic activation, produces sufficient motion to allow mechanical properties to be recovered. The poroelastic model is more consistent with the measured data from brain at low frequencies than the linear elastic model. Intrinsic activation allows MRE to be performed without a device shaking the head so the patient notices no differences between it and the other sequences in an MR examination.
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- 2012
13. Absence of abnormal vessels in the subarachnoid space on conventional magnetic resonance imaging in patients with spinal dural arteriovenous fistulas
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Clifford J. Eskey, Alexander C. Mamourian, and Timothy R. Miller
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Male ,medicine.medical_specialty ,Cord ,Arteriovenous fistula ,Contrast Media ,Gadolinium ,Magnetic resonance angiography ,Subarachnoid Space ,Dural arteriovenous fistulas ,Edema ,medicine ,Humans ,In patient ,Aged ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Spinal Cord ,Arteriovenous Fistula ,Surgery ,Female ,Neurology (clinical) ,Radiology ,Dura Mater ,Subarachnoid space ,medicine.symptom ,business - Abstract
Spinal dural arteriovenous fistula (DAVF) is an uncommon condition that can be difficult to diagnose. This often results in misdiagnosis and treatment delay. Although conventional MRI plays an important role in the initial screening for the disease, the typical MRI findings may be absent. In this article, the authors present a series of 4 cases involving patients with angiographically proven spinal DAVFs who demonstrated cord T2 prolongation on conventional MRI but without abnormal subarachnoid flow voids or enhancement. These cases suggest that spinal DAVF cannot be excluded in symptomatic patients with cord edema based on conventional MRI findings alone. Dynamic Gd-enhanced MR angiography (MRA) was successful in demonstrating abnormal spinal vasculature in all 4 cases. This limited experience provides support for the role of spinal MRA in patients with abnormal cord signal and symptoms suggestive of DAVF even when typical MRI findings of a DAVF are absent.
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- 2012
14. Role of oxygen vs. glucose in energy metabolism in a mammary carcinoma perfused ex vivo: direct measurement by 31P NMR
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Rakesh K. Jain, Michael M. Domach, Clifford J. Eskey, and Alan P. Koretsky
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Magnetic Resonance Spectroscopy ,Time Factors ,Cellular respiration ,Metabolite ,Adenocarcinoma ,Carbohydrate metabolism ,Biology ,Phosphates ,chemistry.chemical_compound ,Oxygen Consumption ,In vivo ,Respiration ,Animals ,Glycolysis ,Hypoxia ,Multidisciplinary ,Mammary Neoplasms, Experimental ,Phosphorus ,Hydrogen-Ion Concentration ,Rats, Inbred F344 ,Rats ,Oxygen ,Kinetics ,Glucose ,chemistry ,Biochemistry ,Lactates ,Female ,Energy Metabolism ,Perfusion ,Ex vivo ,Research Article - Abstract
The role of glycolysis vs. respiration in tumor energy metabolism has been studied, to date, primarily in vitro by using single cells, multicellular spheroids, or tissue slices. With the advent of in vivo NMR spectroscopy, several investigators have shown that tumor energy status depends on its blood flow. Since manipulation of blood flow alters both oxygen and glucose delivery to a solid tumor, these studies have not been able to separate the relative contribution of oxygen vs. glucose in energy metabolism in vivo. In the present study, we have overcome this problem by combining two methods: the tissue-isolated R3230AC mammary adenocarcinoma perfused ex vivo and 31P NMR spectroscopy. The isolated tumor permits one to control the perfusion pressure as well as the metabolite concentrations in the perfusate. NMR spectroscopy permits one to measure the ratio of nucleoside triphosphate to inorganic phosphate (NTP/Pi) and pH. Our results show that (i) the NTP/Pi ratio ex vivo is similar to that observed in vivo prior to surgery, (ii) the NTP/Pi ratio is insensitive to flow changes at high flow rates but is proportional to flow rate at flows comparable to those found in vivo, (iii) the NTP/Pi ratio of these tumors is resistant to hypoxia and is not maintained when glucose is removed or replaced with glutamine, and (iv) although both O2 and glucose are consumed by these tumors, the effect of perfusate flow rate appears to be mediated largely through glucose delivery. The current approach not only provides information about the role of glycolysis vs. respiration in a rodent tumor but also is general and versatile enough to provide similar data in human tumors perfused ex vivo.
