Search

Your search keyword '"Kirsch E"' showing total 429 results
Start Over Author "Kirsch E"
429 results on '"Kirsch E"'

1. Dysmenorrhea, a Narrative Review of Therapeutic Options

Author

Kirsch E, Rahman S, Kerolus K, Hasan R, Kowalska DB, Desai A, and Bergese SD

Subjects
dysmenorrhea, prostaglandin, nsaids, hormonal contraception, pelvic pain, pharmacologic management, behavioral interventions, surgical intervention, Medicine (General), R5-920
Abstract

Elayna Kirsch,1 Sadiq Rahman,2 Katrina Kerolus,2 Rabale Hasan,1 Dorota B Kowalska,1 Amruta Desai,2 Sergio D Bergese2 1Department of Obstetrics and Gynecology, Stony Brook University Hospital, Stony Brook, NY, USA; 2Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY, USACorrespondence: Sergio D Bergese, School of Medicine, Stony Brook University, Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794, USA, Tel +631444-2979, Fax +631444-2907, Email sergio.bergese@stonybrookmedicine.eduAbstract: Dysmenorrhea is the most common pathology women of childbearing age face. It is defined as painful uterine cramping associated with menstruation. Primary dysmenorrhea occurs in the absence of an organic cause, whereas secondary dysmenorrhea is pelvic pain associated with an underlying pelvic pathology. The purpose of this review is to discuss the pathophysiology of dysmenorrhea and provide a discussion of pharmacologic and non-pharmacologic treatment options. Prostaglandins play a large role in the pathophysiology of dysmenorrhea by causing myometrial contraction and vasoconstriction. The first-line treatment for dysmenorrhea is with nonsteroidal anti-inflammatory drugs due to the inhibition of cyclooxygenase enzymes, thereby blocking prostaglandin formation, as well as hormonal contraception. Other pharmacologic treatment options include Paracetamol, as well as Gonadotrophic Release Hormone Analogs, which are typically used in the treatment for endometriosis. Non-pharmacologic treatments with strong evidence include heat therapy and physical exercise. There are less evidence-based data behind other modalities for treating dysmenorrhea, such as dietary supplements, acupuncture, and transcutaneous nerve stimulation, and these methods should be used in conjunction with first-line therapy after a discussion of risks and benefits. Lastly, for women who fail medical management, surgical options include endometrial ablation, presacral neurectomy, and laparoscopic uterosacral nerve ablation. Further research is needed to measure the socioeconomic burden of dysmenorrhea on the healthcare system and to evaluate the efficacy of treatment combinations, as a multi-modal approach likely provides the most benefit for women who suffer from this condition.Keywords: dysmenorrhea, prostaglandin, NSAIDs, hormonal contraception, pelvic pain, pharmacologic management, behavioral interventions, surgical intervention

Published
2024

5. Magnetosphere Imaging Instrument (MIMI) on the Cassini Mission to Saturn/Titan

Author

Krimigis, S. M., Mitchell, D. G., Hamilton, D. C., Livi, S., Dandouras, J., Jaskulek, S., Armstrong, T. P., Boldt, J. D., Cheng, A. F., Gloeckler, G., Hayes, J. R., Hsieh, K. C., Ip, W.-H., Keath, E. P., Kirsch, E., Krupp, N., Lanzerotti, L. J., Lundgren, R., Mauk, B. H., McEntire, R. W., Roelof, E. C., Schlemm, C. E., Tossman, B. E., Wilken, B., Williams, D. J., and Russell, Christopher T., editor

Published
2004
Full Text
View/download PDF

10. Predictors of Acute and Persisting Ischemic Brain Lesions in Patients Randomized to Carotid Stenting or Endarterectomy