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- 1993
15. Computed tomographic angiography as an adjunct to digital subtraction angiography for the pre-operative assessment of cerebral aneurysms
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Alexander C. Mamourian, Khashayar Farsad, Clifford J. Eskey, and Jonathan A. Friedman
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medicine.medical_specialty ,digital subtraction angiography ,Surgical planning ,Magnetic resonance angiography ,Article ,pre-operative assessment ,Aneurysm ,Neuroimaging ,Medicine ,cardiovascular diseases ,medicine.diagnostic_test ,business.industry ,musculoskeletal, neural, and ocular physiology ,magnetic resonance angiography ,Computed tomographic angiography ,Digital subtraction angiography ,medicine.disease ,Pre operative ,Psychiatry and Mental health ,cerebral aneurysm ,Neurology ,Angiography ,cardiovascular system ,Neurology (clinical) ,Radiology ,business ,psychological phenomena and processes - Abstract
Objectives: Computerized tomographic angiography (CTA) has emerged as a valuable diagnostic tool for the management of patients with cerebrovascular disease. The use of CTA in lieu of, or as an adjunct to, conventional cere- bral angiography in the management of cerebral aneurysms awaits further experience. In this study, we evaluated the role of CTA specifically for the pre-operative assessment and planning of cerebral aneurysm surgery. Patients and Methods: We reviewed the relevant neuroimaging of all patients treated at Dartmouth Hitchcock Medical Center between January, 2001 and December, 2004 with a diagnosis of cerebral aneurysm and diagnostic evaluation with both CTA and conventional digital subtraction angiography (DSA) using standard imaging protocols. 32 patients under- went both CTA and DSA during the study period for a total of 36 aneurysms. Images were independently re-assesed by two neurosurgeons for information valuable for pre-operative surgical planning. Results: In 26 of 36 aneurysms (72%), the CTA was felt to provide the best image quality in defining the morphology of the aneurysm. In 14 aneurysms (39%), CTA provided clinically valuable anatomic detail not demonstrated on DSA, largely due to better visualization of parent and perforating vessel relationships at the aneurysm neck. There were no in- stances where a lesion was seen on DSA but missed on CTA. The DSA was of most clinical value in determining flow dynamics, such as the arterial supply of an anterior communicating artery aneurysm and distal anterior cerebral branches via the two A1 segments. Conclusion: CTA with three-dimensional reconstructions is a valuable adjunct to the preoperative evaluation of cerebral aneurysms. We advocate routine use of CTA in all patients in whom surgical aneurysm repair is planned, even when DSA has already been performed.
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- 2008
16. A phase II study of thalidomide and irinotecan for treatment of glioblastoma multiforme
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Herbert B. Newton, Bernard F. Cole, Clifford J. Eskey, David W. Roberts, Louise P. Meyer, Linda S. Kingman, Camilo E. Fadul, J. Marc Pipas, and C. Harker Rhodes
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Adult ,Male ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Phases of clinical research ,Irinotecan ,Gastroenterology ,Article ,Central Nervous System Neoplasms ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Clinical endpoint ,medicine ,Humans ,Adverse effect ,Survival analysis ,Aged ,Chemotherapy ,Intention-to-treat analysis ,business.industry ,Middle Aged ,Survival Analysis ,Surgery ,Thalidomide ,Neurology ,Oncology ,Disease Progression ,Camptothecin ,Female ,Neurology (clinical) ,business ,Glioblastoma ,Immunosuppressive Agents ,medicine.drug - Abstract
Purpose Irinotecan is a cytotoxic agent with activity against gliomas. Thalidomide, an antiangiogenic agent, may play a role in the treatment of glioblastoma multiforme (GBM). To evaluate the combination of thalidomide and irinotecan, we conducted a phase II trial in adults with newly-diagnosed or recurrent GBM. Patients and methods Thalidomide was given at a dose of 100 mg/day, followed by dose escalation every 2 weeks by 100 mg/day to a target of 400 mg/day. Irinotecan was administered on day 1 of each 3 week cycle. Irinotecan dose was 700 mg/m2 for patients taking enzyme-inducing anticonvulsants and 350 mg/m2 for all others. The primary endpoint was tumor response, assessed by MRI. Secondary endpoints were toxicity, progression-free survival, and overall survival. Results Twenty-six patients with a median age of 55 years were enrolled, with fourteen evaluable for the primary outcome, although all patients were included for secondary endpoints. One patient (7%) exhibited a partial response after twelve cycles, and eleven patients (79%) had stable disease. The intention to treat group with recurrent disease included 16 patients who had a 6-month PFS of 19% (95% CI: 4–46%) and with newly-diagnosed disease included 10 patients who had a 6-month PFS of 40% (95% CI: 12–74%). Gastrointestinal (GI) toxicity was mild, but six patients (23%) experienced a venous thromboembolic complication. Two patients had Grade 4 treatment-related serious adverse events that required hospitalization. There were no treatment-related deaths. Conclusion The combination of irinotecan and thalidomide has limited activity against GBM. Mild GI toxicity was observed, but venous thromboembolic complications were common.
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- 2008
17. Preliminary experience with onyx embolization for the treatment of intracranial dural arteriovenous fistulas
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Raul G. Nogueira, Clifford J. Eskey, James D. Rabinov, Guilherme Dabus, Joshua A Hirsch, Johnny C. Pryor, and Christopher S. Ogilvy
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Intracranial Arteriovenous Malformations ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Fistula ,Pilot Projects ,Fibrinolytic Agents ,Dural arteriovenous fistulas ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Dimethyl Sulfoxide ,Embolization ,Vein ,Retrospective Studies ,medicine.diagnostic_test ,Interventional ,business.industry ,Arteriovenous malformation ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Radiography ,medicine.anatomical_structure ,Treatment Outcome ,Angiography ,Female ,Polyvinyls ,Neurology (clinical) ,Radiology ,business ,Fibrinolytic agent - Abstract
BACKGROUND AND PURPOSE: Onyx was recently approved for the treatment of pial arteriovenous malformations, but its use to treat dural arteriovenous fistulas (DAVFs) is not yet well established. We now report on the treatment of intracranial DAVFs using this nonadhesive liquid embolic agent. MATERIALS AND METHODS: We performed a retrospective analysis of 12 consecutive patients with intracranial DAVFs who were treated with Onyx as the single treatment technique at our institution between March 2006 and February 2007. RESULTS: A total of 17 procedures were performed in 12 patients. In all of the cases, transarterial microcatheterization was performed, and Onyx-18 or a combination of Onyx-18/Onyx-34 was used. Eight patients were men. The mean age was 56 ± 12 years. Nine patients were symptomatic. There was an average of 5 feeders per DAVF (range, 1–9). Cortical venous reflux was present in all of the cases except for 1 of the symptomatic patients. Complete resolution of the DAVF on immediate posttreatment angiography was achieved in 10 patients. The remaining 2 patients had only minimal residual shunting postembolization, 1 of whom appeared cured on a follow-up angiogram 8 weeks later. The other patient has not yet had angiographic follow-up. Follow-up angiography (mean, 4.4 months) is currently available in 9 patients. There was 1 angiographic recurrence (asymptomatic), which was subsequently re-embolized with complete occlusion of the fistula and its draining vein. There was no significant morbidity or mortality. CONCLUSION: In our experience, the endovascular treatment of intracranial DAVFs with Onyx is feasible, safe, and highly effective with a small recurrence rate in the short-term follow-up.