Author

Rostamzadeh, Ayda, Zumbrunn, Thomas, Jongen, Lisa M., Nederkoorn, Paul J., Macdonald, Sumaira, Lyrer, Philippe A., Kappelle, L. Jaap, Mali, Willem P. Th. M., Brown, Martin M., van der Worp, H. Bart, Engelter, Stefan T., Bonati, Leo H., de Borst, G.J., de Kort, G.A.P., Jongen, L.M., Kappelle, L.J., Lo, T.H., Mali, W.P.Th.M., Moll, F.L., van der Worp, H.B., Bonati, L.H., Engelter, S.T., Fluri, F., Haller, S., Jacob, A.L., Kirsch, E., Lyrer, P.A., Radue, E.-W., Stierli, P., Wasner, M., Wetzel, S.G., Flach, H.Z., Hendriks, J.M., Koudstaal, P.J., Pattynama, P.M.T., van Dijk, L.C., van Sambeek, M.R.H.M., van der Lugt, A., van Urk, H., Verhagen, H.J.M., Clarke, M., Davis, M., Dixit, A.K., Dorman, P., Dyker, A., Ford, G., Golkar, A., Jackson, R., Jayakrishnan, V., Lambert, D., Lees, T., Louw, S., Macdonald, S., Mendelow, D., Rodgers, H., Rose, J., Stansby, G., Wyatt, M., Koelemaij, M.J.W., Majoie, C.B.L.M., Nederkoorn, P.J., Reekers, J.A.A., Roos, Y.B.W.E.M., Adiseshiah, M., Bishop, C., Brew, S., Brookes, J., Brown, M.M., Jäger, H.R., Kitchen, N., Beard, J., Cleveland, T., Dodd, D., Gaines, P.A., Lonsdale, R., Nair, R., Nassef, A., Nawaz, S., and Venables, G.

Published
2014
Full Text
View/download PDF

13. Dynamics of Saturn's magnetosphere from MIMI during Cassini's orbital insertion

Author

Krimigis, S.M., Mitchell, D.G., Hamilton, D.C., Krupp, N., Livi, S., Roelof, E.C., Dandouras, J., Armstrong, T.P., Mauk, B.H., Paranicas, C., Brandt, P.C., Bolton, S., Cheng, A.F., Choo, T., Gloeckler, G., Hayes, J., Hsieh, K.C., Ip, W.-H., Jaskulek, S., Keath, E.P., Kirsch, E., Kusterer, M., Lagg, A., Lanzerotti, L.J., LaVallee, D., Manweiler, J., McEntire, R.W., Rasmuss, W., Saur, J., Turner, F.S., Williams, D.J., and Woch, J.

Subjects
Cassini (Space probe), Magnetosphere -- Observations -- Magnetic properties, Satellite imaging -- Observations -- Magnetic properties, Saturn (Planet) -- Observations -- Magnetic properties, Science and technology
Abstract

The Magnetospheric Imaging Instrument (MIMI) onboard the Cassini spacecraft observed the saturnian magnetosphere from January 2004 until Saturn orbit insertion (SOI) on 1 July 2004. The MIMI sensors observed frequent energetic particle activity in interplanetary space for several months before SOI. When the imaging sensor was switched to its energetic neutral atom (ENA) operating mode on 20 February 2004, at ~[10.sup.3] times Saturn's radius [R.sub.S] (0.43 astronomical units), a weak but persistent signal was observed from the magnetosphere. About 10 days before SOI, the magnetosphere exhibited a day-night asymmetry that varied with an ~11-hour periodicity. Once Cassini entered the magnetosphere, in situ measurements showed high concentrations of [H.sup.+], [H.sub.2.sup.+], [O.sup.+], O[H.sup.+], and [H.sub.2][O.sup.+] and low concentrations of [N.sup.+]. The radial dependence of ion intensity profiles implies neutral gas densities sufficient to produce high loss rates of trapped ions from the middle and inner magnetosphere. ENA imaging has revealed a radiation belt that resides inward of the D ring and is probably the result of double charge exchange between the main radiation belt and the upper layers of Saturn's exosphere., The magnetosphere of Saturn was discovered by Pioneer 11 in 1979 (1, 2) and was investigated in detail by Voyager 1 in 1980 (3) and Voyager 2 in 1981 (4). [...]