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- 2007
18. Kyphoplasty for vertebral compression fracture via a uni-pedicular approach
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M Melvin, Hu, Clifford J, Eskey, Samuel C, Tong, Raul G, Nogueira, Stuart R, Pomerantz, James D, Rabinov, Johnny C, Pryor, and Joshua A, Hirsch
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Percutaneous kyphoplasty using a bone expander polymer device, such as percutaneous vertebroplasty and balloon kyphoplasty, is a therapeutic intervention for painful osteoporotic vertebral body compression fractures. Typically the procedure involves placement of bilateral Sky Bone Expanders in the fractured vertebral body via a transpedicular approach. We describe performance of "SKy"phoplasty using the Disc-O-Tech Sky Bone Expander (Disc-O-Tech Medical Technologies, Herzliya, Israel, and Monroe Township, New Jersey) via a unilateral transpedicular approach. The advantage of a unilateral approach is that it reduces the risks associated with large-bore needle placement. These risks include pedicle fracture, medial transgression of the pedicle or transgression into the spinal canal, nerve injury, cement leakage along the cannula tract, and spinal epidural hematoma. Additionally, using a unilateral approach reduces operative time and costs.A 68-year-old man with osteoporosis presented with severe upper back pain which occurred following a fall. The pain was reproducible on palpation of the L1 spinous process. A lumbar spine magnetic resonance imaging (MRI) with STIR (short tau inversion recovery) sequence demonstrated an acute L1 vertebral body compression fracture. A L1 "SKy"phoplasty was performed using a single Sky Bone Expander polymer device via a unilateral transpedicular approach. The patient reported immediate relief of pain after the procedure. He denied any residual back pain at his follow-up visit. He was able to resume his normal activities including walking, which had been inhibited by pain prior to the procedure."SKy"phoplasty can be performed using a single Sky Bone Expander via a unilateral pedicular approach. The key is a medial needle trajectory with a final Sky Bone Expander position in the midline of the vertebral body.
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- 2006
19. Diffusion-weighted imaging in the follow-up of treated high-grade gliomas: tumor recurrence versus radiation injury
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Patrick A, Hein, Clifford J, Eskey, Jeffrey F, Dunn, and Eugen B, Hug
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Adult ,Male ,Adolescent ,Brain Neoplasms ,Brain ,Glioma ,Middle Aged ,Combined Modality Therapy ,body regions ,Diagnosis, Differential ,Diffusion Magnetic Resonance Imaging ,Chemotherapy, Adjuvant ,Humans ,Female ,Radiotherapy, Adjuvant ,Cranial Irradiation ,Neoplasm Recurrence, Local ,Radiation Injuries ,Aged ,Retrospective Studies - Abstract
BACKGROUND AND PURPOSE: Diffusion-weighted (DW) MR imaging is a means to characterize and differentiate morphologic features, including edema, necrosis, and tumor tissue, by measuring differences in apparent diffusion coefficient (ADC). We hypothesized that DW imaging has the potential to differentiate recurrent or progressive tumor growth from treatment-induced damage to brain parenchyma in high-grade gliomas after radiation therapy. METHODS: We retrospectively reviewed follow-up conventional and DW MR images obtained starting 1 month after completion of radiation treatment with or without chemotherapy for histologically proved high-grade gliomas. Eighteen patients with areas of abnormal enhancing tissue were identified. ADC maps were calculated from echo-planar DW images, and mean ADC values and ADC ratios (ADC of enhancing lesion to ADC of contralateral white matter) were compared with final diagnosis. Recurrence was established by histologic examination or by clinical course and a combination of imaging studies. RESULTS: Recurrence and nonrecurrence could be differentiated by using mean ADC values and ADC ratios. ADC ratios in the recurrence group showed significantly lower values (mean ± SD, 1.43 ± 0.11) than those of the nonrecurrence group (1.82 ± 0.07, P < .001). Mean ADCs of the recurrent tumors (mean ± SD, 1.18 ± 0.13 × 10(−3) mm/s(2)) were significantly lower than those of the nonrecurrence group (1.40 ± 0.17 × 10(−3) mm/s(2), P < .006). CONCLUSION: Assessment of ADC ratios of enhancing regions in the follow-up of treated high-grade gliomas is useful in differentiating radiation effects from tumor recurrence or progression.