Published
2005

28. Energetic ions at comet Grigg-Skjellerup measured from the Giotto spacecraft

Author

McKenna-Lawlor, S.M.P., Daly, P.W., O'Sullivan, D., Thompson, A., Wenzel, K.-P., Afonin, V., and Kirsch, E.

Subjects
Comets -- Research, Space astronomy -- Usage, Space vehicles -- Usage, Environmental issues, Science and technology, Zoology and wildlife conservation
Abstract

The EPONA instrument on Giotto spacecraft detected charged, energetic particles deep within the inner coma of the comet Grigg-Skjellerup. The ions close to the nucleus were strongly coupled to the ambient magnetic field. The Giotto spacecraft, that flew within about 200 km of the nucleus of Grigg-Skijellerup, had the closet approach so far of a spacecraft to a cometary nucleus.

Published
1993

29. Search for lunar pickup ions

Author

Kirsch, E., primary, Wilken, B., additional, Gloeckler, G., additional, Galvin, A.B., additional, Geiss, J., additional, and Hovestadt, D., additional

Published
1998
Full Text
View/download PDF

39. Xanthogranulomatöse Pyelonephritis mit phlegmonöser Bauchwandinfiltration: Diagnose und Ausdehnungsbestimmung im Computertomogramm

Author

Cathomas G, Achim H. Kaim, W. Steinbrich, Kirsch E, and Schmid Hp

Subjects
medicine.medical_specialty, Fossa, biology, business.industry, medicine.medical_treatment, General Medicine, medicine.disease, biology.organism_classification, Nephrectomy, Abdominal wall, medicine.anatomical_structure, Hounsfield scale, medicine, Abdomen, Radiology, Abscess, business, Infiltration (medical), Nephrotomy
Abstract

A 34-year-old woman who 14 years previously had undergone a left nephrotomy for nephrolithiasis complained of pain in the left renal fossa which was reddened and painful on percussion. She had a fever of 38.2 degrees C. C-reactive protein was raised to 80 mg/l, the white cell count to 14,620/microliters (83% neutrophils). Protein and white cells were found in the urine together with a significant number of E. coli on urine culture. Plain film of the abdomen showed a staghorn calculus and ultrasonography demonstrated renal enlargement with a possible paranephritic abscess. The computed tomography diagnosis was xanthogranulomatous pyelonephritis, on the basis of renal enlargement, staghorn calculus, hypodense areas with typical density values (10-15 Hounsfield units), contrast enrichment and extrarenal extension of partly phlegmonous partly fused-together inflammatory changes. The abscessing parts were drained under computed tomography control. Starting 7 days pre-operatively the patient had been receiving ciprofloxacin (0.4 g daily) intravenously. A nephrectomy had to be performed subsequently. Antibiotic treatment was discontinued 2 weeks later and she was discharged symptom-free. The diagnosis of diffuse xanthogranulomatous Pyelonephritis was confirmed by histological examination of the surgical specimen.