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- 2004
20. Functional recovery after rehabilitation for cerebellar stroke
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Karen L. Furie, Joel Stein, Saad Shafqat, Peter J. Kelly, Yuchiao Chang, A. Kurina, Clifford J. Eskey, and Daniel Doherty
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Rehabilitation hospital ,medicine.medical_specialty ,Cerebellum ,medicine.medical_treatment ,Ischemia ,Comorbidity ,Severity of Illness Index ,Central nervous system disease ,Physical medicine and rehabilitation ,Cerebellar Diseases ,Predictive Value of Tests ,Severity of illness ,medicine ,Humans ,Stroke ,Aged ,Cerebral Hemorrhage ,Retrospective Studies ,Advanced and Specialized Nursing ,Rehabilitation ,business.industry ,Cerebral infarction ,Stroke Rehabilitation ,Cerebral Infarction ,Recovery of Function ,medicine.disease ,medicine.anatomical_structure ,Treatment Outcome ,Multivariate Analysis ,Physical therapy ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background and Purpose —Relatively few data exist concerning functional recovery after ischemic and hemorrhagic cerebellar stroke. We studied patients admitted to a rehabilitation hospital after cerebellar stroke to quantify recovery after rehabilitation therapy and to identify variables that predicted functional outcome. Methods —This study was a retrospective review of consecutive cases admitted in a 4-year period with new cerebellar infarct or hemorrhage. Clinical features of stroke were recorded and comorbidities scored with the Charlson Index. Follow-up information was obtained by telephone interview. The Functional Independence Measure (FIM) was scored at admission (AFIM), discharge (DFIM), and follow-up (FFIM). Outcome measures were DFIM and FFIM. Univariate and multivariate analyses were performed. Results —Fifty-eight cases were identified (mean age 69.2 years; 49 infarcts, 9 hemorrhages). Mean AFIM was 65.5, and mean DFIM was 89.8. Mean AFIM was significantly higher in the infarct than in the hemorrhage subgroup (70 versus 43, P =0.006). Mean DFIM was also higher in the infarct subgroup but did not reach statistical significance (93 versus 74, P =0.1). Follow-up information was obtained for 45 cases (78%) (mean interval 19.5 months). Median FFIM was 123.5. Outcome was significantly positively correlated with AFIM and initial presenting syndrome of vertigo/vomiting/ataxia/headache. Outcome correlated negatively with preexisting comorbidity score, altered level of consciousness at initial presentation, and superior cerebellar artery infarction. On multivariate analysis, AFIM and comorbidity score were independent predictors of outcome. Conclusions —Substantial improvement of mean FIM score frequently occurs after rehabilitation after cerebellar infarction. Functional outcome is best predicted by preexisting comorbidities and functional status at the time of discharge from acute hospitalization.
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- 2001
21. Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic
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Satoshi Yamada, Thomas G Devlin, David S Liebeskind, Michael D Hill, Tudor G Jovin, Jordi Blasco, Raul G Nogueira, John Thornton, Romain Bourcier, Robert Fahed, Michel Piotin, Salvatore Mangiafico, Maxim Mokin, Shadi Yaghi, Diogo C Haussen, Eytan Raz, Italo Linfante, Vitor Mendes Pereira, Monika Killer-Oberpfalzer, Alhamza R Al-Bayati, Patrick Nicholson, Georgios Tsivgoulis, Vanessa Chalumeau, Lissa Peeling, Xianjin Shang, Hao Zhang, Ajit S Puri, Osama O Zaidat, Santiago Ortega-Gutierrez, Dheeraj Gandhi, Gregory Walker, Kenichi Todo, Ameer E Hassan, Michael Chen, Nobuyuki Sakai, William J Mack, Simon Nagel, Pascal Jabbour, Michael Kelly, Don Frei, Hong Gee Roh, Fawaz Al-Mufti, Emma Griffin, Thanh N Nguyen, Alicia C Castonguay, Roberta Novakovic, Mohamad Abdalkader, Mario Martínez-Galdámez, Toshiyuki Fujinaka, Ken Wong, Daisuke Watanabe, Rishi Gupta, Sunil A Sheth, Melanie Walker, Hiroshi Yamagami, Brendan Steinfort, Alex Brehm, Johanna T Fifi, Nobuyuki Ohara, Yuichi Murayama, Ajay K Wakhloo, Wenguo Huang, Gianmarco Bernava, Paolo Machi, Nabeel Herial, Teddy Y Wu, Anna Luisa Kühn, Markus Möhlenbruch, James E Siegler, Stephan A Mayer, Takuya Kanamaru, André Beer-Furlan, Dileep Yavagal, Charles Matouk, Yuji Matsumaru, Pedro Lylyk, Allan Taylor, Leonardo Renieri, Pablo M Lavados, Verónica V Olavarría, Malveeka Sharma, Marios Psychogios, Laura Mechtouff, Vasu Saini, Jun Luo, Barbara Voetsch, Mudassir Farooqui, Ossama Y Mansour, Viktor Szeder, Jean Raymond, Muhammad M Qureshi, Michael Frankel, Zhongming Qiu, Omer F Eker, Fabricio Oliveira Lima, Francisco Mont'Alverne, Wazim