Published
2008

47. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial

Author

Ederle, J., Dobson, J., Featherstone, R. L., Bonati, L. H., Worp, H. B., Borst, G. J., Lo, T. H., Gaines, P., Dorman, P. J., Macdonald, S., Lyrer, P. A., Hendriks, J. M., Mccollum, C., Nederkoorn, P. J., Brown, M. M., Algra, A., Bamford, J., Beard, J., Bland, M., Bradbury, A. W., Clifton, A., Hacke, W., Halliday, A., Malik, I., Mas, J. L., Mcguire, A. J., Sidhu, P., Venables, G., Bradbury, A., Collins, R., Molynewc, A., Naylor, R., Warlow, C., Ferro, J. M., Thomas, D., Coward, L., Featherstone, R. F., Tindall, H., Mccabe, D. J. H., Wallis, A., Brooks, M., Chambers, B., Chan, A., Chu, P., Clark, D., Dewey, H., Donnan, G., Fell, G., Hoare, M., Molan, M., Roberts, A., Roberts, N., Beiles, B., Bladin, C., Clifford, C., Grigg, M., New, G., Bell, R., Bower, S., Chong, W., Holt, M., Saunder, A., Than, P. G., Gett, S., Leggett, D., Mcgahan, T., Quinn, J., Ray, M., Wong, A., Woodruff, P., Foreman, R., Schultz, D., Scroop, R., Stanley, B., Allard, B., Atkinson, N., Cambell, W., Davies, S., Field, P., Milne, P., Mitchell, P., Tress, B., Yan, B., Beasley, A., Dunbabin, D., Stary, D., Walker, S., Cras, P., D Archambeau, O., Hendriks, J. M. H., Schil, P., Bosiers, M., Deloose, K., Buggenhout, E., Letter, J., Devos, V., Ghekiere, J., Vanhooren, G., Astarci, P., Hammer, F., Lacroix, V., Peters, A., Verhelst, R., Dejaegher, L., Peeters, A., Verbist, J., Blair, J. F., Caron, J. L., Daneault, M., Giroux, M. F., Guilbert, F., Lanthier, S., Lebrun, L. H., Oliva, V., Raymond, J., Roy, D., Soulez, G., Weill, A., Hill, M., Hu, W., Hudion, M., Morrish, W., Sutherland, G., Wong, J., Alback, A., Harno, H., Ijas, P., Kaste, M., Lepantalo, M., Mustanoja, S., Paananen, T., Porras, M., Puutala, J., Railo, M., Sairanen, T., Soinne, L., Vehmas, A., Vikatmaa, P., Goertler, M., Halloul, Z., Skalej, M., Brennan, P., Kelly, C., Leahy, A., Moroney, J., Thornton, J., Koelemay, M. J. W., Reekers, J. A. A., Roos, Y. B. W. E. M., Koudstaal, P. J., Pattynama, P. M. T., Lugt, A., Dijk, L. C., Sambeek, L. R. H. M., Urk, H., Verhargen, H. J. M., Bruininckx, C. M. A., Bruijn, S. F., Keunen, R., Knippenberg, B., Mosch, A., Treurniet, F., Dijk, L., Overhagen, H., Wever, J., Beer, F. C., Den Berg, J. S. P., Hasselt, B. A. A. M., Zeilstra, D. J., Boiten, J., Otterloo, J. C. A. D., Vries, A. C., Nieholt, G. J. L. A., Kallen, B. F. W., Blankensteijn, J. D., Leeuw, F. E., Kool, L. J. S., Vliet, J. A., Kort, G. A. P., Kapelle, L. J., Mali, W. P. T. M., Moll, F., Verhagen, H., Barber, P. A., Bourchier, R., Hill, A., Holden, A., Stewart, J., Bakke, S. J., Krohg-Sorensen, K., Skjelland, M., Tennoe, B., Bialek, P., Biejat, Z., Czepiel, W., Czlonkowska, A., Dowzenko, A., Jedrzejewska, J., Kobayashi, A., Lelek, M., Polanski, J., Kirbis, J., Milosevic, Z., Zvan, B., Vasco, J., Blasco, J., Chamorro, A., Macho, J., Obach, V., Riambau, V., San Roman, L., Branera, J., Canovas, D., Estela, J., Gaibar, A. G., Perendreu, J., Bjorses, K., Gottsater, A., Ivancev, K., Maetzsch, T., Sonesson, B., Berg, B., Delle, M., Formgren, J., Gillgren, P., Kall, T. B., Konrad, P., Nyman, N., Takolander, R., Andersson, T., Malmstedt, A., Soderman, M., Wahlgren, C., Wahlgren, N., Binaghi, S., Hirt, L., Michel, P., Ruchat, P., Engelter, S. T., Fluri, F., Guerke, L., Jacob, A. L., Kirsch, E., Radue, E. W., Stierli, P., Wasner, M., Wetznel, S., Bonvin, C., Kalangos, A., Lovblad, K., Murith, N., Ruefenacht, D., Sztajzel, R., Higgins, N., Kirkpatrick, P. J., Martin, P., Adam, D., Bell, J., Crowe, P., Gannon, M., Henderson, M. J., Sandler, D., Shinton, R. A., Scriven, J. M., Wilmink, T., D Souza, S., Egun, A., Guta, R., Punekar, S., Seriki, D. M., Thomson, G., Brennan, A., Enevoldson, T. P., Gilling-Smith, G., Gould, D. A., Harris, P. L., Mcwilliams, R. G., Nasser, H. C., White, R., Prakash, K. G., Serracino-Inglott, F., Subramanian, G., Smyth, J. V., Walker, M. G., Clarke, M., Davis, M., Dixit, S. A., Dolman, P., Dyker, A., Ford, G., Golkar, A., Jackson, R., Jayakrishnan, V., Lambert, D., Lees, T., Louw, S., Mendelow, A. D., Rodgers, H., Rose, J., Stansby, G., Wyatt, M., Baker, T., Baldwin, N., Jones, L., Mitchell, D., Munro, E., Thornton, M., Baker, D., Davis, N., Hamilton, G., Mccabe, D., Platts, A., Tibballs, J., Cleveland, T., Dodd, D., Lonsdale, R., Nair, R., Nassef, A., Nawaz, S., Belli, A., Cloud, G., Markus, H., Mcfarland, R., Morgan, R., Pereira, A., Thompson, A., Chataway, J., Cheshire, N., Gibbs, R., Hammady, M., Jenkins, M., Wolfe, J., Adiseshiah, M., Bishop, C., Brew, S., Brookes, J., Jager, R., Kitchen, N., Ashleigh, R., Butterfield, S., Gamble, G. E., Nasim, A., O Neill, P., Edwards, R. D., Lees, K. R., Mackay, A. J., Moss, J., Rogers, P., Developmental Genetics, International Carotid Stenting Study, ACS - Amsterdam Cardiovascular Sciences, Neurology, Surgery, Radiology and Nuclear Medicine, and ANS - Amsterdam Neuroscience

Subjects
Male, medicine.medical_specialty, SURGERY, medicine.medical_treatment, Carotid endarterectomy, 030204 cardiovascular system & hematology, Neuroinformatics [DCN 3], 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Angioplasty, medicine, Humans, Carotid Stenosis, cardiovascular diseases, ANGIOPLASTY, Stroke, Endarterectomy, Aged, Endarterectomy, Carotid, Intention-to-treat analysis, Cardiovascular diseases [NCEBP 14], business.industry, Stent, General Medicine, Interim analysis, medicine.disease, 3. Good health, Surgery, Female, Stents, Human medicine, Carotid stenting, business, 030217 neurology & neurosurgery, Angioplasty, Balloon
Abstract

Contains fulltext : 88112.pdf (Publisher’s version ) (Closed access) BACKGROUND: Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. METHODS: The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470. FINDINGS: The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4.0%) events of disabling stroke or death in the stenting group compared with 27 (3.2%) events in the endarterectomy group (hazard ratio [HR] 1.28, 95% CI 0.77-2.11). The incidence of stroke, death, or procedural myocardial infarction was 8.5% in the stenting group compared with 5.2% in the endarterectomy group (72 vs 44 events; HR 1.69, 1.16-2.45, p=0.006). Risks of any stroke (65 vs 35 events; HR 1.92, 1.27-2.89) and all-cause death (19 vs seven events; HR 2.76, 1.16-6.56) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal, in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events; p=0.0197). INTERPRETATION: Completion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery. FUNDING: Medical Research Council, the Stroke Association, Sanofi-Synthelabo, European Union.