Izzath, Mahmoud Mohammaden, David Ozretic, Saima Ahmad, Umair Rashid, Syed Irteza Hussain, Seby John, Jose Antonio Fiorot, Rodrigo Rivera, Nadia Hammami, Anna M Cervantes-Arslanian, Hormuzdiyar H Dasenbrock, Huynh Le Vu, Viet Quy Nguyen, Steven Hetts, Romain Guile, Atilla Ozcan Ozdemir, Ozlem Aykac, Chandril Chugh, Pascale Lavoie, Randall Edgell, Vikram Huded, Dong Hun Shin, Pedro SC Magalhaes, Raghid Kikano, Amal Abou-Hamden, Tatsuo Amano, Ryoo Yamamoto, Adrienne Weeks, Elena A Cora, Rotem Sivan-Hoffmann, Roberto Crosa, Hosam Al-Jehani, Victor S Lopez Rivera, Achmad Fidaus Sani, Daniel G Abud, Octavio M Pontes-Neto, Brijesh P Mehta, Naoto Kimura, Mamoru Murakami, Jin Soo Lee, Ji Man Hong, Eiji Hagashi, Steve M Cordina, Juan F Arenillas, Alejandro Rodriguez Vasquez, Luisa Fonseca, M Luis Silva, Simon John, Matthew Tenser, Tatemi Todaka, Miki Fujimura, Jun Deguchi, Yuri Sugiura, Hiroshi Tokimura, Rakesh Khatri, Hugh Stephen Winters, Johnny Wong, Mohamed Teleb, Jeremy Payne, Hiroki Fukuda, Kosuke Miyake, Junsuke Shimbo, Yusuke Sugimura, Masaaki Uno, Yohei Takenobu, Ryuhei Kono, Masafumi Morimoto, Junichi Iida, Saif Bushnaq, Jawad Kirmani, Ruchir Shah, Lee Birnbaum, Anchalee Churojana, Hesham E Masoud, Carlos Ynigo Lopez, Alice Ma, Amal Al Hashmi, Mollie McDermott, Alex Chebl, Odysseas Kargiotis, Jane G Morris, Clifford J Eskey, Jesse Thon, Leticia Rebello, Dorothea Altschul, Oriana Cornett, Varsha Singh, Jeyaraj Pandian, Anirudh Kulkarni, Yuki Yamamoto, Gisele Sampaio Silva, Serdar Geyik, Jasmine Johann, Sumeet Multani, Artem Kaliaev, Kazutaka Sonoda, Hiroyuki Hashimoto, Adel Alhazzani, David Y Chung, and Zhengzhou Yuan
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Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.Methods We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation.Findings There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, p
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22. Malignant lymphoma of the testis
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Clifford J. Eskey, Felix S. Chew, and Gary J. Whitman
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Male ,endocrine system ,Pathology ,medicine.medical_specialty ,Lymphoma, B-Cell ,business.industry ,Mediastinum ,Echogenicity ,General Medicine ,Testicle ,Middle Aged ,medicine.disease ,Spermatic cord ,Lymphoma ,medicine.anatomical_structure ,Mediastinum testis ,Testicular Lymphoma ,Testicular Neoplasms ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Orchiectomy ,Lymphoma, Large B-Cell, Diffuse ,business ,Ultrasonography - Abstract
showed a well-defined. spherical. hypoechoic mass in the upper pole of the testis (Fig. 1A). The mass measured 3. 1 cm in size and had internal echoes. After orchiectomy, gross pathologic examination of the testis revealed a wellcircumscribed nodule that abutted and could not be separated from the tunica albuginea testis (Fig. IB). Microscopy showed invasion of the seminiferous tubules and blood vessels (Fig. IC) and focal extension through the tunica albuginea testis. The epididymis and spermatic cord were not involved. Six years earlier, the patient had received chemotherapy for nonHodgkin’s lymphoma involving the mediastinum. The immunophenotype of the testicular lesion was identical to that of the earlier disease, and the final pathologic diagnosis was recurrent diffuse large B-cell lymphoma. Non-Hodgkin’ s lymphomas. especially B-cell lymphomas, represent the most common secondary neoplasms of the testis and the most common testicular malignancy in men more than 60 years old [ 1 1. The testis is often the first site of recurrence after an initial response to chemotherapy, and most cases occur in the setting of widespread disease. The most common presenting symptom is a painless testicular mass. Bilateral involvement is also common. The normal glandular structure of the testis is composed of convoluted seminiferous tubules arranged in hundreds of lobules separated by fibrous septa that extend between the mediastinum testis and the tunica albuginea testis. This entire structure is highly echogenic and results in a uniformly hyperechoic appearance on sonography. Infiltration of this tissue by lymphoma reduces its echogenicity, leading to the sonographic appearances of a focal hypoechoic mass without a definable capsule or diffuse enlargement and decreased echogenicity of the entire testis [2, 3]. Extension into the epididymis and spermatic cord often occurs, but invasion of the tunica albuginea testis is relatively rare [1]. These sonographic findings are not sufficiently specific to differentiate lymphoma from other neoplasms. The treatment of testicular lymphoma includes orchiectomy and chemotherapy or radiation therapy.