Published
2010

48. Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy

Author

Bonati, L., Ederle, J., Dobson, J., Engelter, S., Featherstone, R., Gaines, P., Beard, J., Venables, G., Markus, H., Clifton, A., Sandercock, P., Brown, M., Bland, J., Buckenham, T., Taylor, R., Tognoni, G., Warlow, C., Bleakley, T., Colquhoun, D., Coward, L., Crawley, F., Dobinson, P., Holder, S., McCabe, D., Pereira, A., Rogers, J., Silver, L., Burrett, J., Crowther, J., Dobson, M., Hafner, B., Heineman, J., Hope, C., Knight, S., Naughten, A., Radley, A., Richards, S., Smith, D., Wenzel, S., Harrison, M., Ferro, J., Bladin, C., Donnan, G., Fell, G., Fitt, G., Royle, J., Davis, S., Gerraty, R., Mitchell, P., Goodman, M., Hankey, G., Khangure, M., Lawrence-Brown, Michael, Linto, J., McAuliffe, W., Prendergast, F., Siennarine, K., Stewart-Wynne, E., Grahovac, S., Morrish, W., Pageau, N., E Pringle, C., Richard, D., Malms, J., Reiher, L., Siebler, M., Belloni, G., Porta, M., Chamorro, A., Vila, N., Riambau, V., Vazquez, F., Boza, F., Garcia Rodríguez, J., Gil Peralta, A., González, A., González Marcos, J., Mayol Deya, A., Rauno, J., Kirsch, E., Lyrer, P., Rem, J., Bogousslavsky, J., Uske, A., Cleveland, T., Doyle, C., Sivaguru, A., Leopold, P., Loosemore, T., Enevoldson, T., Gilling-Smith, G., Harris, P., Nixon, T., Baskerville, P., Cox, T., Fraser, S., Jeffrey, M., Molloy, J., Butler, P., Dick, J., Frankel, F., Bradbury, A., Collie, D., Murie, J., Ruckley, C., Schultz, D., Sellar, R., Wardlaw, J., Ashleigh, R., McCollum, C., O'Neill, P., Gholkar, A., Mendelow, A., Walls, T., Angus-Leppan, H., Halpin, S., Hughes, J., Lane, I., Wiles, M., Wood, A., Birch, P., Earnshaw, J., Fuller, G., Heather, B., Poskitt, K., Tottle, A., Hope, D., Jefferson, D., McConachie, N., Duddy, M., Heafield, M., Vohra, R., Bonati, L., Ederle, J., Dobson, J., Engelter, S., Featherstone, R., Gaines, P., Beard, J., Venables, G., Markus, H., Clifton, A., Sandercock, P., Brown, M., Bland, J., Buckenham, T., Taylor, R., Tognoni, G., Warlow, C., Bleakley, T., Colquhoun, D., Coward, L., Crawley, F., Dobinson, P., Holder, S., McCabe, D., Pereira, A., Rogers, J., Silver, L., Burrett, J., Crowther, J., Dobson, M., Hafner, B., Heineman, J., Hope, C., Knight, S., Naughten, A., Radley, A., Richards, S., Smith, D., Wenzel, S., Harrison, M., Ferro, J., Bladin, C., Donnan, G., Fell, G., Fitt, G., Royle, J., Davis, S., Gerraty, R., Mitchell, P., Goodman, M., Hankey, G., Khangure, M., Lawrence-Brown, Michael, Linto, J., McAuliffe, W., Prendergast, F., Siennarine, K., Stewart-Wynne, E., Grahovac, S., Morrish, W., Pageau, N., E Pringle, C., Richard, D., Malms, J., Reiher, L., Siebler, M., Belloni, G., Porta, M., Chamorro, A., Vila, N., Riambau, V., Vazquez, F., Boza, F., Garcia Rodríguez, J., Gil Peralta, A., González, A., González Marcos, J., Mayol Deya, A., Rauno, J., Kirsch, E., Lyrer, P., Rem, J., Bogousslavsky, J., Uske, A., Cleveland, T., Doyle, C., Sivaguru, A., Leopold, P., Loosemore, T., Enevoldson, T., Gilling-Smith, G., Harris, P., Nixon, T., Baskerville, P., Cox, T., Fraser, S., Jeffrey, M., Molloy, J., Butler, P., Dick, J., Frankel, F., Bradbury, A., Collie, D., Murie, J., Ruckley, C., Schultz, D., Sellar, R., Wardlaw, J., Ashleigh, R., McCollum, C., O'Neill, P., Gholkar, A., Mendelow, A., Walls, T., Angus-Leppan, H., Halpin, S., Hughes, J., Lane, I., Wiles, M., Wood, A., Birch, P., Earnshaw, J., Fuller, G., Heather, B., Poskitt, K., Tottle, A., Hope, D., Jefferson, D., McConachie, N., Duddy, M., Heafield, M., and Vohra, R.

Abstract

Background: The anatomy of carotid stenosis may influence the outcome of endovascular treatment or carotid endarterectomy. Whether anatomy favors one treatment over the other in terms of safety or efficacy has not been investigated in randomized trials. Methods: In 414 patients with mostly symptomatic carotid stenosis randomized to endovascular treatment (angioplasty or stenting; n=213) or carotid endarterectomy (n=211) in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), the degree and length of stenosis and plaque surface irregularity were assessed on baseline intraarterial angiography. Outcome measures were stroke or death occurring between randomization and 30 days after treatment, and ipsilateral stroke and restenosis =50% during follow-up. Results: Carotid stenosis longer than 0·65 times the common carotid artery diameter was associated with increased risk of peri-procedural stroke or death after both endovascular treatment [odds ratio 2·79 (1·17-6·65), P=0·02] and carotid endarterectomy [2·43 (1·03-5·73), P=0·04], and with increased long-term risk of restenosis in endovascular treatment [hazard ratio 1·68 (1·12-2·53), P=0·01]. The excess in restenosis after endovascular treatment compared with carotid endarterectomy was significantly greater in patients with long stenosis than with short stenosis at baseline (interaction P=0·003). Results remained significant after multivariate adjustment. No associations were found for degree of stenosis and plaque surface. Conclusions: Increasing stenosis length is an independent risk factor for peri-procedural stroke or death in endovascular treatment and carotid endarterectomy, without favoring one treatment over the other. However, the excess restenosis rate after endovascular treatment compared with carotid endarterectomy increases with longer stenosis at baseline. Stenosis length merits further investigation in carotid revascularisation trials. © 2013 The Authors. International Journal of Strok

Published
2014

50. Optimizing brain MRI protocols in the follow-up of patients with multiple sclerosis: T2-weighted MRI of the brain after the administration of gadopentetate dimeglumine

Author

Taschner, C., Kirsch, E., Scheffler, K., Wetzel, S., Schulte-Mönting , J., Kappos, L., and Radü, E.

Abstract

The aim of our study was to determine whether T2-weighted (T2w) MRI of the brain could be performed immediately after the administration of gadopentetate dimeglumine (gadolinium DTPA) in patients with multiple sclerosis (MS) without a loss in image quality or diagnostic reliability. Sixteen patients with clinically diagnosed MS were included in the study. Twenty-four patients with various cerebral pathologies (14 patients with multiple lacunar lesions) were examined in order to exclude masking of T2 hyperintense lesions other than MS lesions. Images of 10 patients without pathological changes served as a control condition for the qualitative analysis. In these 50 patients, T1w and T2w MRI was performed before and after the administration of gadolinium DTPA. Signal intensities were measured within T2 hyperintense cerebral lesions, in T1-enhancing lesions and in normal appearing brain tissue on T2w turbo spin-echo (TSE) sequences. Both quantitative and qualitative analysis did not show significant differences between T2w pre- and postcontrast series. T2w MRI performed prior to and after the administration of gadolinium DTPA provides similar information in patients with MS. With a TR of 3.2 s, not a single lesion was obscured on T2w postcontrast series. Acquisition of T2w MR images immediately after the administration of gadolinium DTPA allows for shorter examination time and assures sufficient time for contrast enhancement in cerebral lesions with a disrupted blood–brain barrier.

Published
2005

Catalog

Books, media, physical & digital resources
See catalog results