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- 1997
23. Contents Vol. 14, 2002
- Author
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T. Nakamura, Pierre Bedoucha, José M. Ferro, Zvi R. Cohen, Birgitta Lundgren-Lindquist, Steven M. Greenberg, J. van Gijn, Tobias Neumann-Haefelin, Achim Gass, Carolina Araújo, Marcel Chatel, T. Erkinjuntti, Anne Desmet, J. Bogousslavsky, Joachim Röther, C. Schleime, S. Osthaus, Karen L. Furie, R. Gilberto Gonzalez, Konstantinos Spengos, Andreas Terént, Ynte M. Ruigrok, Markku Kaste, Lisbeth Claesson, Sarah L. Keir, Gabriel J.E. Rinkel, V. Oliveira, Lee H. Schwamm, Jamary Oliveira-Filho, Zaza Katsarava, Antoine Dunac, F. Soares, Ester S. Bitanga, Yasuhiro Fjino, Nachshon Knoller, James F. Meschia, Kazuo Yamada, Mathias Hoehn, M. Jauss, Ingegerd Nydevik, J.M. Ferro, Moshe Hadani, Stephen J. Victor, Athanassios Grivas, R. Vataja, Walter J. Koroshetz, Eun Jung Choi, Peter D. Schellinger, M.G. Hennerici, Clifford J. Eskey, M. Iwata, Jong S. Kim, Einat Peles, Zvi Ram, Maire-Hélène Mahagne, Isabel Henriques, Robert Gan, Yasuhiko Baba, Tatsuo Yamada, Christian Blomstrand, Atsushi Umemura, Marianne Kloke, Cesare Fieschi, M. Kaste, Ferdinando S. Buonanno, Naoki Shimazu, Peter Sandercock, Yuchiao Chang, A. Leppävuori, P. Batista, M. Hügens-Penzel, Jean-Marc Orgogozo, H. Traupe, Leila Florento, Mario Siebler, T. Pohjasvaara, Hans-Christoph Diener, Guy Rordorf, Charalambos Pavlopoulos, Assia Jaillard, M. Kaps, Andrew J. Catto, Masashi Nakajima, Åke Seiger, Gunilla Gosman-Hedström, Zhengming Chen, S. Uchiyama, Gabriela C. Lopes, Rosalia A. Teleg, Atsuo Masago, Björn Fagerberg, M. Yamazaki, Joanna M. Wardlaw, Christian Weimar, Yoshio Tsuboi, Hakan Ay, Jonathan Rosand, Yoshie Kanda, Pamela W. Schaefer, Jochen B. Fiebach, Kaori Sakiyama, Geoffrey A. Donnan, Jens Fiehler, Martina Schlott, Julien Bogousslavsky, Peter J. Grant, Peter Appelros, Eliseo O. Salinas, Thomas Kucinski, Ángel Chamorro, Maria José Rosas, Arno Villringer, B. Rosengarten, Alastair J. Lansbury, Takashi Matsumoto, Rüdiger von Kummer, and Allan Pallay
- Subjects
Neurology ,Traditional medicine ,business.industry ,Medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2002
24. Subject Index Vol. 14, 2002
- Author
-
Christian Blomstrand, Peter D. Schellinger, Walter J. Koroshetz, Karen L. Furie, Sarah L. Keir, M.G. Hennerici, Tobias Neumann-Haefelin, Steven M. Greenberg, P. Batista, Alastair J. Lansbury, J. van Gijn, Atsuo Masago, Åke Seiger, Ferdinando S. Buonanno, Anne Desmet, C. Schleime, Peter Appelros, Yasuhiro Fjino, Hans-Christoph Diener, Guy Rordorf, Jean-Marc Orgogozo, Atsushi Umemura, Maire-Hélène Mahagne, Eliseo O. Salinas, Assia Jaillard, Takashi Matsumoto, Ynte M. Ruigrok, M. Yamazaki, Achim Gass, Robert Gan, Mathias Hoehn, Joachim Röther, Mario Siebler, Jamary Oliveira-Filho, Ingegerd Nydevik, Isabel Henriques, H. Traupe, Thomas Kucinski, Allan Pallay, R. Gilberto Gonzalez, Rosalia A. Teleg, Einat Peles, Clifford J. Eskey, Arno Villringer, B. Rosengarten, S. Osthaus, Kazuo Yamada, T. Pohjasvaara, Leila Florento, Jong S. Kim, Marianne Kloke, James F. Meschia, Pierre Bedoucha, Peter J. Grant, M. Kaste, Lisbeth Claesson, Geoffrey A. Donnan, Charalambos Pavlopoulos, Gabriela C. Lopes, Jens Fiehler, Yasuhiko Baba, T. Erkinjuntti, Zhengming Chen, Eun Jung Choi, M. Iwata, S. Uchiyama, J. Bogousslavsky, José M. Ferro, Carolina Araújo, Marcel Chatel, Birgitta Lundgren-Lindquist, Martina Schlott, Christian Weimar, Björn Fagerberg, Zvi R. Cohen, Andrew J. Catto, Hakan Ay, Masashi Nakajima, Stephen J. Victor, F. Soares, Jochen B. Fiebach, Kaori Sakiyama, Andreas Terént, Gabriel J.E. Rinkel, Zvi Ram, M. Hügens-Penzel, Nachshon Knoller, Naoki Shimazu, J.M. Ferro, Moshe Hadani, Yoshie Kanda, Joanna M. Wardlaw, Yoshio Tsuboi, Jonathan Rosand, Konstantinos Spengos, Rüdiger von Kummer, M. Kaps, Zaza Katsarava, Ángel Chamorro, Julien Bogousslavsky, Tatsuo Yamada, Maria José Rosas, Cesare Fieschi, Yuchiao Chang, A. Leppävuori, Antoine Dunac, Peter Sandercock, T. Nakamura, Pamela W. Schaefer, Gunilla Gosman-Hedström, Markku Kaste, V. Oliveira, Lee H. Schwamm, Ester S. Bitanga, M. Jauss, Athanassios Grivas, and R. Vataja
- Subjects
Index (economics) ,Neurology ,business.industry ,Statistics ,Medicine ,Subject (documents) ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2002
25. Invasive aspergillosis of the orbit
- Author
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Felix S. Chew, Clifford J. Eskey, and Gary J. Whitman
- Subjects
Male ,business.industry ,Aspergillus fumigatus ,General Medicine ,Space-occupying lesion ,medicine.disease ,Aspergillosis ,Magnetic Resonance Imaging ,Tomography x ray computed ,medicine.anatomical_structure ,X ray computed ,Orbital Diseases ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Tomography, X-Ray Computed ,Sinusitis ,business ,Nuclear medicine ,Mycosis ,Aged ,Orbit (anatomy) - Abstract
Kameswaran M,Al-Wadei A,Khurana P.OkaforBC.Rhinocerebral aspergillosis. JLaryngol Otol1992;106:981-9852.Ashdown BC.TeenRD.Felsberg GJ.Aspergillo-sisofthebrainandparanasal sinuses inimmuno-compromised patients: CT and MR imagingfindings. AiR 1994;l62:l55-l593.Daghistani KJ.Jamal TS,Zaher 5,Nassif 01.Allergic a.spergillus sinusitis with proptosis. JLaryngo! Otol 1992; 106:799-803
- Published
- 1996
26. Dartmouth Middle Meningeal Embolization Trial (DaMMET) (DAMMET)
- Author
-
Clifford J. Eskey, Director, Interventional Neuroradiology
- Published
- 2024
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